Highlights
- •Low-carb diets can lead to weight loss, but can exacerbate hypercholesterolemia.
- •Hypercholesterolemia can develop with or without underlying genetic hyperlipidemia.
- •This article describes patients who developed marked increases in plasma cholesterol.
Background
The adoption of low-carbohydrate diets can lead to weight loss in many patients. However,
these now widespread diets also have the potential to exacerbate hypercholesterolemia.
Objective
The objective of this study is to display the potentially harmful effects of the ketogenic
diet on cholesterol levels in patients with or without underlying hyperlipidemia.
Methods
We describe 5 patients who developed marked increases in plasma cholesterol on ketogenic
diets and assessed whether they had a well-described underlying genetic hyperlipidemia.
Results
Three out of 5 patients had extraordinary increases of blood cholesterol levels to
over 500 mg/dL. The other 2 patients more than doubled their low-density lipoprotein
cholesterol levels on a ketogenic diet. One patient had an APOE E2/E2 genotype. A higher burden of common genetic polymorphisms was found in 2 patients,
with no major mutations found. No potential genetic cause was seen in a fourth patient,
and the fifth patient had no genetic testing. Three patients, including the one who
was most hypercholesterolemic, had a marked reduction in cholesterol after reverting
to a more liberal diet. One refused to change his diet but had a satisfactory low-density
lipoprotein cholesterol reduction on ezetimibe.
Conclusion
These cases should serve as a caution that high-fat low-carbohydrate diets have the
potential to exacerbate or cause hypercholesterolemia in patients with or without
underlying genetic hyperlipidemia.
Keywords
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Article info
Publication history
Published online: October 30, 2020
Accepted:
October 28,
2020
Received:
July 22,
2020
Identification
Copyright
© 2020 National Lipid Association. All rights reserved.
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- Extreme elevations of low-density lipoprotein cholesterol with very low carbohydrate, high fat dietsJournal of Clinical LipidologyVol. 15Issue 3
- PreviewGoldberg and colleagues recently shared in this Journal 5 remarkable cases of extreme hypercholesterolemia associated with increasingly popular very low carbohydrate, high fat diets.1 The authors concluded by advising caution to those employing such diets, given the potential for individuals both with and without underlying genetic hyperlipidemia to develop momentous and potentially harmful increases in cholesterol. We add to that report by sharing 3 cases of our own.
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