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-   -   What do you make of this death???? (http://forum.lowcarber.org/showthread.php?t=68582)

Lebette Thu, Oct-31-02 14:36

What do you make of this death????
 
Just curious, it seems to unlikely that following a diet would cause this kind of reaction and is just the stuff most people have stereotyped this WOL to be: dangerous.

I hope not! Im feeling healthier than ever!
Here's the article posted today:

US Teen Dies After Following High-Protein Diet
1 hour, 43 minutes ago
By Dana Frisch

NEW YORK (Reuters Health) - Missouri doctors describe the case of an apparently healthy 16-year-old girl who collapsed suddenly and died after spending one to two weeks on a high-protein, low-carbohydrate diet.



Electrolyte imbalances due to the diet, and the resulting damage to her heart function, were likely responsible, the physicians who cared for her report in a recent issue of the Southern Medical Journal. The girl had no known illnesses or medical conditions.


The teen had low potassium and calcium levels when she arrived at the University of Missouri Health Sciences Center, most likely as a consequence of the diet, the doctors state in their report. This disrupted the normal electrical function of her heart, leading it to stop and causing her to collapse, they write.


Dietitians and proponents of the Atkins diet, one example of a low-carbohydrate/high-protein diet, say that other weight-loss measures including eating disorders like bulimia or the use of diuretics were far more likely to have contributed to the low electrolyte levels found in the teen's blood.


Dr. D. Paul Robinson, a co-author of the paper, said in an interview that while there might be other explanations for the teen's death, including an abnormal heart rhythm, interviews with her parents did not suggest that she had a history of bulimia or diuretic use. Robinson is an assistant professor of child health in the division of adolescent medicine at the University of Missouri, Columbia.


"Most kids with eating disorders, even if they're able to hide the bulimia, they're constantly talking about being fat or needing to lose weight and exercise," Robinson said. "My indication, from what I understand of the interview with this girl's family, is that none of these things were the case."


Colette Heimowitz, director of education and research at Atkins Health and Medical Information Services, told Reuters Health that the Atkins approach has been used by millions of Americans for 30 years now, and there have been no documented cases of serious reactions or fatalities.


"The actual dietary approaches or practices that this particular teenager followed for days or weeks couldn't possibly account for what (the physicians are) attributing it to," said Heimowitz. She noted that the irregular chemical levels detected during the autopsy could be associated with drugs emergency medical personnel and doctors administered to resuscitate the teen, or with other weight-loss efforts.


Robinson disagrees. "I don't think there is any way the resuscitative drugs would have affected (the teen's electrolytic balance)," he said, noting that when the teen came in, she had low potassium levels.


Very high-protein/low-carbohydrate diets result in a condition called ketosis. In ketosis, the body has used up its preferred fuel reserves, glycogen derived from carbohydrates, and instead burns fat. This generates substances called ketone bodies, which can be smelled in the breath.


Wahida Karmally, a spokesperson for the American Dietetic Association, told Reuters Health that these diets can cause muscle breakdown, weakness, nausea and dehydration. They limit the intake of entire categories of food that provide certain nutrients, such as potassium, she explained. "These effects can happen right away," she said.

"It is a worrying set of circumstances when kids die suddenly," Robinson said. "The whole point of writing the paper is to ask clinicians to keep their eyes open. If kids come in with sudden death and they're on this kind of diet, we really have to start paying more attention to it."

SOURCE: Southern Medical Journal 2002;95:1047-1049.

seyont Thu, Oct-31-02 14:46

There are no details. What was she eating?

If one hears that 'everybody does Atkins', learns from a newspaper clipping that it's deemed 'high-protein', already 'knows' that 'fat is evil' and then puts all the pieces together, one comes up with a chicken and tunafish diet.

Yes, that'll kill you. It's called rabbit starvation. It's also purported to be a torture technique in SE Asia somewhere (don't remember where I saw that).

Lebette Thu, Oct-31-02 14:52

Good point, Seyont. I found the article disturbingly lacking in content. I also find it telling that it is a young girl who may have been obsessive, unrealistic or simply uninformed.

But of course, Im getting all these people sending me copies of this and telling me how Im in danger! lol Ug. Just goes to show the way the media opperates....

MrFrumble Thu, Oct-31-02 14:57

Total fluff piece. They don't even know how long she was doing the diet... 1 to 2 weeks? Maybe it was 1 day for all we know.

Most humans can eat nothing for 2 weeks and they won't suddenly collapse and die, particulary if they are a teenager. I'd be a litte more worried if they had said after 6 months on the diet this had happened.

Maybe she had done an extreme workout and then collapsed. One hears about that happening every once in awhile with people, even teens. Even if they are not on a low carb diet!

Lisa N Thu, Oct-31-02 15:19

In all fairness, low carbing can cause low levels of potassium which is why in the initial stages a potassium supplement is recommended, although it's often not necessary if you are eating veggies from the allowed list other than lettuce. Broccoli and spinach are both excellent sources of potassium. Low carbing is not known, however, to cause dangerously low levels of potassium. Diuretics can. Just because she wasn't talking about being fat doesn't mean that she wasn't using a diuretic to help speed her weight loss and it's very unlikely that she would have shared that information with her parents. Teens do some dangerous things on the recommendation of the friend of a friend. Given her sudden collapse, I'm very surprised they didn't do a drug panel in the ER to find out if she was taking anything that could have caused her condition.
The statement that low carb diets cause muscle breakdown is absolutely false. If you are consuming adequate amounts of protein the body has no reason to break down its own muscle mass for the protein or energy that it needs. For energy it will go to its fat stores first.
As for the dehydration, nausea, weakness, etc....yes, those sometimes do happen in the first few days due to carb withdrawal (why do you think it's recommended to drink at least eight 8 oz. glass of water daily?).
If low carb was to blame for this (and I'm not saying it is) it's because this girl was doing her own version of it without any research as to what she should have been doing (note: had she been eating the veggies, it's unlikely she would have had low potassium and had she been eating cheese and/or cream, low calcium would have also been unlikely) and possibly taking things that don't mix with low carb or starving herself.
Low carb without sufficient water, veggies or supplements is not Atkins. As a matter of fact, it's not any low carb plan that I'm aware of.

asugar Thu, Oct-31-02 15:41

Two weeks of starvation wouldn't have killed a 16 year old unless there were underlying conditions. I'm not convinced the autopsy was thorough. Some 16 year olds do all kinds of stupid things to their bodies and some teenagers have even been known to experiement with illegal drugs.

The Atkins diet has been around for years and millions of people have been on it for more than 2 weeks. I think the truth is the doctors have no idea what caused her death and they don't want to look stupid, so they're blaming Atkins.
asugar :wave:

Angeline Thu, Oct-31-02 15:49

You could eat nothing but chocolate bars for 2 weeks and it wouldn't kill you. You could eating nothing but water for 2 weeks and it wouldn't kill you.

If humans could die after 2 weeks of a high protein low carbohydrate diet, the human race would have died out a long time ago.

Obviously something else was going on in her case and that needs to be investigated.

This article is completely irresponsible.

seyont Thu, Oct-31-02 15:57

The original smj article (don't ask!) is an encrypted pdf, so I can't post the text.

The abstract:
Quote:
_ Sudden Cardiac Death of an Adolescent During Dieting - 1047
Amy Stevens, D. Paul Robinson, Julie Turpin, Ted Groshong, and Joseph D. Tobias

ABSTRACT
We describe a 16-year-old girl who had sudden onset of cardiorespiratory arrest while at school. She had recently attempted weight loss using a low-carbohydrate/high-protein, calorie-restricted dietary regimen that she had initiated on her own. During resuscitation, severe hypokalemia was noted. At postmortem examination, no other causes for the cardiac arrest were identified. Toxicologic findings were negative. The potential role of the dietary regimen as a contributing factor to the hypokalemia and subsequent cardiac arrest are discussed.


She was apparently following her mother's diet, "...eating meat, cheese, and salads, without fasting". However, elsewhere they also say she was doing caloric restriction, and further: "Caloric restriction is generally not recommended on most low-carbohydrate diets, including the Atkins diet, further emphasizing the danger of using these diets without strict adherence to their recommendations."

Though it's a case study, the authors spend most of the article saying fad protein diets are bad. Ketosis is bad. Losing calcium is bad. Losing potassium is bad. Fat is bad. Because there were deaths reported on the liquid protein diets of the 60's and 70's, they counsel against a high-protein, low-carb diet.

They end the article with, "While it is possible that the patient's dietary regimen had nothing to do with her cardiovascular collapse, continued surveillance for similar cases is suggested."

How, Doctors, exactly, was science or medicine served by your article? How was the mother served?

suze_c Thu, Oct-31-02 16:08

Yes, this type of diet could cause a death in someone who is not taking the proper supplements, and who may have a potassium and/or electrolyte imbalance the first place. Even though she may have had no known medical conditions or symptoms, doesn't mean that there wasn't any there! There are many many athletes who keel over during sports who have a certain heart disorder, called Marfan Syndrome, that was undiagnosed. It is supposed that Abraham Lincoln may have had this disease. It is an INDIVIDUAL THING... no one can TRULY give cause to what the actual cause of death was... but we do not know what she ate, what was her physical condition BEFORE she started the diet, was she getting enough nutrition.. factors like that. And Seyont.... fooey with your rabbit starvation diet theory... My diet is lean meats and cheeses,eggs and an occasional salad, and I am not only feeling better than I have in years... I also done this diet when I was younger for over a month, and I am still alive! Twenty MILLION people have also been reported to have done a similiar diet, and those people did not all die either!To say that sort of diet is a death sentence is as ludicrious as asserting that it was DEFINITELY the high protein/low carb diet that killed this young girl.
Quote:
Low carb without sufficient water, veggies or supplements is not Atkins. As a matter of fact, it's not any low carb plan that I'm aware of.
LisaN, Stillmans diet had no veggies, although he does/did propose adequate water and vitamin supplements. Stillman Diet Summary And as far as not getting enough food.... I fasted for 6 weeks in 1999, with nothing but water... no supplements or vitamins... if someone dies from lack of supplements... wouldn't I have died? Like I said before, in MY OPINION, there was some underlying cause as to why this girl had a potassium/electrolyte imbalance... I know in cases of extreme diarrhea/vomiting, that this can happen... especially in babies... that is the main reason for pedialyte... and also excessive sweating combined with insufficient water intake can also cause potassium/electrolyte imbalances... it is why they put electrolytes in drinks like gatorade!

suze_c Thu, Oct-31-02 16:18

Eating Disorders & Body Imbalances
 
WEB SITE DISCUSSING COMPLICATIONS OF EATING DISORDERS including FLUID AND ELECTROLYTE ABNORMALITIES (click here)



These are just a few of the abnormalities that eating disorders can cause:
Cardial effects (conduction abnormalities, irregular rhythms and sudden death,Effects of resultant metabolic alkalosis, potassium and chloride deficiencies,Electrolyte Imbalance ,

seyont Thu, Oct-31-02 16:26

just a sidenote for suze_c
 
suze_c:

I think you are saying "hey, bonehead, *I* eat a high-protein diet!". But lean meats, cheese, and eggs is hardly a high-protein, low-fat diet. Your egg, for instance, can be up to 70% fat. Even lean sirloin is over 40% fat by calories. Cheese, of course, is mostly fat.

Tunafish is 93% protein. Eaten to the exclusion of all else, THAT's high-protein. And that's where I was just supposing a fatal misunderstanding could have occurred.

But that was just speculation, which is apparently good enough to get published in a medical journal.

They have no idea why she died. Her calcium and potassium were low, and they guess her magnesium was probably also low. They don't know if she was bulimic, anorectic, or abusing diuretics or laxatives. They caught right on to the fact that her heart stopped, though.

suze_c Thu, Oct-31-02 16:36

Got ya now Seyont
 
Now that you explain it that way... it makes a little more sense... Although Stillmans is primarily a very high protein diet, more so than any other LC plan I know of, with emphasis on lean meats, low fat cheeses... the addition of eggs is not a low fat thing, although they are high in protein: Eggs= 75 calories/6.5 protein gm/ carb gm 0.6/5 gm fat.

p.s. seyont... I would not call you names just because you had a different opinion than I do, although I was pointing out that my diet is more protein than Atkins, and a lot less fat. ;)

Lisa N Thu, Oct-31-02 17:01

Re: What do you make of this death????
 
Quote:
Originally posted by Lebette


Wahida Karmally, a spokesperson for the American Dietetic Association, told Reuters Health that these diets can cause muscle breakdown, weakness, nausea and dehydration. They limit the intake of entire categories of food that provide certain nutrients, such as potassium, she explained. "These effects can happen right away," she said.


SOURCE: Southern Medical Journal 2002;95:1047-1049.


Low carbing (unless you eat no veggies whatsoever) does not eliminate foods high in potassium or calcium. Broccoli, Spinach and Avocados are all excellent sources of potassium and are not eliminated by the Atkins plan. Cheese, cream and broccoli are good natural sources of calcium and are not eliminated by the Atkins plan.
I already addressed the inaccuracy of the statement about muscle breakdown; this only occurs when protein consumption is very low as in fasting, starvation or low fat diets where protein consumption is likely to be low.
It's sad that the medical profession and the media are so quick to blame this girl's death on how she was eating instead of looking for the real cause and in the process unduly alarming a lot of people. IMHO, this young lady had some underlying medical condition that may have been aggrivated by what she was doing or had an eating disorder that her parents were not aware of and was even possibly abusing diuretics or over the counter diet pills. There's a good reason that Dr. Atkins recommends a complete medical exam before beginning....to make sure that you don't have an underlying medical condition that would make low carbing unadvisable.
Toxicology reports, by the way, only test for illegal substances and commonly abused substances, not over the counter diurectics or over the counter diet pills.
In healthy individuals, the body can go for up to 40 days without food (longer if you have a lot of fat stores), so I have a hard time with even speculating that eating meat, cheese and salads for a week or two caused this poor girl's death.
Suze_c....I never said that someone would die from lack of supplements, but they make it a lot less likely that you will develop a deficiency in something like potassium, calcium or magnesium which is important when you are following a diet plan like low carb, that has a diuretic effect where you will be losing more of those minerals that you would normally through your kidneys, especially at the beginning when carb levels are low and your body has not adjusted to the new way of eating yet.

doreen T Thu, Oct-31-02 17:01

I just did a quick check of our nutrient data tool, and I find it hard to believe that she could become hypokalemic (pathologically low in potassium) in such a short time.

(note - 100g = 3˝ oz)

- 100g average beef cut provides 380 mg potassium

- 100g average pork cut provides 390mg potassium

- 100g tuna packed in water provides 240mg potassium

- 100g chicken .. 230mg potassium

- 100g plain sole fillet ... 360mg potassium

- 100g cheese provides 750mg calcium

Low calcium levels tend to be a chronic condition ... it doesn't just happen in 2 weeks. If there's insufficient calcium coming from the diet, then the body turns to bone and uses that. Unless there's a metabolic disorder, such as hypoparathyroidism or kidney disease.

I'd stamp this one with a big question mark.

Doreen

seyont Thu, Oct-31-02 17:14

regarding the hypokalemia, some more from the smj report:

Quote:
During resuscitation, with a pH of 6.89, the serum potassium level was 3.8 mEq/L, suggesting profound hypokalemia if corrected for the pH. The ionized calcium level was 1.12 mEq/L (normal, 1.10 to 1.22 mEq/L). ...corrected for the pH, this would indicate significant hypocalcemia.


Was she low on minerals or, if that K level is also normal for a normal pH, was her pH off? It's that "(normal..." bit that made me wonder.

SlimShAdY Thu, Oct-31-02 21:32

OMG. Bullshyt!
 
"apparently healthy 16-year-old girl who collapsed suddenly and died after spending one to two weeks on a high-protein, low-carbohydrate diet."

:bash:LIES!! :bash:

There probably was something else wrong with her that the drs couldn't figure out, ey probably heard she was on Atkins and blamed it on them right then and there. I'd be more apt to believe this story if she was doing it for months. Not 1-2 freakin weeks. Hell, annorexics can go on for months eating nothing but salads, and they don't die....

Theres deffinetly pieces missing from this story.

Angeline Thu, Oct-31-02 22:08

Re: OMG. Bullshyt!
 
Quote:
Originally posted by SlimShAdY
Hell, annorexics can go on for months eating nothing but salads, and they don't die....


Actually anoxeria is a very serious disease that kills a lot of people. But yes it usually takes years of abuse.

cre8tivgrl Fri, Nov-01-02 13:03

We can vent....
 
Let's get it out here... but we can be proactive too!!!!!

I just heard about this story on Good Day Live and of course had to run hear to read the discussion that I knew would be going on. ;)

I agree with the posts in this thread. The story is missing, well quite a bit of the story. But we all know that doctors have been *WAITING*WAITING*WAITING* for one person to die that they could blame on low-carbing in hopes of starting a landslide, and to make it worse we all know that the media has been waiting just as long to report it. I am certain this is just the beginning.

The best thing we can do is fight it in our own circles of family, friends, co-workers, neighbors, communities with facts. Perhaps we could even compile a fact sheet that can be downloaded and printed out. I realize that with so many plans it could get detailed but it could be done off of Atkins and people could add their own changes for their own plans. I am talking something that covers what this story accuses. Nutrients, hydration (for pete's sake, I drink 100 oz of water!!!), muscles, fat/protein/carb ratio, etc.

Any input??

--------------------------------------

p.s. the biggest problem I have with the original artical is not low-carb related at all. The Dr.'s accounts of anorexic and bulemics as complainers of being fat is so very misleading. After having a best friend who was bulemic, I did a study paper on it in college. Often anorexics but more often bulemics hide their eating disorder so very well that even their own families don't know. And furthermore a high number are often bulemic, not because of their weight or eating issues but because of other personal issues and abuse that has gone unreported and undetected. Bulemics can die from a torn esophogus (sp?) that is often never caught. Doctors will say that their electrolites and nutrients were off (because they were) and leave it at that.

Now tieing it in to low-carbing... The fact that an educated professional would blow off an eating disorder as a factor in the cause of death because she wasn't touting that she was fat is highly irresponsible. She obviously had weight related issues or she wouldn't have been low-carbing in the first place.

mango Fri, Nov-01-02 14:52

full report from Southern Medical Journal
 
Sudden Cardiac Death of an Adolescent During Dieting

Source: , Sep2002, Vol. 95 Issue 9, p1047, 3p


ABSTRACT
We describe a 16-year-old girl who had sudden onset of cardiorespiratory arrest while at school. She had recently attempted weight loss using a low-carbohydrate/high-protein, calorie-restricted dietary regimen that she had initiated on her own. During resuscitation, severe hypokalemia was noted. At postmortem examination, no other causes for the cardiac arrest were identified. Toxicologic findings were negative. The potential role of the dietary regimen as a contributing factor to the hypokalemia and subsequent cardiac arrest are discussed.

INTRODUCTION
The pressures to meet our society's definition of beauty may lead young women to jeopardize their health to lose weight and stay thin. More than 40% of female adolescents in the United States have been on a diet at some point, and 80% of teenagers report that they diet to look better.(n1) We present the case of an adolescent who was following a low-carbohydrate, high-protein diet and who had sudden onset of cardiorespiratory arrest. Laboratory evaluation during resuscitation revealed severe hypokalemia. Other potential causes for the condition were ruled out by parental history, autopsy findings, and postmortem toxicologic evaluation.

CASE REPORT
Emergency teams were summoned to a local high school to care for a 16-year-old girl who had suddenly collapsed. She was 5 feet 8 inches tall and weighed approximately 80 to 85 kg (176 to 187 lb). The patient had been in good health with no known history of medical problems. She had started a low-carbohydrate/high-protein diet 1 or 2 weeks earlier in an effort to lose weight. She had learned about the diet from video tapes, purchased from an advertisement on television. Her mother had been on the same diet. She had complied with the dietary regimen, eating meat, cheese, and salads without fasting.

When the paramedics arrived, the girl was pulseless and apneic. The electrocardiogram revealed ventricular fibrillation. The patient's trachea was intubated and cardiopulmonary resuscitation was initiated. Resuscitative measures, including defibrillation, were without effect. On arrival in the emergency department, the patient remained pulseless, with no evidence of cardiac activity.

Arterial blood gas analysis revealed a pH of 6.89, with a base deficit of -19.8. Other laboratory values were serum sodium 142 mEq/L, ionized calcium 1.12 mEq/L, and serum potassium 3.8 mEq/L. Further resuscitative efforts were without effect. Postmortem and toxicologic examinations revealed no apparent cause for the death. Subsequent cardiologic evaluation of the patient's 12-year-old sibling including echocardiography and electrocardiography was within normal limits.

DISCUSSION
Low-carbohydrate/high-protein diets have fallen in and out of popularity since the 1960s, resurfacing in various forms including the Stillman Diet, the Scarrsdale Diet, the Zone Diet, the Carbohydrate Addicts' Diet, and the Atkins Diet. The Atkins Diet was developed by Robert C. Atkins, MD, in 1970 and has gained recent popularity once again with the release of the revised and updated book Dr. Atkins' New Diet Revolution.(n2)

Low-carbohydrate/high-protein plans seem attractive to many dieters because these diets set no limit on the amount of certain types of foods one can eat, exclude hunger from the dieting experience, reduce appetite, and at times, produce steady weight loss, even after dramatic failures or weight gain on other diets.

With a high-protein/high-fat intake, there is the release of cholecystokinin, a known appetite suppressant. The lack of glucose in the diet also avoids the 1-hour postprandial insulin surge associated with stimulation of neurogenic feeding centers. Additionally, the increased reliance on fat to meet the metabolic demands results in the production of ketone bodies and systemic ketosis, which may also suppress the appetite and curb feelings of hunger.

However, low-carbohydrate/high-protein diets are not without the potential for adverse biochemical and physiologic consequences. Ketone bodies compete with uric acid for renal tubular excretion, which can exacerbate disease in patients with gouty diathesis. Bloom and Azar(n3) reported that postural hypotension can develop in subjects on low-carbohydrate diets. Using an isolated, perfused rat heart model, Russell and Taegtmeyer(n4) showed that the beating heart loses contractile function (more than 50% in 60 minutes) when oxidizing acetoacetate alone.

Although results are contradictory, some studies have linked these diets to increases in serum triglycerides and low-density lipoprotein cholesterol.(n5,n6) Elevated levels of free fatty acids may promote both vascular thrombosis and cardiac arrhythmias.( n7,n8 ) Plasma lipolysis and infusion of albumin-bound free fatty acids have been associated with the development of serious arrhythmias in dogs, possibly through a detergent effect on mitochondrial and cell membranes.(n7) These diets have also been associated with hypothyroidism characterized by a decrease in thyrotropin and a marked decrease in triiodothyronine, as well as alterations in the metabolism of diuretics and cholesterol medications.(n9)

More importantly, deaths associated with other specialized diets have been reported. In the 1960s and 1970s, liquid protein diets were associated with several deaths.(n10) Some of these deaths were related to QT prolongation with pathologic findings of myocardial atrophy and myocarditis. Other findings in patients who had sudden cardiac death related to liquid protein diets included electrolyte disturbances such as hypokalemia, hypocalcemia, and hypomagnesemia.(n10) Restriction of caloric intake to less than the basal needs results in the catabolism of protein and glycogen stores, which have a high water content, leading to a diuretic effect with the loss of free water and electrolytes. Ketone bodies undergo urinary excretion with a cation to maintain electrical neutrality, resulting in the additional loss of cations, including calcium, magnesium, and potassium.(n11) When compounded by inadequate intake, deficiencies of these cations may ensue. Caloric restriction is not generally recommended on most low carbohydrate diets, including the Atkins diet, further emphasizing the dangers of using these diets without strict adherence to their recommendations.

Our patient's sudden onset of cardiorespiratory arrest occurred without an underlying cause identified by history or on postmortem examination. Initial electrocardiogram revealed ventricular fibrillation, an unusual presenting arrythmia in a 16-year-old adolescent without underlying cardiac disease or electrolyte disturbance. During resuscitation, with a pH of 6.89, the serum potassium level was 3.8 mEq/L, suggesting profound hypokalemia if corrected for the pH. The ionized calcium level was 1.12 mEq/L (normal, 1.10 to 1.22 mEq/L). As with serum potassium, correction for the pH would indicate significant hypocalcemia. Serum magnesium level was not measured. Because potassium and magnesium undergo similar handling mechanisms in the renal tubules, hypomagnesemia is another potential cause of our patient's cardiorespiratory arrest. When considering the potential causes of these electrolyte disturbances in an otherwise healthy female adolescent, questions arise regarding the potential role of the low-carbohydrate/high-protein diet compounded by a period of inadequate caloric intake and the resultant catabolic state. It is also possible, although no such history was obtained in this case, that associated problems such as bulimia, anorexia, and diuretic or laxative abuse can cause or potentiate electrolyte losses in such patients.

In light of the previous reports of mortality related to liquid protein diets and the lack of information on electrolyte and physiologic changes during low-carbohydrate, high-protein diets, we do not recommend such dieting regimens. We continue to suggest moderate caloric restriction with a balanced macronutrient and micronutrient intake and increased physical activity under a physician's guidance. While it is possible that the patient's dietary regimen had nothing to do with her sudden cardiovascular collapse, continued surveillance for similar cases is suggested.

KEY POINTS
• More than 40% of female adolescents in the United States have been on a diet at some point, and 80% of teenagers report that they diet to look better.

• Low-carbohydrate/high-protein plans seem attractive to many dieters because these diets set no limit on the amount of certain types of foods one can eat.

• Plasma lipolysis and infusion of albumin-bound free fatty acids have been associated with the development of serious arrhythmias in dogs, possibly through a detergent effect on mitochondrial and cell membranes.

• Ketone bodies undergo urinary excretion with a cation to maintain electrical neutrality, resulting in the additional loss of cations, including calcium, magnesium, and potassium.

• In light of the previous reports of mortality related to liquid protein diets and the lack of information on electrolyte and physiologic changes during low-carbohydrate, high-protein diets, we do not recommend such dieting regimens.

REFERENCES
(n1.)Neumark-Sztainer D, Hannan PJ: Weight-related behaviors among adolescent girls and boys: results from a national survey. Arch Pediatr Adolesc Med 2000; 154:569-577

(n2.)Atkins RC: Dr. Atkins' New Diet Revolution. New York, Avon Books Inc, 1999

(n3.)Bloom WL, Azar GJ: Similarities of carbohydrate deficiency and fasting: weight loss, electrolyte excretion, and fatigue. Arch Intern Med 1963; 112:333-337

(n4.)Russell RR III, Taegtmeyer H: Changes in the citric acid cycle flux and anaplerosis antedate the functional decline in isolated rat hearts. J Clin Invest 1991; 87:384-390

(n5.)Council on Foods and Nutrition: A critique of low-carbohydrate ketogenic weight reduction regimens. JAMA 1973; 224:1415-1419

(n6.)Rickman F, Mitchell N, Dingman J, et al: Changes in serum cholesterol during the Stillman diet. JAMA 1974; 228:54-58

(n7.)Oliver MF, Yates PA: Induction of ventricular arrhythmias by elevation of arterial free fatty acids in experimental myocardial infarction. Cardiology 1972; 56:359-364

(n8.)Peyreigne C, Bouix D, Aissa Benhaddad A, et al: Hemorheologic effects of a short-term ketogenic diet. Clin Hemorheol Microcirc 1999; 21:147-153

(n9.)Ullrich IH, Peters PJ, Albrink MJ: Effect of low-carbohydrate diets high in either fat or protein on thyroid function, plasma insulin, glucose and triglycerides in healthy young adults. J Am Coll Nutr 1985; 4:451-459

(n10.)Surawicz B, Waller BF: The enigma of sudden cardiac death related to diet. Can J Cardiol 1995; 11:228-231

(n11.)Zeman FJ, Hansen RJ: Diabetes mellitus, hypoglycemia and other endocrine disorders. Clinical Nutrition and Dietetics. Seman FJ (ed). New York, Macmillan Publishing Co, 2nd Ed, 1991, pp 409-410

~~~~~~~~

Lisa N Fri, Nov-01-02 15:25

What I find interesting is this....
 
How many people have died as a direct result of using those very popular cholesterol lowering statin drugs and yet you hear barely a peep from the media or the medical establishment and yet one girl dies while following a low carb regimen and the media is all over it even though it has not been shown to clearly be the cause of death?
I know that this is just the beginnig of the attack against low carb, but let's get real here. She obviously had an issue with her weight or she would not have been dieting, so I agree with Cre8tivgrl that it's irresponsible to simply dismiss the possibility of an eating disorder or laxative/diuretic abuse simply because her parents weren't aware of it and she wasn't constantly talking about needing to lose weight. As Doreen pointed out, hypocalcemia isn't something that would normally develop in a matter of a week or two. Use of laxatives and/or diruetics to speed weight loss is very popular among teen girls these days (and even some adults who should know better). If they truly wanted information about this girl's habits, they would have probably gotten more (and better) information interviewing her friends than her parents. How many 16 year olds do you know who would say to their mom or dad "Hey...that was a great meal...I'm going to go throw up now and pop a few laxatives and a diuretic or two for good measure."?

Angeline Fri, Nov-01-02 16:05

Re: full report from Southern Medical Journal
 
Quote:
Originally posted by mango
[B When considering the potential causes of these electrolyte disturbances in an otherwise healthy female adolescent, questions arise regarding the potential role of the low-carbohydrate/high-protein diet compounded by a period of inadequate caloric intake and the resultant catabolic state. It is also possible, although no such history was obtained in this case, that associated problems such as bulimia, anorexia, and diuretic or laxative abuse can cause or potentiate electrolyte losses in such patients. [/B]


He basically says that her electrolytes levels are usually associated with a eating disorder but dismisses it saying there was so such history in this case.

He also says the symptons she manifested are often found in high-protein liquid diet, but she wasn't following such a diet.

He then says that inadequte caloric intake causes problems, but unless she wasn't following guidelines, this wasn't the case here

So how exactly does he conclude that an Atkins style diet could cause these problems, if the diet itself does not correspond to any of the situations where problems are cited. Atkins is not a high protein liquid diet, nor even a high protein diet and does not advocate inadequate caloric intake (on the contrary).


It's ridiculous to conclude that someone could die from simply cutting out certain foods from her diet for a period of 2 weeks. You can fast for much longer with no problems. They simply didn't look further than they had to, because they liked the conclusion. Plain bad science.

Well this forum has really really opened to eyes to the politics of the medical establishment. Basically push your own personal agenda for gain or reputation and cover it up with a lot of medical blah blah

suze_c Fri, Nov-01-02 16:25

Former Bulimic
 
I use to have bulimia... when I was younger, I would make myself sick after eating, and use other methods to purge myself of food... it was very unhealthy, and I realized just how unhealthy it was, and forced myself to stop. Eating disorders is not just about anorexia nervosa and bulimia, it is also about dieting to an extreme, being obsessed with dieting,and unrealistic body image. How many people are at a weight that is considered right for their height and think they are fat? Too many... that is how many. Dieting is responsible for more deaths than it should be. I am not saying that this girl died from doing a low carb/high protein diet... but the facts show that she was not getting the proper nutrients/ minerals/vitamins that her body needed. The family says she did not have an eating disorder... did they truly know that? Not one person in my family, or any of my friends even had a clue as to what I use to do when I was bulimic... and yes, I did fit the diagnostic criteria for being one.The following is a form that is on the website for eating disorders: I invite all to read it, and see where you are at with what it says...
No Weigh!
- A Declaration of Independence from a Weight-Obsessed World -
--------------------------------------------------------------------------------
Signing this declaration from a weight-obsessed world may help you accept your body's natural shape and size.

I, the undersigned, do hereby declare that from this day forward, I will choose to live my life by the following tenets. In so doing, I declare myself free and independent from the pressures and constraints of a weight-obsessed world.

I will accept my body in its natural shape and size.

I will celebrate all that my body can do for me each day.

I will treat my body with respect, giving it enough rest, fueling it with a variety of foods, exercising it moderately, and listening to what it needs.

I will choose to resist our society’s pressures to judge myself and other people on physical characteristics like body weight, shape, or size. I will respect people based on the qualities of their character and the impact of their accomplishments.

I will refuse to deny my body of valuable nutrients by dieting or using weight loss products.

I will avoid categorizing foods as either “good” or “bad.” I will not associate guilt or shame with eating certain foods. Instead, I will nourish my body with a balance of foods, listening and responding to what it needs.

I will not use food to mask my emotional needs.

I will not avoid participating in activities that I enjoy (i.e., swimming, dancing, enjoying a meal) simply because I am self-conscious about the way my body looks. I will recognize that I have the right to enjoy any activities regardless of my body shape or size.

I will believe that my self-esteem and identity come from within!!

SIGNATURE:_____________________DATE:_________________
Interesting eh? I am not saying that a person should not lose weight for health reasons. I am not saying that ppl should not lose weight at all... I am simply asking ppl to evaluate their bodies in a realistic manner, and be healthy about the way that they are trying to lose the weight. I put the above form up as a reference point, and whether or not you can sign it or not is a personal decision, and should be made by someone of their own choosing, and not as something forced. I hope that I have made some sense here about healthy body image, and opened some eyes up to unhealthy dieting... there are reasons why the plans include supplements, and warnings not to go below certain caloric levels... it is for the benefit of the one following the plan~

WHY DIETS DON'T WORK (click here to read)

Scarlet Fri, Nov-01-02 19:27

You guys are so quick. I saw this this afternoon and was gonna post it but it was already here! It has really scared me to be honest. I know sugar and white flour is BAD but is it possible to die from too much meat?


Not liking this scary information :(

tamarian Fri, Nov-01-02 21:14

I can't help being a bit irate at this so called medical paper!

1. My condolence to her family.

2. Did it occure to anyone that she just died? I mean, just plain died? Do I have to check what millions of other teens ate a few days before they died? People die, don't they?

3. Did these objective doctors take into account that she was a female teenager, doing all the teenage drugs and eating disorder thing that teenagers do? I mean, I lost 70 lbs as a male teenager in a month eating nothing but water and coffee. Yes, it was low-carb, but it was low everything as well. So I can only imagine what teenage girls might do to "fit" in.

4. Is it ethical to publish conclusions based on an interview with parents? And form a case study of one subject and only after the fact? Did they monitor her before all this took place? I mean. do parents really know what their teenagers are doing, much less eating, or injesting?

5. Did they ever consider what other diets she tried before this so called "high protein" diet she followed based on a TV commercial?

6. If, according to the good doctors, people can die within 2 weeks of eliminating sugar and high carbs, wouldn't they at least consider enforcing that we all eat sugar and high carbs to avoid this eminent death? Or, don't they feel silly publishing such offensive paper? We have malnourished populations, who eat no carbs, no protein, no fat and nothing, nada, and they survive months. Why would eating protein and fat without sugar cause death within a week or two of eliminating sugars/carbs?

7. If this was meant as a score against low-carbing, should we we start counting how many died while eating the so called healthy low-fat, high sugar diet they want to brain-wash us in to? If so, low-carbing would win hands down, it's like a score of 1000 to 1. Otherwise, maybe some wanna-be scientists should admit that people, including teens, do die every now and then, just random death.

Wa'il

doreen T Fri, Nov-01-02 21:51

I recalled reading somewhere about the liquid protein fasts that the article makes a note of, which were popular back in the late '60s, early '70s. Yes, people died ... but it was later determined that the protein was a poor-quality collagen formula, with a low bioavailability. Very different from the isolated whey and soy proteins we have now, which have a very high biological value. Also, the diets were extremely low-calorie ... 300 to 400 cals per day.

I found this interesting piece on the topic:
Quote:
LIQUID PROTEIN DIETS

In 1976 a book entitled THE LAST CHANCE DIET popularized the idea of a calorie-restricted (300-400 calories/day) obesity-treatment diet supplemented with liquid protein to counteract the effects of nitrogen loss. A scholarly review of the history of this "fad" can be found in the book MANAGEMENT OF OBESITY BY SEVERE CALORIC RESTRICTION by B.Blackman & G.Bray (1985). Seventeen individuals died of ventricular fibrillations as a result of the program. Where data was available, these individuals showed the classic pattern of ECG voltage with prolonged QT interval & myocardial damage [AMERICAN JOURNAL OF CLINICAL NUTRITION 34:453-461 (1981) and CIRCULATION 60:1401-1412 (1979)]. Only 4 of the cases showed lowered blood potassium [AMERICAN JOURNAL OF CLINICAL NUTRITION 45:1126-1134 (1987)]. Interestingly, there was a linear correlation between initial BMI and time-to-death on the Very Low Calorie diet [AMERICAN JOURNAL OF CLINICAL NUTRITION 39:695-701 (1984)]. Dogs placed on a hypocaloric, micronutrient-supplemented, protein-poor diet have shown similar damage to the heart myofibrils [AMERICAN HEART JOURNAL 97:733-744 (1979)].

The exact cause of death for the 17 individuals on the Very Low Calorie (VLC) diet has never been proven, but it is suspected that the poor quality of the protein (collagen, often supplemented with tryptophan) was responsible. Modern VLC diets use protein of high biological value (often egg albumin) and carbohydrate to reduce ketosis & electrolyte loss (although the inclusion of carbohydrate often leads to intense hunger & increased difficulty complying with the diet) [INTERNATIONAL JOURNAL OF OBESITY 13(Suppl.2):1-9 (1989)]. A review of these modern VLC (800 calories/day) diets in the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION stated that the mortality of the VLC dieters was actually lower than that of obese controls [JAMA 270:967-974 (1993)].

http://www.benbest.com/calories/weight.html
Most sources now acknowledge that hydrolysed bovine collagen (from cows) is an incomplete protein. Ever found a piece of tough gelatin-like gristle in your steak? That's collagen.

Interesting too that the experiments on dogs showed the exact same type of heart damage following a low calorie, LOW protein diet.

Doreen

McRumi Sat, Nov-02-02 16:49

The truth behind the report
 
News release:

The reporter had just been dumped by his long-abused girlfriend, who had lost 100 lbs on the Atkins diet in the past year and had just accepted a job modeling for Chanel. The parents were less than forthcoming about their daughter's history, because like most parents today, they simply had absolutely no clue what she did all day. Unclear whether they considered that Dr. Atkins would be rich enough to justify a law-suit. The news agency was looking for a little sensationalism on yet another boring day of the "black is white" Bush reign.

America's brain is shrinking. We are now entering medieval America: superstitions, myths, lies, idiocy. Turn off your TVs and turn on your brains before the dark ages return.

We have only ourselves to blame. And only ourselves to reverse the tide.

FIGHT BACK. Write emails to the news source. Find out who the reporter is. Dig. Respond. Make a difference. Be part of the solution, not the problem.

Your roaming reporter,
M

tamarian Sat, Nov-02-02 17:01

If you haven't seen it, check Dr. Atkins response to this article:

http://forum.lowcarber.org/showthre...&threadid=68840

Wa'il

nikkic Sun, Nov-03-02 12:08

I skimmed through this very quickly, so I may have missed this, please let me know if I did. Does anyone have any idea how much water she was drinking a day?
Recently, there was an article in a womans magazine that said to drink a gallon of ice water a day. I've talked to some other women on the web that have followed this advice and landed in the hospital from severe electrolyte depletion-they had low levels of potassium and calcium to name a couple. Their muscles became so weak, they couldn't hold up their heads and had to go on IV's to replace their potassium.

For some people, you can drink up to a gallon of water a day and it's ok, for some it's not. If you drink too much water, you do flush out your electrolytes, vitamins and supplements that you take (if you take any). Potassium is necessary for your heart to beat regularly.

MarieB Sun, Nov-03-02 12:47

To the parents who said this girl had no history of buliemia: are you retarded? How many bulemics tell everyone they are bulemic? DUH! Parents today....grrr.
Also, the point about not drinking enough water is also a good one. Another thing is that this girl might have been eating high protien and low fat, while also not drinking enough water....if she was dieting at 16 years old, I am sure this wasn't her first diet. She may have still had the mentality of fat is bad...and if fat is bad, and now carbs are bad, that leaves her with only protien, which can be harmful if there isn't a balance.

McRUMI: here here! I totally agree with you! The media and television is turning our society into a bunch of idiots! Well, I guess we were pretty stupid before...didn't your mother tell you not to believe everything you read? I know mine did, and my mother is a lunatic...so if she can come up with good advice like that...'nuf said!
Start thinking for yourselves and you will start to see what is going on right under our noses! And it isn't just America...this really is a global problem. The entire world needs to wake up and smell the coffee.

suze_c Sun, Nov-03-02 12:54

Water Water Everywhere
 
Nicki, I drink OVER a gallon of water a day, it is always ice cold, as I like drinking it that way, and I am not having any problems with everything washing away... except pounds that is :lol: And that washing away is just fine by me! I have read that drinking ice water is also beneficial, as your body has to expend some energy, although who knows how much, to "warm" the water... hmmm is it true? I don't know.... don't care... it's just the way I prefer drinking it~
My best friend told me that his mom told him when he was young, to believe none of what you hear, and half of what you see. I think it is even more true for this day and age. Media is a great hype, and just because it is in the media, doesn't necessarily make it true!


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