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.
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 .
What Is A Ketogenic Diet
This diet severely restricts carbohydrates, typically providing only 5-10% of calories , compared to the 50% currently recommended. It also includes moderate levels of protein with no restriction of fat .
The idea behind the ketogenic diet is to use fat as a fuel source rather than carbohydrates, which is the bodys preferred source of fuel. This process produces ketones. Ketosis occurs when these ketone bodies accumulate in the blood. Exact quantities of carbohydrates to induce ketosis will vary, as achieving ketosis is highly individualised.
Many types of ketogenic diets exist, but all ban carb-rich foods such as sweet sugary foods, breads, cereals, pasta, rice, potatoes and other starchy vegetables and fruit juices. But also foods like beans and legumes, and most fruits. Most ketogenic diets allow foods high in saturated fat and cholesterol, such as fatty cuts of meat, processed meats, lard, butter, cream, and cheese, as well as sources of unsaturated fats, including nuts, seeds, avocados, plant oils, and oily fish.
As a result, a ketogenic diet can end up being high in saturated fat and cholesterol, and low in foods which we know are cardio-protective e.g. legumes, whole grains, fibre-rich starchy vegetables and most fruits.
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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.
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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
- Avocados
- 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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Final Thoughts On The Keto Diet And Cholesterol
So does the keto diet raise cholesterol? It can due to the high-fat content of the diet, however, the keto diet overall has positive effects on cardiovascular health markers.
The bottom in is that instead of focusing so much on cholesterol levels, its a better idea to tackle chronic inflammation. Inflammation is the primary cause of atherosclerosis, or hardening and stiffening of arteries that accompanies plaque deposits and increases risk for heart attacks.
If youre following the ketogenic diet, what are some ways you can take care of your heart and keep chronic inflammation at bay?
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Ketogenic Diet: Is The Ultimate Low
- By , Contributor
Recently, many of my patients have been asking about a ketogenic diet. Is a ketogenic diet safe? Would you recommend it? Despite the recent hype, a ketogenic diet is not something new. In medicine, we have been using it for almost 100 years to treat drug-resistant epilepsy, especially in children. In the 1970s, Dr. Atkins popularized his very-low-carbohydrate diet for weight loss that began with a very strict two-week ketogenic phase. Over the years, other fad diets incorporated a similar approach for weight loss.
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 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%.
Inflammation Causes Heart Disease Not Cholesterol
A common misconception is that cholesterol builds up and clogs your arteries, like grease blocking a pipe. The process is more nuanced than that.
As you read about in the last section, cholesterol is a repair molecule that shows up to heal damaged cells. When your arterial walls get damaged, cholesterol arrives to fix the problem. The issue is that LDL particles carrying cholesterol are large, and they can get stuck in the tear in your arterial wall. Thats when plaques begin to form.
The solution, then, shouldnt be to decrease your LDL and deprive your body of repair. It should be to get rid of whatevers tearing holes in the walls of your arteries. LDL is a symptom of an underlying problem, not a cause. The question is, what causes arterial damage in the first place?
The answer seems to be inflammation.
One of my favorite examples is smoking, Feldman says. Smoking causes oxidative stress that damages endothelial cellsthe damaged cells then become problematic, to the extent that it makes sense that the body would take action to repair them. Would you rather have a hole in the endothelial wall of your blood vessel, or would you rather have some spackle there to try to plug the leak?
Cholesterol seems to be a symptom of a larger problem. So why the confusion all these years about cholesterol causing heart disease?
The Framingham Study and related studies have found that the main risk factors for heart attack are:
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High Density Lipoproteins : The Ones You Want
HDL particles are produced in your liver and intestines and contain more protein than fat. This makes them denser .
HDL has been crowned good cholesterol because it corrals all the cholesterol thats not being used by your body and brings it all back to your liver. There it will either be recycled or leave the body as waste.
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 .
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What Should You Look For On An Nmr Lipoprofile Test
Begin by looking at the LDL particle concentration and size. Research suggests that particle size is the most important factor to consider when looking at cardiovascular health . A smaller LDL particle size is correlated to a higher risk of atherosclerosis. This means that you should be looking for larger particle sizes.
These more in-depth measurements will give you a better understanding of your cholesterol levels as compared to surface-level total levels.
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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How A Ketogenic Diet Effects Cholesterol
Research has shown time and time again that following a low-carb, high-fat diet improves cholesterol numbers and reduces your risk of heart disease in 4 main ways .
A Ketogenic Diet:
- Increases LDL particle size to the less oxidation-prone state
- It increases the amount of HDL available to recycle LDL from the blood before it has a chance to become oxidized
- It improves the LDL to HDL ratio
- Lowers triglycerides and improves triglyceride to HDL ratio
If you do not notice these beneficial changes in your cholesterol levels after following a well-formulated ketogenic diet for some time, you may want to consider other potential underlying causes.
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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