Last Friday was the first part of this current discussion of the ketogenic diet.  One I advocate for those folks who have ESRD (end stage renal disease), diabetes, epilepsy, and maybe even extended to those subject to Alzheimer’s.

But, as I also said, many health professionals take issue with a ketogenic diet.  They fear it leads to an explosion in cholesterol levels.  (Trust me, unless you are a ‘hyper-responder’, it really doesn’tas we discussed on Friday.) The hyper-responders do see a rise in LDL (low density lipoprotein), which is normally termed “bad cholesterol”.  [The number of hyper-responders tends to be about 4 to 5% of those on the ketogenic diet; in particular these folks are already fairly thin and relatively muscular, compared to those others adopting the diet.]  Even so, those hyper-responders and the rest of the cohort on ketogenic diet see the rest of their health markers (HDL [high density lipoprotein], tryglycerides, blood pressures, as well as insulin response) effect a shift to the “healthy portion” of the spectrum.

Maybe now it’s time to remind you of another piece of information I’ve reported on my blog.  Cholesterol is really not the particular parameter that we need to control for proper health.  It’s simply a surrogate measurement- something we can easily measure that seems to correlate with heart disease.

And, now, it’s long past time to reframe our discussion of cholesterol.  We don’t just have two different kinds of cholesterol.  Sure, we hear about  “Bad cholesterol” (LDL or low density lipoproteins) and  “good cholesterol” (HDL, high density lipoproteins) all the time.

As a matter of fact, many health care professionals have gone beyond good and bad cholesterol. Instead, they address what is called “metabolic syndrome’- a triad of maladies (type 2 diabetes, obesity, and heart disease).  Interestingly, most of these folks don’t have their arteries overloaded with fat, blocking free passage of blood through the vessels.  Instead, metabolic syndrome is probably related to insulin resistance; the body has higher standing insulin levels and fat storage, because the body simply doesn’t respond well enough to insulin any more.  Also, all those statins we take (which successfully lowers our LDL levels) don’t seem to protect against heart attacks, even though they do provide anti-inflammatory effects.

But, it’s just as likely to be something else entirely.  As I’ve discussed on this blog, Dr. Ronald Krauss (Oakland Research Institute Children’s Hospital, UCSF [University of California, San Francisco], and UCB [University of California, Berkeley]) has developed a more elaborate cholesterol model we probably should be using.  (Obviously, I am a firm believer in this model.) Krauss’ model has further characterized “bad cholesterol” (LDL) using ion mobility analysis.  He labels the four subtypes as large, medium, small, and very small.  In so doing, his theory is better able to explain why some folks with high LDL levels don’t manifest all those cardiac issues.  Because, he’s determined that it’s just the smaller, denser versions of LDL that correlate with heart disease, as opposed to all LDL (you know, the ‘bad cholesterol’) in general.

Normally, HDL (good cholesterol) has heart protective effects.  HDL binds toxic substances in our blood and helps excess cholesterol levels get excreted from the body.  (Note that such effects are NOT manifested by those folks on dialysis- whether it’s via peritoneal or hemo- dialysis.)

While I believe wholeheartedly in ketogenic diet, I must warn you that my belief is certainly NOT universal. There is conflicting evidence on the subject.  After all, there is a Joint (American College of Cardiology/American Heart Association) Report on the Prevention of Heart Disease that clearly wants folks to avoid red meat, choosing fruits, vegetables, and nuts.  (Of course, none of the trials have been effected long-term; comparing low-carbing with low-fat diets.  Or, the fact that many of us can’t stick with a low-carb diet- we miss our challa, our rice, and our noodles and cheese too much.)

There are other issues- non-medical- with ketogenic diets.   Like the fact that some 15% of all greenhouses world-wide arise from our livestock farming.  If we were to switch our diet to consist primarily (maybe even exclusively) of fruits, vegetables, whole grains, and legumes (with our protein intake derived from plant-based sources like tofu, tempeh, quinoa, etc.), we’d not only address our climate change issues- but, perhaps, improve our health.

(For what it’s worth, the Supreme Being hoped that we Jewish folks would adopt the vegan lifestyle.  But, he knew our blood lust would drive us to consume meat- so we were allowed to consume meat.  Limiting us to kosher animals would narrow our drive to kill all the animals.)

But, then again, once we perfect our ability to grow meat and fish products in the lab- the greenhouse gas issue may simply blow away. With the wind farms…

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