Fruit and ketoacidosis

One more reason to go easy on fruit. You might end like this guy. 

From the paper:

"During the last decade, our patient had being suffering from a progressive eating disorder, starting with a lacto-ovovegetarian diet followed by a strict vegetarian diet, complying with all the alimentary habits that involve fruitarianism. After a week of complete fasting, patient was brought to our hospital by his family, alerted by his noticeable behavioural alteration. Previous week strict fasting was the cause that triggered severe ketoacidosis."

"In our clinical experience, followers of this way of life [fruitarianism] are vulnerable not only to suffer nutritional deficiencies, but also to develop serious metabolic impairments that may be life-threatening, as occurred in our patient."

This is the first case of ketoacidosis associated with fruitarianism (at glance, sounds like an oxymoron). The trigger was one week of fasting, which produces a metabolic milieu completely different from that of somebody eating a high sugar diet. 

"A 35 year old male patient with a medical history of three previous admissions to psychiatric units was brought to the Emergency Room via ambulance, presenting with behavioural disturbances, including aggressiveness and voluntary complete fasting for over a week. In the last 10 years, the patient followed a strict vegetarian diet that leads him progressively to restrict his diet only to fruit. On presentation, patient was ill appearing with psychomotor impairment and incoherent speech. On physical examination, he was hemodynamically stable and he had a body mass index (BMI) of 16."

The biochemical markers can be seen in the full text (its free). When admitted, the patient had several markers abnormal, seen in cases of malnutrition. He showed some responses to refeeding similar to that of the "Refeeding Syndrome" (see Table I). 

"Patient motivation for eating only fruits was based on the desire to avoid harming animals and vegetables. He only allowed himself to eat fruit because it was produced by a plant, and consumption of the fruit did not kill the plant. The patient refused to receive tube feeding claiming that "receiving enteral nutrition won´t allow him to follow his dietary habit", a subclavian central venous line was placed and total parenteral nutrition was initiated with supplemental phosphate, potassium, calcium and magnesium. A psychiatric consult was requested, and a diagnosis of undetermined psychotic disorder was given. Patient remained hemodynamically stable with normal urine output."

Sounds like a "hardcore" dogma follower (although this is not exclusive for vegetarianism).

"Even though, the patient underwent strict fasting for only a week, he showed a protein-calorie malnourished state, as revealed biochemical markers of nutritional status that were obtained plasma albumine level, 2.3 g/dl; retinol-binding protein (RBP) 2.85 mg/dl; transferrin 108 mg/dl and prealbumin, 12.6 mg/dl. Also levels of vitamins were obtained B₁₂ 464.00 pg/ml (200.00-732.00); folate 2.10 ng/ml (2.80-13.50) and Vitamin D of 17 (30ng/ml). These findings and patient´s underweight alert us of starvation as the possible cause of his ketoacidotic state. Intravenous fluid replacement and parenteral nutrition were discontinued and enteral feedings were started on hospital day 3. Also, the acidosis was resolved, and following cessation of insulin infusion, patient remained normoglycemic."

Normally, it takes weeks or even months for malnutrition and micronutrient deficiencies to start to appear. The fact that it only took him 1 week to develop ketoacidosis reflects that this patient had severe macro and micronutrient deficiencies developed over the time. This is important because some people think their diet is OK because they feel normal, while there is a severe underlying subclinical nutrition deficiency. 

Bottomline: say no to dietary non-sense and eat your meat. 

Causso C, Arrieta F, Hernández J, Botella-Carretero JI, Muro M, Puerta C, Balsa JA, Zamarron I, & Vázquez C (2010). Severe ketoacidosis secondary to starvation in a frutarian patient. Nutricion hospitalaria : organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral, 25 (6), 1049-52 PMID: 21519781