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.
Foods To Eat On A Ketogenic Diet
High cholesterol levels, especially bad LDL, are linked to increased heart disease risk. Also correlated with elevated risk are low healthy HDL cholesterol and high triglycerides. Your food and other risk factors have a substantial impact on your cholesterol.
Here are foods that may decrease cholesterol and boost other heart disease risk factors.
Meat: Red meat, beef, pork, sausage, poultry, turkey, and bacon.
Fatty fish: salmon, trout, tuna, and mackerel, for example.
Eggs: Search for whole-grazed or omega-3 eggs.
Butter and cream: If appropriate, search for grass-fed items.
Cheese: Cheese that has not been refined .
Nuts and seeds: Almonds, walnuts, flax seeds, pumpkin seeds, chia seeds, etc.
Nuts and seeds: Whole avocados or guacamole, freshly made.
Low-carb vegetables: Some green vegetables, potatoes, carrots, peppers, etc.
Condiments: You can use salt, pepper, and different herbs and spices that are good.
What Are The Different Types Of Cholesterol
If you have ever tried to mix oil and water, you know that lipids and water do not mix. The same properties are true within the body cholesterol does not mix well in the blood.
Because of the hydrophobic nature of cholesterol, it must be transported via a special carrier called a lipoprotein. Lipoproteins are made of both lipids and proteins, allowing it to travel throughout the body and delivers cholesterol to cells that need it.
Lipoproteins are classified based on their protein and lipid composition since protein is dense and fats are not, lower density lipoproteins contain more fat and less protein, whereas higher-density lipoproteins have more protein and less fat.
When referring to blood cholesterol levels, it is actually these lipoproteins that are referenced. There are five different lipoproteins:
LDL: This is often referred to as the bad cholesterol and stands for low-density lipoprotein. LDLs job is to transport cholesterol to needed tissues throughout your body however, LDL is highly vulnerable to oxidation. Oxidized LDL can cause inflammation and cause plaque build-up in arterial walls.
HDL: Often called the good cholesterol HDL stands for high-density lipoprotein. HDL is often seen as the good guy because it transports cholesterol from your body to the liver to either be broken down into waste or recycled. HDL has anti-inflammatory properties and has many benefits for your immune system.
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How To Maintain Healthy Cholesterol On Keto
We still dont know the best diet for high cholesterol, but the data suggests that Keto can improve cholesterol profiles in obese people and those with diabetes. Its a promising drug-free therapy for these populations.
But what if your LDL spikes on Keto? Some people say not to worry about it. That other risk markers are more important. That high cholesterol alone doesnt cause heart disease.
Maybe theyre right. We dont have good long-term data on otherwise healthy people that develop high LDL on Keto.
But since high LDL is a well-established heart disease risk factor in other populations, its probably wise to play it safe. Beyond consulting with your doctor to manage your cholesterol, be mindful of these 3 dietary considerations:
What Happens To Ldl On Keto Diet
A ketogenic diet typically leads to improvements in a range of blood lipids and other markers for cardiovascular health like blood pressure, inflammation, and triglycerides. But the changes to LDL are less predictable and can sometimes go up.
However, studies show that on keto we typically see that even when the total LDL increases, there is a reduction in the small bad LDL, referred to as VLDL or, very low density lipoprotein. This means that most of the increase is in the larger, heart friendlier LDL particles .
Its important to note here that for most people on keto LDL either stays the same or goes down. This finding is reflected in a 2006 study looking at the effects of carbohydrate restriction on LDL cholesterol in a group of 29 men for a 12 week weight-loss intervention found that LDL particle concentrations decreased by 9.6% .
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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
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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What Is Ldl Cholesterol
Low-density lipoprotein cholesterol is called bad cholesterol. Ldl cholesterol can be found built up in the walls of your blood vessels and makes them narrow. After a blockage, a clot can form and get stuck in the narrowed space, causing a heart attack or stroke. So try to keep low-density lipoprotein cholesterol under control by eating healthy foods or taking medicine.
What Happens To Your Cholesterol On A Ketogenic Diet
ââFor most people, a ketogenic diet leads to improvements in cholesterol, but there are sometimes transient rises in cholesterol levels during weight loss. During rapid weight loss, cholesterol that you had stored in your adipose tissue is mobilized, which will artificially raise serum LDL as long as the weight loss continues. To avoid being misled by this, the best time to check blood lipids is a couple of months after weight loss ceases. Total cholesterol includes HDL , which usually goes up 10-15% on a ketogenic diet. That said, some people have high calculated LDL cholesterol values even after weight loss stops. If this occurs, you should discuss further diagnostic tests with your doctor. Current research is looking at LDL cholesterol as a mix of different particle sizes, where the small ones are dangerous and the larger ones are not. With a well-formulated ketogenic diet, we see a shift away from the small dangerous LDL even when the total LDL goes up.
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Pattern A Vs Pattern B Ldl
A relatively newer concept when it comes to looking at cholesterol is actually the difference between LDL particle sizes. The type of LDL you have in your body actually makes a huge difference in the amount of risk for heart disease that it presents .
Pattern A LDL actually has a larger particle size. So, one LDL particle that is pattern A is larger than a single particle of LDL that is pattern B. Pattern A LDL also tends to carry more fat-soluble nutrients and antioxidants. These antioxidants protect it from oxidative stress, making them cardioprotective.
Pattern B LDL, on the other hand, has a much smaller particle size and is much more prone to oxidation. Another thing about pattern B LDL is that it is small enough to enter into the endothelial lining of the artery where it can become oxidized and more likely to form plaque. There is a high association between these small dense particles and cardiovascular disease.
This means that two individuals with the same LDL, HDL, and Triglyceride levels could have vastly different heart disease risk depending on what type of LDL they are predominantly carrying in their blood. A ketogenic diet has been shown to reduce the number of pattern B LDL particles .
What If Keto Is Making Your Cholesterol Levels Worse
Although the evidence suggests that the keto diet can help optimize cholesterol in many groups of people, there are others that may not fare well, from a heart health perspective, when they eat a high fat, low carb diet.
One way to tell if the keto diet may not be ideal for you is if your total-to-HDL cholesterol ratio is above 4 and/or your LDL-P remain high or increase after starting the keto diet. If this is the case for you, then it may indicate that you have a particular condition that requires you to make adjustments to your keto diet or follow a completely different diet altogehter.
Here is a brief overview of the most common conditions that can cause cholesterol levels to increase in an unhealthy way on a keto diet:
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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.
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.
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What Are Triglycerides
Triglycerides are found in your blood and are a form of fat. Theyre an important marker for your health. triglyceride levels can be influenced by diet, obesity & weight loss, aging, gender, activity level, cholesterol medications, or diabetes medication. While triglycerides help to provide energy when needed from storage sites on body tissues , elevated triglycerides indicate that this process is impaired and more triglyceride-rich lipoproteins circulate through blood where they contribute to atherosclerosis hardening of arteries -which leads to heart attack and stroke.Triglyceride levels tend to go up with age and insulin resistance: two hallmarks of metabolic syndrome associated increased risk for chronic diseases such as cardiovascular disease .
Focus On Healthy Carbs
Eating 150 grams of carbohydrates or less a day is considered a low-carb diet. However, many popular plans restrict carbs to as few as 20 grams a day. If your LDL cholesterol level concerns you, you might want to adjust your diet to focus largely on healthy vegetarian foods, according to Harvard Health Publishing.
That doesn’t mean you should eat more pasta and white bread. Those extra carbs should come from low-carb, cholesterol-lowering foods, including vegetables, low-carb fruits and plant proteins such as beans, lentils and peas. A number of healthy veggies have 10 grams or less per serving, including spinach, broccoli, kale, peppers, tomatoes, asparagus and cauliflower. Pumpkin, technically a fruit, is also very low in carbs with 6 grams in a 1/2-cup serving.
Using net carbs â total carbs minus fiber â some fruits that might fit your plan include raspberries with about 14 grams per cup and strawberries with about 11 grams per cup. Legumes are little higher in carbs a 1/2-cup serving of cooked lentils, kidney beans or garbanzo beans has about 20 grams of carbs.
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The Importance Of Ongoing Monitoring
People who follow the keto diet should consult their doctors to arrange .
If a doctor notices that LDL cholesterol levels are rising, the diet may no longer be appropriate.
People with high levels of fats, such as cholesterol and triglycerides, in their blood have an increased risk of developing cardiovascular disease.
People with high cholesterol should adopt a lifestyle that reduces these levels. This is because high cholesterol is associated with cardiovascular disease.
The keto diet emphasizes high amounts of fat, but not all fats have equal value. For example, replacing saturated fats with unsaturated fats is associated with a lower risk of cardiovascular disease, according to the 20152020 Dietary Guidelines for Americans .
Saturated fats occur in foods such as cookies, cakes, and other snacks. Coconut oil, butter, and ghee contain high levels of saturated fats, whereas extra virgin olive oil and margarine are higher in monounsaturated and polyunsaturated fats.
Fish such as salmon, tuna, and cod can be an excellent source of protein, and they contain unsaturated fat, such as omega-3 fatty acids, which can be beneficial for the body.
People with high cholesterol who follow the keto diet can snack on certain nuts and seeds that are generally low in carbs and rich in fiber and protein. Chia seeds have a higher content of polyunsaturated fats.
What Types Of Cholesterol Does Keto Allegedly Affect
The keto diet has been shown to affect both LDL and HDL cholesterol, but studies have been small and short-term with varying results.
Some studies have found that the keto diet has beneficial effects on LDL and HDL cholesterol levels, while others have found no effect. Some have reported an increase in LDL cholesterol.
Its kind of a toss-up, but science seems to agree that eating nutrient-dense foods while on the keto diet wont negatively affect your cholesterol levels or heart health.
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