19 May 2023

Do you like it fattier? Then you should know

A recent study indicates that, compared with individuals following a typical diet, those on a low-carb, high-fat diet have statistically significant increases in low-density lipoprotein (LDL) cholesterol and apolipoprotein B (apoB) concentrations. The purpose of this observational study was to examine whether a ketogenic-like diet is associated with a twofold increased risk of heart disease.

When enrolled in the Biobank database, 305 individuals on a low-carb, high-fat diet completed a daily diet questionnaire. In addition, 1,220 age- and sex-matched individuals who followed a typical diet were included in the analysis. On average, individuals who followed a low-carbohydrate, high-fat diet had a higher body mass index (27.7 vs. 26.7) and were more likely to develop diabetes (4.9% vs. 1.7%).

Individuals on the ketogenic-like diet had slightly higher LDL cholesterol and apoB concentrations than those on the normal diet.

During 11.8 years of follow-up, approximately 9.8% of individuals on the low-carb, high-fat diet reported the following disorders: angina, heart attack, coronary heart disease, myocardial infarction, coronary stroke (blood clots), peripheral artery disease, coronary/carotid artery revascularization, etc, compared to 4.3% of those on the regular diet. In addition, after adjusting for other risk factors for heart disease, such as diabetes mellitus, high blood pressure, obesity, and smoking, those on a low-carb, high-fat diet had twice the risk of a cardiovascular (CV) event.

For the first time, the study found an association between following this popular diet and an increase in LDL cholesterol and risk of CV events. These findings are troubling, given the fact that this low-carb, high-fat diet is followed by a large proportion of the population. Despite the fact that many individuals following a low-carbohydrate, high-fat diet had only a modest increase in mean LDL cholesterol concentrations, there was a nearly two-fold increase (>5 mmol/l or 190 mg/dL) (in 10% versus 5%), which increased risk of CVD by a factor of 6.

Individuals choosing a low-carbohydrate, high-fat diet are advised to first determine their cholesterol levels and pay attention to controlling CVD risk factors. A ketogenic diet may help reduce body weight in the short term, but a Mediterranean diet is recommended to reduce the risk of CVDs. Future studies are needed to more closely examine the benefits and harms of a ketogenic-like diet.

Source: 'Keto-like' Diet Linked to Doubling of Heart Disease Risk (medscape.com)

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