Naveh Nurit, Avidan Yuval, Zafrir Barak
Department of Family Medicine, Clalit Health Services, Haifa, ISR.
Cardiology, Lady Davis Carmel Medical Center, Haifa, ISR.
Cureus. 2023 Aug 18;15(8):e43683. doi: 10.7759/cureus.43683. eCollection 2023 Aug.
A high-fat, very low-carbohydrate diet, often named the "ketogenic diet," is gaining popularity, particularly among patients with obesity and metabolic syndrome seeking rapid weight loss and improvement in glycemic control. A favorable reduction in triglycerides and an increase in high-density lipoprotein-cholesterol levels is often observed in the ketogenic diet. However, people vary significantly in their low-density lipoprotein-cholesterol (LDL-C) response to the dietary change. Here, we present the case of a 38-year-old normal-weight male with average cholesterol levels showing an extreme fourfold elevation in LDL-C levels, reaching 496 mg/dL after initiating a ketogenic diet. We highlight that a dramatic elevation in LDL-C may manifest following a ketogenic diet in normal-weight people without known genetic dyslipidemias before the dietary change; therefore, increased awareness and close monitoring of blood lipid profile is essential for all individuals following a ketogenic diet. We further discuss the potential mechanisms for the "lean mass hyper-responders" phenotype which has been recently gaining recognition, and suggest that these patients may benefit from ezetimibe therapy, decreasing the absorption of intestinal cholesterol to the liver.
高脂肪、极低碳水化合物饮食，通常被称为“生酮饮食”，正越来越受欢迎，尤其是在肥胖和代谢综合征患者中，他们希望快速减重并改善血糖控制。生酮饮食通常会使甘油三酯明显降低，高密度脂蛋白胆固醇水平升高。然而，人们对饮食变化的低密度脂蛋白胆固醇（LDL-C）反应差异很大。在此，我们报告一例38岁体重正常、胆固醇水平平均的男性病例，其在开始生酮饮食后LDL-C水平极度升高四倍，达到496mg/dL。我们强调，在饮食改变前无已知遗传性血脂异常的体重正常人群中，生酮饮食后可能会出现LDL-C显著升高；因此，对于所有采用生酮饮食的个体，提高对血脂谱的认识并密切监测至关重要。我们进一步讨论了最近逐渐得到认可的“瘦体重高反应者”表型的潜在机制，并建议这些患者可能从依泽替米贝治疗中获益，该药物可减少肠道胆固醇向肝脏的吸收。
