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by carbohydrate restriction. The atherosclerosis-inducing small,
dense LDL particles tend to decrease with carb restriction, while
the less dangerous large LDL particles are in greater amount. So a
patient whose LDL goes from 110 to 120 while on a low carb diet
might have less chance of MI due to a decrease in small LDL. More
information will be elucidated in future studies, but the LDL increase
as Kryptonite for the very low carb diet may be unfounded.
On to what really matters to health care professionals: cardiovascular risk and mortality. This is where my self-satisfaction with my
own change in lifestyle began to waver. The biggest blow is the Jan
2013 meta-analysis by Noto et al. In this review of albeit limited
observational studies, the authors conclude “low-carbohydrate
diets were associated with a significantly higher risk of all-cause
mortality.” Moreover, low carb diets apparently had no positive or
negative effect on cardiovascular disease incidence and mortality.
Most of the remaining literature comments on effects of carbohydrate restriction on cardiovascular risk factors, surrogate markers
rather than events and mortality. We cannot ignore that the most
common cause of death in our patients is cardiovascular - and
diabetes, hypertension and lipids appear to contribute.
It is up to us as health care providers to synthesize the data, be it
from popular science books, talk show guests, scientific literature,
and our own experience. We are in a position to appreciate the
diversity of patient response to dietary measures. I believe we cannot blindly accept government agency recommendations for large
quantities of healthy whole grains and we should not propagate the
fear of dietary fat present in America for decades.
We also want happy patients. Dr. Mary Barry recommends that her
patients have only one flour food a day. In my snapshot encounters
with emergency department patients, I encourage a low carb approach and point out the processing perversion of our food by the
industry. The key to success for our patients seems to be adapting a
lifestyle, rather than a diet. And of course - we must predict which
50% of all of these data will be proven wrong in the next 50 years.
References
Lieberman, Daniel. The Story of the Human Body: Evolution, Health,
and Disease. Random House 2013.
Taubes, Gary. Why We Get Fat: And What to do About It. Random House
2010.
Davis, William MD. Wheat Belly: Lose the Wheat, Lose the Weight, and
Find Your Path Back To Health. Rodale Books. 2011.
Phinney, Stephen, Volek, Jeff. The Art and Science of Low Carbohydrate
Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable. Beyond Obesity. 2011.
Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC. Comparison of the Atkins, Zone, Ornish, and LEARN
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