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From New York, New York, USA:

I am writing concerning a previous question and answer. In a letter that began "I would like your opinion(s) on the Atkins Diet....", the answer included the following: "There is a lot of controversy about this diet and you are correct to think that it could be risky to put oneself into 'ketoacidosis'."

This is incorrect as the Atkins' Diet would never advocate "Ketoacidosis" which is a possibly fatal condition! Dr. Atkins advocates the condition of "Ketosis" which is entirely different.


For clarification, the Atkins' Diet will cause production of ketones, and will lead to ketosis. The Atkins' Diet is unlikely to cause DKA [diabetic ketoacidosis], but stopping insulin therapy (which was suggested by the original writer) certainly can! Patients with type 1 diabetes should not discontinue their insulin therapy, and certainly not stop insulin because they are on a highly-promoted diet.


Additional comments from Dr. Tessa Lebinger:

First of all, people with classical type 1 diabetes (their pancreas makes too little insulin) will go into diabetic ketoacidosis and could die if they skipped their insulin -- even if they eat nothing for a day! The ketoacidosis will be from skipping their insulin.

Anyone who eats a very low carb diet or fasts for a long time will spill ketones into their urine as they break down fat to get calories, but if they don't have type 1 diabetes, their blood sugar won't go high. Some people who don't have diabetes will even develop a low blood sugar (ketotic hypoglycemia) if they severely restrict their carbohydrate and calorie intake.

People with type 1 diabetes develop diabetic ketoacidosis with ketones in their urine and blood, very high blood sugar and acid in the blood because they have too little insulin even for fasting -- you always need some insulin as long as you are alive. Although the Atkins' diet may not cause diabetic ketoacidosis with high blood sugar, the ketones spilled in the urine when you properly follow the Atkins' diet may be confused with the ketones spilled when you need more insulin right away.

Even people with type 2 diabetes who don't normally require insulin, may temporarily require insulin if they are sick. They know they need insulin when they have ketones in their urine!

I don't think enough research has been done to say if there is any one diet that works and is safe for everyone. The Atkins' diet is a diet very restrictive in carbohydrate. To know that you are restricting carbohydrates "enough", you must test your urine to see if their are ketones in the urine indicating that you are breaking down fat for calories (and therefore losing weight). Ketones can cause nausea (and occasionally vomiting) and probably further decrease the appetite, making the diet easier to follow.

There are some data to suggest (but not prove) that diets low in carbohydrate (and higher in protein and fat) may also help promote weight gain because you need less insulin to metabolize protein and fat than you do to metabolize carbohydrate (for the same number of calories eaten). Since insulin can increase the appetite, some people say they eat fewer calories on diets that stimulate the insulin less. same number of calories ingested, people will lose more weight on a low carb diet than on a low fat diet -- but they may be able to follow the diet more easily if the low carb diet requires less insulin and they are less hungry. Also protein and fat make you feel full, so if you eat a very low fat diet, you may wind up eating more calories per day if you never feel full eating all the high carb, low fat "healthy" food. Since people with type 2 diabetes have insulin resistance (Their own insulin doesn't work as well as it should and they have to make more insulin than normal to keep their blood sugar normal -- which further causes insulin resistance.), they might theoretically do better on a low carb diet and even be able to lower or stop their insulin if they lose enough weight. However, it has not been proven that extremely low carb diets with high protein and fat content are safe for the kidneys and heart, especially in people with type 2 diabetes who are prone to kidney disease and atherosclerotic heart disease.

People with diabetes should never switch diets or stop their insulin without first discussing the change in diet with their physician! I suspect, that for different people, different diets will be more effective. For most people who are overweight, they need a long term change in diet and life style -- something they can follow indefinitely until we figure out how to treat the genetic tendency to gain weight and develop type 2 diabetes.

People with type 1 diabetes also often have mild insulin resistance in addition to their main problem of insulin deficiency. Theoretically, they may need slightly less insulin (but some insulin) to keep their blood sugar normal if they keep their carbohydrate intake on the low normal side. With the current popularity of carbohydrate counting and giving insulin to match the carbs eaten, there is also an increased incidence of weight gain (which may be detrimental in the long run even if the blood sugars are normal).

Although I don't believe there is adequate data to make a definitive, scientifically proven statement, it is my personal opinion that a well balanced diet (balanced in carbohydrate, protein and fat) with adequate vitamins (usually found in low calorie vegetables) and adequate mineral (especially adequate calcium which can be taken as a calorie free supplement if dairy foods aren't consumed), is usually the best for most people. Lower carbohydrate percentage might theoretically have advantages for many people, including people with type 2 diabetes, but I would recommend especially for people with any type of diabetes, not to restrict their carbohydrate so much that they spill ketones in the urine. This way, if they do spill ketones in their urine, they know this is an emergency warning sign that they need more insulin very soon to prevent to development of potentially fatal ketoacidosis.


Additional comments from Dr. Stuart Brink:

There is so little real research about any diet approach. However, the Atkins' diet does not produce ketoacidosis although it does produce ketonuria and ketonemia, by definition, because with lowered carb intake and burning of excess body fat, everyone who follows such an approach would spill ketones on urine testing (of acetone and acetoacetate) with Ketostix and uK strips or their variants. The newest Atkins' paperback book has a very elegant and scientifically accurate description of the controversy of ketonuria, ketonemia and DKA, talking about the confusion.


Additional comments from Dr. David Schwartz:

I would emphasize that this diet is likely inappropriate for type 1 diabetes, given the ketogenic nature of the diet. As for type 2, there may be concerns, but with education and supervision, perhaps not a contraindication.


Original posting 28 Aug 2002
Posted to Meal Planning, Food and Diet


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Last Updated: Tuesday April 06, 2010 15:09:38
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