LDL levels ARE associated with atherosclerosis

cholesterol
ldl
cac
cait
(David Pegg) #1

Hi everyone. I’m sure the post topic got your interest. Is it just another statin funded silly journal article which misses the important risk factors of heart disease, or doesn’t look at all cause mortality, carotid artery itima thickness ultrasounds or CAC scans?

Well, no.

I am well versed with the lectures by Dave Feldman, Ivor Cummins, Gary Taubes, Ken Sikaris, Tim Noakes etc. I am a hyper responder so I have vested interest. Especially in reassuring myself and my family that my strong family history of CVD and my now high LDL is fine in the presence of a ketogenic diet.

However, it seems that this study looks carefully at what WE, as ketogenic people, would want to consider.

That is, end point disease measurement. This study evaluated people looking at their cardio vascular health by CAC and carotid artery itima thickness ultrasounds, exactly what Ivor would say is powerfully predictive.

They also looked at all the things which we would consider to be abnormal, high glucose, insulin, HbA1c, blood pressure, lifestyle, fibrinogen, oxidized LDL, Lp(a), triglycerides and low HDL. And nothing correlated with the progression of cardio vascular disease as well as high LDL-C (not even oxidized LDL).

Here is a quote:

…we demonstrated an independent and direct link between LDL-C levels and atherosclerotic burden. In fact, LDL-C was the strongest modifiable factor associated with atherosclerosis…Conversely, the multivariable models showed no link to subclinical atherosclerosis for other apolipoprotein B–containing particles, specifically oxidized LDL-C and lipoprotein (a).

I would love to hear your thoughts on the study. I wonder why there was no association with blood risk factors that we normally consider to be predictive.

https://ars.els-cdn.com/content/image/1-s2.0-S0735109717412320-fx1.jpg

(bulkbiker) #2

One observation I would make … doesn’t this show that people with “normal” to low cholesterol have a higher risk of atherosclerosis with all participants selected by having total cholesterol of 240 or less?
Just an observation so shoot me down if I’m being dumb.

(Bunny) #3

LDL levels are not the cause nor the “association,” it is the bodies (cells) ability to absorb and effectively utilize Vitamin K (regulator of calcium or preventing calcification) in the presence of high glucose (K has to compete with glucose) and fat when these two are together in the blood stream for long periods of time in dietary intake variables…just sayin!

Natokinase and Chia seed are really good at regulating this also if you like taking supplements!

References:

  1. Saturated fat, regardless of type, linked with increased heart disease risk
    …Your data suggest that heart disease risk was not as significantly influenced by lauric acid, which is the abundant fatty acid found in coconut oil. Is it possible that certain foods like these may be included as part of an overall heart-healthy diet even though they are technically high in saturated fat?..” …More

  2. Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality: Two Cohort Studies Conclusion:
    A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates. …More

#4

It is an interesting paper. One that would get a ketogenic eater (and any LDL-cholesterol hyper-responders) to have a closer look at the formulation, and eating timing, of their ketogenic diet.

Almost 50% (49.7%) of low risk participants were shown to have subclinical atherosclerosis!

The bits that interested me in the Methods section were where and how the researchers grouped the test subjects.

CVRF (cardiovascular risk factor) freedom was defined as:

  • No current smoking
  • Untreated blood pressure <140/90 mm Hg
  • Fasting glucose <126 mg/dl,
  • Total cholesterol <240 mg/dl,
  • Low-density lipoprotein cholesterol (LDL-C) <160 mg/dl, and
  • High-density lipoprotein cholesterol ≥40 mg/dl.

A subgroup with optimal CVRFs (n = 740) was also defined as having blood pressure <120/80 mm Hg, fasting glucose <100 mg/dl, glycosylated hemoglobin <5.7%, and total cholesterol <200 mg/dl.

Look at the parameters. One would hope a ketogenic eater on a well formulated eating plan would get better and tighter control of the listed bio-markers than those applied to the test subjects. It would open up the question of; What are the associated bio-markers for sub-clinical atherosclerosis in ketogenic compared to non-ketogenic eaters?

Another interesting point in the Results and the interpreted associations (the paper does not claim causal relationships) was:

Atherosclerosis presence and extent was also associated in the CVRF-free group with glycosylated hemoglobin levels.

Atherosclerosis association with HbA1C was in the CVRF freedom group NOT the CVRF optimal group. The CVRF optimal group had and HbA1C measurement of <5.7%. To me, that’s quite a high HbA1C when looked at from a person in ketosis. The CVRF freedom group were not as optimally quantified. I can’t find the freedom group HbA1c numbers, but they would be equal to or greater than the 5.7% of the optimal group (otherwise they’d be in the CVRF optimal group).

Overall, it looks like a study on some select people who seemed to be doing OK on a standard way of eating that has more carbohydrates. They selected people with LDL < 160mg/dl to look for the atherosclerotic changes, so in the initial selection excluded many people who may have been on a low carb diet.

In Study Limitations:

We did not evaluate other nonmodifiable risk factors (e.g., second-hand smoking or air pollution) and did not explore the potential roles of diet and exercise in greater detail because this was not the focus of this study.

Like many studies it is difficult to apply the methods and results found from standard western diet eaters to individuals pursuing a ketogenic way of eating. We are the white zebras with black stripes.

For keto-eaters it is probably best to get our own, individual coranary artery calcification (CAC) CT scores done, and , if keen, consider a carotid artery ultrasound as well.

For the sake of the conversation, and n=1, my LDL cholesterol has varied from ‘upper normal’ to ‘high’ over 4 years, but my coronary artery calcification score has remained zero.

(Banting & Yudkin & Atkins & Eadeses & Cordain & Taubes & Volek & Naiman & Bikman ) #5

A thing about CAC and Cartotid ultransounds. Like keto, people tend to get the first CAC after they are already overweight and sick. Fatty liver and so on. You ate SAD for twenty years and keto for six months and it’s the keto that laid down the plaque? Not according to Ivor and Dr. Gerber.

It’s funny that the headline is about the LDL-C while the data suggests that even folks with low LDL-C have plaque in the intima.