Is It Safe To Be On The Keto Diet With High Cholesterol
Bob Harper will be the first to tell you its best to talk to your doctor before attempting something like the keto diet.
Some people, particularly those with familial hypercholesterolemia , kidney disease, and liver disease, are not good candidates for keto because it can often make these conditions worse.
Some may find their bodies cant handle taking in that much fat on the daily.
Even for otherwise healthy people, a keto diet filled with saturated fats from red meat and full fat dairy thats also low in fruits and vegetables wont lead to improved cardiovascular health in the long term and may actually do some damage.
In fact, a 2011 study found that otherwise healthy men had an increased risk of developing type 2 diabetes after eating a low carb diet rich in saturated fat.
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Should You Worry About Cholesterol
The medical community should seriously re-evaluate the role of cholesterol in heart disease and what dietary recommendations they prescribe.
Here are the current cholesterol ranges in conventional medicine:
- Total Cholesterol 200 mg/dl or less. However, its mostly irrelevant because of not really giving enough detail about HDL and LDL etc.
- Triglycerides 150 mg/dl or less. Thats a good guestimate because you would expect triglycerides to go down when eating fewer carbs and burning more fat for energy
- HDL Cholesterol 40 mg/dl or more. More HDL tends to be better and if youre eating a healthy diet you should see HDL to be actually higher at about 50-60 mg/dl.
- LDL Cholesterol 100 mg/dl or less. However, based on new research on low carb ketogenic diets, the amount of LDL for optimal health can vary greatly between people and is determined by many other things.
- If your triglycerides are low and HDL is high, then it means youre using up those fatty acids. A higher LDL, in that case, isnt that relevant. Inflammation or C-Reactive Protein would then also have to be low.
- If your triglycerides are high and you have high CRP, then a higher LDL and total cholesterol isnt good because youll have more inflammation, which will create more scarring of arteries, which then can promote plaque formation
Therefore, the key to heart disease prevention is to avoid inflammation and foods that promote arterial scarring.
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What Happens To Triglycerides On Keto
Studies show that on a keto diet, triglycerides generally decrease . This makes sense when considering that triglycerides are a type of stored fat. When youre on keto your body uses fat for fuel leaving less triglycerides to be stored in your fat cells.
Reduced triglyceride levels decrease the risk of developing chronic diseases including diabetes and cardiovascular disease .
Butter Bacon And Fat: The Truth About Keto And Cholesterol
How can eating a diet rich in butter, red meat, cheese, eggs, and bacon not raise your cholesterol levels? Thats like saying eating a whole pint of ice cream wont raise your blood sugar levels, right? Far from it. As it turns out, the keto and cholesterol combo could be a good thing.
You see, a low-carb diet like keto will change your lipid profile but maybe not in the way you expect.
When you know exactly how cholesterol works in your body, you may see keto in a whole new light. Youll also probably need to rethink everything you thought you knew about cholesterol.
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Cutting Through The Fat: What Are Lipids And Cholesterol
Before we can examine the research, we need to understand the roles fat, cholesterol, and carrier molecules called lipoproteins play in the body.
Fats, also known as lipids, are a diverse group of molecules with a non-polar characteristic that repels water. This means that you if you put a fat in water, they will not mix.
In the human body, fats are most commonly found in the bloodstream in one of two forms. The first is triglycerides, a fatty acid that stores energy for later use.
These long molecules can be broken down into other fatty acids and glycerol to create fuel for the body. Glycerol can further be broken down and converted into glucose. Elevated levels of triglycerides in your blood can increase your risk of developing diabetes, cardiovascular illnesses, and other life-threatening diseases.
The other important class of lipids in the body is a waxy substance called cholesterol. These molecules have a variety of functions in your body such as building hormones including estrogen and testosterone, maintaining the integrity of cell membranes, and aiding in the absorption of vitamins.
Your body produces all the cholesterol you need in the liver and other cells throughout the body. Cholesterol is also obtained by consuming animal-based foods such as poultry, dairy, and red meat. Typically, 75% of the bodys cholesterol is produced endogenously while the other 25% is ingested from external sources.
Ketogenic Diets And Chronic Disease: Weighing The Benefits Against The Risks
- 1Physicians Committee for Responsible Medicine, Washington, DC, United States
- 2Brenda Davis Nutrition Consulting, Kelowna, BC, Canada
- 3Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
- 4Department of Medicine, New York City Health + Hospitals/Bellevue, New York, NY, United States
- 5College of Liberal and Professional Studies, University of Pennsylvania, Philadelphia, PA, United States
- 6School of Public Health, Loma Linda University, Loma Linda, CA, United States
- 7Adjunct Faculty, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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Is Cholesterol Bad For You
High cholesterol levels are considered a significant risk factor for heart disease, heart attacks, atherosclerosis, and higher mortality.
Here are the contributing factors to higher cholesterol levels:
- Chronic inflammation and stress
- Eating processed food with too much sugar, carbs, and fat
Heart disease is one of the primary causes of death in Western populations and theres no doubt about it that people who get stroke usually suffer from high cholesterol. However, whether or not its the cause or effect depends on many other variables and biomarkers.
The amount of cholesterol in your blood is irrelevant to how it affects atherosclerosis and risk of heart disease because the build-up of plaque in the arteries is mostly caused by inflammation.
If you suffer from higher inflammation and oxidative stress, then youll also have more free radicals in the blood which can oxidize LDL. Oxidation of LDL by free radicals is associated with an increased risk of cardiovascular disease.
Free radicals and high inflammation damages the arterial lining called the endothelium, which the cholesterol then gets stuck to. Over the long run, this leads to the accumulation of plaques and increased risk of heart disease.
Additionally, higher VLDL is considered a better predictor of heart disease risk than LDL.
How To Fix Cholesterol On Keto
Heres how to fix your cholesterol on keto and still continue eating low carb high healthy fat without giving yourself heart disease.
The ketogenic diet is a great thing for your health and biomarkers, as shown by research. However, there are many ways you can do it wrong and thus damage yourself. New research is showing that our understanding of cholesterol may be disrupted slightly but it doesnt mean that too much cholesterol cant damage your health. Its still involved in the process of atherosclerosis.
If theres any diet you dont want to be making mistakes on then its keto. Thats why you want to educate and learn about it before jumping in head first. If you want to know how to start a well-formulated ketogenic diet, then check out my Ultimate Keto Meal Plan!
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Predicting How Keto May Affect Your Cholesterol Levels
To have an idea if the keto diet may have a negative effect on your cholesterol, consider your starting triglyceride number. According to the Mayo Clinic, triglycerides are another type of lipid in your blood that your body uses for energy high triglyceride and LDL levels can lead to fatty deposits that gum up arteries, notes the American Heart Association. Normal levels are less than 150 milligrams per deciliter . About a quarter of the population has triglyceride levels above 150 mg/dL, which is the threshold to consider elevated triglycerides. This is a large percentage of the population, so its not uncommon, says Soffer.
If you have normal levels, keto is likely safe to try. For people with normal or perfect triglyceride levels, the impact from keto is minimal or none, says Soffer. If, on the other hand, you have insulin resistance,type 2 diabetes, and/or abdominal obesity, and your triglycerides are elevated it may seem like you should shy away from keto, but the opposite may be true, Soffer argues, explaining that the low-carb nature of keto has the potential to decrease insulin resistance and improve triglycerides.
Still, though, the aforementioned Nutrition & Metabolism study involved a mere 34 people so more research, particularly larger, longer-term studies, is needed before scientists can fully understand the true effects of keto on insulin resistance and triglycerides.
How Does Cholesterol Affect The Body
HDL travels around the body and gets rid of the bad LDL cholesterol. HDL can also help to unclog arteries by clearing out the artery walls. This also means that if your level of HDL is too low, you can also be at a higher risk for heart attack or heart disease. LDL gets stuck on the walls of your arteries, which can cause them to clog, and therefore, your risk of a heart attack is higher.
To find out your cholesterol levels, you can simply have a blood test done. Your doctor can let you know if your levels of each type of cholesterol are too high or too low. As you may or may not know, most of the cholesterol in our bodies, about 75%, is created inside our bodies. The rest of it enters our system through the foods that we eat. Some foods are higher in cholesterol than others. This is why a targeted ketogenic diet is important to follow if you are looking to maintain healthy levels of cholesterol in your body.
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Does Keto Work For Weight Loss
Dr. Hollywood says that she did notice weight loss while following the diet, but once she started to reincorporate carbs, she gained the weight back.
Id encourage those following a keto diet to consult his or her primary care doctor or nutritionist for a transition plan to sustain this weight loss and welcome back proteins and carbs, she recommends.
However, Dr. Hollywood warns that it is important to be mindful of these extreme diet programs, like an aggressive carb-conscious keto. The all or nothing phenomenon Ive found is not that practical and not that sustainableand individuals can develop unhealthy relationships with food, she says.
Your Cholesterol Panel On The Keto Diet
When getting a cholesterol panel on keto there are a few points to consider:
How long have you been on the diet? It can take some time for your body to adapt to a ketogenic diet, and it will take time for your cholesterol panel to reflect these dietary changes.
During the first 2-3 months of losing large amounts of weight, which is common on keto, cholesterol can swing both up and down. Once weight loss stabilizes youll get a more accurate read on your levels .
What were your cholesterol levels prior to switching to a ketogenic diet? A single value at one point in time wont give you much information to compare with your keto levels. Serial labs will give you repeat values over time, and this is what you need to make meaningful conclusions
Do you have a genetic condition that may be related to increased cholesterol levels? These conditions include familial hypercholesterolemia, hypothyroidism, as well as chronic inflammation due to autoimmune conditions and lifestyle factors including stress, poor sleep, alcohol use, and smoking.
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So What Foods Should I Eat
Some cleaner keto-friendly food options include:
- Nut butters such as peanut, almond and cashew
- Healthy fats from coconut oil, olive oil and avocado oil
- Non-starchy vegetables including broccoli, tomatoes, mushrooms and peppers
Keto-friendly foods that you can eat, but in moderation, include:
- Red meats
- High-fat dairy products including cream cheese and sour cream
Who Is Most At Risk For Fh
Familial hypercholesterolemia can affect anyone whose family carries the genetic mutation. However, its found more frequently in those who are of French Canadian, Ashkenazi Jewish, Lebanese or Afrikaner descent. The biggest problem with FH is that more than 90% of people who have it havent been diagnosed, which means you should pay careful attention to your family history,
Seth Martin, M.D., M.H.S., associate professor of medicine at the Johns Hopkins University School of Medicine and director of the Advanced Lipid Disorders Center.
If people in your family have had heart attacks, needed stents or had bypass surgery earlier in life before age 55 in men and before 65 in women those are signals that theres something causing your family to be at higher risk for heart disease, he explains. It could be familial hypercholesterolemia.
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How Genetics Plays A Part
While the ketogenic diet may be safe for most people, it might not be healthy for others to follow. A ketogenic diet could increase LDL cholesterol levels in some people at high risk for heart attack and stroke.
In particular, people with an inherited condition called familial hypercholesterolemia should always consult with their healthcare provider before trying a ketogenic diet. Familial hypercholesterolemia is marked by very high LDL cholesterol levels and an increased risk of premature heart disease. The American Heart Association has state that only 10% of people with familial hypercholesterolemia are aware they have it.
Additionally, some people have a rare genetic condition that affects how LDL particles are regulated, causing high LDL cholesterol levels. The genetics causing this response isnt completely understood, but the APOE gene, which provides instructions for making a protein called apolipoprotein e, may be one of several factors involved. People who have this inherited genetic condition should avoid the keto diet.
What Is Hdl And Why Is It Good
HDL, or high density lipoprotein, is often called good cholesterol. However, it isnt actually a type of cholesterol. Its a lipid-carrying protein that transports cholesterol throughout the body.
The primary role of HDL is collecting excess cholesterol and transporting it to the liver where its recycled or destroyed. This prevents accumulation of cholesterol in the blood, which keeps cholesterol from building up in blood vessels and preventing heart disease.
HDL particles also have anti-inflammatory and anti-clotting properties. The combination of these beneficial properties is why HDL is associated with cardiovascular health.
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Ldl Cholesterol: Clearing The Confusion
The story behind LDL, or low-density lipoprotein, is more complicated. LDL transports cholesterol produced by your liver and cells throughout your body. Unlike HDL, LDL molecules move slowly through the bloodstream and are vulnerable to oxidizing agents known as free radicals. Once oxidized, LDL can easily burrow itself into the walls of your arteries and impede cardiovascular function. This triggers an inflammatory response in which white blood cells called macrophages rush to eat up the LDL.
Typically known as the bad cholesterol to its healthy counterpart HDL cholesterol, increased levels of LDL cholesterol are associated with an increased risk of cardiovascular diseases . Some studies show a strong correlation between LDL cholesterol and the risk of cardiovascular diseases in both men and women. Evidence also suggests that decreasing blood levels of LDL-C reduces the risk of CVD.
Recent research paints a more intricate picture of this peculiar molecule and has called into question the statement that elevated LDL cholesterol is bad for you. This is for two main reasons. First, LDL can be measured in two ways. The first is called LDL-C which measures the concentration of cholesterol transported by LDL in the blood.
In a large community-based sample, LDL-P was a more sensitive indicator of low CVD risk than either LDL-C or non-HDL-C, suggesting a potential clinical role for LDL-P as a goal of LDL management.
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Practical Application: How To Interpret The Cholesterol Levels On Your Blood Test Results
The beneficial effects that the ketogenic diet has on cholesterol levels are not guaranteed for everyone. This is why it is important to consult your doctor and get your blood tested to track the results of your dietary changes.
Most of your blood test results, however, may only cause more confusion. Your LDL-C, HDL-C, Total cholesterol, and triglycerides numbers are valuable, but they only provide small pieces to the puzzle of your cardiovascular health. Does this mean that you have to get an advanced cholesterol panel?
Although some doctors may suggest it if you have genetic factors that are actively contributing to your cardiovascular health, an advanced cholesterol panel isnt necessary for everyone. Instead, most people should look for a different blood marker that can be found from the results of a standard blood lipid panel the total-to-HDL cholesterol ratio. Why?
Dr. Chris Masterjohn postulates that this ratio is an accurate marker for the amount of time that LDL particles spend in the blood . This is an important thing to take note of because the LDL particles are more likely to become oxidized and cause atherosclerosis when they are in the blood for longer periods of time. This gives us a deeper explanation of why the authors of the 2003 meta-analysis looked at the total-to-HDL cholesterol ratio rather than total cholesterol levels.
Key Takeaway: Total-to-HDL cholesterol ratio is the best predictor of cardiovascular disease risk on the basic blood lipid panel.