Doctors, in a case study reported in The Lancet on Friday, place a safety question mark over the Atkins diet, the high-protein food regime that unleashed a craze in the US in the 1990s.
Atkins stresses lashings of meat, butter and other dairy products -- high-fat foods typically limited in classic diets -- but cuts potatoes, rice and pasta to negligible levels and greatly limits intake of fruit and vegetables.
The diet's premise is that a carbohydrate-starved body will start to burn up stored fat cells, a process called ketosis.
But in their case reported in the British medical weekly, doctors at New York's Lenox Hill Hospital blame Atkins for a "life-threatening complication" for a woman who had strictly followed the diet.
The patient, a 40-year-old obese woman, reported a weight loss of 9kg a month after she began the diet.
She ate meat, cheese and salads, supplemented by minerals and vitamins sold by Atkins Nutritionals Inc (ANI), the company founded by diet pioneer Robert Atkins in 1989.
She was admitted for emergency treatment, complaining of a shortness of breath, nausea and repeated vomiting that had lasted several days, as well as mild gastric pains.
Urine and blood analysis showed she had severe ketoacidosis -- a condition in which dangerously high levels of ketone acids build up in the liver as a result of a depletion of the hormone insulin. Ketoa-cidosis, which is more usually seen among diabetics and victims of star-vation, can lead to a coma.
The patient responded well to rehydration and glucose infusion and left hospital after four days.
"Our patient had an underlying ketosis caused by the Atkins diet, and developed severe ketoacidosis, possibly when her oral intake was compromised from mild pancreatitis or gastro-enteritis," say the doctors, led by Klaus-Dieter Lessnau.
"This problem may become more recognized because this diet is becoming increasingly popular worldwide."
In a commentary also published in The Lancet, Lyn Steffen and Jennifer Nettleton of the University of Minnesota's School of Public Health blasted Atkins as "clearly not nutritionally balanced."
"Low-carbohydrate diets for weight management are far from healthy, given their association with ketosis, constipation or diarrhoea, halitosis, headache and general fatigue to name a few [problems]," they said.
"These diets also increase the protein load to the kidneys and alter the acid balance of the body, which result in loss of minerals from bone stores, thus compromising bone integrity."
They add: "Our most important criterion should be indisputable safety, and low-carbohydrate diets currently fall short of this benchmark."
The Atkins diet builds on a long history of low-carbohydrate diets that reach into the 19th century. More than 45 million copies of Atkins diet books have been sold, and the impact of the fad has been far-reaching, elevating meat and "low-carb dishes" in favor of pasta, potatoes and rice.
ANI emerged from bankruptcy protection earlier this year, specializing as a company that sells low-carb bars and shakes.
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