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By Bhavana Kunkalikar Apr 27 2023 Reviewed by Lily Ramsey, LLM

In a recent study published in the American Journal of Preventive Cardiology, researchers explored the impact of ketogenic dieting on low-density lipoprotein (LDL) cholesterol levels.

Study:  Dramatic elevation of LDL cholesterol from ketogenic-dieting: A Case Series . Image Credit: SewCreamStudio/Shutterstock.com Background

Due to the escalating obesity levels, the ketogenic (keto) diet has been studied as a potential remedy for overweight patients' deteriorating weight gain, cardiovascular outcomes, and insulin resistance.

Though popular as a comparatively safe, non-pharmaceutical therapy, the long-term effects of the keto diet for weight loss are not fully understood, and most professional medical societies do not advise this regimen.

Some individuals on a ketogenic diet may experience a significant rise in low-density lipoprotein (LDL) cholesterol levels due to its high saturated fatty acid content. About the study

In the present study, researchers described a cohort of patients whose LDL-cholesterol levels rose to an unprecedented level after beginning a ketogenic diet.

The team evaluated medical records of patients who presented to Cardiology for a hyperlipidemia diagnosis after lipid panel blood work revealed an LDL cholesterol level of 190 mg/dL or more. The charts of these patients were cross-referenced to involve the words "keto" or "ketogenic".

The physician's notes were manually inspected for the patient's dietary routines to confirm that these terms were correctly applied. Almost 17 patients consuming a high-fat, low-carbohydrate diet (called the ketogenic diet) were detected and evaluated via chart review.  Results

Eleven patients were male, and six were female. The mean age at hyperlipidemia assessment was 46 years. The ethnicity of 14 patients was Caucasian, while one was Lebanese, one was Asian, and one was Hispanic.

Two patients reported a history of documented coronary artery disease, one had prior ST-elevation myocardial infarction (STEMI), and another reported coronary artery calcifications. Also, ten patients revealed a family history of hyperlipidemia and atherosclerotic coronary disease. Three patients fulfilled the criteria for familial hyperlipidemia established by the Dutch Lipid Clinic Network. Related StoriesNew VA Medical Center program to help veterans with atherosclerotic cardiovascular diseaseReversing infertility in sterile mice by reducing high-circulating cholesterol with a bacterial proteinLDL cholesterol levels reduced by oral PCSK9 inhibitor in phase 2 trial

The patient's body-mass index (BMI) ranged from 14.83 to 43.87 kg/m2, averaging 27 kg/m2. Only one patient had xanthelasmas, while the others did not. No patients displayed additional physical manifestations of hyperlipidemia, such as tendinous xanthomas or corneal arcus.

The cohort's average LDL cholesterol at baseline was 129 mg/dL. Almost three patients presented with no basal LDL cholesterol levels before recruitment. During an average of 12.3 months on a low-carbohydrate and high-fat diet, the mean LDL cholesterol was 316 mg/dL.

Thirteen patients who stopped dieting and received a lipid panel after almost nine months had an average LDL cholesterol level of 142.7 mg/dL. Seven of these thirteen patients who underwent follow-up laboratory testing could change their LDL cholesterol through dietary modification alone without altering their exercise routine. Statin medications were prescribed to eight patients. At follow-up, one of the patients continued the ketogenic regimen.

In seven and ten patients, Apolipoprotein A1 (Apo A1) and Apo B were collected, respectively. The mean Apo A1 concentration was 149.4 mg/dL, and the mean Apo B concentration was 191 mg/dL.

Furthermore, no acute atherosclerotic cardiovascular disease (ASCVD) events have been recorded while these patients were on the ketogenic diet. Five patients were evaluated genetically for familial hypercholesterolemia. Two patients were discovered to have an LDL-R gene mutation. Conclusion

The study findings showed patients who followed the ketogenic diet for 12.3 months displayed a mean elevation in LDL cholesterol of 187 mg/dL, accounting for a 245% increase.

When patients stopped consuming the ketogenic regimen, their LDL cholesterol levels were reduced by a mean of 174 mg/dL, or 220%. Further research is necessary to comprehend this heightened response's causes and long-term medical importance. Journal reference:

Schmidt, T. et al. (2023) "Dramatic elevation of LDL cholesterol from ketogenic-dieting: A Case Series", American Journal of Preventive Cardiology, 14, p. 100495. doi: 10.1016/j.ajpc.2023.100495.https://www.sciencedirect.com/science/article/pii/S2666667723000363?via%3Dihub

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Dodgers advance to NLCS after Kerkering’s error

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Dodgers advance to NLCS after Kerkering's error

LOS ANGELES — Orion Kerkering made a wild throw past home instead of tossing to first after mishandling Andy Pages‘ bases-loaded comebacker with two outs in the 11th inning, and the Los Angeles Dodgers beat the Philadelphia Phillies 2-1 Thursday to win their NL Division Series 3-1.

Kerkering hung his head and put hands on knees after his throw sailed past catcher J.T. Realmuto as pinch-runner Hyeseong Kim crossed the plate, advancing the Dodgers to the NL Championship Series against the Chicago Cubs or Milwaukee.

Realmuto had pointed to first when the broken-bat, two-hopper hit off Kerkering’s glove and rolled just in front of the mound.

Kerkering picked up the ball and in one motion made a sidearm throw, 46 feet from the plate. The ball sailed up the third-base line, past Realmuto’s outstretched mitt, and fans in the crowd of 50,563 at Dodger Stadium erupted after spending the final three innings on their feet.

“It’s brutal,” Dodgers manager Dave Roberts said. “It’s one of those things that it’s a PFP, a pitcher’s fielding practice. He’s done it a thousand times. And right there he was so focused, I’m sure, on just getting the hitter and just sort of forgot the outs and the situation.”

Phillies manager Rob Thomson wrapped an arm around Kerkering when the distraught reliever reached the dugout.

“He just got caught up in the moment a little bit,” Thomson said. “I feel for him because he’s putting it all on his shoulders.”

This was the second postseason series to end on a walk-off error, according to the Elias Sports Bureau. A wild relay throw by Texas second baseman Rougned Odor on a potential double-play grounder allowed Josh Donaldson to score and give Toronto a 7-6, 10-inning win and a three-game sweep of their 2016 AL Division Series.

Los Angeles ended a postseason series with a walk-off win for the third time after Bill Russell’s single against the Phillies in Game 4 of the 1978 NLCS and Chris Taylor‘s homer in the 2021 NL wild card game.

Nick Castellanos‘ RBI double in the seventh off Emmet Sheehan had put the Phillies ahead but Jhoan Duran walked Mookie Betts with the bases loaded in the bottom half, forcing in the tying run.

Tommy Edman singled off Jesús Luzardo with one out in the 11th and took third on Max Muncy‘s two-out single that eluded diving shortstop Trea Turner.

Kerkering walked Enrique Hernández, loading the bases. Pages, in a 1-for-23 postseason slide, hit what appeared to be a routine grounder, the type every pitcher practices gloving from spring training on.

Philadelphia, wearing its powder blue throwback uniforms on the road for the second straight day, was knocked out in the Division Series for the third straight season while the defending World Series champion Dodgers reached the LCS for the eighth time in 13 years.

Dodgers rookie Roki Sasaki, averaging 99.5 mph his his fastball, threw three innings of hitless relief, combining with Tyler Glasnow, Sheehan and winner Alex Vesia on a four-hitter.

Glasnow allowed two hits and three walks in six innings with eight of the 12 strikeouts by Dodgers pitchers.

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Politics

Starmer’s found new enthusiasm for his digital ID project – but will he be able to sell it?

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Starmer's found new enthusiasm for his digital ID project - but will he be able to sell it?

One metric for the rise and fall of this government might end up being the progress of the rollout of digital ID.

The lack of a clear plan – despite the high profile announcement by the PM – means the destination still remains slightly opaque, and some cabinet ministers are sceptical.

However, the PM’s India trip suggests that there might just be a path to success, if things fall in Keir Starmer’s favour.

During his visit, Starmer met the boss of Infosys, Nandan Nilekani, who is behind the rollout of digital ID to more than 1.4 billion Indian citizens.

Afterwards, when I asked about it at the closing press conference of the India trip, he was infused by a fresh enthusiasm for the plan, not evident at the Labour gathering in Liverpool in the days after he first unveiled it.

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Digital ID cards for everyone?

Below is what he said to me, transcribed in full.

But as you read it, notice how the PM’s explanation and justification for this scheme – which will be one of the biggest projects this government undertakes if it does happen – centres around convenience for citizens and makes no mention of the case originally used for it – to combat illegal migration.

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Starmer told me: “We did discuss [digital ID] yesterday. And in particular, the benefits that it has brought in India.

“We’ve obviously also looked at other countries – Estonia, for example. The speed with which it allows citizens here to access services, particularly financial services, is something that was recognised in our discussions yesterday and actually at the fintech discussion that we had today, as well.

“So, we’re looking at those examples of how digital ID helps individuals, with the processes that sometimes take too long and are too cumbersome, and makes it easier for them.”

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Who opposes BritCard?

The answer is clear: the prime minister now puts personal convenience as the top justification.

While Starmer was locked in the Fintech summit, we visited Mumbai University to gauge opinion on digital ID, which has rolled out across India over the past 10 to 15 years.

We asked students as they could traditionally have been thought to be one of the more cautious groups in society towards a project which involves state intrusion into the lives of individuals.

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Sky’s Sam Coates reports from India

Among all the people that we talked to – and you can watch our video at the top of this page – there was a recognition of privacy concerns, worries about data leaks, and uncertainty about how some of the information might be used.

But every single person we stopped and talked to about it was nevertheless enthusiastically in favour – and said it had made their lives simpler and more efficient.

The net benefits of this scheme had landed with the Indian citizens we spoke to.

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Is this the end of digital privacy for UK citizens, or a tech solution to illegal immigration?

The engagement from Infosys is also significant after the boss of Palantir, a rival tech company, gave the idea of a UK digital ID scheme a comprehensive shellacking last week.

For a moment, it looked like the corporate world might be pulling back from the scheme – so the engagement of a massive multinational corporation has come at just the right moment.

None of which is to downplay the obstacles.

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Who is going to implement Labour’s new policy on digital ID cards?

In a bizarre move, the Home Office appears to have been allowed to swerve responsibility for the project, which has gone instead to Liz Kendall’s Department of Science, Innovation and Technology (DSIT), which does not yet have any track record of major delivery.

One DSIT aide said that the young average age of staff at the newly formed department is an advantage, a claim which seems somewhat doubtful.

So, Whitehall may tie itself up in knots over this project. Or, it might turn out that India’s cultural norms simply make it an easier place to roll out a scheme like this.

But on the basis of our enquiries, there is the potential case for a scheme that can be sold to a willing public.

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