Ketogenic diets, not for everyone.

Abstract

BACKGROUND:

The adoption of low-carbohydrate diets can lead to weight loss in many patients. However, these now widespread diets also have the potential to exacerbate hypercholesterolemia.

OBJECTIVE:

The objective of this study is to display the potentially harmful effects of the ketogenic diet on cholesterol levels in patients with or without underlying hyperlipidemia.

METHODS:

We describe 5 patients who developed marked increases in plasma cholesterol on ketogenic diets and assessed whether they had a well-described underlying genetic hyperlipidemia.

RESULTS:

Three out of 5 patients had extraordinary increases of blood cholesterol levels to over 500 mg/dL. The other 2 patients more than doubled their low-density lipoprotein cholesterol levels on a ketogenic diet. One patient had an APOE E2/E2 genotype. A higher burden of common genetic polymorphisms was found in 2 patients, with no major mutations found. No potential genetic cause was seen in a fourth patient, and the fifth patient had no genetic testing. Three patients, including the one who was most hypercholesterolemic, had a marked reduction in cholesterol after reverting to a more liberal diet. One refused to change his diet but had a satisfactory low-density lipoprotein cholesterol reduction on ezetimibe.

CONCLUSION:

These cases should serve as a caution that high-fat low-carbohydrate diets have the potential to exacerbate or cause hypercholesterolemia in patients with or without underlying genetic hyperlipidemia.

• Authors: Ira J Goldberg, Nouran Ibrahim, Cindy Bredefeld, Sandra Foo, Vivien Lim, Deborah Gutman, Lesley-Ann Huggins, Robert A Hegele
• Journal: Journal of clinical lipidology (J Clin Lipidol) 2021 Jan-Feb Vol. 15 Issue 1 Pg. 61-67 ISSN: 1933-2874 [Print] United States
• PMID: 33191194 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2020 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Diet, Fat-Restricted
• Diet, Ketogenic
• Humans
• Male
• Weight Loss