How A Keto Diet May Influence Cholesterol
There has been some research done on low-carbohydrate diets and their effects on cardiovascular health. It can be hard to draw specific conclusions on the topic, though, because many of the studies are short term , are of a small sample size, and examine different variations of very-low-carb diets.
Nevertheless, we are starting to understand a little bit more about how very-low-carbohydrate, or ketogenic, diets may affect cholesterol levels. Below is a summary of some of the research studies.
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.
How Does Keto Affect Your Arteries
How the keto diet affects your arteries depends on your individual health and the types of fats consumed while on the diet. Saturated fats have been shown to negatively affect your cholesterol levels mainly by increasing your LDL cholesterol levels. This can contribute to plaque buildup in your arteries.
However, unsaturated fats have the opposite effect on heart health by decreasing LDL cholesterol and increasing HDL cholesterol levels. This can improve your heart health, decreasing your risk of heart attack and stroke.
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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.
The Keto Diet And Concerns About High Cholesterol
TheKetogenic Diet is a low-carbohydrate food plan that is gaining in popularity.The diet has allowed thousands of people to lose weight, without the feeling ofdeprivation that accompanies many weight loss plans. Like other lowcarbohydrate diets, the diet restricts foods such as bread, potatoes and pasta.An unusual feature of the keto diet is its reliance on fats to trigger ametabolic state of ketosis, in which calories are burned efficiently.This emphasis on fats can lead to higher cholesterol levels. If you areconcerned about your cholesterol level, you can make adjustments to the ketodiet to provide better cholesterol control.
Keto and Cholesterol
Thefoods on the keto diet have been found to increase HDL the goodcholesterol humans need for normal body function. However, some individuals mayalso experience a rise in LDL, the bad cholesterol component thatcan lead to heart disease. Some individuals have a genetic predisposition tohaving high LDL levels, which the keto diet can worsen. You may wish to talk toyour doctor about taking a statin medication to lower your cholesterol levels.But you can also make minor adjustments in the types of foods you consume onthe diet, to help lower your cholesterol.
The Benefits of Olive Oil
Fish and Omega-3 Fatty Acids
The Importance of Fiber
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Ketogenic Diets Impact On V
Provided the research showing an increase in LDL levels in human subjects after a low-carbohydrate diet, what does the research say about extreme carbohydrate restriction on V-LDL and LDL particle count?
In a 2006 study, researchers assessed the effects of carbohydrate restriction on LDL cholesterol in a group of 29 men for a 12 week weight-loss intervention. The subjects ages ranged from 20-69 years their BMIs ranged from 25 kg/m2 to 30 kg/m2.
Their intervention diets consisted of 10% of energy from carbohydrates, 65% of energy from fat, and 25% of energy from protein. Assuming a 2000 kilocalorie diet, this translates to approximately 50 grams of carbohydrates daily.
After the 12 weeks intervention, researchers noted that the concentration of LDL particles decreased by 9.6% from 1180 nmol/L 1180 to 1066 nmol/L. As previously mentioned, lower levels of LDL particles are beneficial to cardiovascular fitness. Additionally, the particle size of LDL increased by an average of 5.2% from 20.75 mm to 21.27 mm.
Researchers also observed that the size of VLDL particle size did not change in either of the groups. However, they noted that the total number of VLDL particles decreased by 19% from 76.2 nmol/L to 61.7 nmol/L. More specifically, large VLDL particles reduced by 40.2% from 3.33 nmol/L to 1.74 nmol/L, medium VLDL particles decreased by 4.8% from 46.2 nmol/L to 44 nmol/L.
From this, we can conclude that a low-carb, ketogenic diet helps you optimize your LDL cholesterol.
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 Did My Cholesterol Increase On Keto
Ive been on the keto diet together with my husband for four months.
When I went for my annual check-up, I found out that my cholesterol numbers had gone up:
2019: 78 mg/dl2020: 130 mg/dl
I am worried that this diet is detrimental to my health at this time. Could you please give me some advice?
Thanks for the question, Deirdre.
This is a challenging question that has to be individualized. If you are concerned about your cholesterol changes, I suggest you consult with a doctor familiar with low-carb diets and lipids. I like to remind my patients that lipids are just one part of cardiovascular risk. That is why studies such as the one by Virta health, can show a slight increase in LDL but an overall decrease in cardiovascular risk. I suggest people work with a doctor who can help put their overall cardiovascular risk into perspective rather that focus on one solitary variable.
Additionally, here are three guides that may help you understand more about the issue:
Keto And Cholesterol: What Youve Heard Is Probably Wrong
Cholesterol is a waxy substance only produced by animals and humans. Plant-based foods like fruits and veggies are cholesterol-free.
When scientists first studied the human heart and noticed a correlation between hardened, clogged arteries and an increase in heart attacks, cardiovascular disease, strokes, and other cardiovascular risk factors such as high blood pressure, obesity, and an increase in body fat, they blamed cholesterol. Why? Because thats what they found built up as plaque.
Eating foods high in cholesterol, they said, would then in turn give you high cholesterol.
You can see why their original theory made sense. When you see congealed bacon grease sitting in a pan, its not such a stretch to imagine the same happening in your body.
But this isnt an accurate picture of how cholesterol truly works. In fact, many studies associating dietary cholesterol, high cholesterol levels, and an increased risk of heart disease have since been debunked.
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Carbohydrate Moderation Increases Hdl In Healthy Non
The majority of studies assessing the effects of carbohydrate restriction on HDL have been conducted on primarily Caucasian, obese subjects.
In 2006, researchers sought to investigate the relationship between carbohydrate intake and HDL cholesterol in a healthy, diverse population. Scientists examined data from Canadians of South Asian, Chinese, European, and Aboriginal origin from two cross-sectional studies conducted in the late 90s.
They included participants who were 35-75 years of age and who were not born in Canada but had lived there for at least 5 years. Subjects who suffered from moderate to severe medical conditions such as diabetes, heart diseases, and active cancer were not included. Subjects of all different weights and BMIs were included as long as they were considered healthy.
Scientists then randomly selected 619 subjects who met these inclusion criteria and examined their carbohydrate intake and levels of HDL cholesterol.
After adjusting for demographic factors such as age, sex, and ethnicity and lifestyle factors such as smoking, researchers noted that subjects in the lowest third of carbohydrate consumption had significantly higher levels of HDL cholesterol than subjects in the highest third of carbohydrate consumption.
Fewer servings of sugary drinks were also associated with higher levels of HDL. Because of their findings, the researchers attributed differences in HDL concentration to carbohydrate intake.
The Bottom Line On Trying The Keto Diet To Lower Cholesterol
If you have high cholesterol or triglycerides, speak with your medical team first before embarking on a keto diet. If you get the green light, continue to seek their help. There are a lot of popular books out on how to follow a keto diet, but I think patients need additional support and guidance and ongoing conversations about if its working for you, says Ryskamp. Its a tool that someone can use to improve their health, but it may not be the right tool for them, or the right tool the way theyre doing it, she says.
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What To Do If Cholesterol Worsens On The Keto Diet
If your cholesterol worsens on the keto diet, there are adjustments you can make without giving up a low carb lifestyle:
- Avoid bulletproof coffee: This refers to adding butter, coconut oil, or MCT oil to your daily cup of coffee.
- Intermittent fasting: Only eat when hungry. While further research is needed to look at the association between time-restricted eating and cholesterol levels, a recent pilot study of time restricted eating showed a reduction in LDL.
- Reduce saturated fat: Adjust the amount of saturated fat, and balance it with more monounsaturated & polyunsaturated fats. Minimally processed sources are essential.
- Incorporate leaner protein sources such as fish, seafood, poultry, and eggs. Dial back the amount of coconut oil, butter, and ghee, and replace these with extra virgin olive oil and avocado oil.
- Eat more LDL-lowering keto foods such as low-carb plant foods. These include avocado, dark leafy vegetables, cacao and dark chocolate, macadamia nuts, brazil nuts, and pecans. One analysis of 25 studies found that eating two servings of nuts per day reduced LDL cholesterol by an average of 7% . However plant foods contain numerous toxins that can harm your body and cause chronic inflammation, so be aware of the trade-off and closely monitor the effects.
- Increasing vitamin K2 may help protect heart health by keeping calcium in your bones and out of your arteries.The best sources of vitamin K2 include liver, eggs, grass-fed dairy products, and chicken .
If You Have High Cholesterol Should You Avoid Keto
Having high cholesterol doesnt automatically disqualify you from keto. Were seeing really good cardiovascular results from a keto diet, says Susan Ryskamp, RDN, clinical dietitian at Michigan Medicines Frankel Cardiovascular Center in Ann Arbor.
Doctors will want to look at the overall picture with the goal of improving biomarkers like triglycerides, A1C, blood pressure, and body mass index . On keto, if patients lose weight, get their BMI closer to, if not under 30 , and these biomarkers improve, we feel theyre at less of a cardiovascular risk, says Ryskamp.
If a patient has severely elevated triglyceride levels upwards of 1,000 mg/dL then Ryskamp would likely suggest another diet first. But a triglyceride level of 300 may still be a go, with close monitoring and frequent lipid checks. Most of the patients I see can safely go on keto, she says.
The fact is, says Ryskamp, people start down the road to heart disease in different ways , and cardiovascular patients respond uniquely to treatment. Not everyone will want to go on keto, but it may be recommended for some, she says. As a Clinical and Scientific Debates on Atherosclerosis points out, keto is not the only option. Other diets are as effective, more sustainable and safer, the authors write. The AHA still recommends a plant-based diet high in fruits, vegetables, legumes, whole grains, and lean vegetable or animal protein.
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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.
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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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.
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.
Five Ways To Lower Your Ldl On A Keto Or Low
Has your cholesterol increased on a low-carb diet? Do you fear that you may need to abandon this way of eating and its potential benefits?
Here are five ways you can reduce your total and LDL cholesterol levels while maintaining a keto or low-carb lifestyle. Consider trying them in this order.
1. Avoid Bulletproof coffee
Bulletproof coffee refers to adding butter, coconut fat or MCT oil in coffee. Avoid drinking significant amounts of fat at all when youre not hungry. This alone can sometimes normalize elevated cholesterol levels.23
2. Eat only when hungry
Only eat when hungry and consider adding intermittent fasting. This may reduce cholesterol levels. Although most research on intermittent fasting and LDL reduction come from low-quality observational studies during Ramadan, a recent pilot study of time restricted eating showed a significant reduction in LDL.24 While we need more data, this remains a promising intervention.
3. Eat foods higher in unsaturated fats instead of saturated fats
Foods higher in unsaturated fats include fats like olive oil, fatty fish and avocados. Replacing sources of saturated fat with these foods may be enough to lower LDL cholesterol.
However, remember that many unsaturated oils are highly processed. As with food, we recommend focusing on the least processed oils like olive oil, macadamia oil, and avocado oil.
4. Eat LDL-lowering keto-friendly foods
These low-carb plant foods may help lower cholesterol levels somewhat:
5. Eat more carbs
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