KETO-CTA trial - LMHR phenotypes showed rapid plaque accumulation on Keto diet \ stacker news ~HealthAndFitness

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They basically wanted to study the "Lean Mass Hyper-Responders" group- healthy, fit looking people who develop high levels of LDL cholesterol on Keto diets (not everyone on Keto does). Their hypothesis was that this is fine in this subgroup, despite reservations from traditional medicine practitioners that every other genetic condition that results in highly elevated LDL levels results in rapid progression of coronary artery disease and heart attacks.

Unfortunately they hid their primary end-point, which any scientist will tell you is a huge unethical no-no.

In fact the healthy participants in the study showed marked progression of coronary plaque progression on keto, much more rapid than seen in similar healthy cohorts:

Now the lead author is claiming he never signed off on the study and other authors making other silly excuses, and others stating they left the study early for ethical concerns (can follow the controversy on twitter).

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My point is not to say you should not be on a keto diet- I often recommend it to patients myself, particularly if you have diabetes/epilepsy/morbid obesity etc. Just be aware that it is NOT without controversy. Particularly if you are a "hyper-responder" that develops very elevated levels of LDL (again this is not everyone on keto)- you may be at higher risk for CVD progression.

Remember that just like big pharma, most of the big keto influencers online are also trying to sell you something- their diet books, diet plans, multivitamins, training programs, or simply influence. For every magic health transformation you hear online about online, we hear whispers from cardiologists about very young patients on controversial diets who end up presenting with heart attacks. Cardiologists generally make zero prescribing generic statins but do quite well placing stents.

Decent youtube summary: https://www.youtube.com/watch?v=ZDr4iFqENgc

Decent twitter summary: https://x.com/MichaelAlbertMD/status/1916175837549731889

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99 sats \ 2 replies \ @Undisciplined 22h

Cardiologists generally make zero prescribing generic statins but do quite well placing stents.

Well taken, but they do make off well with patients who require ongoing treatment.

I didn't follow up on the controversy. Why do you view the study as credible, when it has the issues with authorship that you mentioned?

Btw, my priors lean heavy against most keto diets, so I'm mostly asking out of curiosity.

37 sats \ 1 reply \ @gmd OP 21h

There is no shortage of patients, only a shortage of cardiologists and most other physicians. This has led to the proliferation of dangerously undereducated NPs.

The main issue is that they claimed one result from the study while the data behind the buried primary end-point they tried to hide showed the opposite. It's not conclusive but it's a certainly a negative data point for keto enthusiasts.

I had heard about this study years ago and was hoping for the opposite result so that I could more enthusiastically endorse the keto diet.

My priors are that life is too short to restrict yourself to any particular diet, especially when the evidence base in nutrition is generally incredibly poor. Anything/everything in moderation - less is more.

0 sats \ 0 replies \ @Undisciplined 21h

There is no shortage of patients

That's my point. There don't need to be anywhere near the number of cardiology patients. I'm not laying that primarily on doctors, but my impression has always been that they do a poor job of impressing the importance of lifestyle changes, compared to the importance placed on medications and other treatments.

they claimed one result from the study while the data behind the buried primary end-point they tried to hide showed the opposite

I see. I didn't catch that originally.

5 sats \ 0 replies \ @byzantine 11h

I think it's very unlikely that people were in ketosis for long periods of time from an evolutionary standpoint

0 sats \ 0 replies \ @realBitcoinDog 17h

So eating a lot of fat is bad for you??

0 sats \ 0 replies \ @nitter 22h bot

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