Tuoreessa tutkimuskatsauksessaan David S. Ludwig kirjoittaa, että vähähiilihydraattiset ruokavaliot saattavat pienentää sv-tautiriskiä, vaikka sisältävät runsaasti tyydyttynyttä rasvaa. Vhh-ruokavaliot kun alentavat verensokeria, alentavat triglyjä, vähentävät pieniä ja tiheitä LDL-partikkeleita, alentavat verenpainetta, putsaavat maksasta rasvaa jne jne.The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed
Low-Carbohydrate Diets Might Lower CVD Risk despite High Saturated Fat Content
Although LDL cholesterol—an established CVD risk factor—can increase on low-carbohydrate diets (25), in part due to high saturated fat content, lipoprotein size distribution can indicate a relatively lower risk, characterized by larger, more buoyant particles (26). Consistent with this possibility, individuals with isolated elevated LDL cholesterol, compared with those who also have high triglycerides and low HDL cholesterol, were at lower risk for coronary events and benefited less from statins in the Scandinavian Simvastatin Survival Study (27). Indeed, there is precedent for reduced cardiovascular risk in the context of higher LDL cholesterol: treatment with sodium-glucose cotransporter 2 inhibitors (28). The mechanisms elicited by this drug class share similarity on the physiological, if not molecular, level with a ketogenic diet. Both shift substrate utilization from carbohydrates to lipids, cause ketosis, reduce glycemic excursions, lower insulin concentrations, produce weight loss, promote natriuresis, and lower blood pressure—actions that can counterbalance or attenuate any adverse cardiovascular effects of elevated LDL cholesterol.
Carbohydrate restriction benefits multiple components of the metabolic syndrome, a major CVD risk factor. A low-carbohydrate diet improves hyperglycemia, triglycerides, HDL cholesterol, small dense LDL subclass phenotype, oxidized plasma lipids, and hepatic steatosis, whereas a low-fat diet can adversely affect some of these components (26, 29–34).
The relation between dietary fat and mortality in observational research is controversial due to methodological challenges involving confounding, reverse causality, and effect modification (e.g., overall diet quality, physical activity level). In a high-quality, 2-cohort study, high intake of fat as a proportion of total energy was associated with reduced risk of premature death, although the type of dietary fat importantly modified risk: decreased with unsaturated fat and increased with saturated fat (35). However, the relation between saturated fat and mortality observed in a general population might not apply to those consuming a ketogenic diet due to exceptionally high rates of saturated fat oxidation and low rates of de novo lipogenesis (36). Demonstrating this point, serum saturated fat did not increase through a wide range of saturated fat intakes for 3-wk intervals in a study of 16 adults with metabolic syndrome (37).
Ludwig twiittasi: https://twitter.com/davidludwigmd/statu ... 19200?s=20
Said about a ketogenic diet:
1979: Such high fat intake will make you fat
1999: You might not get fat but you'll get heart disease
2019: You might not get heart disease, but it has severe side-effects
My new review of the science (full free access): https://academic.oup.com/jn/advance-art ... 45fa522d3b