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A ketogenic diet, also known as a low-carb, high-fat diet, has gained popularity in recent years as a way to lose weight and improve overall health. However, a new study has caused quite a stir in the medical community, as it suggests that consumption of a low-carbohydrate, high-fat diet, popularly known as a “keto-like” diet, is associated with an increased risk of cardiovascular events. The study’s findings were presented at the American College of Cardiology Scientific Session/World Congress of Cardiology 2023, and it has garnered media attention, with headlines implying a causal relationship between the diet and cardiac events.

The study, led by Dr. Iulia Iatan of the University of British Columbia (UBC), Canada, analyzed data from the UK Biobank, a large-scale prospective database with health information from over half a million people living in the United Kingdom who were followed for at least 10 years.
The researchers defined a low-carbohydrate, high-fat diet as one consisting of no more than 25% of total daily energy from carbohydrates and more than 45% of total daily calories from fat.

The study found that consumption of a “keto-like” diet was associated with an increase in LDL (cholesterol) levels and a twofold increase in the risk for future cardiovascular events. Dr. Iatan concluded that “hypercholesterolemia occurring during a low-carb, high-fat diet should not be assumed to be benign.”

However, not everyone is convinced by the study’s conclusions. Lipid expert Dr. Steven Nissen of the Cleveland Clinic, Ohio, pointed out that the increase in LDL levels in the “keto-like” diet group was relatively small and “certainly not enough to produce a doubling in cardiovascular risk.” He also noted that the people on the “keto-like” diet were different from those on the standard diet, with a higher incidence of diabetes and being more overweight, meaning that their risk profiles were completely different.

Dr. Gurm’s message:
The key takeaways from this study: keto-diet can be helpful in weight management and can also be a useful adjunct to cancer treatment and recurrence prevention. On the flip side, research indicates it may increase the risk of heart disease which is the leading cause of death in men and women over the age of 50. Not all patients on a keto-diet will develop heart disease, but some are more susceptible based on a variety of factors – physical activity levels, hereditary factors, lifestyle behaviours (past and present) and the individual’s unique genetic blueprint. 

If you are considering starting a keto-diet, be sure to ask your physician to check serum cardiovascular biomarkers prior to commencing the keto-diet (i.e. baseline levels) and then every 3-6 months to monitor the impact on your risk for developing cardiovascular disease risk. These include electrolytes, LDL, HDL, triglycerides, total cholesterol, hsCRP, apo-B lipoprotein, creatine kinase and creatinine. I also evaluate serum markers of insulin resistance and diabetes as these will often improve over the course of the keto-diet. Insulin resistance and diabetes contribute to the development of CVD. Improving glycemic balance will reduce the risk of CVD. Check fasting blood glucose and HbA1c at baseline and again every 3-6 months as appropriate. Have your BP checked prior to starting the diet and monitor periodically depending on your baseline levels. Lastly, if your waist-to-hip ratio is greater than 1, it is a significant risk factor for CVD. If your W:H ratio improves while on keto-diet then you are effectively reducing your risk of CVD. Taken together, the impact of keto-diet is complex and varies depending on the individual. While there can be many benefits, there may also be some significant harms. Have a thorough conversation with your medical or naturopathic physician before starting the keto diet to ensure you understand the potential harms and benefits specific to you. 

~ Dr. Sharon Gurm, ND

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