This is what WebMD 'taught' me today

I received an email today from WebMD telling me I should “Lose 10 Pounds the Right Way.” Because I need to lose 10 lbs (ok maybe 20) this peaked my interest. So I clicked. And read this–>

…"Simply cutting lots of carbs – a common dieting strategy – can be
dangerous, Gerbstadt says. When your body doesn’t have carbs to burn for
your metabolism changes into what’s known as ketosis – and fat is
instead. You’ll feel less hungry, and eat less than you usually do –
long-term ketosis can cause health problems.

"Ketosis decreases oxygen delivery to the tissues, which puts stress on eyes, kidneys, heart, liver," Gerbstadt says. "That's why the low-carb, high-protein Atkins diet is not really safe for people with diabetes. Diabetics need to try to stick with a more balanced diet so your body can handle nutrients without going into ketosis." "...

Are they trying to scare people who may confuse "ketosis" with "ketoacidosis"? Regardless of the input of nutrients, all are changed into glucose (in varying percentages), and insulin is used to shuttle the glucose into cells. So we don't necessarily need to literally 'burn fat' into ketones for energy, right?

I am a bit confused on this. Would someone help me out?

And this from a Registered Dietician. No need for confusion, simply ignore the phlegm. The fact that this so called expert does not know the difference between ketosis and diabetic detoacidosis is all you neeed to properly categorize this advice use “useless.”

What rubbish! Scary that people are receiving emails with misinformation.

Ketosis is the burning of fat for energy. That what fat stores are for & how to lose weight. Ketosis doesn’t put a strain on organs. It’s not clear that the author is confusing DKA & ketosis. More that he/she doesn’t know what what they’re talking about.

To answer your question, in the absence of sufficient carbs ketones are used for energy. That’s the goal for weight loss.

Do what bsc & Gerri says. Don’t pay that no attention!

Okay, I beg to differ a bit. Low-carb diets (especially extremely low carb diets) do cause the body to burn fats, which in turn produces ketones. But this would only be dangerous for diabetics IF the blood sugar was also high, as burning ketones combined with high blood sugars can cause ketoacidosis.

For non-diabetics, I don’t know if ketosis (burning ketones without high blood sugar) is dangerous…I’ve done a quick search and the answer is unclear.

But of course, many diabetics follow low-carb diets and do extremely well with blood glucose control on them, so I wouldn’t disagree that they can work for diabetics. I think any unequivocal statements are usually not helpful…no matter what they’re about.


Here’s a recent thread from the Dr. Bernstein group with some choice comments concerning the dangers of Low Carb

With DKA, the body is in starvation mode without insulin to transport glucose to the cells. Since the cells aren’t receiving energy, the body is signaled to burn fat reserves. Of course, that doesn’t get to the cells either & BG keeps climbing. Different than burning ketones for energy.

Ketosis is safe for diabetics & non-diabetics. Many thousands of people on low carb diets for health & weight loss where ketosis is the goal. It’s a natural process. People have always done this, but now it has a name–ketosis.

Actually, I’m tempted to fire off an email to the good Dr. Gerbstadt. But in all fairness, I’d hate to rant on her without seeing the whole email. Would you post the entirety of the email?

This doctor is not comparing ketosis to ketoacidosis, nor does it imply that anywhere in the article. He/She is simply stating that ketosis CAN potentially put strain on other organs. This doesn’t usually happen, but in diabetics who may already have complications affecting other organs (including complications not yet diagnosed), being in ketosis can be detrimental. Also, it’s been proven that diets very high in protein (which many low-carb diets are), can put extra strain on the kidneys - and we as diabetics should try to avoid extra strain to our kidneys. I think the article could do a better job of making the reader understand that all of this is POTENTIAL, not CERTAIN; however, the article is not incorrect.

I did not want to rant on the good Dr. inappropriately which is why I think it is important to see what is written as a whole. I have never seen any evidence that ketosis has negative impacts unto itself, although I am open to such evidence. I have also never seen evidence that high protein diets are a problem unless you have kidney problems. It is however standard fare to criticize Atkins, and any high protein/high fat diet. Some of the underlying criticism of Atkins is likely motivated based on the low fat muth. Should you have any evidence that high protein diets strain healthy kidneys or have an adverse effect I’d be happy to see it. I can provide you the reference to the Nurses Health Study work which showed that diabetics with kidney failure had accelerated kidney decline on high protein diets.

A low carb diet can also be high fat not high protein. Fat can be substituted for carbs with the protein component held steady. I know the word fat carries a lot of baggage, but in the absence of sufficient carbs your body will happily use fat (and protein to an extent) as energy.

I’m not against a diabetic working towards and maintaining a diet designed to induce ketosis, however I do believe that a diabetic doing this does need to closely monitor and practice if not excellent BG control, great control. Why . . . ketosis does generate ketones in the body. Ketones are acidic and at the low levels generated from a Atkins type of diet the blood can buffer itself and maintain ideal PH levels.

Now this alone isn’t enough for concern, however ketoacidosis is a condition defined by it’s name, keto for the ketone levels that have risen high enough to upset the neutral PH of our blood and turn it acidic, the acidosis. As mentioned before, ketones already present in a body mixed with poor BG control may just be a recipie for disaster.

The medical community is divided on how harmful ketosis is to the body and is the primary reason why Atkins and other extreme low carb diets are not pushed by the mainstream medical community. If in fact their correct, then it may stand to reason that given all the other stresses diabetes places on us that a ketogenic diet may not be the best course of action.

As for me, I’m having a couple of perogies with dinner . . .

I’ve been on a very low carb diet (30-35 carbs daily) for over 2.5 years. Ketones produced from this are low, not high as they are with DKA. Simply drinking water with low ketones eradicates them. People have low ketones in the morning just from fasting overnight.

What’s going with DKA is a different situation. Apples & oranges. During DKA, the acidosis is from the body’s electrolytes being imbalanced from dehydration, constant urination, etc. Again, these are two different things. Ketosis from reduced carbs doesn’t turn into DKA.

I don’t believe a ketogenic diet in itself alone causes or leads to DKA either, that would take poor BG control, high BG levels, and the associated electrolyte imbalance from, dehydration, constant urination. etc. Ketosis just introduces the ketones, a small part of the picture. That’'s why I said I believe excellent Bg control is a must for one following this type of diet,.

Given the conservative nature of the medical community at large the portion of the WebMD article posted falls in line with their beliefs. I may not agree with the article in its entirety, but I understand where their coming from.

BTW, the perogies were delish . . .

Ah perogies delicacy of my ancestors, but unfortunately off limits these days

Excellent BG control isn’t a must for people for people on a low carb/ketogenic diet. Again, it’s a whole different situation. Low ketones has nothing to with it. Being on a low carb diet doesn’t put anyone at greater risk. In fact, the opposite is true.

As for the OP’s question of "ketosis and “ketoacidosis” are two different things. The medical community at large believes that ketones such as present in ketogenic diet are “long term” not healthy for anybody. This is why Atkins and Bernstein aren’t readily accepted by the mainstream medical community.

Ketosis is caused by the body not quite getting enough of its energy needs from glucose of which carbs are the major source, so it turns to fats to produce ketones as an alternative energy source. In a ketogenic diet this is usually kept under control as there is sufficient glucose and insulin natural or otherwise present to keep the ketones in check.

Ketoacidosis is caused the by the body getting virtually nil energy from glucose due to a lack of insulin natural or otherwise causing high blood sugars. Associated dehydration from the high Bg’s, higher levels of ketones being generated to supply the energy not being provided from the glucose eventually upsets our electrolyte balance turning our blood acidic.

Without reading the entire e-mail I don’t see from the copied portion where the author was trying to confuse anyone. She was just sticking to ketosis and the medical communities perceived issues with ketosis in general.

I would be interested in any references or pointers you have to ketosis being unhealthy. Given that “all” fat loss in the body takes place through the conversion of body fat to ketones, this seems like a very odd situation. Basically, everyone goes into ketosis at various points every day of their lives, hardly an unnatural condition. Every time I’ve found a claim that ketosis is harmful it has ended up that the claimant is confusing ketosis with DKA.

My experience is that the medical community as a whole is not very knowledgable about nutrition and weight loss. A short discussion with your doctor can convince you of this.

We experience ketosis overnight. Unless we stuff our faces constantly, this occurs during the day as well. Our ancestors survived on a ketogenic life–feast or famine. The purpose of fat stores is for it to be turned into energy when needed. Why would a normal process be unhealthy or risky? The danger zone is when people eat low carb & low calorie by not getting sufficient fat & protein.Lack of protein is cause for concern, not reduced carbs.

Low carb seems to be such a taboo that the most far fetched ideas are presented to support high carb eating. Brain starvation, ketosis as unhealthy & a host of others are put forth. None are based on fact.

Feast or famine is the rule in the natural world. Animals store fat in the good times and burn it in the lean times. It’s counter intuitive to think the coping mechanism for the inevitable lean times would be unhealthy.