Ketosis will kill you (and other myths about Atkins)

For a while, it seemed like everybody was doing Atkins. Walmart stocked a dozen varieties of pork rinds. Beef jerky appeared next to the potato chips in grocery check out lines. The diet promised quick weight loss without calorie counting.

Atkins is a type of ketogenic diet. In Lyle MacDonald’s ebook, The Ketogenic Diet, he provides the following definition: “any diet that causes ketone bodies to be produced by the liver, shifting the body’s metabolism away from glucose and towards fat utilization” [1]. These diets work by forcing your body to stop utilizing glucose (quick and easy energy) and to burn free fatty acids for fuel. Ketones are a by-product of this process. In the absence of glucose, your brain runs on ketones. (“This is your brain. This is your brain on ketones.”)

Myth #1 – Ketosis will kill you
Anti-Atkins people love this one. First of all, Inuits who eat a traditional diet spend most of their lives more or less in ketosis [2]. Heart disease and diabetes were uncommon in these native people before Western style diets were introduced. Secondly, some children with severe epilepsy live for years on strict ketogenic diets [3].

Ketoacidosis is a condition in which ketones build up to toxic levels in the blood stream and, yes, it can kill you. Type I diabetics with poorly controlled blood sugar and alcoholics are at risk for ketoacidosis (not ketosis).

Some folks get absolutely hysterical over ketosis. If it were truly that dangerous, we would have Atkins dieters dropping dead in the streets (clutching their bags of pork rinds).

Myth #2 – Ketosis results in kidney failure
Ketones do cause extra work for your kidneys. Increased protein metabolism raises uric acid levels in the blood. At the same time that the kidneys are processing additional ketones, uric acid must also be flushed from the system. Ketone removal is given preference so uric acid levels increase then return to normal after a couple of weeks. [4]

People with pre-existing kidney disease probably shouldn’t undertake this diet. Or any diet without close supervision by a physician. In healthy individuals, there is no significant evidence for kidney damage caused by ketogenic diets. [5]

Myth #3 – You just lose water. The weight all comes back when you go off the diet.
Not entirely false. Ketogenic diets cause mild dehydration. This site does a pretty good job of explaining the process (your muscles store glucose as glycogen)

“… what most people don’t know is that each molecule of glycogen is bound to four molecules of water and water has weight too. This means that when your liver and muscles are charged up with glycogen it adds an additional four pounds or more to your body weight.” www.phlaunt.com/lowcarb

As your body starts burning up stored glycogen, fluid is released. This water loss (and regain) is a common feature of ketogenic diets. I typically gain 5 lbs in a day when cycling off low carb.

While it is true that a lot of people regain weight after Atkins, rebound occurs among all weight loss programs. [6] I am not convinced that ketogenic diets have worse outcomes than anything else.

Human beings are enormously diverse. Some people cannot tolerate ketogenic diets either psychologically or physiologically. Listen to your body. Find the lowest calorie level and dietary composition that allows you to lose the pounds while maintaining your sanity.

References
1. MacDonald, Lyle. The Ketogenic Diet. 1998: 11.
2. Stefansson, Vilhjalmur. Not by Bread Alone. New York: The Macmillan Company, 1946.
3. Swink TD. et. al. The ketogenic diet: 1997. Adv Pediatr (1997) 44: 297-329.
4. Worthington BS and Taylor LE. Balanced low-calorie vs. low-protein-low carbohydrate reducing diets. II: Biochemical changes. J Am Diet Assoc (1974) 64: 52-55.
5. Lemon P. Is increased dietary protein necessary or beneficial for individuals with a physically active lifestyle? Nutrition Reviews (1996) 54: S169-S175.
6. Byrne Susan M et al. Psychological predictors of weight regain in obesity. Behaviour research and therapy 2004;42(11):1341-56.