What Happens To Your Cholesterol When You Go On A Keto Diet
Even if youre at risk for cardiovascular disease, you still may be a candidate for the popular diet.
For every person who talks up the ketogenic diet, theres another warning about the ill effects on your heart. The worry is that following a very high-fat, moderate-protein, and very low-carbohydratediet will create a subsequent spike in cholesterol levels, which could, in turn, raise your risk for heart disease.
The worry is certainly valid. On the keto diet, each day youre eating up to 80 percent of your calories from fat and sticking with 20 to 50 grams of net carbs, a term used in popular diets, including keto and Atkins but one that is not officially recognized in the medical community. This all means youll be eating a lot of fat per day, and in the name of meeting that quota, that may include unhealthy choices such as butter, coconut oil, and animal fat, all sources of saturated fat, which has been linked to poor heart health, according to the American Heart Association .
But the effect of keto on heart health isnt as straightforward as it sounds. Indeed, the keto diet may not have as detrimental an effect on your cholesterol as some have thought.
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Ldl And Carbohydrate Restriction: What Is The Relationship
Lets go back to the research assessing how the low-carb, high-fat diets such as the ketogenic diet affect your LDL levels. In the meta-analysis by Bueno et al., low-carb diets were shown to increase HDL twice as much as low-fat diets after randomized controlled interventions. It also showed that there was a small increase in LDL-C in low-carb subjects compared to low-fat diet subjects who experienced no increase.
The research study by Brinksworth et. al also showed that low-carb diets yielded greater increases in HDL cholesterol when compared to a low-fat diet.
Key Takeaways: Some research suggests that high-fat, ketogenic diets can increase LDL-C by a small amount.
What Are Normal Cholesterol Levels
The recommended targets for cholesterol vary slightly among different countries and health agencies. The US National Institutes of Health website lists the following optimal cholesterol and triglyceride values for people at low risk for heart disease, measured after a fast of 9-12 hours:
- Total cholesterol:< 200 mg/dL
- LDL cholesterol:< 100 mg/dL
- HDL cholesterol:> 40 mg/dL for men, > 50 mg/dL for women
- Triglycerides:< 150 mg/dL
LDL levels > 160 mg/dL are considered high, and levels 190 mg/dL and above are considered very high.
Many factors can affect your blood cholesterol, including genetics, hormonal changes, injury, and certain health conditions. For instance, people with untreated hypothyroidism often have elevated cholesterol.
A persons diet can also influence cholesterol levels sometimes significantly.9
Some would argue that since these cut-off points are based on epidemiologic studies, they likely do not apply the same to all individuals regardless of their baseline metabolic health and overall health. For instance, there are data that show people with low LDL levels can have heart attacks and people with high LDL can live long lives.10
The point is that LDL levels should be regarded as one of many variables for evaluating cardiovascular risk, using an individuals metabolic status and other risk factors to adjust that risk assessment up or down.
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The Breakdown Are Your Levels Really High
Interpreting cholesterol numbers can be fairly complicated.
Most people are familiar with Total, HDL and LDL cholesterol.
People with high HDL have a low risk of heart disease, while people with high LDL have an increased risk.
But the true picture is much more complicated than good or bad the bad LDL actually has subtypes, primarily based on the size of the particles.
People who have mostly small LDL particles have a high risk of heart disease, while those with mostly large particles have a low risk .
However, science is now showing that the most important marker of all is the LDL particle number , which measures how many LDL particles are floating around in your bloodstream .
This number is different from LDL concentration , which measures how much cholesterol your LDL particles are carrying around. This is what is most commonly measured on standard blood tests.
It is important to get these things tested properly in order to know if you truly have anything to be concerned about.
If you can, have your doctor measure your LDL-p or ApoB, which is another way of measuring LDL particle number.
If your LDL cholesterol is high, but your LDL particle number is normal , then you probably have nothing to worry about .
On a low-carb diet, HDL tends to go up and triglycerides down, while Total and LDL cholesterol tend to stay the same. LDL particle size tends to increase and LDL particle number tends to go down. All good things .
Add These Foods To Lower Ldl Cholesterol
Different foods lower cholesterol in various ways. Some deliver soluble fiber, which binds cholesterol and its precursors in the digestive system and drags them out of the body before they get into circulation. Some give you polyunsaturated fats, which directly lower LDL. And some contain plant sterols and stanols, which block the body from absorbing cholesterol.
1. Oats. An easy first step to lowering your cholesterol is having a bowl of oatmeal or cold oat-based cereal like Cheerios for breakfast. It gives you 1 to 2 grams of soluble fiber. Add a banana or some strawberries for another half-gram. Current nutrition guidelines recommend getting 20 to 35 grams of fiber a day, with at least 5 to 10 grams coming from soluble fiber.
2. Barley and other whole grains. Like oats and oat bran, barley and other whole grains can help lower the risk of heart disease, mainly via the soluble fiber they deliver.
3. Beans. Beans are especially rich in soluble fiber. They also take a while for the body to digest, meaning you feel full for longer after a meal. That’s one reason beans are a useful food for folks trying to lose weight. With so many choices from navy and kidney beans to lentils, garbanzos, black-eyed peas, and beyond and so many ways to prepare them, beans are a very versatile food.
4. Eggplant and okra. These two low-calorie vegetables are good sources of soluble fiber.
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What Happens To Hdl Levels On A Keto Diet
Though eating fat doesnt affect blood cholesterol levels in a standard carb-heavy diet, when carbs are restricted and fat becomes the basis of your diet, HDL levels ultimately improve.
So on a keto diet eating fat does affect your cholesterol levels, just in the opposite way weve been told!
Supporting these observations, A 2017 review of human and animal studies found keto diets to be generally associated with reductions in total cholesterol, increases in HDL decreases in triglycerides, and reductions in LDL .
A 2020 high quality randomized control study of 34 older adults with obesity found that over 8 weeks participants on the keto diet lost three times the body fat compared with a group eating a low-fat diet. The keto group also had greater improvement in insulin sensitivity, triglyceride levels, and HDL cholesterol
A 2013 meta-analysis of 12 high quality studies involving more than 1200 participants investigating the impact of very-low-carbohydrate ketogenic diets vs. low fat diets, found that the average increase in HDL particles in the low carb group was double that of the low fat group .
Taken together these findings all affirm that differences in HDL are due to carbohydrate intake, not fat intake.
The Effect Of A Ketogenic Diet On Weight And Cardiometabolic Risk Factors
Because of the increasing popularity of the ketogenic diet, the US National Lipid Association Nutrition and Lifestyle Task Force recently reviewed the evidence and published a scientific statementi on the effect of these types of diets on body weight and cardiometabolic risk factors, including lipids. They concluded:-
Its also worth noting this diet has been associated with short term side effects such as gastrointestinal complaints including constipation, nausea, and abdominal pain which are often experienced in the first few weeks. Some individuals may experience symptoms described as the keto flu within 2 to 4 days of starting a keto diet, which may occur as the body adapts to using ketone bodies for fuel. It may last a few days to one week and include light-headedness, dizziness, fatigue, difficulty exercising, poor sleep and constipation.
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What Is Hdl Cholesterol
HDL cholesterol is frequently known as the good cholesterol. In addition to transporting cholesterol around the body, HDL collects cholesterol that is not being used by cells and brings them back to the liver to be recycled or destroyed.
Additionally, HDL cholesterol may have anti-inflammatory effects. A recent research study published by De Nardo et al shows that HDL may be responsible in reducing inflammatory activity by regulating immune system cells called macrophages. Furthermore, epidemiological studies have noted an inverse association between levels of HDL and certain forms of cancer.
More research needs to be performed to investigate the source of these relationships as well as the molecular mechanisms through which HDL operates. However, there is a general consensus among clinicians and scientists that HDL-cholesterol is healthy for the body and that higher levels of HDL-C are healthy for the body. In fact, one study observed that, with every 1 mg/dL reduction in HDL cholesterol, diabetes risk increased by 4%.
The Impact Of Carbohydrate Restriction On Hdl Cholesterol
In a recent meta-analysis published in the British Journal of Nutrition by Bueno et al, researchers investigated the impacts of very-low-carbohydrate ketogenic diets on key metrics of cardiovascular health including HDL cholesterol.
The authors defined a VLCKD as a diet lower in 50g of carbohydrates lower than the daily recommended grams of carb consumption clinicians recommend to diabetics. They included 13 randomized controlled studies with a total of 1,415 subjects. All studies took place for at least a full year and all subjects included were over 18 years old and had a BMI of at least 27.5 kg/m2. In each of these studies, VLCKD diets were compared to low-fat diets.
Overall, 12 studies including 1257 patients examined the impact of a VLCKD on HDL cholesterol. When assessing the data, the individuals assigned to a VLCKD achieved an average increase in HDL of 0.12 mmol/L. This was double the average increase in HDL of the low-fat dieters who achieved an average increase in HDL of 0.06 mmol/L. As a result, the authors concluded that carbohydrate-restricted diets confer cardiovascular benefits because they improve levels on HDL in the body.
Key Takeaways: A low-carb diet is an effective method in raising HDL cholesterol when compared to traditional weight-loss diets that emphasize reducing fat intake.
Recommendation: If you need to increase levels of heart-healthy HDL cholesterol, a carbohydrate restricted diet can be an effective tool.
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Remove Bulletproof Coffee From Your Diet
Bulletproof coffee is very trendy in the low-carb and paleo communities.
It involves adding 1-2 tablespoons of MCT oil and 2 tablespoons of butter into your morning cup of coffee.
I havent tried it myself, but many people claim that it tastes delicious, gives them energy and kills their appetite.
Well Ive written a lot about coffee, saturated fat, butter and coconut oil. I love all of them and think they are very healthy.
However, even though normal amounts of something are good for you, it doesnt mean that massive amounts are better.
All the studies showing that saturated fat is harmless used normal amounts that is, amounts that the average person consumes.
There is no way to know what happens if you start adding massive amounts of saturated fat to your diet, especially if youre eating it instead of other more nutritious foods. This certainly isnt something that humans evolved doing.
Ive also heard reports from low-carb friendly docs (Drs Spencer Nadolsky and Karl Nadolsky. They had low-carb patients with massively increased cholesterol whose levels normalized when they stopped drinking bulletproof coffee.
If you drink bulletproof coffee and have cholesterol problems, then the first thing you should do is try removing this from your diet.
Bottom Line:
Try removing bulletproof coffee from your diet. This alone may be sufficient to solve your problem.
Replace Some Saturated Fats With Monounsaturated Fats
In the largest and highest quality studies, saturated fat is not linked to increased heart attacks or death from heart disease .
However if you have problems with cholesterol, then it is a good idea to try to replace some of the saturated fats you are eating with monounsaturated fats.
This simple modification may help to bring your levels down.
Cook with olive oil instead of butter and coconut oil. Eat more nuts and avocados. These foods are all loaded with monounsaturated fats.
If this alone doesnt work, then you may even want to start replacing some of the fatty meat you are eating with leaner meat.
I cant emphasize olive oil enough quality extra virgin olive oil has many other benefits for heart health that go way beyond cholesterol levels.
It protects the LDL particles from oxidation, reduces inflammation, improves the function of the endothelium and may even lower blood pressure .
It is definitely a superfood for the heart and I think anyone at risk of heart disease should be using olive oil, no matter whether their cholesterol is high or not.
It is also important to eat fatty fish that is high in Omega-3 fatty acids, at least once per week. If you cant or wont eat fish, supplement with fish oil instead.
Bottom Line:
Monounsaturated fats, like those found in olive oil, avocados and nuts, may have cholesterol lowering effects compared to saturated fats.
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Chronic Inflammation And Stress
Both Inflammation and stress elicit similar mechanisms one of which is an increase in cholesterol levels to bring the necessary nutrients to our tissues to help them heal and recover.
If you have chronic inflammation and/or stress, you may also have persisting high cholesterol levels which, in most cases, isnt doing anything but causing more problems. The preponderance of this chronic inflammation and stress is typically caused by a variety of lifestyle factors, from eating foods that trigger inflammation to sleeping poorly.
Fortunately, the keto diet has been found to decrease inflammation . However, if you still have high levels of inflammation after following the keto diet, then you may have to address other important variables like your stress levels, sleep quality, and food allergies/sensitivities before your cholesterol levels can rest at healthier levels.
One way to find out if the keto diet is helping quell your chronic inflammation is by seeing how your C-reactive protein levels change over time on your routine blood test. If CRP levels decrease after youve made your lifestyle and dietary changes, then you are on the right track. The ideal result is if your cholesterol levels are optimized along with that.
However, for those of you who see a drop in inflammation and a worsening of your cholesterol levels, you may have one of the two issues that we explored earlier.
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Ketogenic Mediterranean Diet With Phytoextracts
An Italian study in 2019 looked at 106 overweight or obese people who ate a diet known as the ketogenic Mediterranean diet with phytoextracts and took a daily multivitamin supplement over six weeks. Subjects were allowed to consume unlimited calories in a diet made up of green vegetables, olive oil, fish, meat, and other high-quality proteins, along with specific food supplements and herbal extracts.
The results showed a significant decrease in body mass index , total cholesterol, LDL cholesterol, triglycerides, and blood glucose levels. There was also a significant increase in HDL cholesterol levels.
How Your Body Maintains Cholesterol Levels
A diet high in cholesterol has almost zero impact on your cholesterol levels because your body is smarter than you think.
Since its such a major producer of cholesterol, your body hustles hard to make sure your cholesterol levels are in constant balance all on their own .
Too much cholesterol hanging around and your body will slow down production, too little cholesterol in your diet and your body will kick production into overdrive.
The 2015-2020 Dietary Guidelines for Americans is the first to get rid of the daily dietary cholesterol limit something many countries eliminated years ago.
So if dietary cholesterol isnt a high risk, and foods with high cholesterol dont build up in your arteries like a clogged shower drain, what causes plaque formation?
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