Ira J Goldberg1, Nouran Ibrahim2, Cindy Bredefeld3, Sandra Foo2, Vivien Lim4, Deborah Gutman5, Lesley-Ann Huggins2, Robert A Hegele6. 1. Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, New York, NY, USA. Electronic address: Ira.Goldberg@nyumc.org. 2. Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, New York, NY, USA. 3. Winthrop Endocrinology, Diabetes and Metabolism, NYU Long Island School of Medicine, Mineola, NY, USA. 4. Queens Cardiovascular and Division of Cardiology, Long Island Jewish Hospital, Flushing, NY, USA. 5. Department of Emergency Medicine, Warren Alpert School of Medicine, Providence, RI, USA. 6. Departments of Medicine and Biochemistry, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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.
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: Samuel S Gidding; Mary Ann Champagne; Sarah D de Ferranti; Joep Defesche; Matthew K Ito; Joshua W Knowles; Brian McCrindle; Frederick Raal; Daniel Rader; Raul D Santos; Maria Lopes-Virella; Gerald F Watts; Anthony S Wierzbicki Journal: Circulation Date: 2015-10-28 Impact factor: 29.690
Authors: Cliff J D C Harvey; Grant M Schofield; Caryn Zinn; Simon J Thornley; Catherine Crofts; Fabrice L R Merien Journal: PeerJ Date: 2019-02-05 Impact factor: 2.984
Authors: Richard D Feinman; Wendy K Pogozelski; Arne Astrup; Richard K Bernstein; Eugene J Fine; Eric C Westman; Anthony Accurso; Lynda Frassetto; Barbara A Gower; Samy I McFarlane; Jörgen Vesti Nielsen; Thure Krarup; Laura Saslow; Karl S Roth; Mary C Vernon; Jeff S Volek; Gilbert B Wilshire; Annika Dahlqvist; Ralf Sundberg; Ann Childers; Katharine Morrison; Anssi H Manninen; Hussain M Dashti; Richard J Wood; Jay Wortman; Nicolai Worm Journal: Nutrition Date: 2014-07-16 Impact factor: 4.008
Authors: Nicholas G Norwitz; Adrian Soto-Mota; Bob Kaplan; David S Ludwig; Matthew Budoff; Anatol Kontush; David Feldman Journal: Metabolites Date: 2022-05-20
Authors: Cara B Ebbeling; Amy Knapp; Ann Johnson; Julia M W Wong; Kimberly F Greco; Clement Ma; Samia Mora; David S Ludwig Journal: Am J Clin Nutr Date: 2022-01-11 Impact factor: 7.045
Authors: Nicholas G Norwitz; Adrian Soto-Mota; David Feldman; Stefanos Parpos; Matthew Budoff Journal: Front Endocrinol (Lausanne) Date: 2022-04-14 Impact factor: 6.055