Summary of Сенсационное исследование : бляшки в сосудах не связаны с высоким холестерином. Революция в науке!

Scientific Concepts and Discoveries Presented

• Atherosclerotic Plaques and Cholesterol:
  • A recent sensational study challenges the long-held belief that high levels of Low-Density Lipoprotein Cholesterol (LDL-C) and Apolipoprotein B (apoB) directly correlate with the formation and growth of Atherosclerotic Plaques.
  • The study found no significant relationship between LDL-C/apoB levels and the progression of Atherosclerotic Plaques in people on a Ketogenic Diet with very high LDL-C but otherwise healthy metabolic profiles.
  • However, individuals who already had plaques showed continued plaque growth, indicating existing plaques predict further progression regardless of LDL-C/apoB levels.
• Ketogenic Diet and Lipid Metabolism:
  • The Ketogenic Diet is very low in carbohydrates, leading the body to use fat as the primary energy source, producing ketones (acetone, acetoacetate, beta-hydroxybutyrate).
  • Some individuals on the keto diet, termed "lean hyper-responders," develop very high LDL-C levels despite being metabolically healthy, with low triglycerides and high HDL cholesterol.
  • Possible mechanisms for high LDL-C in these individuals include:
    • Increased synthesis of very low-density lipoproteins (VLDL) by the liver due to fat metabolism.
    • Increased cholesterol synthesis triggered by high intake of saturated fats.
    • Genetic variations causing enhanced intestinal cholesterol absorption and reduced excretion.
• Study Design and Limitations:
  • The study involved 100 lean individuals on a Ketogenic Diet for at least 2 years with LDL-C >4.9 mmol/L but no genetic hypercholesterolemia.
  • Coronary CT scans measured non-calcified (soft) plaque volume at baseline and after one year.
  • No control group with normal LDL-C was included, limiting the generalizability of results.
  • The study was not randomized and lasted only one year, whereas atherosclerosis typically develops over decades.
  • The initially registered primary endpoint (change in total plaque volume) was not fully reported, raising concerns about data transparency.
  • Despite claims that LDL-C/apoB levels do not affect plaque progression, further analysis showed an average plaque volume increase of 18.8 mm³/year in the cohort, which is significant and comparable to or worse than some high-risk groups (e.g., people with diabetes).
• Implications and Critique:
  • The study’s conclusions have been widely misinterpreted on social media to suggest that high LDL-C is harmless on a keto diet, which is misleading and potentially dangerous.
  • High LDL-C and apoB remain significant risk factors for cardiovascular disease.
  • The study highlights the complexity of lipid metabolism and cardiovascular risk in keto diet followers but does not overturn decades of evidence linking LDL-C to atherosclerosis.
  • The lack of a control group and short duration limit the study’s ability to definitively assess risk.
• Practical Recommendations:
  • Keto diet can be beneficial for some, especially those with autoimmune diseases or metabolic conditions, but LDL-C and apoB levels must be monitored regularly.
  • Replacement of animal saturated fats with vegetable fats (e.g., olive oil, nuts, fatty fish) is advised to manage cholesterol levels.
  • Regular lipid profiling (lipidogram), blood pressure monitoring, physical activity, and avoiding insulin resistance are critical for cardiovascular health.
  • Awareness that cardiovascular disease can present suddenly and fatally without prior symptoms underscores the need for proactive monitoring.

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Methodology of the Study

• Selection Criteria:
  • 100 lean individuals on keto diet for ≥2 years.
  • LDL-C levels >4.9 mmol/L without genetic hypercholesterolemia.
  • Metabolically healthy (no diabetes, hypertension, or cardiovascular disease).
• Measurements:
  • Coronary computed tomography (CT) scans at baseline and after 1 year.
  • Focus on volume of non-calcified (soft) Atherosclerotic Plaques.
• Study Design:
  • Observational cohort study, not randomized controlled trial.
  • No control group included.
  • Registered primary endpoint was total plaque volume change, but this data was not fully published.

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Researchers and Sources Featured

• The study was published in the Journal of the American Heart Association.
• The research was conducted at the Lungvist Research Institute.
• The video references ongoing discussions and critiques on English-language Twitter and YouTube.
• The author of the video (unnamed) corresponded with one of the study’s authors to clarify some findings.
• Historical references to Ketogenic Diet research from the 1920s (epilepsy treatment) and the 1960s Atkins Diet.

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Summary

A recent high-profile study on keto diet followers with very high LDL-C challenges the direct link between LDL-C/apoB and atherosclerotic plaque growth but suffers from methodological limitations and incomplete data reporting. While the study

Notable Quotes

— 02:30 — « The slimmer a person is, the worse animal fats affect him, not everyone, of course, but there are such observations. »

— 03:50 — « The study showed that high levels of low-density lipoprotein cholesterol and apolipoprotein B are the most significant risk factors associated with an increase in the volume of atherosclerotic plaques. »

— 04:10 — « If you are on the keto diet, replace animal fats with vegetable fats. Try olive oil instead of butter, fatty fish instead of fatty meat, eat chicken breast, nuts, turkey white meat, veal, and a lot of vegetables. »

— 04:40 — « Don't lean on cream, butter, lard, bacon fat and so on if these lead to an increase in low-density lipoproteins. »

— 05:50 — « Keep ideally a lipidogram, monitor blood pressure, do not allow high insulin numbers, in no case should there be diabetes, walk, move, do physical exercise. »

Category

Science and Nature

Video