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Based on???? Elizabeth Mac Namara On May 1, 2019, at 08:43, Neely, Dermot <[log in to unmask]<mailto:[log in to unmask]>> wrote: I would caution against asking Dr Malhotra for any advice. He epitomises the aphorism “empty vessels make most sound” Get Outlook for iOS<https://aka.ms/o0ukef> On Wed, May 1, 2019 at 2:27 PM +0200, "Ian Young" <[log in to unmask]<mailto:[log in to unmask]>> wrote: To be balanced, I do use low CHO diets in the short to medium term in some patients, for weight loss. I monitor LDLc – most show only modest rises and no change in the LDLc:HDLc ratio. Best wishes Ian From: Sharpe, Peter [mailto:[log in to unmask]] Sent: 01 May 2019 13:23 To: Ian Young <[log in to unmask]<mailto:[log in to unmask]>>; [log in to unmask]<mailto:[log in to unmask]> Subject: RE: Puzzling patient In the meantime I will take a “balanced” approach in my advice to patients – less calories and less CHOs but not low CHOs. A very high LDL-C as a consequence of a low CHO diet would greatly concern me. I would feel that the benefits of the low CHO diet might be neutralised or even reversed by the very significant increase in LDL-C. Kindest regards Peter Dr Peter Sharpe Consultant Chemical Pathologist Associate Medical Director, Research & Development Southern Health & Social Care Trust Ext: 60869 Tel: 028 38360696 Fax: 028 38334582 From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Ian Young Sent: 01 May 2019 13:05 To: [log in to unmask]<mailto:[log in to unmask]> Subject: Re: Puzzling patient There is currently a UK working group looking at the evidence around low CHO diets in Diabetes, of which I am a member, which will report in due course. I would not recommend seeking Aseem Malhotra’s advice on this issue, but rather reading a range of views from the literature in the interim. (https://www.gov.uk/government/groups/scientific-advisory-committee-on-nutrition#joint-sacn---nhs-england---diabetes-uk-working-group-to-review-the-evidence-on-lower-carbohydrate-diets-alongside-higher-fat-andor-higher-protein-compared-to-current-government-advice-for-adults-with-type-2-diabetes). Best wishes Ian From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Elizabeth MacNamara, Dr. Sent: 01 May 2019 12:55 To: [log in to unmask]<mailto:[log in to unmask]> Subject: Re: Puzzling patient The problem with saying low CHO diets are dangerous is that you are looking at things in silo. Diabetes and obesity are the most serious problem in our society. Low CHO treat diabetes in the way no drug can. If you eat low CHO you can reverse fatty liver associated with obesity and diabetes, decrease all medication for diabetes if not stop it and drop HbA1c to normal not to mention decrease orthopaedic operations on knees and hips. This patient is difficult in that her LDLc is high but there is a lot of evidence that shows Coronary Artery Calcium (the best predictor of CAD) is not linked to LDL concentration. I’d suggest measuring small dense LDL (the atherogenic part). She is the exception rather than the rule for patients on low CHO diets but no one knows why LDL shoots to this height and if it’s harmful. I would try contacting Dr Aseem Malhorta, a cardiologist from Stevenage and ask his advice. But also look at his recent presentation to the UK Parlement on low CHO diet and diabetes https://youtu.be/HvMFj6NxPGI before you start telling your patients to stop taking low CHO diets. Elizabeth Mac Namara On May 1, 2019, at 04:07, Sharpe, Peter <[log in to unmask]<mailto:[log in to unmask]>> wrote: Is there evidence that these patients are at increased risk of CV disease? If so, should we be discouraging low CHO diets? Kindest regards Peter Dr Peter Sharpe Consultant Chemical Pathologist Associate Medical Director, Research & Development Southern Health & Social Care Trust Ext: 60869 Tel: 028 38360696 Fax: 028 38334582 From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Ian Young Sent: 01 May 2019 08:56 To: [log in to unmask]<mailto:[log in to unmask]> Subject: Re: Puzzling patient It sounds from the discussion as if there are a few of these cases. I assume that there is a genetic basis for hyper-responsiveness. It might be worth defining a phenotype and gathering them together with a view to some genetic studies if anyone has time to lead on it…. Best wishes Ian Ian S.Young Professor of Medicine Queen’s University Belfast [log in to unmask]<mailto:[log in to unmask]> Tel: 02890632743 From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Waise, Ahmed Sent: 01 May 2019 08:52 To: [log in to unmask]<mailto:[log in to unmask]> Subject: Re: Puzzling patient Last year I had a 55 year patient, on statin for primary prevention, and who went on a ketogenic diet and lost three stones. LDL rose from 2.6 to 15.7 mmol/L with ApoB >3 gm/L. Sterols did not show significant abnormality. I think it presumed that AN patient can have high raised LDL due to a similar mechanism. Ahmed Waise From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Paul Collinson Sent: 30 April 2019 12:44 To: [log in to unmask]<mailto:[log in to unmask]> Subject: Puzzling patient I would be interested in the collective wisdom of the mailbase users especially those with a particular interest in lipid disorders. I have an 18-year-old girl with a cholesterol of 21.1 mol/L triglyceride 1.5 mmol. History is slightly complicated as she previously had anorexia nervosa diagnosed as due to an autonomic dysfunction which made her feel full easily. She remains underweight however. In addition, she does not tolerate carbohydrate very well and has a diet which is predominantly meat and dairy. Genetic testing excludes familial hypercholesterolaemia with a high likelihood of polygenic hypercholesterolaemia. Carotid imaging shows no evidence of early atherosclerosis. Any suggestions would be most gratefully received as I am very puzzled as to what is going on. My current working hypothesis is a combination of diet plus the underlying polygenic hypercholesterolaemia. ________________________________ Professor Paul Collinson T: +44 (0)208 725 5934 sec (0)208 725 5923 Consultant Chemical Pathologist and Professor of Cardiovascular Biomarkers F: +44 (0)208 725 5868 Clinical Blood Sciences E: [log in to unmask]<mailto:[log in to unmask]> St. George's Healthcare NHS Trust W: www.stgeorges.nhs.uk<http://www.stgeorges.nhs.uk/> ________________________________ P Save Paper - Do you really need to print this e-mail? ________________________________ Disclaimer: This e-mail and any files transmitted with it are confidential. If you are not the intended recipient, any reading, printing, storage, disclosure, copying or any other action taken in respect of this e-mail is prohibited and may be unlawful. If you are not the intended recipient, please notify the sender immediately by using the reply function and then permanently delete what you have received. 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