Can anyone site any study at all that proves that a patient in ketosis from a zero carb diet is in any danger.

Question

If the patient is healthy. And secondarily. Is there any evidence that that a patient who stays on a zero carb diet for a very long time will eventually deplete all of their fat reserves and go into full protieolytic gluconeogenesus? Or will intake of fat and protein prevent the body from exhausting all of it's fat reserves? And finally is there any evidence that if a patient is ingesting zero carbs that appreciable structural protein breakdown will occour concomitant with fat breakdown if there are availble fat reserves? And lastly. If you believe some carbs are needed eventually then why would more carbs be needed than the bare minimum to keep the patient out of ketosis? Would not the extra be unhealthy? And also if man does not evolve very much in say 40 thousand years then given the fact that things like farming, frains, rice and hybrid carb containing plants did not exist 40 thousand years ago then how did man survive on virtually all meat?

Answer 1

I think the previous person listed quite a few good references from reputable sources.

Your body is required to breakdown protein in order to produce CHO on a zero CHO diet as the obligatory users (brain) require it. Remember that fat is not oxidised into glucose rather to ketone bodies by the liver which are put into the blood and circulate. Cells can then take these up and convert them to acetyl CoA which can enter the TCA cycle thereby producing energy (never converted directly to glucose). So, your body does need to breakdown protein in order to provide glucose.

In response to your evolution hypothesis. Firstly,

40,000 years ago the human diet consistent MOSTLY of fruits, vegetables and unprocessed cereals and meat was quite scarce (b/c they had to catch and kill it). Furthermore, the meat nutrient profile was different as the animals were game/ non-domesticated therefore they were low in fat. Also huamns have evolved in the 40,000 years (we have gotten taller).

In addition, if you are refering to a low CHO, high protein & fat diet then your intake of total fats, saturated fats and cholesterol will be signficantly increased. All linked to CVD. And even on a high oily fish diet so omega-3 fat intake is high the amount would not off set your relative risk. Also the few berries that you could consume on such a diet would not provide sufficient vitamins, minerals & phytochemicals which are required to function as antioxidants. And simply taking a multi vitamin supplement to cover this deficiet would not work as 1) they generally do not contain phytochemicals (e.g. anthocyanin) 2) there bioavaiability is often significantly reduced.

I understand how you may be tempted to justify such a diet based on GNG and the physiological consequences (e.g. weight loss). However, further investigations into the consequences of continually forcing your body to metabolise non-glucose substrates into glucose has its long (and short) term consequences. I also agree with the other person, why are you so suspicious of CHO????

One more thing, do you have the reference for this statement 'Also we must account for why CV disease began in Inuits after introduction of carbs' - just out of interest as I would like to read it. Thanks.

Answer 2

Here's the closest I could get:

"A diet characterized by low carbohydrate and high protein intake was associated with increased total and particularly cardiovascular mortality amongst women. Vigilance with respect to long-term adherence to such weight control regimes is advisable." Low carbohydrate-high protein diet and mortality in a cohort of Swedish women. Journal of Internal Medicine. 261(4):366-74, 2007 Apr

"Prolonged consumption of diets low in carbohydrates and high in protein is associated with an increase in total mortality." Low-carbohydrate-high-protein diet and long-term survival in a general population cohort. European Journal of Clinical Nutrition. 61(5):575-81, 2007 May

Also interesting is:

"Recently, diets low in carbohydrate content have become a matter of international attention because of the WHO recommendations to reduce the overall consumption of sugars and rapidly digestible starches. One of the common metabolic changes assumed to take place when a person follows a low-carbohydrate diet is ketosis. Low-carbohydrate intakes result in a reduction of the circulating insulin level, which promotes high level of circulating fatty acids, used for oxidation and production of ketone bodies. It is assumed that when carbohydrate availability is reduced in short term to a significant amount, the body will be stimulated to maximize fat oxidation for energy needs. The currently available scientific literature shows that low-carbohydrate diets acutely induce a number of favourable effects, such as a rapid weight loss, decrease of fasting glucose and insulin levels, reduction of circulating triglyceride levels and improvement of blood pressure. On the other hand some less desirable immediate effects such as enhanced lean body mass loss, increased urinary calcium loss, increased plasma homocysteine levels, increased low-density lipoprotein-cholesterol have been reported. The long-term effect of the combination of these changes is at present not known. The role of prolonged elevated fat consumption along with low-carbohydrate diets should be addressed. However, these undesirable effects may be counteracted with consumption of a low-carbohydrate, high-protein, low-fat diet, because this type of diet has been shown to induce favourable effects on feelings of satiety and hunger, help preserve lean body mass, effectively reduce fat mass and beneficially impact on insulin sensitivity and on blood lipid status while supplying sufficient calcium for bone mass maintenance. The latter findings support the need to do more research on this type of hypocaloric low-carbohydrate diet." Low-carbohydrate diets: nutritional and physiological aspects.

And:

"Low-carbohydrate diets have re-emerged into the public spotlight and are enjoying a high degree of popularity as people search for a solution to the population's ever-expanding waistline. The current evidence though indicates that low-carbohydrate diets present no significant advantage over more traditional energy-restricted diets on long-term weight loss and maintenance. Furthermore, a higher rate of adverse side-effects can be attributed to low-carbohydrate dieting approaches. Short-term efficacy of low-carbohydrate diets has been demonstrated for some lipid parameters of cardiovascular risk and measures of glucose control and insulin sensitivity, but no studies have ascertained if these effects represent a change in primary outcome measures. Low-carbohydrate diets are likely effective and not harmful in the short term and may have therapeutic benefits for weight-related chronic diseases although weight loss on such a program should be undertaken under medical supervision. While new commercial incarnations of the low-carbohydrate diet are now addressing overall dietary adequacy by encouraging plenty of high-fibre vegetables, fruit, low-glycaemic-index carbohydrates and healthier fat sources, this is not the message that reaches the entire public nor is it the type of diet adopted by many people outside of the world of a well-designed clinical trial. Health effects of long-term ad hoc restriction of inherently beneficial food groups without a concomitant reduction in body weight remains unanswered." Safety of low-carbohydrate diets. Obesity Reviews 6 (3) , 235–245

It's mostly studies on low-carb dieting but like I say that's the closest I could get. What I don't understand is why you're suspicous of carbohydrates. People have been eating bread and rice as staple foods for millenia.