For every individual who advocates for the ketogenic diet, there is another person cautioning about the negative impacts it can have on one’s heart.
People are concerned that if someone follows a diet high in fat, moderate in protein, and low in carbs, their cholesterol levels may jump and increase their risk of developing heart disease.
The worry is certainly valid. With the keto diet, you eat up to 80% of your calories from fat and limit your net carbs to 20-50 grams. This term is used in diets such as keto and Atkins, but it is not medically accepted.
To meet the requirement of high fat intake, you will have to subtract the fiber and sugar alcohols from the total carbohydrates, as per Atkins, and this may mean that you’ll be consuming an abundance of unhealthy fats such as butter, coconut oil, and animal fat.
The AHA has associated saturated fat derived from these sources with negative impacts on heart health. The goal of the ketogenic diet is to move your metabolism from being dependent on carbohydrates to being dependent on fat, which is known as ketosis.
The influence of the keto diet on heart health is not as simple as it appears. It appears that the keto diet may not be as damaging to your cholesterol levels as was formerly assumed.
When you analyze the information, two points become apparent. Examining population surveys and clinical tests, the impact of the keto diet on lipids is relatively small, as indicated by Daniel Soffer, MD, an internist and lipidologist at Penn Medicine in Philadelphia.
Dr. Soffer is part of the National Lipid Association, a group devoted to handling lipid issues.
In October 2019, the National Lipid Association issued a stance on low-carb and very-low-carb, ketogenic diets and their link to lipids and published it in the Journal of Clinical Lipidology (PDF).
According to him, studies usually demonstrate that the keto diet causes slight decreases in triglycerides, minor modifications in the beneficial high-density lipoprotein (HDL, or “good”), and very little alterations in the unfavorable low-density lipoprotein (LDL, or “bad”) levels.
Certain research, the review notes, demonstrate that LDL levels rise on diets that are low in carbohydrates or nearly devoid of them. (Long-term studies, however, are lacking.)
The levels of HDL cholesterol will be impacted by how well your ketogenic diet is designed.
There isn’t a unified ketogenic diet. Soffer states that there are a variety of approaches to following a diet, and that some individuals are mindful of the fats they consume, while others are not.
It has been pointed out that in studies conducted on both normal weight and obese individuals, following a ketogenic diet usually results in a decrease in total cholesterol, an increase in HDL cholesterol, a decrease in triglycerides, and a decrease in LDL cholesterol.
At the same time, the review points out that other studies show varied results, such as an increase in LDL or no change in levels at all. In the trials where levels of LDL dropped, those involved ate a diet that was low in carbohydrates and rich in beneficial unsaturated fats, while cutting back on unhealthy saturated fats, state the authors.
An earlier study incorporated in the article reviewed the effects of a low-calorie diet and a very low-carb, high-fat diet (the same as a keto diet) in more than 360 people who were overweight or obese.
Some of the participants had diabetes, others did not. It took roughly twelve months, but those in the keto group noticed a decrease in their overall cholesterol, triglycerides, and LDL levels, while the HDL level rose.
Cholesterol and Diet
Cholesterol is a type of wax-like, oily material that circulates in the bloodstream. This substance is present in items derived from animals and is created within our bodies.
Cholesterol has a role in the formation of cell walls and the synthesis of vitamin D and hormones. Different forms of lipoproteins transport cholesterol throughout the body. The two main types of cholesterol are HDL (high-density lipoprotein) and LDL (low-density lipoprotein).
LDL cholesterol is known as “bad” cholesterol due to its ability to build up in arteries, potentially blocking them and raising the risk of atherosclerosis, which can result in heart attack and stroke, as well as other cardiovascular complications.
HDL cholesterol is known as “good” cholesterol. It helps to remove LDL cholesterol from the blood. This may prevent any cardiovascular-related issues that can arise from having a high level of LDL cholesterol.
When someone has high cholesterol, they could have a total cholesterol level that is too high due to elevated LDL cholesterol levels or a reduced HDL cholesterol in the blood. Alternatively, their total cholesterol level could be in the normal range, but they still have an unhealthy LDL/HDL ratio due to a high LDL level.
Does following a ketogenic diet cause high cholesterol
Eating keto may cause high cholesterol in some people. It appears that whether a keto diet raises cholesterol or not may depend on the type of fat consumed and the quality of carbs eaten.
Consuming items with high amounts of saturated fat, cholesterol, and trans fat has been linked to elevated LDL cholesterol levels. An increased consumption of unsaturated fat has been linked to lower levels of LDL cholesterol.
What does the research say
Studies have been inconclusive regarding whether a keto diet can result in elevated cholesterol levels.
Studies indicate that a keto diet may lead to an increase in the levels of LDL cholesterol. Many investigations have discovered that the increase in cholesterol is usually caused by ingesting foods that are high in saturated fat.
A woman was studied who was on a ketogenic diet for a period of between 30 to 40 days and it was noted that her LDL and total cholesterol levels rose quickly. Nevertheless, it was not established if the heightened cholesterol was specifically linked to the ketogenic diet or if the cholesterol in the fat cells was set free as a result of the woman’s fast weight reduction.
Several studies were conducted to contrast the blood lipid (fat) levels in diets with either a low-carbohydrate or balanced approach compared to the high-carbohydrate, low-fat diet. Investigations revealed that those on low-carb diets were more probable to have higher levels of total cholesterol and LDL cholesterol.
A research study of 17 healthy and normal-weight women who followed a ketogenic diet abundant in saturated fats for a month resulted in a detrimental blood fat profile with elevated levels of LDL cholesterol in all of the women.
How keto may change your LDL cholesterol
It is unclear what effects a diet with a high fat content and minimal carbs will have on your LDL levels. According to the American Heart Association, low-density lipoprotein (LDL) cholesterol is associated with atherosclerosis, a condition that can raise your chances of suffering from heart disease or a stroke.
It could increase, decrease, or remain relatively unchanged. If you are doing the keto diet to lose weight and have a typical triglyceride level, Soffer suggests that your LDL levels may stay the same.
If your triglyceride levels were high to begin with and the ketogenic diet lowers them, the LDL levels may remain the same.
In conclusion, it is unlikely that following the keto diet will cause a spike in cholesterol levels.
If you start to consume more saturated fat as you are following a ketogenic diet, your low-density lipoprotein levels are likely to increase. It has been proven multiple times that when the consumption of saturated fat is increased, the level of LDL in the body rises, according to Soffer.
The Ketogenic Diet and Genetic Mutation
Some people may find a ketogenic diet to be a potential hazard. Before beginning this dietary regimen, it is important to take into account the following elements. Genes can affect how much a diet affects one’s cholesterol levels.
Individuals with a family history of hypercholesterolemia may be genetically predisposed to the condition due to a mutation passed down from one or both of their parents, otherwise known as familial hypercholesterolemia (FH).
Individuals diagnosed with FH should stay away from a keto diet as some people may go through severe results of the keto diet on LDL cholesterol levels due to their genetic characteristics.
The National Lipid Association has shown concern regarding this. Individuals with familial hypercholesterolemia should consider the keto diet, but only when monitored closely by a medical professional.
Patients suffering from an extreme rise in triglyceride levels may have an inability to utilize the enzyme lipoprotein lipase, which may be caused by genetic or acquired conditions.
They may be predisposed to having high cholesterol levels and sudden pancreatitis. It is instructed that these patients should consume a diet that is low in fat, so the ketogenic diet is not suggested due to the potential risks that it may possess.
It is important to remember this information before making the decision to try a ketogenic diet. A doctor should be consulted prior to starting a ketogenic diet if there are any worries about its effects on your health.
Can a ketogenic diet lower cholesterol
Although there are some indications that the ketogenic diet raises cholesterol levels, it possibly could also help to lower them.
It all comes down to the structure of the diet and the amount of polyunsaturated and monounsaturated fats consumed – if these are the primary sources of fat, it could have a beneficial effect on the person’s cholesterol levels.
It is important for individuals who have elevated levels of cholesterol to consult with a doctor before starting the keto diet as a significant change in diet may occur.
Those who eat the keto diet should monitor their body weight, total cholesterol, LDL cholesterol, and glucose levels.
Eating a lot of sugar and processed carbohydrates can lead to elevated cholesterol levels. The keto diet severely limits the intake of sugary items (carbohydrates), which could potentially lead to lower cholesterol.
Studies have shown support for the notion that the keto diet can lead to betterment in cholesterol levels, as indicated by certain research. An investigation was conducted on 66 overweight but healthy males with either high or common cholesterol levels who were on the keto diet.
The study found that after being on the diet for 56 weeks, both men who had high levels of cholesterol and men who had regular levels of it saw a drop in their weight and LDL cholesterol, as well as an increase in their healthy HDL cholesterol.
An investigation of 83 individuals with obesity and high cholesterol measured the effects of adhering to the diet for 84 weeks.
The participants saw a drop in their overall cholesterol levels as well as an increase in their HDL cholesterol. The report showed an appreciable decline in LDL after two full months of the keto diet.
The participants were instructed to ensure that 20% of their dietary fat was of the saturated variety, with the remaining 80% being the unsaturated kind. The research determined that the ketogenic diet is secure to practice over a long period of time.
Additional research has indicated that the ketogenic diet may be effective in increasing HDL cholesterol levels. This is advantageous because HDL cholesterol assists in transferring LDL cholesterol from the circulatory system to the liver, where it will be broken down and then excreted from the body.
Eating a lot of omega-3 polyunsaturated fats while on the keto diet may help boost HDL cholesterol levels.
Despite the success of the keto diet in reducing cholesterol levels, it is still necessary to take other measures to maintain healthy levels. This includes managing diabetes, decreasing alcohol consumption, quitting smoking, exercising regularly, and losing weight if necessary.
How to follow keto in a heart-healthy way
A major advantage of a ketogenic diet is that you can consume all the fatty foods that you desire. That’s not a healthy mindset to step into.
Susan Ryskamp, a clinical dietitian at Michigan Medicine’s Frankel Cardiovascular Center in Ann Arbor, suggests that patients consume cardioprotective unsaturated fats, such as nuts, nut butter, seeds, avocado, and extra virgin oils like olive oil.
Steer clear of foods that contain a great deal of saturated fat (such as butter) as the main fat sources.
Maximizing the limited amount of carbohydrates you are allowed to consume is just as important as fats. It can be difficult to acquire a sufficient amount of fiber. Therefore, it is important to eat a lot of vegetables with a low glycemic index, such as broccoli and spinach, which are not high in carbs.
In the end, the advantages come from exchanging out unhealthy food items, such as processed carbohydrates, that professionals think are not beneficial to general health, with those that are beneficial to the heart, like unsaturated fats, she states.
It has been said more than once that if you decide to make a major alteration to your diet, such as trying the ketogenic diet, you must consult with your doctor first to make sure it is safe for your particular medical conditions.
It is recommended that you have your lipids tested before and during a ketogenic diet, so that your physician can monitor for an increase in cholesterol and make sure this type of diet is suitable for you.
Soffer is worried that if someone stops following the keto diet, they may still be eating a lot of saturated fat while also consuming a diet that is high in calories and consists of refined grains, proteins, and very few fruits and vegetables, which is the standard American diet according to the U.S Department of Agriculture (PDF).
Since the ketogenic diet is very restrictive, most people can’t maintain it in the long run, so it’s important to be mindful of what you eat when you stop following the diet.
