Thread by @nicknorwitz

Colleague and I had this RCT thrown in our face bc suggested a #ketogenicdiet option. Arguement was this RCT shows LCHF ⬆️LDL, therefore bad. Here's a thread about what I think...
(Spoiler, LCHF = good)...

1/ The LDL increase in the LCHF group may not itself be an adverse outcome. There was no subfractionation and it’s likely the increase in LDL and ApoB was driven by large fluffy healthy LDL particles. This assumption is supported an improvement in HDL levels in the LCHF group.

2/ HDL increased on the LCHF group, not the control group. When HDL is high and triglycerides are low, CVD risk is not meaningfully increased. See figure attached from Framingham. Furthermore, HDL (and waist circumference, below) are markers of metabolic syndrome. LDL is not.

3/ Waist circumference significantly decreased in the LCHF group, whereas WC trended upward in the control group! Waist circumference is a good proxy for visceral fat, the most inflammatory and metabolically damaging type of fat.

4/ The short-term (3 week) nature of study explains the increase in uric acid, as the kidneys take about 12 weeks to adapt to organic acid competition at the kidney. Further, the makes it difficult (impossible) to draw conclusions about the final metabolic homeostasis.

5/ study design overall questionable. “The diet itself was self-selected, thus the type of fat was optional” & insulinogenic sweeteners, processed veg oil, alcohol permitted. Good chance the participants’ diets were suboptimal. We need more infoon properly formulated LCHF diets.