The Ketogenic Diet: A Neurologist’s Warning

[george05]

I followed Caldwell Esselstyn's diet to the letter for 3 years. My heart disease tripled. He is not concerned with triglycerides. Mine where sky high on his diet (spoke to him on the phone many times about this). I am pretty convinced that the high trigs caused my plaques to increase rapidly, even in the absence of any fats in my diet. I am Apoe 3/4.

[NF52]

I followed Caldwell Esselstyn's diet to the letter for 3 years. My heart disease tripled. He is not concerned with triglycerides. Mine where sky high on his diet (spoke to him on the phone many times about this). I am pretty convinced that the high trigs caused my plaques to increase rapidly, even in the absence of any fats in my diet. I am Apoe 3/4.

Welcome, george05,

I am sincerely sorry to hear of the increase in heart disease you've experienced. My father (also with the wonderful name of George) experienced severe, undetected coronary artery disease. It likely was triggered by his status as presumably ApoE 3/4, worsened by the standard diet of his time and place, and eventual Type 2 diabetes, since the link between that and heart disease was as yet unknown in the 1970's and early 80's.

I'm guessing that the "tripling" is your triglycerides, since you mention that. Have you discussed with your primary care doctor or cardiologist the options for further testing to more precisely determine whether that sky-high score signals actual clinical disease.

I have a sky-high Lp(a) score and had a sky-high LDL-particle score. My doctor noted that "not every biomarker is a prediction of clinical disease and not every sign of clinical disease (ex. plaque) is a prediction of a cardiac event." And then he agreed to write a prescription for a coronary calcium scan, which cost about $150. and took less than 10 minutes. The results for me were encouraging; for a friend of mine they led to her making lifestyle changes and feeling much better about her future risk.

Your results on a diet that seems to have worked well for others (Bill Clinton?) shows what many of us have found: our bodies are enormously diverse in their physiology and often we have to work harder than others without risk factors to find what is the right fit for us as individuals.

Knowledge is power; George. I continue to be glad that I know of my own cardiac genetic risk so that I can try to make choices that work for me. I may not be able to control the outcome, but I can try to chart a course that doesn't lead me through the rapids--even if other people fly through them safely.

[george05]

Not exactly. It was my heart calcium score that tripled on the Esselstyn diet. It started at a 600 and increased to over 1800 while being vegan with no oils. The triglycerides remained in the upper 200’s to 300’s during that time. My triglycerides are now under 50 with no grains and niacin.

[Melanie R.]

Hello George,

I wanted to jump in and give you a warm welcome to the site. I hope you find what you are looking for here.

I'd love to point you to a few helpful resources:

The Wiki is a valuable tool for navigating the site, along with the Primer written my Dr. Stavia, a member, in layman's terms. It's an introduction to ApoE4, biochemistry, and possible prevention strategies.

We're happy to have you join us. If you're comfortable, feel free to introduce yourself here.

Warmest regards,
Melanie

[Julie G]

Not exactly. It was my heart calcium score that tripled on the Esselstyn diet. It started at a 600 and increased to over 1800 while being vegan with no oils. The triglycerides remained in the upper 200’s to 300’s during that time. My triglycerides are now under 50 with no grains and niacin.

Very powerful information, George. I’m sorry that your calcium scored dramatically worsened while using this approach. I’m curious if you’ve re-tested now that you’ve found a path that seems to be working? Also, given your results, to what do you owe the presumed success of Esselstyn and others, like Ornish? Do you think that they’re just not checking the correct biomarkers?

[Tincup]

Also, given your results, to what do you owe the presumed success of Esselstyn and others, like Ornish? Do you think that they’re just not checking the correct biomarkers?

I followed Ornish's program from 1990 to about 2007. I have his book, but Tg & HDL aren't in the index and I can't find them on a quick look through the book. I recall from reading nearly 30 years ago that he noted that HDL was low on his program and Tg's increased. I don't recall his Tg explanation, but the HDL explanation is that it didn't need to be high on his program. For me Tg & HDL were reasonable (both around 50 mg/dL), however when I purchased my first glucometer in 2006, I did an oral glucose tolerance test that (with what I know now) indicated insulin resistance and hyperinsulinemia. Joseph Kraft would not have been happy with my insulin response.

[Tincup]

Also, given your results, to what do you owe the presumed success of Esselstyn and others, like Ornish? Do you think that they’re just not checking the correct biomarkers?

I followed Ornish's program from 1990 to about 2007. I have his book, but Tg & HDL aren't in the index and I can't find them on a quick look through the book. I recall from reading nearly 30 years ago that he noted that HDL was low on his program and Tg's increased. I don't recall his Tg explanation, but the HDL explanation is that it didn't need to be high on his program. For me Tg & HDL were reasonable (both around 50 mg/dL), however when I purchased my first glucometer in 2006, I did an oral glucose tolerance test that (with what I know now) indicated insulin resistance and hyperinsulinemia. Joseph Kraft would not have been happy with my insulin response. I was also very fit during this time.

{edit} Found the quote from Ornish's book, p269 of the hardback. "In our research, for example, we found that triglycerides often increased, sometimes substantially, and that HDL sometimes decreased in people who were on the Reversal Diet." I'm not slamming Ornish's program - any non-SAD diet should have benefits. In addition to his low fat, high carb, whole foods vegan diet, it has exercise, meditation, yoga and group interaction. He also says, on p 277, "Better to eat sugar than fat, but only in limited quantities.

[Julie G]

I followed Ornish's program from 1990 to about 2007. I have his book, but Tg & HDL aren't in the index and I can't find them on a quick look through the book. I recall from reading nearly 30 years ago that he noted that HDL was low on his program and Tg's increased.

Very telling. It's easy to claim success when you use change the goal post, i.e. use alternative biomarkers. Correct me if I'm wrong, but I recall Peter Attia also being pretty dismissive of both HDL and TGs in terms of optimizing lipids. Both, high for the first and low for the latter, appear to be important and protective for our genotype. I recall his justification for HDL was that pharmaceutically raising it didn't protect against heart disease, so what's the point? IMHO, that's a pretty weak argument with the body of evidence demonstrating that high functional non-pharmaceutically induced HDL is protective.

[Tincup]

I recall his justification for HDL was that pharmaceutically raising it didn't protect against heart disease, so what's the point? IMHO, that's a pretty weak argument with the body of evidence demonstrating that high functional non-pharmaceutically induced HDL is protective.

My understanding is that there are some cases where high natural HDL is not high functional. I think there are some advanced lipid tests that can look for this, but I haven't paid attention to the specifics as I'm not in that category (high HDL). May have been in an Attia podcast, either Dayspring or Weiss, don't remember exactly.

[Julie G]

My understanding is that there are some cases where high natural HDL is not high functional. I think there are some advanced lipid tests that can look for this, but I haven't paid attention to the specifics as I'm not in that category (high HDL). May have been in an Attia podcast, either Dayspring or Weiss, don't remember exactly.

Yes, I'm aware which is why I included "functional" as a descriptor in my post. I seem to recall this is genetic and pretty rare. According to Attia and Dayspring, there is no agreed upon testing that determines HDL functionality. In terms of assessing my own HDL, I think it makes sense to assess the downstream effects of the known functions of HDL (like reverse cholesterol transport and the antioxidant properties) to roughly determine functionality. In other words, if your LDL-C (and more importantly LDL-P) are decent and your oxLDL is low, it's probably doing it's job. All that said, I still find it stunning that Attia doesn't recognize the benefits of naturally high functional HDL.