Impact of A Two-Year Trial of Nutritional Ketosis on Indices of Cardiovascular Disease Risk in Patients With Type 2 Diabetes

Abstract

Background: We have previously reported that in patients with type 2 diabetes (T2D) consumption of a very low carbohydrate diet capable of inducing nutritional ketosis over two years (continuous care intervention, CCI) resulted in improved body weight, glycemic control, and multiple risk factors for cardiovascular disease (CVD) with the exception of an increase in low density lipoprotein cholesterol (LDL-C). In the present study, we report the impact of this intervention on markers of risk for atherosclerotic cardiovascular disease (CVD), with a focus on lipoprotein subfraction particle concentrations as well as carotid-artery intima-media thickness (CIMT). Methods: Analyses were performed in patients with T2D who completed 2 yrs of this study (CCI; n=194; usual care (UC): n=68). Lipoprotein subfraction particle concentrations were measured by ion mobility at baseline, 1, and 2 yrs and CIMT was measured at baseline and 2 yrs. Principal component analysis (PCA) was used to assess changes in independent clusters of lipoprotein particles.Results: At two years, CCI resulted in a 23% decrease of small LDL IIIb and a 29% increase of large LDL I with no change in total LDL particle concentration or ApoB. The change in proportion of smaller and larger LDL was reflected by reversal of the small LDL subclass phenotype B in a high proportion of CCI participants (48.1%) and a shift in the PC representing the atherogenic lipoprotein phenotype characteristic of T2D from a major to a secondary component of the total variance. The increase in LDL-C in the CCI group was mainly attributed to larger cholesterol-enriched LDL particles. CIMT showed no change in either the CCI or UC group.Conclusion: Consumption of a very low carbohydrate diet with nutritional ketosis for 2 yrs in patients with type 2 diabetes lowered levels of small LDL particles that are commonly increased in diabetic dyslipidemia and are a marker for heightened CVD risk. A corresponding increase in concentrations of larger LDL particles was responsible for higher levels of plasma LDL-C. The lack of increase in total LDL particles, ApoB, and in progression of CIMT, provide supporting evidence that this dietary intervention did not adversely affect risk of CVD.

Low-Carb-Diäten – die unvoreingenommene und evidenzbasierte Betrachtung ist überfällig

“…Der in der Aktuellen Ernährungsmedizin im März 2021 (Aktuel Ernahrungsmed 2021; 46: 246–254) abgedruckte Übersichtsartikel „Prävention nicht übertragbarer Erkrankungen durch ,gesunde‘ Ernährung“ von Anja Bosy-Westphal und Manfred Müller 5 beschreibt im Abschnitt zu „Low Carb-Diät (26–45 % Kohlenhydrate [KH]) und Extremely Low Carb-Diät oder ketogene Diät (< 26 % KH)“ (S. 250–251) ausschließlich mögliche negative Mechanismen und unerwünschte Nebenwirkungen streng ketogener Diäten. Hingegen werden die zahlreichen gesundheitlich positiv bewerteten Mechanismen und Effekte 6 7 8 9 10 kaum berücksichtigt. Wir freuen uns, dass sich die Aktuelle Ernährungsmedizin für die kontroverse Diskussion entschieden hat und ergreifen hiermit die Chance, einige Punkte aufzugreifen, um Lücken in der Darstellung zu schließen.…”

Correction to: Impact of a 2‑year trial of nutritional ketosis on indices of cardiovascular disease risk in patients with type 2 diabetes

“…Following publication of the original article [ 1 ], the author noticed an error in the last sentence of "Lipid analyses" under Methods section. The last sentence should read, “ApoB: ApoA1 ratios were computed.…”