Intro: Keto Diet And Cardiometabolic Risk Factors
Although originally used as a therapeutic approach to reduce seizures in children with intractable epilepsy, nowadays the ketogenic diet is more well-known and broadly used for weight loss and cardiometabolic disease management.
A question frequently asked when considering the implementation of a low-carbohydrate, high-fat diet is whether there are potential negative health outcomes associated with this approach, such as worsening cholesterol levels. Unfortunately, the answer to this question is not cut and dry and is dependent on many potential variables including ethnicity, length of time diet is utilized, amount of carbohydrate intake , level of exercise/activity, and whether the type of fat in the diet is predominately unsaturated or saturated.1-7
Reviews of the literature have shown that in non-epileptic, obese individuals with metabolic dysfunction, as well as in healthy participants, the ketogenic diet has been associated with many positive changes in cardiometabolic biomarkers:1-2
- Reductions in total cholesterol and triglycerides
- Increases in HDL cholesterol
- Increase in size and volume of LDL cholesterol particles
- Improvements in glucose control and reductions in insulin resistance and diabetes medication use
- Reduction in 10-year atherosclerotic cardiovascular disease risk score
- *Variable* changes to LDL cholesterol
Does keto impact cholesterol levels? It depends
The skinny on the keto diet and cholesterol levels
Citations
Bianca Garilli, ND, USMC Veteran
Does The Keto Diet Affect Cholesterol
Time and time again, research shows that high-fat diet plans, like the keto diet, are actually healthy for cholesterol profiles. Healthy fat sources, such as macadamia nuts, fish, coconut oil, and others are great for your heart and blood lipids.
In fact, research shows ketone bodies can enhance blood lipid profiles and cardiac wellness by reducing LDL cholesterol and fasting serum insulin levels.
Some naysayers will lambast the keto diet on the premises that it endangers health and wellness. Nevertheless, only a select few research studies have actually examined the impacts of a ketogenic diet plan on cholesterol profiles and potential risk factors for cardiovascular disease .
Read on as this article dives into the data to uncover the surprising truth about how the keto diet affects cholesterol.
Keto May Harm People With A Genetic Mutation That Affects Ldl Regulation
Where things get possibly dangerous is if youre one of the people who has an inherited genetic mutation that affects the way LDL particles are regulated. If these individuals follow a keto diet, their LDL levels can skyrocket, says Soffer. This result doesnt happen often enough to skew overall results in population studies, but what matters most is the effect the diet has on your individual health. Its a long-recognized phenomenon that hasnt been published well, he says, adding that the genetics that drive this response arent completely understood.
You may not be aware that you have a preexisting genetic mutation, also called familial hypercholesterolemia . In fact, as the AHA notes, for people with FH, only 10 percent know they have it. Being aware of your family history, including members who have had a heart attack at a young age, is important and can help point your provider in the right direction. In some instances, research shows that a low-carb diet may actually be beneficial for those with FH who also have insulin resistance, suggests an analysis published in BMJ Evidence-Based Medicine in July 2015. This is not something to tease out on your own. Instead, its just another reason why you should talk to your doctor about a dietary change, particularly if you have other health conditions, like high cholesterol.
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The Difference Between Dietary And Blood Cholesterol
Although it may sound like common sense that eating a high-fat low-carb diet filled with cholesterol-rich foods would raise blood cholesterol levels, thats not the way it actually works.
Your body expertly regulates your blood cholesterol by controlling how much cholesterol it makes. When you eat more cholesterol, your body makes less. When you eat less cholesterol, your body makes more.
Because of this regulating ability, studies show that foods high in dietary cholesterol have very little impact on blood cholesterol levels in most people . This is why for most people, high-cholesterol keto foods do not negatively impact your blood cholesterol levels.
A 2012 study in Nutrition compared a low-calorie diet to a low-carb, high-fat diet among 360 overweight and obese participants. After one year, participants on the keto diet saw their total cholesterol, triglycerides, and LDL decreased, while HDL rose. HDL is often referred to as good cholesterol.
What Foods Are Keto
A keto diet is typically mapped out using some specific calculations to make sure you enter and stay in ketosis and meet your individual needs. Eating more than 5 to 10 percent carbs will usually take ya right out of ketosis.
Youll be eating mostly:
- non-starchy vegetables
For most people, getting 5 to 10 percent of calories from carbs means eating 50 grams or less per day, and it can be as low as 20 grams. For reference, 2 cups of cooked broccoli or 1 1/2 cups of strawberries roughly equals 20 grams of carbs, which is more than the measly 1/2 cup of rice you could eat for the same 20 grams of carbs with hardly any nutrients.
Once youve figured out your carb sitch, its all fat and protein from there.
Technically you can choose to eat any fats and proteins youd like, but stick with unsaturated fats and lean proteins like eggs, fish, seeds, and nuts to maintain or even improve your health, depending where youre starting from.
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Why Fat Source Matters
In this study, there was a substantial 33% decline in postprandial lipemia after a fat-rich meal. Even more significant was the 50% decline in postprandial lipemia in subjects who followed a keto diet plan that was higher in monounsaturated fats.
In contrast to these outcomes, a different study reports that a low-fat , high-carbohydrate diet plan actually increases overall cholesterol and decreases HDL cholesterol. Ironically, low-carb diet plans like the keto diet actually improve cholesterol profiles in nearly all extant literature.
Its interesting to think that your body naturally has a better balance of blood lipids when you eat more fat and fewer carbs. Not sure which fat sources are best for the keto diet? Check out our Ultimate Keto Food List!
Moreover, the substantial decrease in fasting blood lipids from the keto diet is most likely due to a lower VLDL cholesterol synthesis rate.
Moreover, there is a boost in blood fat elimination from high-fat diet plans. This denotes a substantial increase in plasma lipoprotein lipase activity and skeletal muscle LPL activity in human beings. LPL is an enzyme responsible for breaking down fat molecules in your body.
The bulk of research studies report compelling connections between modifications in fasting and postprandial blood lipids. A current research study shows that a high-carb, low-fat dietary program reduces fasting blood lipids, but does not result in a decrease in the postprandial blood lipids.
Answering Your Questions About How The Keto Diet Impacts Cholesterol
Before diving into more details about the keto diet and cholesterol, lets 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
- Forming structures of the brain
- Supporting cognitive/mental function, including in children and older adults
- Facilitating absorption of fat-soluble nutrients
- 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 that travel through the bloodstream. Whats 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 and small particle LDL . Whats 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?
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Why Is My Blood Pressure Or Cholesterol Going Up On Keto
Cholesterol
For most people, the ketogenic diet will optimize your blood pressure and cholesterol levels. Unfortunately, this isnt the case for everyone.
When it comes to cholesterol, you will most likely experience an increase in healthy cholesterol that will help prevent heart disease. In other words, if your cholesterol levels go up while you are on the keto diet, this is usually a good thing. To learn more about what happens to your cholesterol levels on keto and how to interpret your cholesterol numbers, check out this article.
On the other hand, if you have familial hypercholesterolemia, then increasing your fat intake will most likely cause your cholesterol levels to rise in an unhealthy way. In this case, you will usually do better with a lower fat diet.
Blood Pressure
Regarding blood pressure, keto seems to decrease it more than any other diet that has been studied. A low-carbohydrate diet incorporating fats from olive oil along with vegetables and fish characteristic of the Mediterranean Diet may be the best diet for lowering blood pressure. For a deeper look at the research, check out our article on keto and blood pressure.
However, if your blood pressure increases after starting the diet a couple of things may be happening. Here are some of the most common reasons for this phenomenon:
For those that are struggling to adapt to the diet, make sure you are eating enough calories and follow the recommendations in this article.
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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What You Eat On The Keto Diet
The exact ratio of fats, proteins, and carbs will vary based on your personal needs, but the main focus on the keto diet is fats, which often means eating fats for every meal. That can look something like 40 grams of carbs, 75 grams of protein, and 165 grams of fat .
The keto diet mainly encourages high amounts of saturated fats, including:
- Plant oils, like coconut and palm oil
The diet also allows for some healthy sources of unsaturated fats, including:
- Nuts, like almonds and walnuts
The main restriction is trans fats, which generally shouldnât exist in any diet, keto or not. Trans fats typically come from hydrogenated oils, which involves adding hydrogen molecules to unsaturated fats. Unlike other fats, trans fats actually raise your âbadâ cholesterol while reducing your âgoodâ cholesterol.
Along with fats, the keto diet includes some protein. There isnât much discrimination here between leaner sources of protein, like poultry and fish, or other sources of protein that tend to be high in saturated fats. This generally includes beef, bacon, and pork.
Because the Keto diet is a low carbohydrate diet, carbs tend to be minimized completely, but where does that leave fruits and vegetables? Fruits tend to be high in carbs . Keto diets generally allow for small portions of certain fruits, like berries. Vegetables, also rich in carbs and fiber, are limited to leafy greens, like kale and spinach, along with:
- Summer squash
What Specific Foods Should I Eat On Keto To Also Maintain Good Cholesterol
Consuming mostly unsaturated fats, compared to saturated fats, while on a keto diet may improve cholesterol levels, especially LDL cholesterol levels. Unsaturated fats are found in foods such as:
- Plant oils like olive, avocado, sunflower, corn, and canola oils
- Fatty fish, including salmon, sardines, tuna, and mackerel
- Nuts and nut butters, including peanuts, almonds, cashews, pecans, and walnuts
- Seeds, such as flax, sesame, sunflower, and chia
The keto diet is also typically lower in fiber, so maximizing the small number of carbohydrates allowed while following keto can benefit not only cholesterol levels but also gut health. Choosing non-starchy fruits and vegetables like avocados, tomatoes, asparagus, broccoli, and spinach can help.
Additionally, many people cannot follow the keto diet in the long term, so having a clear and defined plan for how to transition off the keto diet is important to help retain any positive health benefits acquired.
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Can A Keto Diet Clog Your Arteries
If you are considering going on a Keto Diet, or are already on it, you might have heard the common myth that following it can cause your arteries to clog. You might hear people say this as you explain to them the diet that you are on. It might make you wonder where this myth came from and why people are stuck on it. The Ketogenic diet is a high-fat, low-carb diet with moderate protein. It is commonly known that fats can cause your cholesterol levels to skyrocket and therefore clog your arteries. > Is cottage cheese keto?
Clogged arteries can cause heart attack, heart disease, other cardiovascular issues and even death. What you might not know is that research shows that although a Keto diet is high in fat, it can do wonderful things to the body, including increasing healthy cholesterol. Increasing healthy cholesterol can decrease your risk of cardiovascular diseases. Lets start by discussing what cholesterol is and how it affects the body.
The Myth: A Keto Diet And Cholesterol
Since a Ketogenic Diet requires you to eat a large amount of saturated fats, this means that your cholesterol levels can increase, which many people immediately think is a terrible thing that can cause your arteries to clog and you to die. While it is commonly assumed that this increase in cholesterol is a bad thing that is not necessarily the case. The biggest myth surrounding a Ketogenic Diet is that the diet, which is high in fat, will cause your arteries to clog and give you heart disease. There have been many studies done on the subject of eating a high amount of fats, a low amount of carbs and its effects on the body and cholesterol.
A meta-analysis completed in 2010, discusses this belief that high levels of saturated fat and cardiovascular disease, and reports that this connection has no validity. The meta-analysis did not find that there was a strong linking between high-fat foods and cholesterol. Another study looked into different diets that are low carb and found that these diets can actually decrease your risk of heart disease. And yet, another study done at Johns Hopkins University found that diets lower in carbohydrates and higher in fat posed no greater health risks to developing heart disease.
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How Do I Manage High Cholesterol On The Keto Diet
Consuming too many saturated fats can lead to high levels of LDL cholesterol. Saturated fats are found in many animal and dairy products like beef, pork, butter, and coconut oil. While on the keto diet, patients should try to consume more polyunsaturated and monounsaturated fats which are much better for the body. Try to eat more lean meats and fish like salmon
Polyunsaturated fats reduce the amount of bad cholesterol in the bloodstream and deliver vitamins like Vitamin E to the body. Plant-based oils like sunflower and corn oil are full of polyunsaturated fats. Monounsaturated fats reduce the risk of heart disease and stroke and lower cholesterol. Olive oil and peanut oil are two examples of monounsaturated fats.
Why Is Hdl Considered Good
HDL is considered good because it boasts protective, anti-inflammatory properties that regulate your immune system and protect against certain types of cancer in those with type 2 diabetes and those without.
Plus, researchers believe your risk of developing type 2 diabetes increases by 4% for every 1 mg/dL drop in HDL cholesterol your body experiences. So that means keeping your HDL high is a serious priority.
Though all this makes HDL sound like a plus, its greatest accomplishment is clearing out LDL particles, or the bad cholesterol, from your bloodstream.
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Remind Me: How Does Keto Work
The ketogenic diet is a very low carbohydrate, high fat diet that was developed to help children and adults experiencing epileptic seizures. Its now used to help people reach a number of health goals, including weight loss.
The diet requires getting roughly 5 to 10 percent of your daily calories from carbohydrates, 15 to 20 percent from protein, and a whopping 70 percent from fat. Severely restricting carbohydrates forces your body to burn fat for energy instead.
Research has shown that the keto diet has several health benefits, at least in the short term. Most notably, folks on the diet have experienced significant weight loss, improved blood sugar, and improved cardiovascular health .