A recent study is challenging the long-held belief that elevated LDL cholesterol, often seen in individuals following a ketogenic diet, directly correlates with an increased risk of heart disease. The research indicates that for metabolically healthy individuals, this cholesterol increase may not pose the same threat as previously understood, suggesting a need for more personalized risk assessment.
Key Takeaways
- A year-long study found that high cholesterol levels in individuals on a ketogenic diet did not predict heart disease.
- Metabolically healthy individuals on the keto diet with elevated LDL cholesterol and ApoB showed no increased cardiovascular risk.
- Existing plaque in arteries, rather than LDL or ApoB levels alone, appears to be a stronger predictor of future cardiovascular issues.
- The ketogenic diet may be associated with reduced all-cause mortality without increasing cardiovascular disease-related death.
Rethinking Cholesterol and Heart Health
The ketogenic diet, characterized by its high fat and protein, low carbohydrate intake, has been a subject of ongoing research, with studies highlighting both potential benefits and drawbacks. While previous research has linked the diet to positive impacts on gut health, seizure reduction, and even potential protection against cognitive decline, concerns have persisted regarding its effect on LDL, or "bad" cholesterol.
However, a new study involving 100 metabolically healthy individuals who adhered to a ketogenic diet for a year has offered a different perspective. These participants, identified as Lean Mass Hyper-Responders (LMHRs), exhibited elevated LDL cholesterol and apolipoprotein B (ApoB) levels. Crucially, they also maintained other healthy biomarkers, including low triglycerides, low blood pressure, low body mass index, low insulin resistance, and high HDL ("good") cholesterol.
The study, published in the Journal of the American College of Cardiology: Advances, found no increased risk of heart disease in these individuals despite their high LDL levels. Researchers suggest that pre-existing plaque in the arteries is a more significant predictor of future cardiovascular events than elevated LDL or ApoB alone in this specific population.
Broader Implications for Cardiovascular Risk Assessment
Experts involved in the study emphasize that traditional markers like LDL and ApoB may not be sufficient for assessing cardiac risk in all individuals, particularly those who are metabolically healthy and following a ketogenic diet. They advocate for a shift towards more personalized, data-driven approaches, potentially incorporating advanced cardiac imaging like CT angiography (CTA) or coronary artery calcium (CAC) scoring for a more accurate risk stratification.
Keto Diet and Mortality Risk
In related findings, an analysis published in Scientific Reports suggests that greater adherence to the ketogenic diet may be associated with a reduced risk of all-cause mortality, potentially by up to 24%. This analysis, which examined data from a large cohort, also indicated that the ketogenic diet did not increase the risk for cardiovascular disease-related death, despite its high-fat content. Mechanisms proposed for these benefits include improvements in metabolic health, modulation of gut microbiota, and anti-inflammatory properties.
While these studies offer a nuanced view on the ketogenic diet's impact on cardiovascular health, experts caution that personalized guidance and vigilant monitoring are essential, especially considering potential impacts on nutrient balance and liver function in certain individuals.
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