Reply to a letter to the editor: Reply of Yves Schutz, Jean‐Pierre Montani, and Abdul G. Dulloo to the letter of Dr Anssi Manninen (manuscript ID OBR‐01‐21‐4950) entitled: “Ketogenic diets, dietary ketosis, diabetic ketoacidosis and energy expenditure”

2021 ◽  
Author(s):  
Yves Schutz ◽  
Jean‐Pierre Montani ◽  
Abdul G. Dulloo
Keyword(s):  
Energy Expenditure ◽  
Diabetic Ketoacidosis ◽  
Ketogenic Diets ◽  
Letter To The Editor

scholarly journals Intermittent Fasting as a Trigger of Ketoacidosis in a Patient With Stable, Long-term Type 1 Diabetes

2020 ◽  
Vol 4 (10) ◽  
Author(s):  
Alejandra Fernández-Cardona ◽  
Deyanira González-Devia ◽  
Carlos O Mendivil
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Trauma Surgery ◽  
Intermittent Fasting ◽  
High Morbidity ◽  
Insulin Requirements ◽  
Education Of Patients ◽  
Ketogenic Diets ◽  
Standard Management

Abstract Diabetic ketoacidosis (DKA) is an acute complication of type 1 diabetes (T1DM) with a high morbidity and mortality. Diabetic ketoacidosis is usually triggered by metabolic stressors that increase insulin requirements like infection, trauma, surgery, or some medications. Ketogenic diets are nutritional regimes that drastically reduce the intake of carbohydrates in order to increase circulating ketones and reduce appetite. Intermittent fasting diets similarly aim to impact appetite and body weight, but through the restriction of feeding to specific periods of time or days. A 58-year-old woman with T1DM and no prior episodes of DKA since her diagnosis 16 years ago was admitted to the emergency room with severe metabolic acidosis, ketosis, dehydration, and back pain after 9 days of practicing a ketogenic, intermittent fasting diet on the advice of a friend. The standard management of DKA led to the resolution of the symptoms and metabolic alterations, but this might not be the case in other patients. This case highlights the relevance of close professional monitoring of dietary and insulin schemes in patients with T1DM, and of the adequate nutritional education of patients in order to avoid having them follow fashionable dietary trends without knowledge of their implications.

scholarly journals Dietary carbohydrates modulate metabolic and β-cell adaptation to high-fat diet-induced obesity

2020 ◽  
Vol 318 (6) ◽  
pp. E856-E865 ◽  
Author(s):  
Tracy K. Her ◽  
William S. Lagakos ◽  
Matthew R. Brown ◽  
Nathan K. LeBrasseur ◽  
Kuntol Rakshit ◽  
...  
Keyword(s):  
Energy Expenditure ◽  
Cell Biology ◽  
Dietary Carbohydrates ◽  
High Fat ◽  
Severe Restriction ◽  
Β Cell ◽  
Pancreatic Islet Cell ◽  
Ketogenic Diets ◽  
High Fat Diets ◽  
Fat Diets

Obesity is associated with several chronic comorbidities, one of which is type 2 diabetes mellitus (T2DM). The pathogenesis of obesity and T2DM is influenced by alterations in diet macronutrient composition, which regulate energy expenditure, metabolic function, glucose homeostasis, and pancreatic islet cell biology. Recent studies suggest that increased intake of dietary carbohydrates plays a previously underappreciated role in the promotion of obesity and consequent metabolic dysfunction. Thus, in this study, we utilized mouse models to test the hypothesis that dietary carbohydrates modulate energetic, metabolic, and islet adaptions to high-fat diets. To address this, we exposed C57BL/6J mice to 12 wk of 3 eucaloric high-fat diets (>60% calories from fat) with varying total carbohydrate (1–20%) and sucrose (0–20%) content. Our results show that severe restriction of dietary carbohydrates characteristic of ketogenic diets reduces body fat accumulation, enhances energy expenditure, and reduces prevailing glycemia and insulin resistance compared with carbohydrate-rich, high-fat diets. Moreover, severe restriction of dietary carbohydrates also results in functional, morphological, and molecular changes in pancreatic islets highlighted by restricted capacity for β-cell mass expansion and alterations in insulin secretory response. These studies support the hypothesis that low-carbohydrate/high-fat diets provide antiobesogenic benefits and suggest further evaluation of the effects of these diets on β-cell biology in humans.

scholarly journals Methodologic Issues in Doubly Labeled Water Measurements of Energy Expenditure During Very Low-Carbohydrate Diets

2018 ◽  
Author(s):  
Kevin D. Hall ◽  
Juen Guo ◽  
Kong Y. Chen ◽  
Rudolph L. Leibel ◽  
Marc L. Reitman ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Composition ◽  
Energy Balance ◽  
Energy Expenditure ◽  
Net Energy ◽  
Doubly Labeled Water ◽  
Energy Imbalance ◽  
Long Baseline ◽  
Ketogenic Diets ◽  
Low Carbohydrate

AbstractBackgroundVery low-carbohydrate diets have been reported to substantially increase human energy expenditure as measured by doubly labeled water (DLW) but not by respiratory chambers. Do the DLW data reflect true physiological differences that are undetected by respiratory chambers? Alternatively, are the apparent DLW energy expenditure a consequence of failure to fully account for respiratory quotient (RQ) differences between diets?ObjectiveTo examine energy expenditure differences between diets varying drastically in carbohydrate and to quantitatively compare DLW data with respiratory chamber and body composition measurements within an energy balance framework.DesignDLW measurements were obtained during the final two weeks of month-long baseline (BD; 50% carbohydrate, 35% fat, 15% protein) and isocaloric ketogenic diets (KD; 5% carbohydrate, 80% fat, 15% protein) in 17 men with BMI 25-35 kg/m2. Subjects resided 2d/week in respiratory chambers to measure energy expenditure (EEchamber). DLW expenditure was calculated using chamber-determined respiratory quotients (RQ) either unadjusted (EEDLW) or adjusted (EEDLWΔRQ) for net energy imbalance using diet-specific coefficients. Accelerometers measured physical activity. Body composition changes were measured by dual-energy X-ray absorptiometry which were combined with energy intake measurements to calculate energy expenditure by balance (EEbal).ResultsAfter transitioning from BD to KD, neither EEchamber nor EEbal were significantly changed (∆EEchamber=24±30 kcal/d; p=0.43 and ∆EEbal=-141±118 kcal/d; p=0.25). Similarly, physical activity (−5.1±4.8%; p=0.3) and exercise efficiency (−1.6±2.4%; p=0.52) were not significantly changed. However, EEDLW was 209±83 kcal/d higher during the KD (p=0.023) but was not significantly increased when adjusted for energy balance (EEDLWΔRQ =139±89 kcal/d; p=0.14). After removing 2 outliers whose EEDLW were incompatible with other data, EEDLW and EEDLW∆RQ were marginally increased during the KD by 126±62 kcal/d (p=0.063) and 46±65 kcal/d (p=0.49), respectively.ConclusionsDLW calculations failing to account for diet-specific energy imbalance effects on RQ erroneously suggest that very low carbohydrate diets substantially increase energy expenditure.

scholarly journals Euglycemic Diabetic Ketoacidosis in Concurrent Very Low-carbohydrate Diet and Sodium-glucose Transporter-2 Inhibitor Use: A Case Report

2020 ◽  
Vol 4 (2) ◽  
pp. 185-188
Author(s):  
Matthew Earle ◽  
Brian Ault ◽  
Caitlin Bonney
Keyword(s):  
Case Report ◽  
Diabetic Ketoacidosis ◽  
Weight Control ◽  
Glucose Transporter ◽  
Diabetic Patients ◽  
Low Carbohydrate Diet ◽  
Ketogenic Diets ◽  
Glucose Transporter 2 ◽  
Low Carbohydrate ◽  
Euglycemic Diabetic Ketoacidosis

Introduction: With the incredibly high incidence of Type 2 Diabetes in the current population of emergency department patients, it is critical for clinicians to understand the possible complications of the treatment of this disease. Medication like canagliflozin are more common to encounter on patient’s home medication lists and clinicians should be aware of how these medications, alone or combined with dietary modifications, can result in significant pathology and even mortality if not appropriately treated. Case Report: We report a case of a patient with type II diabetes mellitus who presented with euglycemic diabetic ketoacidosis in the setting of concurrent use of canagliflozin, a sodium-glucose transporter-2 (SGLT-2) inhibitor, and strict adherence to a low-carbohydrate ketogenic diet for weight control. Discussion: Euglycemic ketoacidosis has previously been observed in both diabetic and non-diabetic patients following strict ketogenic diets, as well as in diabetic patients being treated with SGLT-2 inhibitors. Conclusion: As more patients choose ketogenic diets for weight control and diabetes management, clinicians should be aware of this potentially life-threatening complication in patients concurrently taking SGLT-2 inhibitors.

scholarly journals Letter to the editor: Unexpected high mortality in COVID-19 and diabetic ketoacidosis

Metabolism ◽  
2020 ◽  
Vol 110 ◽  
pp. 154301 ◽  
Author(s):  
Natalia Chamorro-Pareja ◽  
Sahana Parthasarathy ◽  
Jayabhargav Annam ◽  
Julie Hoffman ◽  
Christine Coyle ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
High Mortality ◽  
Letter To The Editor

Reply-Letter to the Editor–Superiority of new predictive equation for resting energy expenditure

2018 ◽  
Vol 37 (3) ◽  
pp. 1085-1086
Author(s):  
Ximena Orozco-Ruiz ◽  
Edgar Pichardo-Ontiveros ◽  
Armando R. Tovar ◽  
Nimbe Torres ◽  
Isabel Medina-Vera ◽  
...  
Keyword(s):  
Energy Expenditure ◽  
Resting Energy Expenditure ◽  
Predictive Equation ◽  
Letter To The Editor ◽  
Resting Energy

scholarly journals Methodologic considerations for measuring energy expenditure differences between diets varying in carbohydrate using the doubly labeled water method

2019 ◽  
Vol 109 (5) ◽  
pp. 1328-1334 ◽  
Author(s):  
Kevin D Hall ◽  
Juen Guo ◽  
Kong Y Chen ◽  
Rudolph L Leibel ◽  
Marc L Reitman ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Composition ◽  
Energy Balance ◽  
Energy Expenditure ◽  
Net Energy ◽  
Doubly Labeled Water ◽  
Energy Imbalance ◽  
Long Baseline ◽  
Ketogenic Diets ◽  
Low Carbohydrate

ABSTRACT Background Low-carbohydrate diets have been reported to significantly increase human energy expenditure when measured using doubly labeled water (DLW) but not by respiratory chambers. Although DLW may reveal true physiological differences undetected by respiratory chambers, an alternative possibility is that the expenditure differences resulted from failure to correctly estimate the respiratory quotient (RQ) used in the DLW calculations. Objective To examine energy expenditure differences between isocaloric diets varying widely in carbohydrate and to quantitatively compare DLW data with respiratory chamber and body composition measurements within an energy balance framework. Design DLW measurements were obtained during the final 2 wk of month-long baseline (BD; 50% carbohydrate, 35% fat, 15% protein) and isocaloric ketogenic diets (KD; 5% carbohydrate, 80% fat, 15% protein) in 17 men with a BMI of 25–35 kg/m2. Subjects resided 2 d/wk in respiratory chambers to measure energy expenditure (EEchamber). DLW expenditure was calculated using chamber-determined RQ either unadjusted (EEDLW) or adjusted (EEDLWΔRQ) for net energy imbalance using diet-specific coefficients. Accelerometers measured physical activity. Body composition changes were measured by dual-energy X-ray absorptiometry (DXA) which were combined with energy intake measurements to calculate energy expenditure by balance (EEbal). Results After transitioning from BD to KD, neither EEchamber nor EEbal were significantly changed (∆EEchamber = 24 ± 30 kcal/d; P = 0.43 and ∆EEbal = −141 ± 118 kcal/d; P = 0.25). Similarly, physical activity (−5.1 ± 4.8%; P = 0.3) and exercise efficiency (−1.6 ± 2.4%; P = 0.52) were not significantly changed. However, EEDLW was 209 ± 83 kcal/d higher during the KD (P = 0.023) but was not significantly increased when adjusted for energy balance (EEDLWΔRQ = 139 ± 89 kcal/d; P = 0.14). After removing 2 outliers whose EEDLW were incompatible with other data, EEDLW was marginally increased during the KD by 126 ± 62 kcal/d (P = 0.063) and EEDLW∆RQ was only 46 ± 65 kcal/d higher (P = 0.49). Conclusions DLW calculations failing to account for diet-specific energy imbalance effects on RQ erroneously suggest that low-carbohydrate diets substantially increase energy expenditure. This trial was registered at clinicaltrials.gov as NCT01967563.

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