Ketogenic and low-carb diets are widely promoted as metabolic solutions — but in individuals with elevated chloride, low CO₂ (NAGMA), bile stagnation, or RAAS instability, keto reliably produces collapse instead of adaptation. This preprint defines Ketogenic-Induced Chloride Overload (KICO) as a predictable, mechanistic failure state that emerges when keto is layered onto a terrain already struggling with bicarbonate scarcity, chloride compensation, and impaired bile flow. The paper explains why keto is not “hard,” “detoxifying,” or “electrolyte-intensive” for these patients — it is biochemically incompatible. By increasing renal chloride load, thickening bile, raising acid-base demand, and forcing mitochondrial fuel shifts that the terrain cannot support, keto exposes the underlying architecture of vertical terrain collapse. KICO is not a disease. It is the biochemical engine of keto intolerance, and one of the clearest demonstrations of the Vertical Terrain Axis: • bile → bicarbonate → chloride → NAGMA → RAAS misinterpretation → voltage collapse. This preprint connects clinical presentation (crashes, weight rebound, edema, tachycardia, heat intolerance, electrolyte “instability,” EF dips) with the mechanistic sequence that produces them — providing a map clinicians have never been given.See alsoWhy Chloride Becomes Catastrophic: Taurine Buffer Failure and Glycocalyx Thinning, Lantern of Sulfur, Concept B, v 2026.12DOI: 10.5281/zenodo.18355885 andMechanistic Architecure, Lantern of Sulfur, Concept B, v2025.12.1DOI: 10.5281/zenodo.17834883
Beth Ann Martell (Wed,) studied this question.