Arterial stiffening caused by ketosis?

#1

Been doing keto for over a year. Most that I have read shows an improvement of cardio vascular health. Yet now I have discovered studies showing that it causes arterial stiffening.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325592/

and

How, then, if it causes this, can so many studies show improved cardiovascular health? Is this not a contradiction or am I misunderstanding the situation and one can have improved cardiovascular health and arterial stiffness at the same time?

Also, how can so many keto people be doing heavy exercise, getting healthier, stronger, putting their arteries under more strain than before the diet, and there are no reports of a huge upswing of heart attacks in these people?

(Michael Wallace Ellwood) #2

It’s worth noting that the kind of “keto” diets given medically for epileptics is not necessarily the kind of “well-formulated ketogenic diet” that people like Stephen Phinney and other experts talk about.

If we could see the detail of what the subjects of this study were eating, I suspect our collective eyebrows would raise. (I wonder what sort of fats they were eating, for example).

(Jim Russell) #3

This was my thought exactly. They do not mention anything which variation of the ketogenic diet the subjects had followed. There are several varieties.

The classic ketogenic diet is 3 or 4 to 1 ratio of fat to carbs + protein. That is 3 or 4 grams of fat for every gram of carb + protein. So for 1500 calories, that would be about 50 grams carb + protein and 150 grams fat for a 3:1 ratio and about 38 grams carb + protein and 152 grams fat for the 4:1 ratio. That’s about 90% of calories from fat. This is obviously not typical keto as practiced here. I wonder if some of these issues might be caused by too low protein. They also tend to not be very concerned about what type of fat. I remember watching a video where they were pouring corn oil in a blender with some other things for a meal. Gross.

Plus there are the confounding factors of the seizures that they are trying to treat with the ketogenic diet and the underlying condition which causes the seizures. Who knows if they have an effect on the arteries.

#4

Interesting thought, thanks.

#5

Thanks, good points. We need more information! This is a really serious potential side effect of the diet and if it is actually true then the vast majority of people on the ketogenic diet need to get off of it immediately.

Stiffened arteries lead to heart attacks, meaning the diet would kill people left and right.

The exact opposite usually occurs though: people’s health gets better on the diet. I really wish we knew what the deal was with this.

It is incredibly daunting and makes me wary of continuing the diet but my health has improved dramatically due to it. Ten years of hypoglycemia and weight gain, headaches, low energy, and poor concentration, gone in a flash. I am in the best shape of my life, blood pressure and resting pulse are perfect, weight is what it was when I was in my early twenties and very healthy in all respects and now I hear my arteries may be stiffening? I am frustrated.

(Jim Russell) #6

I am not at all worried. These people were sick and the ketogenic diet they were on is not anywhere near the same as how I am eating. If you were eating 90% of your calories from fat, there is little room to get any vitamins and minerals without supplementation. And in my opinion, supplementation is far inferior to getting vitamins and minerals from food.

Also, there was another study where they followed up for 2 years.

43 children ages 2–15 years were started on dietary therapy; 84% on a standard 4:1 ratio ketogenic diet. They all had carotid ultrasounds at baseline, 3, 12, and 24 months, along with fasting serum lipid profiles. The carotid arteries were less “distensible” at 3 and 12 months but returned to normal by 24 months, and there was no difference in the intimal wall thickness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325592/

So with 84% of the subjects on the strictest version of ketogenic diet, they initially had some stiffening of the arteries in the beginning but it had returned to the baseline by 24 months.

I agree that there needs to be some study of this subject. But what are the odds that every other marker of health would be better but that the arteries would harden? What would the mechanism be that would cause that?

Arteries are made, in part, of muscle and collagen. To me it makes sense that if there is not enough protein in the diet, as in the classic ketogenic diet, that it would have a negative impact on artery health.

I think that you are overreacting.

#7

Thanks.

I appreciate you explaining your understanding. It gives me some new perspectives on the issue. I think it is peculiar to say I am overreacting. With the current lack of information I decided to see if some of the fine people on here could enlighten me. My hope was that someone would have some kind of perfect counter to these studies or an explanation of them that would negate their relevance to myself and the majority of ketogenic dieters.

I posted my thoughts and expressed frustration.
I am pretty calm in general and this issue no exception, I am handling it calmly as well. Overreacting would be if I was posting dramatic stuff like, for example, if I posted that I was sobbing and tearing up all my keto books lol (obviously not the case)!

I am doing just fine and I believe that my earlier posts reflect this and do not imply that I am overreacting but rather, simply, a bit frustrated and seeking more information. And in each post I attempted to balance the potential negatives presented in the study with the reality we see in which the effects are positive by making sure to mention both.

(Jim Russell) #8

I’m sorry if I misread your feelings, but the below quote is what gave me that impression. It sounded to me like you were considering quitting keto.

I think that if you are really concerned about your artery health on the keto diet, you should get a coronary artery calcium score done. Then do another one in a year and see whether the score has gotten better or worse. That is what I plan to do.

#9

No worries. I felt like if it is 100% true and happens to all keto dieters then quitting the diet is a reasonable reaction, not an overreaction.

Anyway, thank you for that tip. I didn’t even know about that test and I will now look into it!

(Jim Russell) #10

Absolutely. If it is something that is happening, that would pretty much kill the keto diet for anyone other than the people with neurological issues that need to do it to be able to live a reasonably normal life. Definitely would not be an overreaction to quit. :slight_smile:

(Michael Wallace Ellwood) #11

I think that if someone had seriously stiffened arteries, they would not have normal blood pressure (although I am open to being corrected by someone with the necessary expert knowledge).

(Mark Rhodes) #12

The types of oils that could be inflammatory are numerous. Inflammatory fats and carbs could be the source of the stiffness. Could catch Jimbo!

(Richard Morris) #13

Jeff Volek did a study on the effect on endothelial function comparing low fat and low carbohydrate diets. I suspect he did this in response to a poorly designed study from another lab that found that low carb diets worsen endothelial function, but that study was set up to capture people in the middle of adapting,

When Jeff Volek’s lab ran the same test with keto-adapted subjects they found that a low carb diet significantly outperformed the low fat diet.

After 12 weeks, peak flow-mediated dilation at 3 hours increased from 5.1% to 6.5% in the CRD group and decreased from 7.9% to 5.2% in the LFD group (P = .004). These findings show that a 12-week low-carbohydrate diet improves postprandial vascular function more than a LFD in individuals with atherogenic dyslipidemia.

I’m not sure about the diet used in the Coppola study, I’ll look into it, but if it’s Ketocal 4:1 which is often used to treat children with refractory epilepsy then that is a diet very high in omega 6 PUFAs (First 3 ingredients are Refined Vegetable Oils (Palm, Soy, High Oleic Sunflower)).

http://www.myketocal.com/ketocal4-1.aspx

(Ben) #14

From the study:

The time interval between the end of the ketogenic diet and follow-up ranged between 16 months and 6 years (mean 3 years; median 3 years and 2 month).

So if I’m reading this correctly, the patients could have eaten anything for a substantial period of time after quitting keto. Seems harsh to point the finger at keto 3 years down the line?

And to me keto means not eating processed oils. Do we know if these patients did? I can’t find any reference in the study (apart from a recommendation to increase polyunsaturated fats). If they have upped their fats to be keto, but upped them with seed oil, then that might be a more likely culprit for hardened arteries than keto itself.

And

All but one with Glut-1 deficiency syndrome was taking antiepileptic drugs in combination (mean 2–3 drugs). The drugs most frequently prescribed in both groups were: valproic acid, levetiracetam, topiramate, carbamazepine, phenobarbital, benzodiazepines, zonisamide, and clobazam.

Are all these drugs side-effect free?

(Richard Morris) #15

The Kapetanakis study didn’t mention the diet at all, other than it was ketogenic which is not adequately specific to take any conclusions on other ketogenic diets. The Koppola study did not detail the diet used either although they did mention it was a 4:1 diet.

I expect it will be ketocal or similar commercial preparation high in vegetable oils. These are high in omega 6 polyunsaturated oils which could cause a change in the lipid membranes of endothelial cells.

On the subject of arterial stiffness they did mention …

On this subject, Dahlin et al.,18 reported the potential efficacy of an early supplementation of the diet with omega-3 fat acid, in the aim of decreasing the omega 6/omega 3 ratio and, accordingly, the cardiovascular risk.

They [ https://www.ncbi.nlm.nih.gov/pubmed/17150333 ] found a significant improvement when supplementing with omega-3 fatty acids and suggested that ketogenic diets be reformulated to increase the omega 3 to omega 6 ratio.

Of course the modified atkins diet that we use is not high in polyunsaturated fats and certainly not seed oils, favouring as it does monunsaturated oils from fats like lard, avocado, olive, and saturated fatty acids from animal fats and dairy.

(Ben) #16

Here’s an alternative study

#17

Interesting! Thank you.

What is “the middle of adapting”? I know that there is a period of adaptation to fat but it seems there is some debate as to how long this period is. Do you know what specifically the target of that study was?

#18

This is a very interesting thread. In July, I got a scale that measures pulse wave velocity, an indication of arterial stiffness. This was about five months into keto. At first, my readings were consistently excellent, but after about a month, they started to tank. In hindsight, I realized that this was right around the time when my coffee consumption went from “occasionally” to “a few cups per day.”

I’ve been intending to cut out coffee for a while to see if my PWV improves, but every morning, I’m looking so forward to it, I keep thinking, “I’ll wait till tomorrow to start this experiment.”

It’s possible that my deteriorating PWV was caused by the effects of keto catching up to me, but I really do suspect the coffee (frequently mentioned in studies as an artery stiffener, though exonerated in a few) or another variable (it might have been right about that time when I hurt my foot and gave up my daily walks; foot is healed, but the walks didn’t resume; that’s probably an easier thing to test than coffee abstinence).

But even though my PWV isn’t as good as it was, it’s still in the normal range, so I’m not too worried that keto is killing me.

(Richard Morris) #19

I went looking for the study and it was Phillips et al 2008

I stand corrected. I was thinking of a different study. The term was 6 weeks which should have been adequate to properly adapt most people to efficiently running preferentially on fat. This study saw a small advantage for the low fat diet.

The Volek study was 12 weeks and that saw a significant advantage for the low carbohydrate diet.

Their explanation for the difference is;

Philips et al reported a small decrease in fasting flow mediated dilation after 6 weeks of a low carbohydrate diet; but this was due to a larger baseline (preocclusion) diameter in those subjects, as peak postocclusion diameter actually increased more in the low-carbohydrate compared with the flow mediate dilation group. These studies all assessed flow mediated dilation responses to a carbohydrate reduced diet in the fasted state,whereas assessment of vascular function in the postprandial state is probably more revealing and clinically relevant because of the perturbations in metabolic homeostasis that have been linked to endothelial dysfunction.

(VLC.MD) #20

Coffee is good for you.

Coffee shows a dose response relationship reducing heart attacks, stroke and car accidents. In humans. In a real study, over 12 years. Obviously this type of studies carries more weight than arterial stiffness parameters in young epileptics.

Don’t blame the Java !
Enjoy it.