Does a ketogenic diet lower a very high Lp(a)? A striking experiment in a male physician.

The level of lipoprotein(a) (Lp(a)), an important cardiovascular risk factor, is considered to be genetically determined. I am a 55-year-old male physician specialised in preventive medicine and a hobby triathlete with a body mass index of 24.9 kg/m2 and a maximum oxygen consumption (VO2max) of ~50 mL/(kg×min), with an average of 7-10 hours of exercise per week. I discovered my own Lp(a) at 92-97 mg/dL in 2004 and measured a maximum Lp(a) of 108 mg/dL in 2013. Surprisingly, I observed a much lower Lp(a) of 65 mg/dL in 2018. This happened after I had adopted a very-low-carb ketogenic diet for long-term endurance exercise. My n=1 experiment in July 2020 demonstrated an increase in Lp(a) back to 101 mg/dL on a very high-carb diet within 2 weeks, and a drop back to 74 mg/dL after 3 weeks on the ketogenic diet afterwards. The observed large changes in my Lp(a) were thus reproducible by a change in carbohydrate consumption and might have clinical relevance for patients as well as researchers in the field of Lp(a).

Reference values for peak oxygen uptake: cross-sectional analysis of cycle ergometry-based cardiopulmonary exercise tests of 10 090 adult German volunteers from the Prevention First Registry.

OBJECTIVE: This study aims to construct quantile reference values for peak oxygen uptake (V̇O2peak) measured by cycle ergometry-based incremental cardiopulmonary exercise tests. DESIGN: Cross-sectional study using quantile regressions to fit sex-specific and age-specific quantile curves. Exercise tests were conducted using cycle ergometry. Maximal effort in the exercise tests wass assumed when respiratory exchange ratio ≥1.1 or lactate ≥8 mmol/L or maximal heart rate ≥90% of the age-predicted maximal heart rate. This was assessed retrospectively for a random subsample with an a priori calculated sample size of n=252 participants. SETTING: A network of private outpatient clinics in three German cities recorded the results of cycle ergometry-based cardiopulmonary exercise tests to a central database (Prevention First Registry) from 2001 to 2015. PARTICIPANTS: 10 090 participants (6462 men, 3628 women) from more than 100 local companies volunteered in workplace health promotion programmes. Participants were aged 21 to 83 years, were free of acute complaints and had primarily sedentary working environments. MAIN OUTCOME MEASURE: Peak oxygen uptake was measured as absolute V̇O2peak in litres of oxygen per minute and relative V̇O2peak in millilitres of oxygen per kilogram of body mass per minute. RESULTS: The mean age for both men and women was 46 years. Median relative V̇O2peak was 36 and 30 mL/kg/min at 40 to 49 years, as well as 32 and 26 mL/kg/min at 50 to 59 years for men and women, respectively. An estimated proportion of 97% of the participants performed the exercise test until exertion. CONCLUSIONS: Reference values and nomograms for V̇O2peak were derived from a large sample of preventive healthcare examinations of healthy white-collar workers. The presented results can be applied to participants of exercise tests using cycle ergometry who are part of a population that is comparable to this study.

Traditional dietary recommendations for the prevention of cardiovascular disease: do they meet the needs of our patients?

THE CHARACTERISTICS OF PATIENTS WITH CVD HAVE CHANGED: whereas smoking prevalence declines, obesity and metabolic syndrome are on the rise. Unfortunately, the traditional low-fat diet for the prevention of cardiovascular disease (CVD) still seems to be the "mainstream knowledge" despite contradicting evidence. But lowering LDL-cholesterol by the wrong diet even may be counterproductive, if sd-LDL is raised and HDL is lowered. New insights into the pathophysiology of insulin resistance and its influence on the effects of dietary changes have led to a better approach: (1) the higher a patient's insulin resistance, the more important is the glycemic load of the diet. (2) Fat quality is much more important than fat quantity. (3) The best principle for a reduced calorie intake is not fat counting, but a high volume diet with low energy density, which means fibre rich vegetables and fruits. (4) And finally, satiation and palatability of a diet is very important: there is no success without the patient's compliance. Thus, the best approach to the dietary prevention of CVD is a Mediterranean style low-carb diet represented in the LOGI pyramid. Dietary guidelines for the prevention of CVD should to be revised accordingly.