Can the Ketogenic diet lead to Wernicke’s encephalopathy?

Abstract

BACKGROUND: Wernicke’s encephalopathy (WE), a neurological disorder due to the deficiency of thiamine, is often underdiagnosed in the pediatric population. The classic triad of mental status changes, oculomotor abnormality, and ataxia is observed in only 16–21% of all pediatric presentations. Wernicke’s is most often associated with alcohol dependence, but also malignancy, parenteral nutrition, and gastrointestinal (GI) malformations. The correlation between following a Ketogenic diet and acquiring Wernicke’s, however, has not previously been reported. CASE REPORT: A 16-year-old previously healthy male presented with an eleven-day history of neurological deficits and GI upset. The patient had recently lost one hundred pounds while following a “ketogenic” diet. He was subsequently diagnosed with Wernicke’s, received intravenous thiamine, and was transferred to the inpatient rehabilitation, where he received extensive diet education. After making significant functional improvement, he was discharged home. RELEVANCE: This case illustrates the importance of including Wernicke’s in the differential diagnosis when a pediatric patient presents with neurological deficits after rapid weight loss. Wernicke’s encephalopathy may be fatal in the pediatric population, therefore, it must be treated immediately if clinically suspected. Children presenting with Wernicke’s would benefit from early intervention, intensive inpatient rehabilitation, and comprehensive education regarding the role of food and exercise on weight loss and health.

Obesity and malnutrition in children and adults: A clinical review

“…The comprehension of the nutritional status of children and adults with obesity is crucial for healthcare providers to identify potential deficiencies before prescribing weight reduction diets [ 3 ]. Despite low-carb, intermittent fasting, ketogenic, and very low-calorie diets being superior in assisting with medical weight reduction, they also have the highest risk of exacerbating nutrient deficiencies [ [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] ]. A summary of the diets and their impact on weight reduction and micronutrient deficiencies are outlined in Table 2 .…”

“…The ketogenic diet is a high-fat, moderate protein, and carbohydrate-restricted diet that has gained popularity for its potential to promote weight reduction [ 32 , 51 ]. In the first two weeks of the diet, individuals typically experience rapid weight reduction due to the depletion of water and glycogen stores [ 32 , 51 ]. Long-term studies must evaluate the efficacy of the ketogenic diet.…”

“…Ketogenic diets, without adequate counseling and monitoring, can lead to severe malnutrition [ 32 , 51 ]. The ketogenic diet limits the intake of fortified carbohydrates, leading to limited thiamine intake [ 32 , 51 ]. A case study reported an adolescent with Wernicke's encephalopathy after losing 100 lbs.…”

“…A case study reported an adolescent with Wernicke's encephalopathy after losing 100 lbs. on a ketogenic diet [ 51 ]. The patient required intravenous thiamine infusions due to severe malnutrition from the diet [ 51 ].…”

“…on a ketogenic diet [ 51 ]. The patient required intravenous thiamine infusions due to severe malnutrition from the diet [ 51 ]. Additional reported side effects include fatigue, headache, nausea, dizziness, vomiting, constipation, and low exercise tolerance [ 32 , 51 ].…”