The incidence of cardiovascular diseases is increasing year by year, bringing a heavy burden to people's life. Therefore, it is important to pay attention to the early prevention of cardiovascular diseases. It is an important way to prevent cardiovascular disease by changing diet habits. Studies have shown that ketogenic diet is associated with cardiovascular disease. During ACC 2023, Iulia Iatan, MD from the University of British Columbia, Canada, was invited by this publication to give an in-depth explanation on relevant issues.
International Circulation：what is the relationship between ketogenic diet and cardiovascular disease, and what are the possible mechanisms?
Doctor Iulia Iatan: First of all, I am not aware of any ketogenic diet that actually improves cardiovascular disease. What I have found out and know is that infusion of ketones or a keto diet can have an effect on cardiomyocytes, but in terms of ketogenic diets per se, I am not aware of any that can improve cardiovascular disease. A ketogenic diet is a diet that actually restricts carbohydrates to <10% and with a relative increase in protein and fat (especially fat) of >70%. In our study, we did not look at a ketogenic diet, but a low-carbohydrate diet, which, in comparison to a ketogenic diet, restricts carbohydrates to <25% or <100grams, and included >45% fat. I hope that answers your first question, that a low-carb/high-fat diet does not, to my knowledge, improve cardiovascular disease. In our study, we actually showed that following a low-carb/high-fat diet, can increase the risk of heart disease.
International Circulation：What is the effect of the ketogenic diet, as a high-fat, low-carbohydrate diet, on lipid level?
Doctor Iulia Iatan:What we found is that when we looked at the association between a low-carb/high-fat dietary pattern (defined as <100grams of carbs and/or <25% of carbs and 45% of fat), the mean levels of total cholesterol, HDL, non-HDL and apolipoprotein B were significantly increased in patients on the carb-restricted group compared to the standard group. When we looked at the overall LDL-cholesterol distribution and apolipoprotein B distribution, we found that severe hypercholesterolemia (defined by an LDL >5mmol/L) occurred in nearly twice as many participants on the low-carb/high-fat diet as in those on the standard diet, with percentages of 11% versus 6% and with similar proportions for apolipoprotein B.
International Circulation：You have conducted research and exploration on ketogenic diet. Would you please share us the main results?
Doctor Iulia Iatan: The main result, as I mentioned, is that we showed that in this population based from the UK BioBank of patients following a normal standard diet (1220 participants), and 305 participants on a low-carb/high-fat diet, we found that self-reported regular consumption of this low-carb/high-fat diet was associated with increased lipid levels of LDL-cholesterol and apolipoprotein B and an increased risk for new incidents of major adverse cardiac events. What we are trying to say is that this finding really highlights the potential cardiovascular risk of this dietary pattern, and suggests that hypercholesterolemia occurring while on this dietary pattern should not be assumed to be benign.
International Circulation：Can ketogenic diet be long-term? How to optimize the clinical application value of ketogenic diet?
Doctor Iulia Iatan:In terms of whether a low-carb/high-fat diet can be long-term, we don’t recommend it. Based on our study, we saw there was an increased risk of adverse cardiovascular events. It is an observational, not a causal study, but what we recommend is that people who want to go on this low-carb/high-fat diet should actually do it in consultation with a healthcare provider or physician to monitor lipid levels over a period of time to make sure the cholesterol does not increase and not increase the risk of potential later heart disease. Also, in terms of how to optimize the clinical application, if you choose to go on a low-carb/high-fat diet to lose weight or improve glycemic control, just do it in conjunction with your physician, and make sure to address any other cardiovascular risk factors if they are present.
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