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 \ 6 replies \ @Undisciplined 27 Apr

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 \ 5 replies \ @gmd OP 28 Apr

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.

99 sats \ 4 replies \ @Undisciplined 28 Apr

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.

33 sats \ 3 replies \ @gmd OP 28 Apr

Curious do you have any fat friends or family? The reality is that it is very hard to get people to change their lifestyles, and most people don't want to hear it. Furthermore you don't need to see a doctor to get this advice. Any half-decent gym-bro can tell you the 80% you need to succeed. Most people already know what to do- it is very simple but very hard.

Many people can lose weight for a short period of time, the difficulty is keeping the weight off over a prolonged period of time. What we hear on social media is the echo of young influencers and virtue signalers, but the reality for most is they are older, have jobs, kids and all kinds of life stressors. When you have 15 minutes to see a patient and they want to talk about W, X, Y, Z it's very hard to insert a lecture about lifestyle stuff they don't want to hear about and probably won't follow anyway.

99 sats \ 2 replies \ @Undisciplined 28 Apr

Curious do you have any fat friends or family?

Pretty much all of my extended family. Some of whom died from it, while refusing to follow doctors' advice.

This is a much bigger topic, and I'm sure you've heard it all before, but I think it's a mistake to let patients believe that the medications they're being prescribed are substitutes for lifestyle changes. I know that's not how almost any doctor explicitly communicates it. However, we all know that patients act that way.

Saying that it's hard to get this across to patients just sounds like a cop out. It's undoubtedly true, but it's also your jobs and failing to do it on a society wide scale should be taken as a huge point of shame for the entire profession, rather than just being brushed aside.

I also have several relatives who are medical professionals and they only reinforce my sense that there's way more emphasis on getting pharmaceuticals into people than addressing underlying issues.

31 sats \ 1 reply \ @gmd OP 28 Apr

It's just not practical or possible. When you are expected to see 30-40 patients a day, older patients come in with a list of 10 things they want to talk about, you have to negotiate them down to the top 2-3 items, reconcile meds and refills, redirect and listen to them ramble about irrelevant nonsense and suddenly you're all out of time and you have a waiting room of patients who are upset you are running late (and then demand more of your time in return).

PCPs are just fighting to stay afloat in clinic. There's a reason my PCP always bugs me to schedule an appointment every year- she knows I'm younger, fit an healthy and it's an easy booking for her.

The loudest voices on social media are young people <50 who want to talk about how amazing their secret sauce is for staying healthy, but the reality is you generally don't need a doctor when you're young (outside of women's health issues). Don't get fat is all most of what you need to hear, which is advice that can be given by anyone. They don't see the 90% of other health issues that physicians actually deal with as patients get older.

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99 sats \ 2 replies \ @realBitcoinDog 28 Apr

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

0 sats \ 0 replies \ @gmd OP 28 Apr

Maybe... maybe not lol.

I would say if you follow a low carb diet and you are part of the minority that shows a sky-high spike in LDL, you might need to weigh things a little differently.

There are in fact cardiologists who eat low carb... they would recommend potentially increasing your fiber intake, consider a statin, etc.

0 sats \ 0 replies \ @byzantine 28 Apr

eating saturated fats are very healthy

99 sats \ 0 replies \ @byzantine 28 Apr

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

63 sats \ 6 replies \ @Signal312 4 May

Wait a minute...this is the exact same research that I wrote about here, right? The most common question I get asked as a Carnivore has been answered

So you're saying there's now a lot of controversy about this study, is that correct?

34 sats \ 5 replies \ @gmd OP 4 May

Yup same article. Surprised it has not been retracted yet from what's a rather large journal. Controversy continues to unfold on twitter...

63 sats \ 4 replies \ @Signal312 4 May

You gave this, as a summary of opinion AGAINST the study:

Is there a good place to look for a summary of the opinion for the other side?

From what I initially heard about the study, it very clearly found that the LMHR did NOT have worse CAC scores.

34 sats \ 2 replies \ @gmd OP 4 May

tbh i haven't heard any really good defense from the authors, but only following peripherally. burying the primary outcome is just basic corruption as a purported scientist.

I encourage patients to look into keto especially those who are obese and diabetic- I was a big fan when I first heard about this study and was really hoping to be able to more enthusiastically advocate for it.

42 sats \ 1 reply \ @Signal312 4 May

I've been carnivore for 15 month and have had enormous health benefits. And so many people have.

And honestly there is SO MUCH MONEY on the side of "Elevated LDL is the cause of heart disease" (i.e. big pharma, with their statin profits at risk) that I would be surprised if they DIDN'T try to discredit the study.

But I would like to know more.

0 sats \ 0 replies \ @gmd OP 4 May

Statins have been generic since forever, there is not much big pharma profits to be made there any longer.

It's really hard to quantify "enormous health benefits". Much of what we do has a significant placebo effect. You will see a lot of plant zealots make similar claims (I am skeptical). If you've lost significant weight that's awesome. Otherwise most people <50 are mostly healthy to begin with. Having more energy doesn't necessarily mean you live longer.

I would say if you are one of the "hyper responder" that sees your cholesterol levels skyrocket, it might be worth reconsidering the diet or re-evaluating benefits or intervention (even if that means trying more fiber). While cholesterol might turn out to be more correlation than cause of cardiovascular disease, in every other disease phenotype (familial hypercholesterolemia, etc) that shows markedly elevated cholesterol levels we see rapid progression of cardiovascular disease.

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0 sats \ 0 replies \ @nitter 4 May bot

https://xcancel.com/MichaelAlbertMD/status/1916175837549731889

0 sats \ 0 replies \ @nitter 27 Apr bot

https://xcancel.com/MichaelAlbertMD/status/1916175837549731889