High Cholesterol From Keto Doesn’t Matter? Not So Fast

[00:00:00]So, a study came out last year that showed that people on a keto diet that had really high cholesterol didn't have a problem with cholesterol.

[00:00:07]>> Wow. Interesting study. It was retracted.

[00:00:10]>> What? What?

[00:00:10]>> Gone. Taken out of the body of science.

[00:00:13]>> Okay. Stick around. Welcome to Talking with Docs. I'm Dr. Brad.

[00:00:16]>> I'm Dr. Paul Zal. Now, a retraction of a scientific article is very rare.

[00:00:22]>> So, we looked it up. Two to five out of every 10,000 articles get retracted.

[00:00:26]>> Okay. The most famous one that comes to mind for me was the one that showed the um vaccinations cause autism. Like >> oh the gastronologist guy with the kids and all that stuff.

[00:00:35]>> That that study was taken out of science.

[00:00:38]>> They said no.

[00:00:39]>> Science giveth and science taketh away, >> right? And it gets taken away for a bunch of different reasons. Sometimes you'll learn afterwards like okay maybe interpretation was wrong. Maybe the data was interpreted wrong. Maybe there were actually full-on falsification or um disclosures that weren't >> open. It's kind of a big deal because you can have a study that says something, then you can have another study that says something else, right?

[00:01:01]>> And it's not retracted if both studies were done well.

[00:01:04]>> Agreed.

[00:01:05]>> Okay. But if there are real flaws with the methodology or the patient population or if the authors just lied, >> right?

[00:01:14]>> Then that study's retracted.

[00:01:16]>> But this study there people really excited. So people on keto diet were really excited. People on the super low carb thing were really excited. The cardiologist and lipidologists were not super excited. So there's like and they they have a lot of conflicts. So So what was the title of the article? Not that you can find it because it's been scrubbed from the internet. Like if you hire like a company to make, you know, that office Christmas party photo go away.

[00:01:37]>> And that never will. That never will. So be careful.

[00:01:40]>> Careful.

[00:01:40]>> Um the study was called longitudinal data from the keto- study. Plaque predicts plaque apple does not. And it was in the journal of the American College of Cardiology. Is that what it is?

[00:01:56]>> Yeah. So pretty GACC.

[00:01:58]>> Yeah. Like a good journal. And in the title, pretty bold claim in the title.

[00:02:02]So that for me is always a red flag when you're like, wait a second. So this one study has taken away you know decades of scientific research randomized control trials mandelian genetics to study that show that you know cholesterol and elevated able B do correlate and potentially are positive in heart disease. They're saying oh well this one study is going to take that away. So let's talk about the study. So >> this doesn't pass the sniff test.

[00:02:26]>> Doesn't pass sniff test. So this study had 100 patients.

[00:02:29]>> 100 patients. Good followup.

[00:02:30]>> Very specifically picked because they're what are called lean mass hyperresponders. Right. That's not what I describe you as.

[00:02:37]>> A lean mass hyperresponder. Wow. I feel like I feel like it's not a dig on the lean mass side. I feel like it's the hyperresponder that's making fun of me.

[00:02:46]>> And I'm just joking.

[00:02:48]>> I resemble that remark. [laughter] >> Yeah. Irregardless.

[00:02:53]>> Did you notice people really thought irregardless? It's quite funny.

[00:02:56]Someone's like, "Please don't use that word." Um, anyway, so 100 people lean mass hypersponders. You're like, "Well, what does that mean?" So these are people who are on a ketogenic or a very ultra- low carb diet, who are lean, who are fit, >> who have actually perfect sugar blood work and often are metabolically totally normal, but have very very high LDL, like dangerously high LDL. And this is a small subset of population. And these were picked because the authors, >> yeah, >> were very interested in this group. They actually coined the term. Yes.

[00:03:26]interestingly and they were big proponents of the keto diet and they had wrote I think a cookbook and some other stuff. So, it was kind of like a little bit trying to propagate their own beliefs, which I think >> it's normal to have some bias, right?

[00:03:39]You you do research probably on things that you believe in or stuff that you really believe against. You're trying to disprove it. But we all come with biases.

[00:03:46]>> First of all, these authors are from all over the place. UCLA, Harvard, Mexico, Washington, they're from all over.

[00:03:53]>> Yes.

[00:03:53]>> Two, you've got a very unique subset, a sample size, a unique population. Then in your title, you go in and put a generalization, >> right?

[00:04:02]>> They're not representative of society.

[00:04:03]>> That that sample size doesn't represent the normal population. So you shouldn't put a generalized statement in your title.

[00:04:11]>> Agreed.

[00:04:11]>> So how does an article get published?

[00:04:13]Well, you write an article, you submit it to a journal. The journal then gets peers, other people, and I do this quite often. I'll get articles from journals say, can you review this and tell us a is it publishable like it is? B, are there some minor changes that need to be made so this can be publishable? C, are there some major changes that need to be made then publish or do you chuck it in the garbage?

[00:04:34]>> Yeah, >> but you don't like when I get these articles to review, I kind you you trust that the authors aren't lying. Like I don't go back, okay, give me all your raw data and let me analy.

[00:04:43]>> Not practical.

[00:04:43]>> No. So you kind of have to trust that people are telling you the truth that but that's the process. So it's a pretty and it's not just one reviewer that you send it to two or three reviewers >> or more I think sometimes even >> right so so it is there's a process so it's kind of a big deal when something gets >> and the other trouble is that humans are involved on both sides so the reviewers can make a mistake the authors can make a mistake either intentionally or unintentionally there's a lot of potential for error >> and the reviewers are arm length away like if I got an article that said that you wrote then I'd be conflicted no >> because you'd rubber stamp it like and then I take Mass respond.

[00:05:18]>> I said, "Rad, you owe me a thousand bucks. I just rubber stamped your your crummy paper."

[00:05:22]>> That's right.

[00:05:23]>> So, arms length away reviewers. You know what I mean?

[00:05:26]>> Right.

[00:05:26]>> So, the first thing that I see when I look at this is like, whoa, you got a tight sample size of of a certain group of people. Now, you put a big general statement in your title, >> right? So, they had 100 people. They had baseline level blood work that showed they had elevated LDL, Apo B. They had a CCTA, so a coronary CT scan angiogram.

[00:05:46]So better than a calcium score, which just assess soft plaque. This is actually a very good or the gold standard test to assess the amount of plaque inside of your vessels.

[00:05:54]>> So plaque in your vessels makes the vessels smaller and that leads to heart attacks and strokes.

[00:05:58]>> And we talk about plaque, how plaque contains cholesterol. We don't have to get into a big discussion about is cholesterol the cause of it. It's combination of things, cholesterol, inflammation, vessel damage, the triad, >> right? So the punch line, what did they see correlating that?

[00:06:12]>> Wait, so so then they did another test at one year.

[00:06:14]>> They followed these people for one year and then they did another test, another CCTA.

[00:06:18]>> Um, and what they showed is that having elevated ALB didn't necessarily mean that you got more plaque than someone that had a lower AP in this group.

[00:06:28]>> Yeah. So they looked at the difference, the progression of plaque and tried to correlate that with the levels of your April B and LDL and said, "Look, there's no correlation. doesn't matter how much you progress your plaque has nothing to do with what your levels are.

[00:06:42]>> They said the biggest risk was the risk of getting more plaque is if you had plaque, which also we know, right? We know that that's a thing. Um, >> so I thought that was kind of like saying if you took a bunch of people who had lung cancer, god forbid you have lung cancer and you're a smoker, right?

[00:06:58]>> And then you looked at the how many tumors you have in your lung or if it's spread, then you check again a few months later and say, "Oh, look, it's spread. Let's correlate how much it spread to how many cigarettes you have.

[00:07:09]>> Right.

[00:07:09]>> Doesn't matter at that point. And then you say, "Look, smoking doesn't cause cancer." Is having cancer causes cancer.

[00:07:16]Like it's the same thing what you're saying. Right.

[00:07:18]>> Right. Because the guy that had five cigarettes didn't get his cancer didn't get worse than the guy that had 25 cigarettes.

[00:07:24]>> Once you got the cancer because cancer spreads. So once you have the plaque, it's going to get more plaque. So it's too you miss the boat. That ship has sailed. You can't correlate it to those blood markers, right? How about whether or not you have the plaque, correlate that to the blood markers, >> right? And so, so what happened was people in the keto community were really excited, >> right? And I think um first thing I would say about keto diet is like all keto diets are not the same.

[00:07:48]>> No.

[00:07:48]>> Right. So, >> the other thing that said there were some issues with the third party that was doing the CTA analysis. They wouldn't re-release their data and there's some methodology study. So, there's some other issues.

[00:07:57]>> Not that the test wasn't good or accurate, but yeah, some of the data.

[00:08:00]Oh, the other thing too is that they're just measuring um blood levels and the CCTA. They were not looking to if they they didn't comment at all if they had a heart attack, if they had a stroke.

[00:08:09]Obviously, no one died because they had 100% follow-up, which is good.

[00:08:12]>> Yes. And the follow-up period is quite short. It was only a year.

[00:08:14]>> One year. So, these are >> and no control group.

[00:08:16]>> There's no control.

[00:08:18]>> So, these are some of the problems why it was. Okay. Now, sorry I interrupt you. You were going to say the keto people.

[00:08:23]>> So, keto people were excited. So, the trouble is all keto diets are not the same. So the principle of keto is if you reduce your carbs, this can help your blood sugar, which certainly elevated blood glucose is a problem for a lot of different metabolic conditions and potentially your triglycerides and potentially and actually these people actually have low triglycerides.

[00:08:40]Ironically, the lean mass hyper responders have low triglycerides um which can contribute to LDL. So a lot of people are really happy, but so one person could be keto and say I take eat zero carbs, but I eat a lot of a lot of animal products that are high in saturated fat. So if you're like on the bacon, butter, cheese team, >> yeah, >> that's different than the keto who say I'm having more more chicken breast, more healthy fish, and maybe they could have some carbs uh but not not refined carbs. So all keto is not created equal.

[00:09:07]There certainly there are ways to do a keto style diet that can be very healthy.

[00:09:11]>> Low carb diet, >> a low a low carb diet. And when we say low carb, it's not because carbs themselves are evil. that sweet potato is not evil per se, but really we could probably agree that refined, highly processed carbs, regardless of their form, are bad for you. They're made to be hyper palatable. You overeat them and they cause a lot of bad things happen.

[00:09:27]>> The funnest kind.

[00:09:28]>> Yeah, true. And someone's going to leave that comment. Yeah, I read the one comment today that said just if you eliminate everything, you don't really live longer. It just seems like because your life sucks or something like that.

[00:09:37]And I'm like I'm like >> I agree with that.

[00:09:39]>> That's kind of fair.

[00:09:40]>> Okay.

[00:09:40]>> Okay. So, at the end of the day, what happened? So a year later, about nine months later, then a bunch of people were looking at it and some of the authors were involved in the retraction.

[00:09:49]They're like, you know what, we're not really comfortable with the conclusions that were made based on this study. It's not it's not that the LDL levels were wrong.

[00:09:58]>> It's not that the imaging studies were wrong, but that to apply this conclusion to say that if you're on a keto diet and your lean mass hyperresponder that your LDL and your AB levels don't matter, because they do matter 100%. Maybe they didn't matter for those 100 people over the course of one year.

[00:10:16]>> Um, but the way that it was interpreted was a not accurate, not applicable to a general population, and definitely not a safe way to advise these people to live their lives.

[00:10:24]>> Yeah. So, you take away the article, say, "Nope, sorry."

[00:10:27]>> Yeah. So, it's gone. Now, you can't find it.

[00:10:29]>> It's gone.

[00:10:29]>> Maybe you find it like the maybe in the black web or the dark web.

[00:10:33]>> Yeah. I'm sure it's kicking around somewhere.

[00:10:35]>> So, when you go looking on the dark web for whatever you're looking for, you might >> found that article, right?

[00:10:40]>> Yeah. and the nunchucks I was trying to buy.

[00:10:43]>> That's right.

[00:10:44]>> All right. So, there you go. That article gone. Keto diets use with caution. Like you said, there's different kinds. What? Like a carnivore diet? Is that like an extreme keto diet?

[00:10:53]>> I think technically if you're a rigid carnivore, that would be a very strict keto diet.

[00:10:58]>> Yeah. Yeah. So, they have their role. I mean, they used to be used to manage diabetes before we had insulin. That's right. Going getting people into ketogenesis. Yes. But in general um what the conclusion of that article are now taken away from science don't exist >> right don't think that if you're doing this diet and you have elevated LDL B that it is not an issue that you should definitely discuss with your family doctor discuss whether or not you require medication whether or not you should tweak your diet whether or not you just need to be followed but but yeah I think there's a lot of things it just goes to show that >> taking one study out of context this happens online all the time yeah and this oh that was the other criticism too is these people were involved in that community, the keto community. And they released a lot of the stuff essentially even before almost like hyping it up and promoting it in a dangerous and arguably irresponsible way. And that's that's the trouble. We want to try to stay as objective as you can. And just like our channels, we just try to give you the information. You can decide what you do for yourself. We just don't want you to make a decision based on something that's not factual or accurate.

[00:11:56]>> And plus, I thought this was just a neat example of how a study gets taken away.

[00:12:00]Yeah. You know what I mean? We don't see it that often. So, it's kind of cool to just highlight. Look, science does have some guard rails that try and make sure that we're moving towards the truth because if something's an outlier, something's wrong, science tries to correct itself.

[00:12:14]>> Now, you know, leave a comment if you are on a keto diet, if you have high cholesterol, if you are a lean mass hyperresponder, leave a comment if you like this video. Please like it, subscribe to our channel, share it with someone that maybe has been piping off about this study.

[00:12:26]>> Remember, you are in charge of your own health. See you next time.