January 24, 2025 • 8 mins
A case so unusual it made it to the medical journals. Dr. Kostas Marmagkiolis, a cardiologist with Tampa Heart and Vascular who's affiliated with Tampa General Hospital, co-wrote an article for JAMA Cardiology about a local patient. The man had a yellow rash on his hands and feet that the doctor identified as a sign of extremely high cholesterol. Listen to find out what drove his levels so high.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Gordon Byrd here Beyond the News. A very unusual case
handled by doctors affiliated with Tampa General Hospital and of
course with the University of South Florida with USF Health
as well, and it's something that became noteworthy enough to
be published in a prominent medical journal. We have doctor
(00:22):
Costas Marmarciolis. He is a cardiologist affiliated with Tampa General
and USF and he's one of the doctors who handled
this case and he joins us now on Beyond the News.
Doctor Marmarcioli is welcome.
Speaker 2 (00:35):
Thank you for the vitation. I'm very glad to be here.
Speaker 1 (00:38):
Well, now, this is a very unusual case and it's
there's a certain novelty involved here, but it provides a
broader message to the rest of us who maybe are
not in the same situation about watching our cholesterol levels.
This is a case that you and the other two
(01:01):
doctors wrote about in Gamma, Journal of the American Medical
Association Cardiology that was published this month, and it involved
a man with a very unusual condition. If you could
explain to us what you encountered with this particular patient.
Speaker 3 (01:19):
So this gentleman is a forty years late gentleman in
the late forties who lived here in Tampa, and he
showed up in our office. We're part of the Tampa
Hart and Bachelor Associates. He came to our office last
spring without any cardiac symptoms, but with a new rash
(01:39):
that showed up in his hands. What was impressive with
him is that eight months ago he had started an
extreme carnivor diet, as you can see in the publication,
getting large amounts of meat and fat and butter every day,
(01:59):
and he claimed that he felt great, he had a
lot of energy.
Speaker 2 (02:05):
Mental clarity.
Speaker 3 (02:07):
But the rush is in his hands is something that
in cardiology we see relatively often in people who have
very high levels of cholesterol.
Speaker 2 (02:17):
This is a rare case of xanthelasma.
Speaker 3 (02:21):
This is a word we use whenever the body is
depositing cholesterol in different parts of the body, mainly the
skin that you can see, and that actually brings our
attention to check their cholesterol level. So this gentleman's cholesterol
was normal in the previous three years in a row,
and after eight months of being on the carnivore died.
(02:43):
His cholesterol level one beyond thousand, which is five times
more than normal levels.
Speaker 1 (02:49):
So when you say a thousand. You know, most people
when they go to the doctor, they have cholesterol levels checked,
and you know, I know that they try to keep that,
you know, in a blow I believe blow two hundred
for most people. But so you're talking about something that
is several times normal levels. And if you saw this level,
(03:11):
if my doctor or anybody listening doctor saw those kinds
of levels, they would be very concerned.
Speaker 2 (03:17):
I assume that is correct.
Speaker 3 (03:20):
We were very concerned, and we advanced him against continuing
this diet, definitely checking his levels again because we initially
thought it was a mistake. So we had to repeat
the test multiple times, and we had to initiate.
Speaker 2 (03:35):
Therapy for decreasing.
Speaker 3 (03:37):
The cholesteral levels as well as trying to investigating if
those high levels had caused any problems in different parts
of the body, mainly the artist.
Speaker 2 (03:49):
This is the most concerning.
Speaker 1 (03:51):
Now I'm going to describe it a little bit colorfully here,
but is it correct to say, you know, with these
nodules on his hands and on his elbows, that he
was quite literally oozing the cholesterol, oozing the fat out
of his body.
Speaker 2 (04:10):
That is correct.
Speaker 3 (04:12):
The body has the ability to metabolize different particles in
the blood stream, and whenever it cannot metabolize them, it
deposits in different parts of the body, one being the skin.
And this is what those nodules, those lesions, that's anthelasma mean.
Speaker 1 (04:31):
Now, when we're talking about this little I don't I
know that there are people There are various fat diets
that catch on from time to time, and one of
these is this carnivore diet where people emphasize eating meat
and fats and as in this case, cheese and butter,
(04:56):
and they take hold from time to time. Uh, are
are you seeing a lot maybe not to this extreme,
but are you seeing people adopting this diet and uh
and running into a situation like this where they're seeing
elevated cholesterol levels? And what what are what are the dangers?
(05:17):
What are things that people need to keep in mind
if they're considering taking up a diet like this.
Speaker 3 (05:23):
Well, we see we see very frequently those diets in
our patients, mainly after after discussions and social media. Those
are very popular diets because they can cause weight loss
and can.
Speaker 2 (05:39):
Make people feel feel great.
Speaker 3 (05:42):
The problem is that, uh, not everybody can metabolize those
extreme fat and cholesterol foods and what happens is that
when the cholesterol is very high blood stream that can
(06:03):
have serious complications like afterrosclerosis. Afterosclerosis is pretty much build
up of fat, of cholesterol in the in the woles
of the arteries in the form of plaques, and that
can cause a narrowing of the of the blood flow.
And this is the beginning of what we call cornery
disease and heart attacks if it happens in the arters
(06:25):
of the heart, or strokes if it happens in the
ards of the brain or the carotids.
Speaker 2 (06:31):
So this is a very serious situation.
Speaker 3 (06:34):
To be honest, I haven't seen many who are doing
those diets at that extreme like this patient, But this
is the first time I have seen the cholesterol increasing
so fast, so high in such a short period of time.
Speaker 1 (06:50):
And what kind of guidance are you giving people who
are considering taking up these kinds of diets, and particularly,
I mean he was in his forties. It's you know,
that's the kind the kind of time of life where
that can be especially more of a problem with that
(07:11):
cholesterol build up. What kind of guidance are you are
you giving patients as far as diet and avoiding I
presume avoiding those kinds of cholesterol levels.
Speaker 3 (07:25):
Our suggestion is to notify their primary care provider or
the cardiologists in our case, so that we keep an
eye on the cholesterol levels. So what we're recommend is
to do blood work early after the initiation of those diets,
and we actually check their cholesterol with regular blood work
(07:47):
every two to three months to make sure that the
levels of cholesterol don't increase above dangerous levels. And if
that is the case, then we have to make a
decision with a patient whether he will he or she
will continue the diet. But we have to treat this
high cholesterol or discontinue the diet.
Speaker 1 (08:09):
So, to sum it up in a very short form,
you shouldn't take up a diet like this unless you
are consulting with your physician.
Speaker 3 (08:18):
That is correct, especially in that extreme diet and for
such a long period of time.
Speaker 1 (08:26):
We appreciate your coming online to talk with us about
this very unusual case. Doctor Costas marmachiolis, cardiologist affiliated with
Tampa General Hospital and the University of South Florida USF Health,
thank you very much for joining us on Beyond the News.
Speaker 2 (08:43):
Thank you for the invitation. Have a great day,
Gordon Byrd here Beyond the News. A very unusual case
handled by doctors affiliated with Tampa General Hospital and of
course with the University of South Florida with USF Health
as well, and it's something that became noteworthy enough to
be published in a prominent medical journal. We have doctor
(00:22):
Costas Marmarciolis. He is a cardiologist affiliated with Tampa General
and USF and he's one of the doctors who handled
this case and he joins us now on Beyond the News.
Doctor Marmarcioli is welcome.
Speaker 2 (00:35):
Thank you for the vitation. I'm very glad to be here.
Speaker 1 (00:38):
Well, now, this is a very unusual case and it's
there's a certain novelty involved here, but it provides a
broader message to the rest of us who maybe are
not in the same situation about watching our cholesterol levels.
This is a case that you and the other two
(01:01):
doctors wrote about in Gamma, Journal of the American Medical
Association Cardiology that was published this month, and it involved
a man with a very unusual condition. If you could
explain to us what you encountered with this particular patient.
Speaker 3 (01:19):
So this gentleman is a forty years late gentleman in
the late forties who lived here in Tampa, and he
showed up in our office. We're part of the Tampa
Hart and Bachelor Associates. He came to our office last
spring without any cardiac symptoms, but with a new rash
(01:39):
that showed up in his hands. What was impressive with
him is that eight months ago he had started an
extreme carnivor diet, as you can see in the publication,
getting large amounts of meat and fat and butter every day,
(01:59):
and he claimed that he felt great, he had a
lot of energy.
Speaker 2 (02:05):
Mental clarity.
Speaker 3 (02:07):
But the rush is in his hands is something that
in cardiology we see relatively often in people who have
very high levels of cholesterol.
Speaker 2 (02:17):
This is a rare case of xanthelasma.
Speaker 3 (02:21):
This is a word we use whenever the body is
depositing cholesterol in different parts of the body, mainly the
skin that you can see, and that actually brings our
attention to check their cholesterol level. So this gentleman's cholesterol
was normal in the previous three years in a row,
and after eight months of being on the carnivore died.
(02:43):
His cholesterol level one beyond thousand, which is five times
more than normal levels.
Speaker 1 (02:49):
So when you say a thousand. You know, most people
when they go to the doctor, they have cholesterol levels checked,
and you know, I know that they try to keep that,
you know, in a blow I believe blow two hundred
for most people. But so you're talking about something that
is several times normal levels. And if you saw this level,
(03:11):
if my doctor or anybody listening doctor saw those kinds
of levels, they would be very concerned.
Speaker 2 (03:17):
I assume that is correct.
Speaker 3 (03:20):
We were very concerned, and we advanced him against continuing
this diet, definitely checking his levels again because we initially
thought it was a mistake. So we had to repeat
the test multiple times, and we had to initiate.
Speaker 2 (03:35):
Therapy for decreasing.
Speaker 3 (03:37):
The cholesteral levels as well as trying to investigating if
those high levels had caused any problems in different parts
of the body, mainly the artist.
Speaker 2 (03:49):
This is the most concerning.
Speaker 1 (03:51):
Now I'm going to describe it a little bit colorfully here,
but is it correct to say, you know, with these
nodules on his hands and on his elbows, that he
was quite literally oozing the cholesterol, oozing the fat out
of his body.
Speaker 2 (04:10):
That is correct.
Speaker 3 (04:12):
The body has the ability to metabolize different particles in
the blood stream, and whenever it cannot metabolize them, it
deposits in different parts of the body, one being the skin.
And this is what those nodules, those lesions, that's anthelasma mean.
Speaker 1 (04:31):
Now, when we're talking about this little I don't I
know that there are people There are various fat diets
that catch on from time to time, and one of
these is this carnivore diet where people emphasize eating meat
and fats and as in this case, cheese and butter,
(04:56):
and they take hold from time to time. Uh, are
are you seeing a lot maybe not to this extreme,
but are you seeing people adopting this diet and uh
and running into a situation like this where they're seeing
elevated cholesterol levels? And what what are what are the dangers?
(05:17):
What are things that people need to keep in mind
if they're considering taking up a diet like this.
Speaker 3 (05:23):
Well, we see we see very frequently those diets in
our patients, mainly after after discussions and social media. Those
are very popular diets because they can cause weight loss
and can.
Speaker 2 (05:39):
Make people feel feel great.
Speaker 3 (05:42):
The problem is that, uh, not everybody can metabolize those
extreme fat and cholesterol foods and what happens is that
when the cholesterol is very high blood stream that can
(06:03):
have serious complications like afterrosclerosis. Afterosclerosis is pretty much build
up of fat, of cholesterol in the in the woles
of the arteries in the form of plaques, and that
can cause a narrowing of the of the blood flow.
And this is the beginning of what we call cornery
disease and heart attacks if it happens in the arters
(06:25):
of the heart, or strokes if it happens in the
ards of the brain or the carotids.
Speaker 2 (06:31):
So this is a very serious situation.
Speaker 3 (06:34):
To be honest, I haven't seen many who are doing
those diets at that extreme like this patient, But this
is the first time I have seen the cholesterol increasing
so fast, so high in such a short period of time.
Speaker 1 (06:50):
And what kind of guidance are you giving people who
are considering taking up these kinds of diets, and particularly,
I mean he was in his forties. It's you know,
that's the kind the kind of time of life where
that can be especially more of a problem with that
(07:11):
cholesterol build up. What kind of guidance are you are
you giving patients as far as diet and avoiding I
presume avoiding those kinds of cholesterol levels.
Speaker 3 (07:25):
Our suggestion is to notify their primary care provider or
the cardiologists in our case, so that we keep an
eye on the cholesterol levels. So what we're recommend is
to do blood work early after the initiation of those diets,
and we actually check their cholesterol with regular blood work
(07:47):
every two to three months to make sure that the
levels of cholesterol don't increase above dangerous levels. And if
that is the case, then we have to make a
decision with a patient whether he will he or she
will continue the diet. But we have to treat this
high cholesterol or discontinue the diet.
Speaker 1 (08:09):
So, to sum it up in a very short form,
you shouldn't take up a diet like this unless you
are consulting with your physician.
Speaker 3 (08:18):
That is correct, especially in that extreme diet and for
such a long period of time.
Speaker 1 (08:26):
We appreciate your coming online to talk with us about
this very unusual case. Doctor Costas marmachiolis, cardiologist affiliated with
Tampa General Hospital and the University of South Florida USF Health,
thank you very much for joining us on Beyond the News.
Speaker 2 (08:43):
Thank you for the invitation. Have a great day,
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com