Usually the body uses glucose (a form of sugar) from carbohydrates (found in foods like sugar, bread or pasta) for its energy source. Chemicals called ketones are made when the body uses fat for energy (this is called ‘ketosis’). With the ketogenic diet, the body mostly uses ketones instead of glucose for its energy source. Research has shown that a particular fatty acid, decanoic acid, may be involved in the way the diet works.
The ketogenic diet exerts anticancer effects by inducing a metabolic shift in malignant tissues that promotes apoptosis (self-programmed death) of cancer cells, inhibiting angiogenesis (the growth of new tumor-supporting blood vessels), reducing oxidative stress and inflammation, suppressing mTOR (a protein in humans involved in the regulation of cell growth and regeneration), and increasing the sensitivity of certain cancer cell types to chemotherapy. (38)
Short-term results for the LGIT indicate that at one month approximately half of the patients experience a greater than 50% reduction in seizure frequency, with overall figures approaching that of the ketogenic diet. The data (coming from one centre's experience with 76 children up to the year 2009) also indicate fewer side effects than the ketogenic diet and that it is better tolerated, with more palatable meals.
Though she returned to her primary care physician repeatedly, he dismissed her complaints as “nerves,” suggesting only a tranquilizer. Eventually, in 1975 she developed a palpable mass the size of a grapefruit in her pelvis, thought by her doctors – finally taking her seriously – to be an indication of obvious recurrent disease. A chest x-ray at the time revealed multiple nodules in both lungs, consistent with widely metastatic cancer.
Epilepsy Ontario is the voice of epilepsy in the province. Since 1956, we have been serving the province as a registered health charity incorporated under the statutes of Ontario as a non-profit and non-governmental organization. We aim to raise public awareness and improve education through publications, conferences, outreach initiatives and our website.
If your LDL cholesterol has significantly increased on a keto or low-carb diet, it's completely understandable if you're at least somewhat concerned. However, you might be reluctant to make any changes to your diet given the benefits you've experienced. On the other hand, you may decide that you want to try to lower your LDL values while still following a keto/low-carb lifestyle.
But there are some cancer biologists out there that feel that while mutations are ubiquitous in cancer, they may not be the primary driving force of the disease and, as we’ll discuss later, they may actually be secondary effects of a deeper underlying process. They believe that cancer is as much a disorder of altered energy metabolism or energy production as it is genetic damage. This goes back to the work of German physician Otto Warburg in the 1920s and 1930s, and we know that healthy cells generate energy using an oxygen-based process of respiration. This is what we refer to as cellular respiration, but Warburg was the first to note that cancer cells prefer an anaerobic, or oxygen-free, process of producing cellular energy known as fermentation.
The nerve impulse is characterised by a great influx of sodium ions through channels in the neuron's cell membrane followed by an efflux of potassium ions through other channels. The neuron is unable to fire again for a short time (known as the refractory period), which is mediated by another potassium channel. The flow through these ion channels is governed by a "gate" which is opened by either a voltage change or a chemical messenger known as a ligand (such as a neurotransmitter). These channels are another target for anticonvulsant drugs.
Thank you, Thank you, Thank you!!!!! Your article couldn't have been timed any better. I got my blood panel back from my "western" doctor two days ago and the numbers had me very worried. After reading your post yesterday I felt so much better and sent the results off to my naturopath knowing that everything should be fine. I printed it out for my own reference and for any others, doctors included, who may have doubts and questions. Again, a big thanks for all your research and putting it out there for the rest of us trying to live a longer, healthier life!!
By the time I began medical school in 1979 I had read the pioneering work of Weston A. Price, DDS, the American dentist and researcher. Beginning in the late 1920s, Dr. Price, accompanied by his wife, spent seven years traveling the world evaluating isolated groups of people living and eating according to long-standing tradition. Today such a study would be impossible, since just about everyone everywhere has adopted the “Western” way of living and eating, down to jeans and junk food.
One potential confounder of ketogenic diet studies is another direct effect of the diet—increased levels of fatty acids. Dietary supplementation of essential fatty acids can improve cognitive dysfunction, including in patients with AD [44, Class II]. This suggests that something other than ketone bodies (in this case, essential fatty acids) may have beneficial effects in neurodegenerative diseases. Essential fatty acids may have a beneficial effect on learning in rodent models, raising the possibility that they may have neuromodulatory properties of their own [45,46].
While I can appreciate Mr. Feldman's efforts and I am also a hyper responder, I have no doubt that cholesterol levels are merely an artifact / symptom of the real cause of CVD which is hyperinsulinemia which for type 2 diebetics or pre-diabetics (which are simply undiagnosed diabetics) is due to high carbohydrate diets causing high blood glucose levels as well as other known causes of infllammation such as trans fat and high omega 6 to omega 3 ratios. In other words, there is no need to try and cure the symptom which is controlling lipoprotein levels directly.
You can still eat plenty of healthy dietary fats and also include gut-healing foods like leafy and cruciferous greens, prebiotic-rich foods like garlic and dandelion greens, and probiotic rock stars including kimchi and unpasteurized sauerkraut. Even with a daily 50-gram carb allowance, you can find a lot of anti-inflammatory, gut-supporting foods.
To identify which genes might be involved, the researchers used microarray "gene chips" to examine changes in gene expression for more than 7,000 rat genes simultaneously. They focused on the hippocampus, a region of the brain known to play an important role in many kinds of epilepsies. More than 500 of the genes they examined were correlated with treatment with the KD. The most striking finding was the coordinated up-regulation of genes involved in energy metabolism.
Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.
The next case report is from 2010. It describes the case of a 65-year-old woman who presented with progressive memory loss, chronic headaches, nausea, and a right hemisphere multi-centric tumor seen with magnetic resonance imaging (MRI). Following incomplete surgical resection, the patient was diagnosed with glioblastoma multiforme (GBM). Now here’s the kicker: The patient underwent standard therapy plus the ketogenic diet. A day after her surgery, she underwent a two-day fast, followed by a three day fast beginning a week after surgery, followed by a restricted ketogenic diet (only 600 Cal/day). Three weeks after her surgery (and two weeks after starting the ketogenic diet) she began standard of care treatment, concomitant radiation plus chemotherapy (temozolomide), “according to standard procedures,” which lasted six weeks. The patient also had a gene mutation in her tumor that produces increased sensitivity to temozolomide. The conclusion? Fortunately for the patient, she had what appears to have been a complete response, after which she went on a less restrictive ketogenic diet. Unfortunately, the patient recurred eight months later. By that point, the patient was off of the ketogenic diet. The authors’ conclusion? Because it was “unlikely” that the tumor would have responded this well on standard therapy alone, it must have been adding the ketogenic diet that done it. Worse, in the talk, Dr. Seyfried strongly implies that the tumor recurred because she had gone off the ketogenic diet two and a half months before her recurrence.
A side benefit of the diet is that many parents say their children are more alert and make more progress when on the diet, even if seizures continue. If the diet seems to be helping, doctors will usually prescribe it for about two years. Then, they may suggest that parents slowly begin including regular food in the child’s diet to see if the seizures can still be controlled, even with a normal diet.
What an excellent and helpful article! I had great cholesterol numbers before starting Keto and now my cholesterol is high. My HDL is good and my Triglycerides are low, but my LDL is high. I'm really questioning what I'm doing. I do experience many benefits of Keto, but I have a family history of heart disease and I'm worried and confused. Unfortunately my doctor is no use. She just says follow a Mediteranean Diet. End of story. Or go on Statins, which I would never do. Thanks to your article, I have some new resources to research.
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Perhaps the first person to really put ketogenic diets on the map was Dr. Robert C. Atkins, a cantankerous medical doctor who began experimenting with a low-carb diet in 1963. His first book, Dr. Atkins Diet Revolution, was published in 1972. Dr. Atkins died in 2003 from a tragic fall (interestingly, the Atkins website’s timeline does not mention his death), but his diet plan lives on today.
In terms of our specific discussion, diet as cancer treatment, Dr. Kelley demonstrated more recently in his Dallas, Texas, and Winthrop, Washington offices, no one diet suits all patients diagnosed with the disease, quite the contrary. Over a 20 year period working in the trenches treating many thousands of people, Dr. Kelley came to learn that each patient who walked into his office required a diet designed specifically for his or her metabolic needs, and these dietary requirements could vary enormously from patient to patient.
Although many hypotheses have been put forward to explain how the ketogenic diet works, it remains a mystery. Disproven hypotheses include systemic acidosis (high levels of acid in the blood), electrolyte changes and hypoglycaemia (low blood glucose). Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is similar to the situation with many anticonvulsant drugs.
You have to keep the protein under control, it can get out of control and people then wonder “Well I’m eating next to no carbs, why am I so hungry? Why is my blood sugar all whack-a-doodle? I thought this Leanne lady with the glasses on YouTube said it wasn’t going to be that way?” Unfortunately, you need to pay attention to the protein as well. Just to give you an example of how mine looks, I can have about 25-30 grams of carbohydrates. I often joke Leanne that I’ve had all the carbs I’m allowed to have my entire life, the first 32 years of my life. Okay, it may not be true but it’s probably closer to true than not, that I have to limit them the rest of my life.
Aggressive tumors typically demonstrate a high glycolytic rate, which results in resistance to radiation therapy and cancer progression via several molecular and physiologic mechanisms. Intriguingly, many of these mechanisms utilize the same molecular pathways that are altered through calorie and/or carbohydrate restriction. Furthermore, poorer prognosis in cancer patients who display a glycolytic phenotype characterized by metabolic alterations, such as obesity and diabetes, is now well established, providing another link between metabolic pathways and cancer progression. We review the possible roles for calorie restriction (CR) and very low carbohydrate ketogenic diets (KDs) in modulating the five R’s of radiotherapy to improve the therapeutic window between tumor control and normal tissue complication probability. Important mechanisms we discuss include (1) improved DNA repair in normal, but not tumor cells; (2) inhibition of tumor cell repopulation through modulation of the PI3K–Akt–mTORC1 pathway downstream of insulin and IGF1; (3) redistribution of normal cells into more radioresistant phases of the cell cycle; (4) normalization of the tumor vasculature by targeting hypoxia-inducible factor-1α downstream of the PI3K–Akt–mTOR pathway; (5) increasing the intrinsic radioresistance of normal cells through ketone bodies but decreasing that of tumor cells by targeting glycolysis. These mechanisms are discussed in the framework of animal and human studies, taking into account the commonalities and differences between CR and KDs. We conclude that CR and KDs may act synergistically with radiation therapy for the treatment of cancer patients and provide some guidelines for implementing these dietary interventions into clinical practice.
There are some treatment centers like Care Oncology Clinic in the UK and ChemoThermia Oncology Center in Istanbul that are using ketogenic diet and fasting along with glucose inhibitors and conventional treatment like chemo. They claim to be getting good results, but I don’t know much about these cancer centers above and beyond what I just told you. Note that keto only seems to work with the faster-growing cancers like breast cancer, but not as much with slower-growing cancers like prostate cancer.
There have been so many advancements in the cholesterol panels and we haven’t even talked about particle size, which we can get into in a minute. Some of the variations that have happened we’re now … we’ve progressed to if your triglycerides are under 70, you’re pretty much guaranteed that that’s the best possible heart health risk marker that you could even look at. Make it your goal to drop the triglycerides to under 70, and you do that with a low carb, high fat, keto diet.
Like all the other treatments for epilepsy, the ketogenic diet has some side effects, which may or may not affect a particular child. Some side effects may go away if caught and managed early on. Knowing what to look for can make a big difference. Reported side effects include dehydration, constipation, and, sometimes, complications from kidney stones or gall stones.
Studies generally show that about a third of patients will have at least a 90 percent reduction in seizures, and another third will experience a 50 percent to 90 percent reduction. This is remarkable, considering that these patients are generally those whose seizures are not well-controlled with medications. Note that the term "epilepsy" encompasses a group of disorders with different causes that are not all fully understood, which is part of the reason different people respond to different treatments.
On the ketogenic diet, carbohydrates are restricted and so cannot provide for all the metabolic needs of the body. Instead, fatty acids are used as the major source of fuel. These are used through fatty-acid oxidation in the cell's mitochondria (the energy-producing parts of the cell). Humans can convert some amino acids into glucose by a process called gluconeogenesis, but cannot do this by using fatty acids. Since amino acids are needed to make proteins, which are essential for growth and repair of body tissues, these cannot be used only to produce glucose. This could pose a problem for the brain, since it is normally fuelled solely by glucose, and most fatty acids do not cross the blood–brain barrier. However, the liver can use long-chain fatty acids to synthesise the three ketone bodies β-hydroxybutyrate, acetoacetate and acetone. These ketone bodies enter the brain and partially substitute for blood glucose as a source of energy.
The issue with the Warburg effect is that it leads to a shift in metabolism that favors glycolysis. As a result of this shift, tumor cells tend to use a lot more glucose than normal cells because glycolysis is much less efficient at converting glucose into ATP molecules used for cellular energy than oxidative phosphorylation. One reason that this is thought to provide a growth advantage to cancer cells is because oxidative phosphorylation requires oxygen while glycolysis does not and cancers frequently outgrow their blood supply such that they often live and grow in tissue spaces where there is not much oxygen. In any case, the avidity of cancer cells for glucose has been known a long time and is the basis for positron emission tomography (PET) scanning, where a radiolabeled derivative of glucose is the most commonly used tracer for exactly that reason: Tumor cells take it up much more avidly than do normal cells, leading to ugly black blobs (old-fashioned PET scans alone) or pretty bright blobs (PET-CT) where there are tumor masses in the scans.
Regardless of the efficacy of the KD, most patients discontinue the diet because of its unpalatable and restrictive features. In the last 20 years, new variants of the KD diet have emerged, including the Modified Atkins diet (MAD), a low-glycemic-index diet, which although it has a high fat content, allows more protein and does not restrict calories and fluids. Several studies have shown that the new variants of the KD have a similar efficacy to the CKD (Kossoff et al., 2006; Tonekaboni et al., 2010; Coppola et al., 2011; Miranda et al., 2012; El-Rashidy et al., 2013). As presently understood, the KD is involved in multiple mechanisms responsible for biochemical alterations, including cellular substrates and mediators responsible for neuronal hyperexcitability. However, it is not yet known with certainty whether the success of the KD is due to a single or several mechanisms (Bough and Rho, 2007; Lutas and Yellen, 2013; Rho, 2017; Youngson et al., 2017).
The use of the LGIT in the treatment of drug-resistant epilepsy was initially reported in 2005 by Pfeifer and Thiele (2005). This alternative diet treatment is based on a ratio 0.6:1 of fat to carbohydrates and protein, containing 60% fats, 30% protein, and 10% carbohydrates with a low glycemic index (GI) (GI<50) (Pfeifer and Thiele, 2005; Payne et al., 2018). The GI measures the tendency of a food to raise the blood glucose levels, compared to an equivalent amount of the reference carbohydrate, usually glucose (Pfeifer et al., 2008). Compared to classic the KD, the LGIT produces a smaller increase in ketone body levels, but has comparable efficacy, better tolerability and easier implementation (Pfeifer and Thiele, 2005; Pfeifer et al., 2008).
Leanne: Yeah, that’s amazing that you took your health into your own hands. I think that’s so empowering for so many people. When we just say “enough is enough and we need to change.” For me I came at this from the hormone piece, but also we have a strong line of dementia in our family. Very, very strong. For me, it was how can I be as good to my brain as possible? Not only is this good for your heart and everything else, but also looking at the health of your brain, which we talked about with having enough cholesterol is important for our brain function, too.
For the latest update we searched the Cochrane Epilepsy Group's Specialized Register (11 April 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO, 11 April 2017), MEDLINE (Ovid, 11 April 2017), ClinicalTrials.gov (11 April 2017) and the WHO International Clinical Trials Registry Platform (ICTRP, 11 April 2017). We imposed no language restrictions. We checked the reference lists of retrieved studies for additional reports of relevant studies.
The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted. It involves a consultation with the patient and their caregivers and, later, a short hospital admission. Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.
First, a little background: Eric Westman, MD, director of the Duke Lifestyle Medical Clinic, explained to Health in a previous interview that in order to successfully follow the keto diet, you need to eat moderate amounts of protein, reduce your carb intake, and increase fats. When you reduce your carb consumption, your body turns to stored fat as its new fuel source—a process called ketosis. To stay in ketosis, followers of the keto diet must limit their carbs to 50 grams a day, Dr. Westman says.
The study also found that two types of bacteria, called Akkermansia muciniphila and Parabacteroides, were elevated by the diet. When these two types of bacteria were given in combination to mice that didn't have their own gut bacteria, the anti-seizure effect of the keto diet was restored. What's more, this combination of bacteria protected against seizures even if the mice were fed a nno-keto diet.
The precise mechanisms behind the physiological effects of the ketogenic diet and ketones are not fully understood. It is believed that the ketogenic diet is anti-inflammatory, that it decreases free radical production while enhancing production of the body’s own natural anti-oxidants, and it improves metabolic efficiency.8 9 10 11 12 Specific conditions a ketogenic diet may benefit include:
Chris: Okay. Thanks, Kelsey, for sending that question in. It’s a really great question, one that’s been on my mind a lot recently, actually, and I’ve been diving into the research on. Most of you probably know that cancer dogma holds that malignancies are caused by DNA mutations inside the nuclei of cells and that these mutations ultimately lead to runaway cellular proliferation, which is the hallmark feature of cancer.
First of all, the “lipoprotein” in this scenario is a special molecule that has one job, transport cholesterol. So when you hear someone talking about HDL or LDL cholesterol, they aren’t really talking about cholesterol, they’re talking about the protein that is wrapped around the cholesterol. These lipoproteins come in different sizes. HDL is a larger protein particle and LDL is a smaller protein particle.
Lazy keto diet: Last but not least, the Lazy keto diet often gets confused with dirty keto … but they’re different, as the “lazy” refers to simply not carefully tracking the fat and protein macros (or calories, for that matter). Meanwhile, the one aspect that remains strict? Not eating over 20 net carb grams per day. Some people find this version less intimidating to start with or end with … but I will caution that your results will be less impressive.
Based on this logic, the keto diet appears to be a safe, inexpensive, easily implementable, and effective approach to selectively target cancer cells. Promisingly, multiple studies show that the keto diet reduces tumor growth and improves survival in animal models of multiple cancers, along with enhancing the effects of other forms of anticancer therapy.11,15 Similarly, fasting has been shown to enhance responsiveness to chemotherapy, along with reducing some of the side effects in preclinical cancer therapy models.11
"Most of the work in this field is still pre-clinical, meaning it's been conducted in animal models," Angela Poff, a research associate in the Department of Molecular Pharmacology and Physiology at the University of South Florida, told U.S. News & World Report. "It's been done in various cancer types, but most of the work has been done in brain cancer specifically. But there's very little clinical data all around. There's some case reports and very small preliminary clinical studies in small groups of patients, usually very late-stage patients with various types of cancers. So in the clinical realm, which is the most important in telling us whether this is going to be useful, we have a long way to go."
Keto flu symptoms and side effects can include feeling tired, having difficulty sleeping, digestive issues like constipation, weakness during workouts, being moody, losing libido and having bad breath. Fortunately, these side effects don’t affect everyone and often only last for 1–2 weeks. (And yes, you CAN build muscle on keto.) Overall, symptoms go away as your body adjusts to being in ketosis.
We know now that plaque formation is a culmination of inflammation at the plaque formation site along with a white blood cell mediated interaction between calcium, cholesterol and other biological substances. In fact, it is thought that cholesterol is actually used by the body as a kind of internal bandage when our arterial lining becomes damaged by inflammation. This means that cholesterol build up in the arteries may actually be a protective mechanism.
8. Van Lenten, B. J., Hama, S. Y., De Beer, F. C., Stafforini, D. M., McIntyre, T. M., Prescott, S. M., … Navab, M. (1995). Anti-inflammatory HDL becomes pro-inflammatory during the acute phase response. Loss of protective effect of HDL against LDL oxidation in aortic wall cell cocultures. Journal of Clinical Investigation, 96(6), 2758–2767. PMID: 8675645
There’s a really great inflammatory marker that you can have any doctor can run this for about fifty bucks, and insurance should cover it. It’s called HSCRP, high-sensitivity C reactive protein, and that is the key marker. There’s some other inflammatory markers in the body but that one will really tell the tale of whether you have high levels of inflammation or not. Ideally you want that one optimally under 1.0, most certainly under 3.0. My recent one just a few months back, Leanne, was 0.44.
Steve McQueen was diagnosed with advanced mesothelioma, a particularly deadly form of cancer associated with asbestos exposure, sought out Kelley after the conventional approaches, radiation and immunotherapy, failed to halt the progression of his disease. Though he seemed to rally initially, McQueen, according to accounts of those involved with his care, was not particularly compliant, and appeared at the time he first consulted Kelley too sick for any therapy to work. He would eventually die at a Mexican clinic under the condemning gaze of the media for his choice of an alternative method.
Our normal healthy cells, be they situated in the brain or the skin of our feet, do prefer glucose as their primary energy source, obtained from the sugar circulating in the blood. That “blood sugar” comes from a variety of sources, including dietary carbohydrates occurring in fruits, starchy vegetables like potatoes, and grains. The complex carbohydrates in such foods are broken down into glucose during the digestive process, catalyzed by a variety of carb-specific enzymes like amylase.
Solomon L. Moshe, MD. Professor of Neurology, Neuroscience and Pediatrics, Director of Clinical Neurophysiology and Child Neurology at Albert Einstein College of Medicine, Bronx, New York; past president of the American Epilepsy Society. William R. Turk, MD. Division Chief, Department of Pediatrics, Division of Neurology, The Nemours Children's Clinic, Jacksonville, Florida.
Disclaimer: The content of this website is based on research conducted by Chris Beat Cancer, LLC unless otherwise noted. The information is presented for educational purposes only and is not intended to diagnose or prescribe for any medical or psychological condition, nor to prevent, treat, mitigate or cure such conditions. The information contained herein is not intended to replace a one-to-one relationship with a doctor or qualified healthcare professional. Therefore, this information is not intended as medical advice, but rather a sharing of knowledge and information based on research and experience. Chris Beat Cancer, LLC encourages you to make your own health care decisions based on your judgment and research in partnership with a qualified healthcare professional.
I won’t sugar coat it. The diet can be hard to start. The first two weeks can be terrible. You give up a lot of comfort foods. Plus, you will need new cookbooks. So, switching to a ketogenic diet isn’t the first thing that pops into your head when you hear cancer. But the diet works. I steadily lost weight without substantial hunger or changes to my limited exercise program. My overall health improved, I slept better, felt better and hopefully look better.
Taken together, results from preclinical studies, albeit sometimes contradictory, tend to support an anti-tumor effect rather than a pro-tumor effect of the KD for most solid cancers. However, even though pro-tumor effects are rare, they cannot be ruled out per se. Most importantly, available preclinical evidence implies that the feasibility of a KD as an adjuvant cancer therapy strongly depends on the type of tumor and its genetic alterations.
Leanne: Yeah totally, chill out. Do a little meditation if you need to get into the zone. Exactly. You mentioned vegetable oils causing inflammation, are there specific fats that will help us, like we’ve talked a little bit about saturated fats, we all know trans fats don’t even go there … the mono poly saturated, unsaturated, is there a certain ratio that we should be aiming for. I know you’re the guy that will just slice off butter and eat it … I am too, a little bit of Himalayan rock salt on there never hurt anyone. Are there specific facts that we should be focusing on?
Compared to TBI, the amount of scientific literature documenting the beneficial effects of a ketogenic diet for epilepsy is vast. The ketogenic diet was first introduced as a therapy in the 1920s, when doctors learned it could successfully treat seizures in children with refractory epilepsy. (27) Interest in the ketogenic diet waned when antiepileptic drugs were introduced in the 1960s and ’70s; however, the ketogenic diet has experienced a recent resurgence in popularity in the epilepsy community, particularly among those suffering from drug-resistant epilepsy.
For many years, LDL-C tests have been used as the primary method of measuring LDL in the blood. It is cheaper and easier to measure. Recent research has called into questioning how effective LDL-C is compared to LDL-P in precisely assessing cardiovascular risk. After reviewing cross-sectional data, a recent peer-reviewed paper from the world-renowned Framingham Heart Study stated that