Of all of the Keto Myths, this particular truth bending really gets under my skin. Do you know how to tell when someone lacks confidence in their point of view? When they create an unlikely scenario to bolster their argument, you can be pretty sure that they are uncomfortable with their position. Enter the argument: A Ketogenic diet can lead to Diabetic KetoAcidosis (DKA).

A Very Serious Condition

When you really want to drive home your Keto myths, it does make sense to use a serious condition to make the most dynamic impact. In Diabetic Ketoacidosis (DKA), blood sugar and Ketones rise to dangerous levels, which disrupts the blood’s delicate acid-base balance. People in Ketoacidosis feel extremely ill and experience profound dehydration, vomiting, abdominal pain, and weakness. DKA requires hospitalization so that IV fluids and insulin can be provided gradually and safely lower blood sugar. Ketoacidosis is a medical emergency.

While the prospect of Ketoacidosis sounds scary, what are the odds of a person with a functioning pancreas reaching this metabolic level? Up until recently, DKA occurred exclusively in Type 1 Diabetics that did not take insulin.

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Criteria for DKA

In order to reach Diabetic Ketoacidosis, the following levels must be acquired.

• Blood glucose must be in excess of 240 mg/dl (Normal is below 130 mg/dl)
• Beta-Hydroxybutyrate (BHB) levels exceed 10 mmol/L
• Inability to produce insulin

A person following a well formulated Ketogenic Diet will typically operate at well below 5 mmol/L and their blood glucose levels will be maintained below 100 mg/dl. Also, unless that person is a Type 1 Diabetic, they have a functioning pancreas. The odds are on the order of a shark attack in the Mississippi River.

Pharmaceutical Exception

There is a new player in the DKA risk game, though. Type 2 diabetics who take medications known as SGLT2 inhibitors, such as Invokana, Farxiga, or Jardiance are at an increased risk of falling into this category. Thus it is recommended that Type 2 diabetics carefully monitor their blood glucose and reduce their medication (with the approval of their medical provider) as they begin a Ketogenic regimen.

So, in short, people with an operating pancreas that are not using SGLT2 inhibitors, are more likely to experience spontaneous combustion than to suffer from DKA.

Who Spreads this Keto Myth?

The warnings of DKA come from several sources:

• Your medical provider
• Many registered dietitians
• Instagram nutritionists
• Every news article about Keto
• Karen at work, she is really concerned about you

If your doctor or medical provider warns you of the dangers of DKA, they may not be current on their nutritional education. A well meaning doctor should be open for discussion and may even change their opinion when provided evidence. But what about those people that are trying to scare you when they KNOW that you are more likely to run into a blizzard in Alabama on July 4 than you are to experience DKA?

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These people fall into to one or more of the following categories:

• Lack of personal integrity
• Monetary motivation (corporate sponsorship)
• Lack of intelligence
• They think you are stupid
• They have zero respect for you

I cannot think of another explanation. A person exposed to truth , is responsible for that information, especially if they are in a position of health authority/care. To do otherwise should be considered an act of bad faith. News articles that spread this type are generally sponsored by large corporations that have a vested interest in your continued consumption of sugars, grains and ultra-processed foods. This is nothing but marketing disguised as news.

Karen at work? Well, she never cared when you polished off a box of donuts, but is now really concerned that you might die from eating a rib-eye and broccoli instead of pizza. She is probably more defensive of her way of eating than your health. It’s OK, Karen.

Other Classic Straw Man Examples

In an effort to discourage eating meat, a hysteria was born linking Bovine Spongiform Encephalopathy (BSE), also known as mad cow disease to Creutzfeldt-Jakob Disease (CJD) in humans. BSE does occur in cattle, but only in cattle that are fed other dead cows along with their other food. In other words, cows that engage in cannibalism get sick. This did result in a tighter restriction on how cattle are fed and cared for. But even in the cases of infected cattle, just eating a steak had zero chance of passing this disease on to humans. The brain or nervous system of the cow would have to be ingested in order to transmit the disease. This resulted in only 4 people in the United States contracting the illness and none of those people originated from the United States.

However, this set of facts did not prevent Vegan activist doctors such as Dr. Michael Greger and Dr. John Mcdougall from launching a fear campaign in 2003 to convince people to cure their beef habit. Even though their hopes (I mean fear) never materialized, we never did see a retraction of these claims. In fact, you can still hear these individuals continue to blather about the dangers of humans getting CJD to this very day.

Scurvy is on the rise

This is generally a dig at people following a carnivore diet (which is a subset of the Ketogenic Diet umbrella). So, it still counts as a Keto Myth.

In a 2015 Slate article titled, “Scurvy Is a Serious Public Health Problem“, the author speaks of a few isolated cases of people testing positive for scurvy. In one case,

It turns out the man, who was mentally ill and lived alone in one of the city’s poorest neighborhoods, had eaten nothing but white bread and American cheese … for years. 

In other cases, the disease is mostly associated with the elderly, chronic alcoholics, or severely neglected children. Tales of ramen-eating college students getting scurvy also pop up in urban lore, though most cases are unconfirmed.

Later in the author speaks of a higher vitamin c deficiency rate in low-income, male smokers (18 percent), likely because smoking affects how the body absorbs vitamin C. It is believed that just a small amount of vitamin C (on the magnitude of a ketchup packet) will reverse potential scurvy symptoms. The truth may actually be how the foods that we eat along with tobacco consumption might actually result in leaching vitamin C from our bodies. There is another theory that people that eat a diet very low in carbohydrates may require less Vitamin C than those with a glucose-based metabolism. Scurvy makes a great headline, but it turns out that there was no there … there.

Erring on the side of Caution

To me, the most important part of a Ketogenic lifestyle is to first get your blood glucose under control. Spiking glucose and, consequently, insulin are likely responsible for the majority of our chronic illness and disease. Every person, whether they follow a Ketogenic protocol or not should know where their fasting glucose levels are. A blood glucose tester can be purchased without a prescription for under $30. A simple prick of your finger can provide a baseline of your diabetic status. If your levels are high, you know that you need to take action. I used to fear the results because I dreaded the thought of being enslaved by medication. Now I gladly prick my finger a few times a week because I have confidence that the results are in my favor.

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This change of attitude has doubtlessly extended not just my life, but my quality of life and reduced my dependence on diabetes medicines, blood pressure medicines and even autoimmune related injections. A regulated blood glucose guarantees that I never have to worry DKA or future diabetic related blindness or amputations. So, yes, I think that we all should err on the side of caution. After all, we all deserve to live the most rewarding lives that we can.

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