Ketoacidosis associated with low-carbohydrate diet in a non-diabetic lactating woman


#1

Was looking up information on non-diabetic ketoacidosis, and saw several references to, but not much info on, lactation in connection with ketoacidosis. Then I came across this case report:

Ketoacidosis associated with low-carbohydrate diet in a non-diabetic lactating woman: a case report

What is interesting here is that they report a ketone level of 7 mmol/L. While that’s far higher than what is considered nutritional ketosis range, and I sometimes see on charts as a “danger” or at least unhelpful range, usually I hear that ketoacidosis starts at 10 mmol/L (or recently virta had an article on Keotacidosis claiming it was 15-25 mM (mmol/L still, I think) range.

But, yea, their ph level of blood was slightly below 7.35 (apparently the base range for human blood?), and they had some pretty bad symptoms.

Note, this was not due to a ketogenic diet alone (and we don’t know exactly what form of the diet they were following beyond being “low carb, high fat”), but was a combination of LCHF while lactating, with lactation causing certain effects on the body to raise ketone levels higher.

I’ve seen some indications of this showing up in connection with lactation elsewhere, but haven’t found sources on that yet, and this indicates,

this is the first reported case in the literature of ketoacidosis, in a non-diabetic patient, associated with a combination of low carbohydrate, high fat diet and lactation.

So probably there is more to it than just that as well, but whatever it is it seems they couldn’t pin down the other factors leading to this.

EDIT: Realizing something of note, this woman appears to have started a LCHF diet 10 days prior to this incident, while already breastfeeding. If this was her first time doing it (we don’t know) she was still undergoing fat adaptation by that point, most likely. Would this have happened if she was already fat adapted before breast feeding? Open question I guess, and this is just a single case so it’s hard to say a whole lot.


#2

A related one but not, stricly speaking, on a LCHF diet, but rather with fasting during lactation (due to some problems eating it seems):


(bulkbiker) #3

Did you read the comment by Dr Csaba Toth from Paleo Medicina at the end of the article… quite informative.


(Door Girl) #4

I didn’t see any comments. Which article? Generally I’m good at finding my way around, but I’m coming up empty. As I’m pregnant and reintroducing carbs is leading to high BG levels, I would really appreciate help finding the comment.

Looks like I’ll need a larger binder for evidentiary support for this pregnancy vs the last two… :slight_smile:


(Ethan) #5

I’m not s doctor or an expert on these things, but I have a brain and good ideas. I can see it being possible, but difficult. In the early stages of ketosis, one is not adapted and still in gluconeogensis for primary energy. Perhaps breastfeeding enhanced the ketosis, but the body was also still using glucose. If insulin was low enough for the ketone production, mild acidosis maybe can occur…


(bulkbiker) #6

Should be here


(Door Girl) #7

Thank you thank you thank you!

In the past I’ve learned the best way to shut down bad medical advice is to flip to a pertinent publication, hand it over, and ask for their opinion.

Now that I’ll have ketone readings every test, I want to have adequate back up and be able to discuss the background behind anything that might raise concerns. I definitely appreciate the help, for some reason I couldn’t get that comment from the first link. Maybe because I’m on my phone?


(Door Girl) #8

Wonderful comment! That should be a guest post on one or more keto blogs. It contains a wealth of information. I really appreciate you calling it out.


(Maria Ortiz) #9

I don’t know about everyone else, but everytime I went back on keto, my supply dried up rather fast.


#10

On a surface-level-observation, that makes a lot of sense to me, even dogs are given oats or breads if they need help with milk supply to feed their puppies and I have seen similar items for sale for expectant mothers (usually loaded with oats, like lactation cookies) - I wonder if it is more of a dehydration thing or the body really kicks out of being able to lactate on Keto WOE?


(Full Metal KETO AF) #11

Fasting while breast feeding just seems like a new level of extremely stupid to me…:-1:


(Chris) #12

He even listed his references, his comment is a gold mine!