100 years ago, ketogenic diets, which typically provide less than 10% of daily energy intake as carbohydrates, first entered the realm of modern medicine with their proven effectiveness in reducing or reversing seizures. While this is still true today, there is a persistent concern that the high fat intake required when following a long-term ketogenic diet poses an undue risk of cardiovascular disease (heart disease).
This concern has been a persistent barrier to the wider use of the ketogenic diet. In fact, a recent statement from the American Heart Association (AHA) stated: “There is not enough evidence to support existing popular or fad diets, such as the ketogenic diet and intermittent fasting to promote heart health “.
Not recognized by this AHA Review Committee and the 2020 Dietary Guidelines Advisory Committee is a substantial and highly cited set of published research showing that a well-formulated ketogenic diet followed for a period ranging from months to years of routinely produces noticeable improvements in weight parameters and metabolic syndrome. , reversal of type 2 diabetes and most components of blood biomarkers that predict coronary heart disease (Athinarayanan 2020, Forsythe 2008, Hyde 2019, Bhanpuri 2018).
Opponents of therapeutic nutritional ketosis often cite two concerns with this dietary intervention.
First, many published human studies report poor diet adherence and common side effects (Tay 2019, Gardner DIETFITS 2019). While it is true that maintaining a diet that induces a physiologically healthy level of ketones in the blood is a major behavioral challenge, most of the symptoms and side effects that are reported to prevent long-term adherence are easily avoided.
Second, it’s not uncommon for some people to experience an increase in their blood LDL levels (often vilified as “bad” cholesterol when they follow a well-formulated ketogenic diet). Unfortunately, this unique biomarker of heart disease risk continues to dominate conventional medical thinking long after its basic premise has been subjected to a compelling scientific challenge.
Specifically, the standard medical laboratory measurement of LDL cholesterol is not a direct measure, but an estimate of cholesterol content. And most importantly, these blood cholesterol-containing particles within the class identified as “LDL” vary in size from large to small. Highly cited studies over three decades have repeatedly shown that high-carb diets increase the proportion of blood levels of small LDL particles that promote heart disease, while ketogenic diets constantly reduce these dangerous small LDL particles in favor of more grains that are neutral or protective against blood vessel injury (Volek 2003, FASTER 2019, Bhanpuri 2018, Hyde 2019, Athinarayanan 2020).
By reducing the LDL cholesterol-lowering approach, most other heart disease risk factors have been shown to improve with a well-formulated ketogenic diet, which includes:
- Body weight (Forsythe 2008, Shai 2008, LaFountain 2019, Athinarayanan 2019)
- Visceral abdominal fat (TANK 2019, Athinarayanan 2019)
- Blood sugar (Volek 2009, Athinarayanan 2019)
- Blood pressure (Forsythe 2008, Hyde 2019, Athinarayanan 2020)
- Type 2 diabetes (Bistrian 1976, Boden 2005, Athinarayanan 2019)
- Inflammation in metabolic syndrome and type 2 diabetes Blood levels of saturated fats (regardless of dietary saturated fats, dietary saturated fats) (Hyde 2019, Astrup 2021)