Extreme Hypercholesterolemia Following a Ketogenic Diet: Exaggerated Response to an Increasingly Popular Diet.

A high-fat, very low-carbohydrate diet, often named the "ketogenic diet," is gaining popularity, particularly among patients with obesity and metabolic syndrome seeking rapid weight loss and improvement in glycemic control. A favorable reduction in triglycerides and an increase in high-density lipoprotein-cholesterol levels is often observed in the ketogenic diet. However, people vary significantly in their low-density lipoprotein-cholesterol (LDL-C) response to the dietary change. Here, we present the case of a 38-year-old normal-weight male with average cholesterol levels showing an extreme fourfold elevation in LDL-C levels, reaching 496 mg/dL after initiating a ketogenic diet. We highlight that a dramatic elevation in LDL-C may manifest following a ketogenic diet in normal-weight people without known genetic dyslipidemias before the dietary change; therefore, increased awareness and close monitoring of blood lipid profile is essential for all individuals following a ketogenic diet. We further discuss the potential mechanisms for the "lean mass hyper-responders" phenotype which has been recently gaining recognition, and suggest that these patients may benefit from ezetimibe therapy, decreasing the absorption of intestinal cholesterol to the liver.

Hospital-community interface: a qualitative study on patients with cancer and health care providers' experiences.

BACKGROUND: Patients with cancer must deal with complex and fragmented healthcare systems in addition to coping with the burden of their illness. To improve oncology treatment along the care continuum, the barriers and facilitators for streamlined oncologic care need to be better understood. PURPOSE: This study sought to gain insight into the hospital-community interface from the point of view of patients with cancer, their families, and health care providers on both sides of the interface i.e., the community and hospital settings. METHODS AND SAMPLE: The sample comprised 37 cancer patients, their family members, and 40 multidisciplinary health care providers. Twelve participants were interviewed individually and 65 took part in 10 focus groups. Based on the grounded theory approach, theoretical sampling and constant comparative analyses were used. RESULTS: Two major concepts emerged: "ambivalence and confusion" and "overcoming healthcare system barriers." Ambiguity was expressed regarding the roles of health care providers in the community and in the hospital. We identified three main strategies by which these patients and their families overcame barriers within the system: patients and families became their own case managers; patients and health care providers used informal routes of communication; and nurse specialists played a significant role in managing care. CONCLUSIONS: The heavy reliance on informal routes of communication and integration by patients and providers emphasizes the urgent need for change in order to improve coordinating mechanisms for hospital-community oncologic care.

Cancer care at the hospital-community interface: perspectives of patients from different cultural and ethnic groups.

OBJECTIVE: To examine perceptions of cancer patients from different cultural and ethnic groups regarding the quality of their care at the hospital-community interface. METHODS: Cross-sectional study of cancer patients from a large tertiary center in Israel. Patients were surveyed on the quality of their primary-care and on their transition from the hospital. Regression analyses were used to examine differences among Hebrew-, Russian-, and Arabic-speaking patients in their assessment of six primary-care domains and of their care transition process. RESULTS: 422 patients completed the survey. Russian speakers gave the lowest and Arabic speakers the highest ratings for all primary care domains. Arabic speakers also gave higher ratings for their care transition process than the other two groups. Minority patients' primary-care physicians were significantly more likely than Hebrew speakers' physicians to facilitate the hospital transition process by reviewing the discharge recommendations. CONCLUSIONS: Cancer patients from different ethnic groups differ in their primary-care experience and their perceptions of their hospital to community transition. Primary-care physicians serve as facilitators of care transitions by discussing discharge recommendations with their minority patients. PRACTICE IMPLICATIONS: Reviewing the discharge recommendations with the patient at the post-discharge primary-care visit is an important contributor to high quality transitional care.