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Low carbohydrate diets should NOT be recommended for patients with familiar hypercholesterolaemia
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    Low carbohydrate diet SHOULD be recommended for patients diagnosed with familial hypercholesterolaemia and metabolic syndrome
    • David M Diamond, Professor University of South Florida, Tampa, FL USA
    • Other Contributors:
      • Abdullah A Alabdulgader, Congenital Cardiologist/Electrophysiologist
      • Michel de Lorgeril, Cardiologist
      • Zoe Harcombe, Independent Researcher
      • Malcolm Kendrick, General Practitioner
      • Aseem Malhotra, Cardiologist
      • Blair J O'Neill, Cardiologist
      • Uffe Ravnskov, Medical Doctor
      • Sherif Sultan, Vascular Surgeon
      • Jeff Volek, Registered Dietitian and Professor

    Pawlak1 critiqued our challenge to conventional dietary guidelines for people diagnosed with familial hypercholesterolaemia (FH)2. Indeed, his criticism was so incriminatory that he stated our recommendation “constitutes malpractice”. Considering the gravity of his claim, especially as it is levied against co-authors who are mostly MDs, it is important to disclose what we actually recommended, and to point out the flawed evidence Pawlak used to claim that we have committed malpractice.

    First, Pawlak misunderstood the purpose of our paper. We did not question “the efficacy of low-saturated fat, low-cholesterol diet to reduce LDL cholesterol”, as he stated. We provided strong support for the hypothesis that factors other than LDL-C, such as smoking, hypercoagulation and hyperinsulinemia, have a potent influence on the incidence of coronary events in FH that dwarfs that of LDL-C3. For example, in our Figure 4 we illustrated the findings of Gaudet et al.4, who demonstrated that FH people without obesity or insulin resistance had no greater rate of coronary heart disease (CHD) than non-FH people. In contrast, obese, insulin-resistant FH people had over 7 times greater incidence of CHD than non-FH people. Moreover, in recent work we have elaborated on the extensive, but largely ignored, literature demonstrating that factors other than LDL-C, such as increased levels of coagulation factors, explain why only a subset of FH individuals develop premature CHD5. Finally, we in...

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    Conflict of Interest:
    DMD is a member of the science advisory board for Anutra and has received honoraria from Pruvit.
    ZH receives royalties for books/content on diet and health.
    MK receives royalties for books on cholesterol and related medical issues.
    AM donates royalties from his diet book to charity.
    UR receives royalties for books on diet and cholesterol.
    JSV receives royalties for low-carbohydrate nutrition books. He is founder, consultant, and stockholder of Virta Health Corp.; a member of the advisory boards for Atkins Nutritionals Inc., UCAN Co., Ketone Sciences, and Axcess Global; and has received honoraria from Metagenics and Pruvit.