Thread by @NTFabiano

Daily Oreos lowered LDL cholesterol more than high-intensity statin therapy.

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These findings are from a single subject crossover experiment in @MetabolitesMDPI which tested the hypothesis that adding carbohydrates to a Lean Mass Hyper-Responder (LMHR) on a ketogenic diet would reduce LDL-C levels similar to statin therapy. 2/12 mdpi.com/2218-1989/14/1…

Recent research has identified a unique population of LMHRs who exhibit increases in LDL cholesterol (LDL-C) in response to carbohydrate-restricted diets to levels ≥ 200 mg/dL, in association with HDL cholesterol ≥ 80 mg/dL and triglycerides ≤ 70 mg/dL. 3/12

This triad of markers occurs primarily in lean metabolically healthy subjects, with the magnitude of increase in LDL-C inversely associated with body mass index. 4/12

The lipid energy model has been proposed as one explanation for LMHR phenotype and posits that there is increased export and subsequent turnover of VLDL to LDL particles to meet systemic energy needs in the setting of hepatic glycogen depletion and low body fat. 5/12

The study was designed as follows: after a 2-week run-in period on a standardized ketogenic diet, study arm 1 consisted of supplementation with 12 regular Oreo cookies, providing 100 g/d of additional carbohydrates for 16 days. 6/12

Throughout this arm, ketosis was monitored and maintained at levels similar to the subject’s standard ketogenic diet using supplemental exogenous d-β-hydroxybutyrate supplementation four times daily. 7/12

Following the discontinuation of Oreo supplementation, the subject maintained a stable ketogenic diet for 3 months and documented a return to baseline weight and hypercholesterolemic status. 8/12

During study arm 2, the subject received rosuvastatin 20 mg daily for 6 weeks. 9/12

Lipid panels were drawn water-only fasted and weekly throughout the study: baseline LDL-C was 384 mg/dL and reduced to 111 mg/dL (71% reduction) after Oreo supplementation. 10/12

Following the washout period, LDL-C returned to 421 mg/dL, and was reduced to a nadir of 284 mg/dL with 20 mg rosuvastatin therapy (32.5% reduction). 11/12

Overall, short-term Oreo supplementation lowered LDL-C more than 6 weeks of high-intensity statin therapy in an LMHR subject on a ketogenic diet. 12/12