A mom tried keto diet for 30 days.
Things went wrong for her, just weeks after starting it.
This is what happened, to her pancreas.
JC is a 32 year old woman, presenting to the emergency room with progressively worsening
speech, vision, and strength.
She opens her mouth to speak to the admitting nurse, but the words don’t make any sense.
4 months ago, JC became a new mom.
She decided that she would feed her daughter, naturally.
JC was an elite athlete in her past life.
She always lived an active lifestyle, and motherhood wasn’t going to change that.
During her pregnancy, she had gained 30 pounds.
Now that baby’s out, JC tried the Keto diet, where she’d restrict all carbohydrates to
zero, while eating only proteins and fats.
Paired with an hour of exercise daily, JC was determined, she was going to shed that
baby weight.
In the weeks following her daughter’s birth, JC felt a numbness in her legs during her
morning runs.
This was without pain.
Without burning sensations.
One day at breakfast, JC’s husband noticed her repeatedly pour water from one bottle
to another and back, while quietly growling to herself.
When asked about this after eating, she had no memory of breakfast.
As the weeks passed, JC felt a panic and anxiety start to overcome her.
She started crying everyday.
She couldn’t sleep through the night.
Breaking her keto diet, and eating carbs would make her feel better, but she resisted every
urge.
She realized something was wrong.
At the doctor’s office days later, JC was diagnosed with postpartum depression.
These changes in her body are normal.
She just had a baby.
Shifts in hormones and increased sensitivity to these changes, can affect anyone.
But the doctor had other concerns.
JC was feeding her daughter.
Human milk incorporates 50 grams of sugar per day.
If she’s not eating those sugars because of her keto diet, this COULD be a problem.
Proteins and fats can be converted to sugar for use in milk, but that conversion doesn’t
happen quickly.
It doesn’t happen easily.
And it MIGHT not be enough to keep up with JC’s lactation.
This can be problematic if it causes blood sugar levels become too low.
And in JC, those levels are too low.
A blood test at that visit revealed severe hypoglycemia.
Hypo meaning low.
Glyce from Ancient Greek referring to sugar.
And emia meaning presence in blood.
Low sugar presence in blood.
The brain uses sugar as its most immediate energy source.
When sugar is suddenly low in the body, this will cause mental status changes and mood
swings as the brain’s energy supply is disrupted.
And when combined with postpartum depression, then this explains everything that’s happening
to JC.
She was sent home with medicines.
She was given advice to stop the strict keto diet, so long as she was still feeding her
daughter.
It didn’t need to be a permanent stop, but a necessary change for the time being.
JC was on her way.
She was feeling great with this flexible diet.
But only for a few weeks.
One morning, JC stepped on the scale.
She had gained another 20 pounds since she relaxed her foods after that doctors visit.
She thought that the medicines were working well on her mood, so that postpartum depression
must have been the only problem.
She saw no reason to continue the relaxed diet, as she vowed again to shed that baby
weight .
She broke the doctor’s recommendation and returned to her strict keto diet, while still
feeding her daughter.
It was time to wean baby off, anyways she thought.
As the days went by, JC felt great.
But one morning, 2 weeks later, her vision started to double.
She felt a tingling in her fingers.
She spoke words to her husband, but he couldn’t understand them.
He thought she was joking, but realized something was wrong, when she tried to put baby in the
refrigerator.
After breakfast, JC had no recollection of anything.
The same episodes, would repeat every morning.
She would snap out of it after her breakfast of greek yogurt and eggs.
Her husband shrugged it off as a joke because it kept happening, every day.
But then JC’s anxiety came back.
The crying and the insomnia.
Over the next 4 days, JC’s vision starts to go dark as her bouts of panic intensify.
She describes to her husband a mental fog clouding her thoughts.
And as the night falls, anxiety shrouds her as she knows the insomnia was waiting for
her.
One morning, JC got out of bed.
She laid on the floor, arms raised.
She was conscious but not responsive.
She was speaking, but incoherent.
She rolled over on her side, and began to seize as 911 was called and she is brought
to the emergency room where we are now.
At examination, JC isn’t visibly ill.
She’s verbal, but she’s incoherent.
She’s responsive, but not oriented.
A blood test again reveals hypoglycemia, but this time, less than half the lower limit
of normal.
The medical team administers a sugar water mixture intravenously to JC, her consciousness
improves in minutes.
All other signs and exams return normal, as she appears to be her normal self.
More tests are done on her, and it’s found that nothing is wrong with her kidneys, liver
and heart.
Overall, it looks like nothing ever happened.
She’s admitted into the hospital because even if she looks ok, something is clearly
amiss.
The next morning, the medical team on rounds finds JC on the floor again, arms raised.
This time, unresponsive but conscious.
Incoherent, but still speaking, as she rolls over and starts seizing again.
Doctors order another test for her blood sugar.
Severe hypoglycemia found again.
Another glucose IV was infused in to her.
JC is conscious, coherent and oriented again, with no recollection at all of what just happened,
as this now gives the medical team some clues as to what’s happening.
Most immediately, JC is showing neuroglycopenic symptoms.
Neuro referring to the brain.
Glyco referring to glucose, another name for sugar
And (suffix)-penia meaning a deficiency of.
A deficiency of sugar, in the brain.
The brain needs sugar to function.
But exactly, how much?
Well, at rest, the brain accounts for 60% of all sugar consumption, even though it’s
less than 3% the mass of the whole body.
In normal function, the body has protections in place to prevent hypoglycemia so that bad
things don’t happen to the brain.
This glucose homeostasis, is the equilibrium, or balance of sugar in the body.
Most of the body’s sugar is stored in the liver.
When blood sugar decreases, hormones tell the liver to start breaking down those stores
and to release them so that levels are steady.
This is called glycogenolysis.
The liver also generates sugar from proteins and fats, a process called gluconeogenesis.
Both of these increase blood sugar, so defects here can cause a decrease in blood sugar.
Nothing here was wrong, because JC’s liver function was found to be normal, but there’s
more.
The liver produces ketones, which are a secondary energy source to sugar that can be used by
the brain.
But they’re not as efficient as glucose.
If someone has been on keto diet for long enough, the liver’s sugar stores become
depleted, forcing ketogenesis, giving way for the namesake of JC’s diet
But lactation can also increase the production of ketones.
So, if she’s doing both the keto diet, and feeding her daughter, then it means that JC
should have a high ketone presence in blood.
The medical team orders JC to fast for 72-hours.
Over these 3 days, they will monitor her blood sugar and ketones.
(+proinsulin and C-peptide— students, what are those for?)
Things seem to be going well just a couple hours in to the fast.
But at 7 hours in, JC started slurring her speech.
She was no longer oriented again as she lay on the floor, her arms up.
On measurement of her blood glucose, the results return— less than half the lower limit of
normal.
Ketones, which should be high, were virtually absent, bringing us back to glucose homeostasis.
Upstream the process, from the liver, is the pancreas.
This organ produces a hormone named insulin, which is released when blood sugar is high.
Most commonly, this happens after one eats.
Insulin tells the body’s cells, to absorb the sugar in the blood.
To take in as much of it as possible, until the levels normalize.
If insulin is high for a long time, then blood sugar will be low.
Results from JC’s fast show that her insulin levels were 3 times the upper limit of normal,
meaning that something is causing her pancreas to secrete too much insulin.
But what could it be?
Well, It’s probably not medicines because nothing she’s been taking in the hospital
would do this.
It’s not her liver because it’s functioning normally, downstream the process.
It’s not performing glycogenolysis or gluconeogenesis as a result of the high insulin presence in
blood.
And it’s not her kidneys since they would filter the blood, functioning as intended
in JC.
Meaning there could be an overgrowth or a tumor in her pancreas, that’s releasing
insulin with no regard to the feedback mechanisms in place.
This is called an insulinoma.
At this realization, the medical team orders an abdominal MRI with contrast.
Images reveal a well-defined tumor, 11 millimeters in diameter, in the body of JC’s pancreas.
Its appearance doesn’t look like pancreatic cancer.
It could be a cancer from somewhere else in her body that has spread to the pancreas,
or it could be a functional neuroendocrine tumor, something releases hormones inappropriately.
The extreme hypoglycemia.
The regular pattern of neuroglycopenic symptoms.
The resolution of her mental status after correction of her blood sugar.
[this is called Whipple’s Triad btw]
The medical team makes a clinical diagnosis of insulinoma as JC was sent in for surgery.
Parts of her pancreas were removed along with the tumor, as her depression medicines were
tapered and then discontinued.
The mornings were the toughest times for JC because of the overnight fasting period where
blood sugars are low in everyone.
The unregulated release of insulin by a tumor, made those levels even lower before breakfast.
The cause of the tumor, is unknown.
It wasn’t caused by her pregnancy.
But the timing of this, just happened to coincide with the pregnancy
In the late term, insulin resistance builds in the mother, which would make JC’s body
less responsive to insulin. Meaning that the symptoms would be masked.
But after the baby is delivered, the mother becomes more responsive to insulin, which
for JC, resulted in pronounced symptoms.
This is described in several case reports of insulinoma diagnosed during pregnancy.
And this is also touched upon in the documentary Microbirth, which you can see on CuriosityStream,
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In her first doctor’s visit, JC noted that eating carbs solved her panic, anxiety and
insomnia, all of which are neuroglycopenic symptoms, meaning she may not have had postpartum
depression from the start, but we can’t say for sure.
The 20 pounds she gained in just a couple of weeks after relaxing her diet the first
time is a normal function of aberrant insulin secretion, as it stored that excess glucose,
as adipose tissue.
All of this was worsened because JC was simultaneously feeding her daughter and following a strict
keto diet. In the medical world, hypoglycemia is considered as more acutely dangerous than
hyperglycemia, because low sugar can take someone out instantly.
As she recovered from the operation, her blood sugar levels stayed within normal limits.
She was able to return home in good mood.
Back to her family.
Back to normal life.
And she was able to live the lifestyle, that she originally wanted.
Thanks so much for watching.
Take care of yourself and be well.