Ketosis Leads to Increased Methylglyoxal Production on the Atkins Diet

: In the popular and widely used Atkins diet, the body burns fat as its main fuel. This process produces ketosis and hence increased levels of β‐hydroxybutyrate (BOB) acetoacetate (AcAc) and its by‐products acetone and acetol. These products are potential precursors of the glycotoxin methylglyoxal. Since methylglyoxal and its byproducts are recognized as a significant cause of blood vessel and tissue damage, we measured methylglyoxal, acetone, and acetol in subjects on the Atkins diet. We found that by 14‐28 days, methylghyoxal levels rose 1.67‐fold (P= 0.039) and acetol and acetone levels increased 2.7‐ and 6.12‐fold, respectively (P= 0.012 and 0.028). Samples from subjects with ketosis showed even greater increases in methylglyoxal (2.12‐fold), as well as acetol and acetone, which increased 4.19‐ and 7.9‐fold, respectively; while no changes were seen in samples from noncompliant, nonketotic subjects. The increase in methylglyoxal implies that potential tissue and vascular damage can occur on the Atkins diet and should be considered when choosing a weight‐loss program.