Stethoscope listening to a heartbeat

Is the ketogenic diet safe for the heart?

Stethoscope listening to a heartbeat

I was asked the other day whether or not eating a low carbohydrate, high fat diet such as a ketogenic diet would be safe for the heart. My answer was YES. However, honestly, up until about two years ago this would not have been my answer.

I remember about 15 years ago when the Adkins diet was a popular diet. Some of my family and friends were on this diet and had great results with it. I however, gave them a hard time, ‘yes you will lose weight but you will die from a heart attack’.

The theory was that eating all that saturated fat would increase cholesterol levels, which would increase the risk for atherosclerosis or clogging of the arteries and then heart attacks. We have since learned that this is not true. As I discussed in another blog, it was shown that people who switched from eating saturated fat to vegetable oils, which at the time was thought to be the healthier type of fat, actually had an HIGHER risk of heart attacks and death. (Ramsden 2016) (Ramsden 2013)

Those studies however, just looked at changing the types of fat that were eaten, i.e. stopping saturated fats and start using vegetable oils, not increasing the amount of fats in the diet. So what happens to cardiac risk factors (obesity, specifically waist circumference, hypertension, diabetes, high triglycerides and high systemic inflammatory markers such as CRP) when start eating more fats and fewer carbohydrates as in low carbohydrates diet? Several studies, which were recently published, answered just that question.

The first was a study published in the journal Obesity Reviews in 2012. This study reviewed 23 studies with a total of 1,141 obese patients eating a low carbohydrate diet for weight loss. They found improvement of all major cardiovascular risk factors associated with eating a low carbohydrate diet.   Specifically, the study found a significant decreased in weight, body mass index and abdominal circumference. Systolic and diastolic blood pressures were also decreased.   Markers for diabetes were improved including, fasting plasma glucose levels, gylcated hemoglobin (HgA1c) and insulin levels. Cholesterol levels were also improved; with lower levels of triglycerides and increased levels of HDL. Lastly the marker of inflammatory, CRP levels, were also improved (Santos, 2012)

Another study looked at very low carbohydrate or ketogenic diet specifically. This study reviewed a total of 13 studies, in which a total 1577 individuals were randomized to either very low carbohydrate diet or a low fat diet. The very low carbohydrate diet group had significantly greater weight loss, improvement of diastolic blood pressures, lower triglycerides and higher HDL levels. Fasting blood glucose, insulin levels, HgA1c and CRP all showed improvement in favor of the very low carbohydrate group compared to low fat groups. (Bueno, 2013)

The LDL levels in the very low carbohydrate group were increased, as expected from eating more saturated fats. However, as discussed in a prior post, it is not the LDL particle itself that is the problem: instead, it is the size of the particle that matters. There are actually two different types of LDL based on size. There is small and large size LDL. The small LDL particles are the ones that are believed to be harmful, or more prone to cause the clogging of the arteries that is of clinical concern. When LDL is exposed to high carbohydrates and high triglycerides, it is more likely to become oxidized or damaged, making the LDL a small dense particle. Whereas, it has been shown the type of LDL particles that are elevated when the diet contains a higher saturated fat (not the inflammatory vegetable oils) combined with carbohydrate restriction, are the larger sized LDL particles, which are the less artherogenic than the small dense LDL. (Krauss, 2006)

Then lastly, a study published in the journal Circulation, used carotid ultrasound as a way to measure atherosclerosis. The participants were randomized into a low fat diet, a Mediterranean type diet or a low carbohydrate diet. After 2 years of dietary intervention, they found that all 3 groups had a significant regression of the atherosclerosis plaques. This suggested that the low carbohydrate diet is at least as effective as the other diets in showing regression. The study did not have the power to show differences between the groups, but there was a slight trend for the greatest improvement seen in the low carbohydrate diet. (Shai, 2010)   Thus, based on this study eating a low carbohydrate diet does not increase risk of atherosclerosis disease; instead it may actually decrease it.

So yes I have to apologize to my friends and family who were ahead of the game. They were right all along. Based on these studies and others, I now come to realize that going on a low carbohydrate, high fat diet such as ketogenic diet is indeed safe for the heart. Not only may the ketogenic diet help you lose weight, it may also improve your cardiovascular risk factors and does not increase your risk of atherosclerosis.

Need help with a ketogenic diet? First step is filling out this form and then I will be happy to help.

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Bibliography

Bueno, N. B. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition (110), 1178-1187.
Krauss, R. (2006). Seperate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. American Journal of Clinical Nutrition (83), 1025-1031.
Ramsden, C. E. (2016). Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from the Minnesota Coronary Experiment (1968-73). British Medical Journal, 353, 1-17.
Ramsden, C. E. (2013). Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. British Medical Journal, 346, 1-18
Santos, F. (2012). Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity Reviews, 13, 1048-1066.
Shai, I. (2010). Dietary Intervention to Reverse Carotid Atherosclerosis. Circulation, 121, 1200-1208.
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Obesity increases risk of migraines

Yes, being obese can actually increase your risk of having more migraines headaches!

Obesity affects one and a half billion adults worldwide, with estimates of a third of adults in United States being obese. Obesity is associated with many health issues including heart disease, stroke, diabetes, and cancer, making obesity is a significant health problem.  Obesity also has a negative effect on quality of life due to increased back and joint pain. What may be surprising to some people is the fact that obesity is also associated with an increased risk of migraine headaches.

Studies have shown obesity is a strong risk factor for having migraines. Being overweight or obese is associated with a two-fold increased risk of having migraines. As the BMI increases so does the risk of having migraine headaches. Additionally, obesity is also associated with having greater than five times the risk of developing chronic migraines. By definition, a chronic headache is having >15 migraines a month, which are typically more difficult to treat.

The fact that obesity increases the risk of both chronic and episodic migraines has been shown in multiple studies.   The first was in 2003 by a study by Ann Scher.  This study showed that not only that the risk of having migraines increased with obesity, but also that compared to those with normal weight, individuals with episodic headaches who also had obesity at baseline were at increased odds of developing chronic migraine at follow up. These results have since been confirmed in several other studies.

What is the mechanism?

The cause of increased migraine in obesity is not exactly known, but most likely it is related to the pro-inflammatory properties of adipose tissue. Adipose tissue is more than just fat that piles up where we don’t want it; it is also a functioning active endocrine organ. Adipose tissue produces and releases pro-inflammatory cytokines including tumor necrosis factor and interleukin-1. Additionally, several hypothalamic peptides adiponectin and orexin, typically felt to be anti- inflammatory, are low in people who are obese.   This increased systemic inflammation has been implicated in the pathogenesis of migraine headaches.  Increased inflammation also is associated with increased central sensitization, which then lead to more frequent and harder to treat migraines.

Can weight loss help prevent migraines?

Currently the only studies on the effects of weight loss in adults were in people who underwent surgical treatment for weight loss. The two small clinical studies that looked at headache frequency after weight loss from bariatric surgery, found that at 6 months after surgery the frequency of migraine did indeed decrease from a pre-surgery average of four per month down to 1-2 per month. There was also an improvement in headache duration, pain severity, disability, and use of pain medications.

The only study looking at non-surgical intervention for weight loss to date was in adolescents. This study looked at whether a behavioral weight loss intervention would reduce migraine frequency. The behavior intervention consisted of encouragement of exercise program and dietary education of the adolescent and their parents. This study showed that a decrease in BMI was associated with a reduction in migraine frequency. With the greater decrease in BMI was a greater decrease in migraine frequency.

How can weight loss cause an improvement in migraine headaches?

Just as obesity is associated with pro-inflammation, weight loss is anti-inflammatory. Weight loss decreases pro-inflammatory cytokines (TNF and IL-1) and the peptides leptin.   Weight loss also increases anti-inflammatory peptides; Orexin A, and adiponectin. Thus with weight loss, there is less neurogenic inflammation resulting in less frequent migraines but also less central sensitization and decreased severity of those migraines.

Additionally, there are also the benefits of physical activity on prevention of migraines. Several studies have been published that have reported beneficial effects on both migraine frequency and severity. Also a study showed that exercise might be just as beneficial as topiramate in the prevention of migraines. Exercise is also felt to be anti-inflammatory and also increases the feel good, pain-reducing chemicals in your brain. In addition, people who exercise, tend to eat better, sleep better and have less stress which all can also decrease migraines.

WHY NOT GIVE IT A TRY?

Given that there is proven benefits seen with both exercise and weight loss in improvement in both frequency and severity of migraines, what is stopping you from giving it a try. I would love to help find an exercise and weight loss program that is right for you.

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Bibliography:

Evan, R. W. (2012, February). The Association of Obesity with Episodic and Chronic Migraine. Headache .

Lockett, D. C. (1992). The effects of aerobic exercise on migraine. Headache, 32 (1), 50-54.

Peterlin BL, R. A. (2010). Migraine and obesity: Epidemiology, mechanisms, and implications. Headache, 50, 631-648.

Varkey, E. e. (2011). Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls. Cephalalgia, 31 (4), 1428-1438.

Verrotti, A. e. (2013). Impact of a weight loss program on migraine in obese adolescents. Euroean Journal of Neurology (20), 394-397.