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Keto Diet and Cholesterol: Does It Help or Hurt?

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Keto and cholesterol - Dr. Axe

Given the fact that the ketogenic diet is a high-fat, low-carb diet — one which emphasizes foods like coconut oil, butter and meat — this leaves many people wondering: Is the keto diet bad for your heart? Despite what you might think, the keto diet has actually been associated with improvements in cardiovascular health.

Is the keto diet safe for someone with high cholesterol? Because keto is rich in fats, including saturated fat and cholesterol found naturally in animal-derived foods like eggs and meat, many people will experience an increase in cholesterol after beginning the keto diet. However, studies suggest the connection between the keto diet and cholesterol is actually positive.

Recently, we’ve come to understand that higher cholesterol isn’t always a bad thing, and rather that experiencing chronic inflammation as well as elevated triglycerides, due to causes like an overall poor diet, insulin resistance and unhealthy lifestyle, is likely a much bigger threat.


Answering Your Questions About How the Keto Diet Impacts Cholesterol

Before diving into more details about the keto diet and cholesterol, let’s start by looking at some basic facts about how cholesterol works.

For decades cholesterol has gotten as a bad rap, but in reality cholesterol plays many important roles in the body. For example, cholesterol has functions including:

  • Helping with sex hormone production (including of progesterone, estrogen and testosterone)
  • Forming structures of the brain
  • Supporting cognitive/mental function, including in children and older adults
  • Facilitating absorption of fat-soluble nutrients (including vitamins A, E, D and K)
  • Ushering nutrients, triglycerides and other compounds into cells to be used for energy

Cholesterol in our body is present in the form of fatty acids (lipids) that travel through the bloodstream. What’s important to understand about cholesterol is that the balance between LDL and HDL cholesterol is very important. If you have higher LDL, you also want to have higher HDL in order to help clear LDL from the bloodstream.

There are two different types of LDL cholesterol, the type that is often referred to as “bad cholesterol”: large particle LDL (or pattern A) and small particle LDL (or pattern B). What’s the difference, and which one is more dangerous for heart health?

Pattern A carries more fat-soluble nutrients and antioxidants and can actually protect against oxidative stress, while pattern B is more likely to be oxidized and to form plaque buildup in the endothelial lining of the arteries, raising the risk for heart-related problems.

How does the keto diet affect cholesterol levels?

Studies have found that the ketogenic diet can positively affect cholesterol levels, heart health and metabolic health in the following ways:

  • Increases LDL particle size (increases pattern A), which leads to less risk for oxidative stress
  • Improves the LDL to HDL ratio. In other words, increases HDL cholesterol, which helps to balance the effects of LDL
  • Lowers triglycerides, which is protective considering high concentrations in the blood indicate an elevated risk of stroke and heart problems
  • Improves triglyceride to HDL ratio
  • Reduces insulin resistance and helps manage blood sugar (glucose) levels, especially when compared to high-carb diets
  • Helps reduce chronic inflammation
  • Helps prevent obesity by reducing hunger and decreasing ad libitum calorie intake

According to a 2017 review published in the British Journal of Sports Medicine ,

Low-carbohydrate high fat diets (LCHF diets) consistently improve all other markers of cardiovascular risk — lowering elevated blood glucose, insulin, triglyceride, ApoB and saturated fat (especially palmitoleic acid) concentrations, reducing small dense LDL particle numbers, glycated haemoglobin (HbA1c) levels, blood pressure and body weight while increasing low HDL-cholesterol concentrations and reversing non-alcoholic fatty liver disease (NAFLD).

Does the ketogenic diet cause high cholesterol? Does ketosis cause high cholesterol?

Eating plenty of healthy fats on the keto diet will raise HDL cholesterol (often called the “good kind”) and increase the LDL/HDL cholesterol ratio, which are two key markers of general health. Studies show keto will usually decrease levels of triglycerides, LDL cholesterol, blood glucose and reduce body mass index.

Is there such thing as a low cholesterol keto diet?

It’s technically possible to eat a low cholesterol keto diet, since the keto diet includes a number of foods that lower cholesterol. Examples include avocado, olive oil, nuts, seeds and vegetables.

However, in most cases, avoiding all foods that contain cholesterol (like eggs or cheese) isn’t necessary to support heart health, especially since some sources of cholesterol can be nutrient-dense foods. What’s important is practicing moderation and finding balance in your diet, as well as eating a combination of natural foods that fight inflammation.

Can the keto diet be good for high cholesterol? Can keto lower cholesterol?

Yes, studies suggest it can. Every person is a bit different in terms of how they will react to a low-carb, high-fat diet, however generally speaking there’s evidence showing that this type of eating plan is safe and effective when it comes to promoting cardiovascular health.

Many factors can negatively affect cholesterol levels — such as genetics, inactivity, diabetes, stress and hypothyroidism — but an unhealthy diet that includes lots of processed foods and is low in nutrients is the biggest contributor. The “standard American diet” is highly inflammatory, which elevates LDL (bad cholesterol) and lowers HDL (good cholesterol), while a “clean keto diet” tends to have the opposite effect.

A 2006 study published in the journal Molecular and Cellular Biochemistry concluded that …

This study shows the beneficial effects of ketogenic diet following its long-term administration in obese subjects with a high level of total cholesterol. Moreover, this study demonstrates that low carbohydrate diet is safe to use for a longer period of time in obese subjects with a high total cholesterol level and those with normo-cholesterolemia.

People who have an increased risk of developing heart disease might need to limit their intake of cholesterol and saturated fats, but everyone else is better off focusing on limiting their intake of ultra-processed, packaged junk foods.


Final Thoughts on the Keto Diet and Cholesterol

So does the keto diet raise cholesterol? It can due to the high-fat content of the diet, however, the keto diet overall has positive effects on cardiovascular health markers.

The bottom in is that instead of focusing so much on cholesterol levels, it’s a better idea to tackle chronic inflammation. Inflammation is the primary cause of atherosclerosis, or hardening and stiffening of arteries that accompanies plaque deposits and increases risk for heart attacks.

If you’re following the ketogenic diet, what are some ways you can take care of your heart and keep chronic inflammation at bay?

  • Eat a “clean keto diet” — such as a keto alkaline diet — which means emphasizing unprocessed fats, vegetables, quality proteins, herbs, spices, nuts, seeds and superfoods like bone broth.
  • Avoid foods that are full of refined vegetable oils, sugar, sodium and artificial ingredients. It’s also beneficial to avoid conventional dairy products (non-organic, homogenized and pasteurized), farm-raised animal products and too much caffeine or alcohol.
  • Include high-fiber foods in every meal, such as nuts, seeds, vegetables and avocado. Vegetables — including leafy greens, beets, onions, cabbage, broccoli and artichokes — are especially useful for upping your fiber intake and protecting heart health.
  • Focus on healthy proteins including pasture-raised poultry like turkey or chicken, grass-fed meats, wild-caught fish and other seafood, and, yes, even eggs.
  • Watch your sodium intake by limiting processed foods.
  • You’ll already be avoiding refined grains and sugar on the keto diet, which is great because these can be inflammatory foods and contribute to issues like diabetes and obesity if even in high amounts.

Read Next: Keto Diet and Diabetes: Do They Work Well Together?


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