They Help in Cholesterol

FAD Diets: Will They Help in Cholesterol
Management?
LAURA T. ACAMPADO, MD, FPCP, FPSEDM

Associate Professor, UP College of Medicine
Chief, Section of Endocrinology, Diabetes and Metabolism, UP-PGH
DISCLOSURES
 No conflict of interest
 Have not tried the Ketogenic Diet and Intermittent Fasting
OUTLINE
I. Introduction
II. Mechanism of Action of Ketogenic Diet and Intermittent Fasting
III. Clinical Effects of Intermittent Fasting
IV. Clinical Effects of Ketogenic Diet
V. Ketogenic Diet and Intermittent Fasting and Lipids
VI. Conclusion
DEFINITIONS
 FAD DIET: diet plan where one eats a restrictive amount of food or an unusual
combination of food for a short period of time to lose weight very quickly
 KETOGENIC DIET: characterized by a reduction in carbohydrates (usually
less than 50 g/day) and a relative increase in the proportions of proteins and
fats
 INTERMITTENT FASTING: diet regimen that cycles between brief periods of
fasting, with either no food or significant calorie reduction, and periods of
unrestricted eating
British Diabetic Association, 2014

Kosinski, Christophe, and François R. Jornayvaz. "Effects of ketogenic diets on cardiovascular risk factors: evidence from animal and human studies." Nutrients 9.5 (2017): 517.
Harvard School of Public Health, 2018
FAD DIETS
Example Description Dietary Concerns

Paleo Diet o Restricts consumption of grains, o Lacks good sources of fiber,
legumes, dairy products, refined vitamins, protein, calcium and
sugar and other highly processed other nutrients
foods
Atkins Diet o Involves four phases of low- o Lower fiber intake
carbohydrate intake o The high intake of saturated fat
South Beach o Based on food’s glycemic index o Nausea, headache, mental fatigue,
Diet bad breath, and sometimes
dehydration and dizziness
Mayo Clinic, 2017

6
KETOGENIC DIET
 Started with Atkin’s diet in the 1970s

 Low carbohydrates, high in fat and/or protein (in practice CHO <50 g/day)
Regular Diet vs Ketogenic Diet
 Goal is to mimic fasting resulting in ketosis
 3 variations: MCT diet, Modified Atkin’s
(VLCD), low GI
www.healthline.com
KD: EXAMPLES OF FAT SOURCES
3 tbsp butter (45 g) 2 tbsp cream cheese 1/3 cup oil (80 g) 1 pc chicken egg (6 g)
(30 g)
1 pc avocado (10 g) 2 pcs chicharon (5 g) 5 strips bacon (25 g)

KD: FOOD TO LIMIT OR AVOID
 Grains & products made from grains

 Legumes and Beans
 Starchy vegetables & tubers
 High carb fruits
 Low-fat dairy products
 Refined fats and oils
 Sugar
 Alcohol
KD: FOOD ALLOWED
 Beef, Pork, Poultry, Fish

 Cheeses, Avocados, Olive Oil, Coconut Oil
 Non-Starchy Vegetables: salad greens, green beans,
kale, broccoli
 HIGHLY RESTRICTIVE
 High fat content can be luscious & satisfying but if
successful, ketogenesis is typically anorexogenic
INTERMITTENT FASTING
TYPES OF FASTING
• INTERMITTENT FASTING (IF): fasting for varying periods of time, typically for 12 h or longer
• CALORIC RESTRICTION (CR): continuous reduction in caloric intake without malnutrition
• TIME-RESTRICTED FEEDING (TRF): restricting food intake to specific time periods of the day,
typically bet 8 and 12 h each day
• ALTERNATE-DAY FASTING (ADF): consuming no calories on fasting days & alternating fasting
days with a day of unrestricted food intake, or a "feast" day
• ALTERNATE-DAY MODIFIED FASTING (ADMF): consuming less than 25% of baseline energy
needs on "fasting" days, alternated with a day of unrestricted food intake, or a " feast" day
• PERIODIC FASTING (PF): fasting only 1-2 days/week and consuming AD Librium on 5-6
days/week
Anton, Stephen D., et al. "Flipping the metabolic switch: understanding and applying the health benefits of fasting." Obesity 26.2 (2018): 254-268.
Mattson, Mark P., et al. "Meal frequency and timing in health and disease." Proceedings of the National Academy of Sciences 111.47 (2014): 16647-16653.
 An interventional strategy consisting of abstinence from food (and even

caloric beverages) for varying periods of time
 Also called Intermittent Energy Restriction (IER), which involves short
periods of substantial (>70%) energy restriction (ER) interspersed with
normal eating
 Versus CER (complete energy restriction)
Azevedo, Ikeoka, Caramelli. Rev Assoc Med Bras. 2013;5 9(2):167–173;

Antoni R, Johnsons KL, Collins AL and Robertson D. British Journal of Nutrition (2018), 119, 507–516.
PATTERNS OF DAILY AND WEEKLY FOOD CONSUMPTION
HISTORY OF KETOGENIC DIET AND
HISTORICAL PERSPECTIVES
 Fasting has been used both as a religious & a medical practice throughout human history.
 Medical uses of fasting have been noted since the time of ancient Chinese, Greek &
Roman physicians.
 Initial studies as early as 1914 reported on the use of fasting for the treatment of both
Type1 & Type 2 diabetes.
 Subsequently, numerous studies suggested the use of fasting as treatment of Type 2
diabetes.
 Resurgence of fad diets in the last decade with the availability of short-term fasting &
animal studies
HISTORY OF KETOTHERAPEUTICS
 Ancient Greece: earliest writings on epilepsy were collected in “On the

Sacred Disease”-part of the Hippocratic collection of works
 Due to fears of demonic forces, society ostracized community members that suffered from
fits (epileptic seizures). Forced to fend for their meals in the wilderness, and being
unequipped to accomplish this task, these persons would struggle to obtain adequate caloric
intake. Interestingly, after undergoing forced prolonged fasts they experienced reduced
seizure frequency and severity.
 1911: Fasting therapies were formally used for the treatment of epilepsy by
the French physicians Guelpa and Marie
Temkin,1994
Wheless, James W. "History of the ketogenic diet." Epilepsia49 (2008): 3-5.
HISTORY OF KETOTHERAPEUTICS
 Fell out of favor with the availability of effective anti-seizure medications, but
interest returned in 2008 with the RCTs on treatment-resistant seizures (seizure
reduction rates as high as 85%)
 KD enjoyed a resurgence in popularity following release of a made-for-TV movie,
First Do No Harm, in 1997 and US media coverage on a television news program,
Dateline in 2000
 MOA: Ketones enhance the production of ATP following their entry into the TCA
cycle enhancing KATP channel opening in neurons
MECHANISM OF ACTION OF KETOGENIC
DIET AND INTERMITTENT FASTING
MECHANISM OF ACTION: INDUCTION OF KETOGENESIS
 Glucose: primary energy source for most tissues.

 Fatty acids (FA): alternative fuel source for the most metabolically active
organs (muscle, liver, brain) & rise overnight during fasting
 Randle (1963): theory of energy metabolism during feeding & fasting
known as the “glucose-fatty acid cycle” whereby glucose & FA compete for
oxidation
 Fed-fast cycle has 4 stages: the fed state, the post- absorptive or early
fasting state, the fasting state, and the starvation or long-term fast state
Stockman, Mary-Catherine, et al. "Intermittent Fasting: Is the Wait Worth the Weight?." Current obesity reports 7 (2018): 172-185.
 METABOLIC SWITCH: the body’s preferential shift from utilization of glucose

from glycogenolysis to fatty acids and fatty acid derived ketones
 KETONES: preferred fuel for the brain & the body during periods of fasting &
extended exercise
 Shift from LIPID SYNTHESIS & FAT STORAGE to MOBILIZATION of fat in the
form of FFA & KETONES
 Ketogenesis can be achieved through caloric restriction (fasting), administering
medium chain triglycerides (MCT), strenuous exercise, and ketogenic diets (KD)
 WHEN? Switch occurs in the 3rd phase of fasting (liver glycogen stores are
depleted & adipose tissue lipolysis is accelerated)
 between12-36 HOURS AFTER CESSATION OF FOOD CONSUMPTION
 dependent on liver glycogen content upon fasting & the individual's energy
expenditure and physical activity during the fast
FED-FAST
CYCLE
PROFILES OF GLUCOSE & KETONE LEVELS WITH
DIFFERENT EATING & FASTING PATTERNS
KETONES IN METABOLIC SWITCH
 KETONES: “superfuels” because they produce more Adenosine

Triphosphate than glucose or fatty acids
 100 g of acetoacetate generates 9.4 kg of ATP
 100 g of B-hydroxybutrate generates 10.5 kg of ATP
 100 g of glucose can generate 8.7 kg of ATP
 Allow the body to maintain efficient fuel production in the face of calorie
loss
KETOGENIC DIET: REDUCED DIETARY CARBOHYDRATES LEADS TO
INCREASED KETONE BODY PRODUCTION IN THE LIVER
Paoli, Antonio, et al. "Ketosis, ketogenic diet and food intake control: a complex relationship." Frontiers in psychology 6 (2015): 27.
METABOLIC
SWITCH
MECHANISM OF ACTION FOR WEIGHT LOSS IN KD
1. Reduction in appetite due to higher satiety effect of proteins, effects on appetite

control hormones & possible direct appetite suppressant action of the ketone bodies
 High protein content, ketone bodies, ghrelin and leptin contribute to the satiety effect & decrease
appetite effect of KD
2. Reduction in lipogenesis and increased lipolysis

 Mediated by the reduction in insulin and increase in glucagon
3. Increased metabolic costs of gluconeogenesis and the thermic effect of proteins:

energy cost has been calculated at ~400–600 Kcal/day
Paoli, Antonio, et al. "Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets." European journal of clinical nutrition 67.8 (2013): 789.
MECHANISM OF ACTION FOR WEIGHT LOSS IN KD
4. Greater metabolic efficiency in consuming fats with reduction in the resting respiratory
quotient (RQ)
 RQ can be used as an indicator of over or underfeeding
 Underfeeding, which forces the body to utilize fat stores, will lower the RQ while overfeeding, w/c causes
lipogenesis, will increase it
 Underfeeding: RQ <0.85; Overfeeding: RQ >1.0
 RQ of 0.7 means that fats or lipids are more metabolized
Paoli, Antonio, et al. "Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets." European journal of clinical nutrition 67.8 (2013): 789.
CLINICAL EFFECTS OF
LIPIDS
FUNCTIONAL EFFECTS & RESPONSES OF VARIOUS
ORGANS TO INTERMITTENT FASTING
CLINICAL DATA
SYSTEMATIC REVIEW
Harris, Leanne, et al. "Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis." JBI database of systematic reviews and implementation reports 16.2
(2018): 507-547.
P • Overweight or obese (BMI ≥25 kg/m) adults (≥18 years)
STUDY • The types of studies included were randomized and pseudo-
randomized controlled trials.
OVERVIEW
I • Intermittent energy restriction (IER) was defined as consumption of
<800 kcal on at least one day, but no more than six days per week.
• IER interventions were compared to no treatment (ad libitum diet)
or usual care (continuous energy restriction of approx. 25% of
recommended energy intake)
O • Primary outcome was change in body weight

• Secondary outcomes: anthropometric outcomes (change in BMI,
waist circumference, fat mass, fat free mass); cardio-metabolic
outcomes (change in blood glucose and insulin, lipoprotein profiles &
blood pressure)
M • Systematic review and meta-analysis

Harris, Leanne, et al. "Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis." JBI database of systematic reviews and implementation
reports 16.2 (2018): 507-547.
STUDY OVERVIEW
 6 studies included in the review (N=386)

 The intermittent energy restriction (IER) regimens varied across studies &
included ADF, fasting for two days, and up to 4 days per week.
 Duration of studies: range of 3 to 12 months
 4 studies included continuous energy restriction as a comparator
intervention & two studies included a no treatment control intervention.
reports 16.2 (2018): 507-547.
RESULTS
 IER: more effective than no treatment for weight loss (4.14 kg; 95% CI 6.30
kg to 1.99 kg; p 0.001)
 IER vs CER achieved similar changes in body weight (approximately 7 kg)
 Pooled estimate for studies that investigated the effect of intermittent
fasting in comparison to daily fasting revealed no significant difference in
weight loss (1.03 kg; 95% CI 2.46 kg to 0.40 kg; p.0.156).
reports 16.2 (2018): 507-547.
RESULTS
 No significant between group differences for total cholesterol, LDL & HDL
cholesterol or TGs for the IER intervention versus no treatment
 No significant effect of IER in comparison to no treatment in changing
either systolic or diastolic blood pressure measurement
reports 16.2 (2018): 507-547.
INTERMITTENT FASTING FOR INDIVIDUALS WITH T2DM
 There is NO evidence for the use of IF among individuals with diabetes.

THERE ARE NO RCTs.
 Only small RCTs that included subpopulations of obese individuals with
prediabetes
 At best may be recommended for obese individuals with pre-diabetes for
whom there is some evidence of benefit for weight loss, decreased visceral
fat, decreased plasma insulin levels, and improvements in measures of
insulin resistance.
CONCLUSIONS
 Clinical research studies of (intermittent) fasting with robust designs and

high levels of clinical evidence are sparse in the literature.
 Whereas the few RCTs and observational clinical outcomes studies
support the existence of a health benefit from fasting, substantial further
research in humans is needed before the use of fasting as a health
intervention can be recommended.
Mechanism of
Action
Cardiometabolic
Risk Factors
Cardiometabolic
Outcomes
Rona Antoni, Kelly L. Johnston, Adam L. Collins and M. Denise Robertson (2014), "The Effects of Intermittent Energy Restriction on Indices of Cardiometabolic Health," Research in Endocrinology, Vol. 2014 (2014), Article ID 459119
ADVERSE REACTIONS
 No serious adverse events were reported.

 Headaches, reduced energy levels, feeling cold, constipation
 Light headiness & bad breath were reported on IER days for 3% and 8% of
participants, respectively.
 Psychological effects in both interventions included a lack of concentration,
pre-occupation with food, and mood swings (IER: range 3–15%;CER: range
3–7%).
 Adverse events were not reported in studies utilizing a no treatment
control intervention.
AVOID INTERMITTENT FASTING
 Among individuals at risk for hypoglycemia i.e. elderly, renal or liver

dysfunction;
 Those taking insulin or any insulin secretagogues (SU, glinides), or
 Drugs which may cause erosive gastritis (anti-platelets, steroids, NSAID’s,
etc)
CLINICAL EFFECTS OF
KETOGENIC DIET
BLOOD LEVELS DURING NORMAL DIET, KETOGENIC DIET
AND DIABETIC KETOACIDOSIS
Ketosis produced by KD is a physiologic or nutritional ketosis & it is completely

different from the pathological ketosis produced by uncontrolled Type 1 DM.
Paoli, A et al Frontiers in Psychology 2015;6:4

Anton, SD et al Obesity 2017; 00
Mattson, MP et al PNAS 2014; 111(47):16649
Paoli A et al.. Eur J Clin Nutr. 2013 Aug;67(8):789.
CLINICAL DATA: 3 META-ANALYSIS
 Unanimous about general positive effects, but not about each single variable
 Santos et al. (2012): Low-carb KD had significant decrease in body weight, BMI, abdominal
circumference, SBP & diastolic BP, TG levels, FBS & HbA1c, an increase in HDL-c levels, and no
change in LDL-c levels but benefits decrease over time.
 Bezerra Bueno (2013): Very-low carbohydrate diets vs low-fat diets [12 mos] confer a greater
weight loss, reduction in TG & diastolic BP, and increase in HDL & LDL-c levels. No diff in SBP
 No significant difference for FBS, insulin levels, and HbA1c
 At 24 months of follow-up, only the change in HDL-c levels remained significant in 4 studies.
 Naude (2014):19 randomized controlled trials (RCT)
Br. J. Nutr. 2013, 110, 1178–1187

Obes. Rev. 2012, 13, 1048–1066.
Naude, Celeste E., et al. "Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis." PloS one 9.7 (2014): e100652.
Naude, Celeste E., et al. "Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis." PloS one 9.7 (2014): e100652.
 10 RCTs, comprising 1376 participants in total
 Conclusions: Low to moderate carbohydrate diets have greater effect on glycemic
control in type 2 diabetes compared with high-carbohydrate diets in the first year of
intervention.
 The greater the carbohydrate restriction, the greater glucose lowering, a relationship
that has not been demonstrated earlier.
 Apart from this lowering of HbA1c over the short term, there is no superiority of
low-carbohydrate diets in terms of glycemic control, weight, or LDL cholesterol.
Snorgaard, Ole, et al. "Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes." BMJ Open Diabetes Research and Care 5.1 (2017): e000354.
CONCLUSION
 Small studies
 Short Term (most are 6-12 months)
 Sparse studies in Type 2 DM
ADVERSE EFFECTS OF KD: SHORT TERM
 Minor adverse effects  Significant differences

 In a study comparing KLC with LF  constipation (68% vs. 35%)
diets in 119 obese adults, minor AEs  headache (60% vs. 40%)
more common in the KLC diet.  halitosis (38% vs. 8%)
 muscle cramps (35% vs. 7%)
 diarrhea (23% vs. 7%)
 general weakness (25% vs. 8%)
 rash (13% vs. 0%)
Sumithran P, Proietto J. Obes Res Clin Pract. 2008 Mar;2(1):I-II.

ADVERSE EFFECTS OF KD: SHORT TERM
 Another study: impairment in a neuropsychological test requiring higher order

mental processing & flexibility in subjects on a 28-day KD compared with a
non-ketogenic very- low-energy diet, worst within the first week of the diet
 Case reports of serious AEs occurring in adults on KLC diets: acute pancreatitis,
exacerbation of panic disorder, severe metabolic acidosis, & severe hypokalemia,
possibly associated with sudden cardiac death in a 16-yr-old dieter
 Studies of the ketogenic diet in children with epilepsy have found a high incidence
of similar AEs, plus dehydration, electrolyte disturbances, infections, hematological
disorders and hepatitis.

ADVERSE EFFECTS OF KD: LONG TERM
 Most of the info were on their use in pediatric epilepsy.

 Very few studies have examined the effects of ketogenic diets for greater than 12
months in adults.
 Although it has been reported that low- carbohydrate diets are at risk of being
nutritionally inadequate, and may lack in fiber, thiamine, folate, potassium, calcium,
magnesium, iron and vitamins A, E and B6, the nutritional adequacy of the diet
will depend on several factors, including its overall composition, the nutrient
sources, the degree of carbohydrate restriction and the diet duration.

ADVERSE EFFECTS OF KD
SHORT TERM LONG TERM

 Nausea/Vomiting  Disruptions in lipid metabolism
 Constipation  Severe hepatic steatosis
 Dehydration  Hypoproteinemia
 Anorexia  Mineral deficiencies
 Lethargy  Cardiomyopathy
 Hypoglycemia  Nephrolithiasis
 Acidosis
CAUTIONS & CONTRAINDICATIONS OF KD
 Various Inborn errors of fat  Severe gastroesophageal reflux

metabolism & enzyme deficiencies e.g.  Poor oral intake
Carnitine deficiency, CPT I or II
deficiency, Porphyria, etc.  Cardiomyopathy
 Renal stones  Chronic metabolic acidosis of whatever

cause
 Severe dyslipidemia
 Patients receiving SGLT-2 inhibitors
 Significant liver disease
 Failure to thrive
J Postgrad Med. 2017 Oct-Dec; 63(4): 242–251.

“The science on KD is wrong…No one
should be doing ketogenic diet –unless
weight loss is more important than their
health… or more important than their life.”
-Dr. Kim Williams, Past President, American

College of Cardiology
 N=15,428 adults aged 45–64 years, in 4 US communities, who completed a
dietary questionnaire at enrolment in the Atherosclerosis Risk in Communities
(ARIC) study (between 1987 and 1989)
 The primary outcome was all-cause mortality.
 ARIC data was combined with data for carbohydrate intake reported from seven
multinational prospective studies in a meta-analysis
Seidelmann, Sara B., et al. "Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis." The Lancet Public Health 3.9 (2018): e419-e428.
 Interpretation: Both high & low percentages of carbohydrate diets were
associated with increased mortality with minimal risk observed at 50–55%
carbohydrate intake.
 Low carbohydrate dietary patterns favoring animal-derived protein and fat sources, from
sources such as lamb, beef, pork, and chicken, were associated with higher mortality,
whereas those that favoured plant-derived protein and fat intake, from sources such as
vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower
mortality, suggesting that the source of food notably modifies the association
between carbohydrate intake and mortality.
Seidelmann, Sara B., et al. "Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis." The Lancet Public Health 3.9 (2018): e419-e428.
FROM THE
ARIC
STUDY
FROM THE ARIC & PURE STUDY
KETOGENIC DIET AND LIPIDS
PATTERNS OF LDL
UNDERSTANDING EFFECTS OF DIETS ON LIPIDS: LOW
CARBOHYDRATE DIETS
Shift the size of LDL particles from

small, dense LDL III and IV particles,
Low CHO which are more atherogenic, to larger,
more buoyant LDL I and small IDL
particles, which appear to be less
dangerous in promoting CVD
UNDERSTANDING EFFECTS OF DIETS ON LIPIDS: LOW
CARBOHYDRATE DIETS
While the low carb, ketogenic

diet did not lower total LDL
Low CHO cholesterol, it did result in a shift
from small, dense LDL to large,
buoyant LDL, which could lower
cardiovascular disease risk
INTERMITTENT FASTING AND LIPIDS
LIPIDS
1989
2003
2011
Rona Antoni, Kelly L. Johnston, Adam L. Collins and M. Denise Robertson (2014), "The Effects of Intermittent Energy Restriction on Indices of Cardiometabolic Health,"
Research in Endocrinology, Vol. 2014 (2014), Article ID 459119
2011
2013
2013
2013
Mechanism of
Action
Cardiometabolic
Risk Factors
Cardiometabolic
Outcomes
Rona Antoni, Kelly L. Johnston, Adam L. Collins and M. Denise Robertson (2014), "The Effects of Intermittent Energy Restriction on Indices of Cardiometabolic Health," Research in Endocrinology, Vol. 2014 (2014), Article ID 459119
WHAT IS THE BEST DIET?
SHORT ANSWER: WHATEVER WORKS!
BOTTOM LINE: REDUCED INTAKE & LONG-

TERM ADHERENCE
MAYBE THE BETTER QUESTION:

WHAT IS THE BEST DIET FOR WHOM?
75
THE NATURAL HISTORY OF OBESITY
WEIGHT LOSS AND ITS MAINTENANCE IS

THE THERAPEUTIC GOAL 76
Eckel, RH et al Diabetes Care 2011; 34: 1428

THE NATURAL HISTORY OF OBESITY
PREVENTION OF PRIMARY WEIGHT GAIN IS

A SOCIETAL ENDEAVOR 77
Eckel, RH et al Diabetes Care 2011; 34: 1428

FLIPPING THE METABOLIC SWITCH
 Why is it difficult to lose weight and

even harder to maintain weight loss?
 Homeostatic mechanisms
defending fat stores: Modifying
energy balance to re-establish original
body weight
78
Eckel, RH. N Engl J Med 2008; 358(18):1947

CONCLUSION
Flipping the metabolic switch through fasting and ketogenic diets has many
potential benefits
 But (short term) weight loss appears to be the only significant outcome from
studies
Amelioration of metabolic abnormalities, to include lipids, is seen in several
diseases & particularly in T2DM and obesity
CONCLUSION
Effects on body composition, aging and performance enhancement are

promising areas of interest
Longer duration of well-designed clinical trials is necessary to establish long-
term efficacy and safety of interventions flipping the metabolic switch
Evidence of long term harm is seen indirectly from ARIC cohort and the
meta-analysis of observational studies
ACKNOWLEDGEMENTS
 Dr. Cecilia Jimeno

 Dr. Gabriel Jasul
 Dr. Louella Santos
 Dr. Elmer Llanes
 Dr. Noemie Mansibang
 Philippine Heart Association
THANK YOU!

They Help in Cholesterol

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FAD Diets: Will They Help in Cholesterol

LAURA T. ACAMPADO, MD, FPCP, FPSEDM

British Diabetic Association, 2014

Example Description Dietary Concerns

Mayo Clinic, 2017

 Started with Atkin’s diet in the 1970s

1 pc avocado (10 g) 2 pcs chicharon (5 g) 5 strips bacon (25 g)

 Grains & products made from grains

 Beef, Pork, Poultry, Fish

 An interventional strategy consisting of abstinence from food (and even

Azevedo, Ikeoka, Caramelli. Rev Assoc Med Bras. 2013;5 9(2):167–173;

 Ancient Greece: earliest writings on epilepsy were collected in “On the

 Glucose: primary energy source for most tissues.

 METABOLIC SWITCH: the body’s preferential shift from utilization of glucose

 KETONES: “superfuels” because they produce more Adenosine

1. Reduction in appetite due to higher satiety effect of proteins, effects on appetite

2. Reduction in lipogenesis and increased lipolysis

3. Increased metabolic costs of gluconeogenesis and the thermic effect of proteins:

 RQ of 0.7 means that fats or lipids are more metabolized

O • Primary outcome was change in body weight

M • Systematic review and meta-analysis

 6 studies included in the review (N=386)

 There is NO evidence for the use of IF among individuals with diabetes.

 Clinical research studies of (intermittent) fasting with robust designs and

 No serious adverse events were reported.

 Among individuals at risk for hypoglycemia i.e. elderly, renal or liver

Ketosis produced by KD is a physiologic or nutritional ketosis & it is completely

Paoli, A et al Frontiers in Psychology 2015;6:4

Br. J. Nutr. 2013, 110, 1178–1187

 Minor adverse effects  Significant differences

Sumithran P, Proietto J. Obes Res Clin Pract. 2008 Mar;2(1):I-II.

 Another study: impairment in a neuropsychological test requiring higher order

Sumithran P, Proietto J. Obes Res Clin Pract. 2008 Mar;2(1):I-II.

 Most of the info were on their use in pediatric epilepsy.

Sumithran P, Proietto J. Obes Res Clin Pract. 2008 Mar;2(1):I-II.

SHORT TERM LONG TERM

 Various Inborn errors of fat  Severe gastroesophageal reflux

 Renal stones  Chronic metabolic acidosis of whatever

J Postgrad Med. 2017 Oct-Dec; 63(4): 242–251.

-Dr. Kim Williams, Past President, American

Shift the size of LDL particles from

While the low carb, ketogenic

SHORT ANSWER: WHATEVER WORKS!

BOTTOM LINE: REDUCED INTAKE & LONG-

MAYBE THE BETTER QUESTION:

WEIGHT LOSS AND ITS MAINTENANCE IS

Eckel, RH et al Diabetes Care 2011; 34: 1428

PREVENTION OF PRIMARY WEIGHT GAIN IS

Eckel, RH et al Diabetes Care 2011; 34: 1428

 Why is it difficult to lose weight and

Eckel, RH. N Engl J Med 2008; 358(18):1947

Effects on body composition, aging and performance enhancement are

 Dr. Cecilia Jimeno

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