Keto And Cholesterol: A Healthy Balance?

The ketogenic diet is a high-fat, moderate-protein, and very low-carbohydrate diet. It is based on the idea that by drastically reducing carbohydrate intake, the body will shift from a carb-burning state to a fat-burning one, known as ketosis. While the keto diet has become popular for weight loss, there are concerns about its impact on heart health and cholesterol levels.

Cholesterol is a waxy, fat-like substance that circulates in the blood and is vital for building cell membranes, vitamin D, and hormones. However, high levels of bad cholesterol (LDL) can lead to fatty buildup in the arteries, increasing the risk of heart disease and stroke. On the other hand, good cholesterol (HDL) helps remove LDL cholesterol, protecting against heart attack and stroke.

The keto diet's impact on cholesterol levels is a subject of ongoing research. Some studies suggest that keto may lead to a decrease in total cholesterol, an increase in HDL, a decrease in triglycerides, and minimal changes or a modest reduction in LDL. Other studies, however, show conflicting results, with some indicating an increase in LDL levels.

The effect of keto on cholesterol may depend on the quality of the diet and individual factors such as genetics. While keto may not be suitable for everyone, particularly those with high cholesterol or certain genetic conditions, some healthcare professionals argue that it can be safe and even improve cardiovascular health when followed appropriately.

To ensure a heart-healthy approach to keto, it is recommended to focus on consuming unsaturated fats, such as nuts, seeds, and fatty fish, rather than saturated fats like butter and coconut oil, which have been linked to poor heart health. Additionally, maximizing the small amount of carbohydrates allowed by choosing fiber-rich, non-starchy fruits and vegetables can benefit both cholesterol levels and gut health.

The impact of keto on heart health

The keto diet is a high-fat, moderate-protein, and very low-carbohydrate diet. It is associated with a range of benefits, including weight loss, reduced triglycerides, and improved insulin sensitivity. However, its impact on heart health is more complex.

Cholesterol and heart health

Cholesterol is a waxy, fat-like substance that circulates in the blood and is found in the cells of your body. While it plays an essential role in various bodily functions, such as building cell membranes and producing hormones, too much cholesterol can lead to heart health problems.

There are two main types of cholesterol:

• Low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol, contributes to heart disease by adding to fatty buildup in the arteries, increasing the risk of heart attack and stroke.
• High-density lipoprotein (HDL) cholesterol, or "good" cholesterol, helps remove LDL cholesterol from the arteries, protecting against heart attack and stroke.

The impact of keto on cholesterol

The keto diet's high-fat content has raised concerns about its potential to increase cholesterol levels and subsequently raise the risk of heart disease. However, the effect of keto on cholesterol and heart health is not straightforward.

Some studies suggest that keto can lead to modest reductions in triglycerides, modest changes in HDL ("good") cholesterol, and minimal changes in LDL ("bad") cholesterol levels. In some cases, LDL levels may even decrease. The impact on LDL levels appears to depend on the quality of the keto diet and individual genetic factors.

Choosing heart-healthy fats on keto

When following a keto diet, it is important to prioritise heart-healthy, unsaturated fats, such as those found in nuts, seeds, avocado, and olive oil. Saturated fats, such as butter, coconut oil, and animal fat, are associated with poor heart health and should be limited.

Weighing the benefits and risks

While the keto diet may offer benefits for weight loss and certain biomarkers associated with heart health, it may not be suitable for everyone, especially those with high cholesterol or a history of heart disease. It is crucial to consult with a healthcare professional before starting any new diet, particularly one as restrictive as keto, to ensure it is safe and appropriate for your individual needs and health status.

Additionally, long-term adherence to the keto diet can be challenging, and a clear plan for transitioning off the diet is essential to maintain any positive health benefits.

The effect of keto on cholesterol levels

The keto diet is a high-fat, moderate-protein, and very low-carbohydrate diet. It involves eating up to 80% of your calories from fat and sticking to 20 to 50 grams of net carbs per day. This means that you will be eating a lot of fat, and to meet this quota, you may end up consuming unhealthy choices such as butter, coconut oil, and animal fat. These are all sources of saturated fat, which has been linked to poor heart health.

Research findings on the effect of keto on cholesterol levels

Impact on HDL ("good") cholesterol

Research shows that the keto diet is generally associated with an increase in HDL cholesterol levels. This is beneficial as HDL helps remove LDL cholesterol from the arteries, protecting against heart attack and stroke.

Impact on LDL ("bad") cholesterol

The impact of keto on LDL cholesterol levels is less clear and varies depending on the quality of the diet and individual genetic factors.

• Diet quality: The type of fats consumed on a keto diet can influence LDL levels. A diet high in saturated fat is more likely to increase LDL levels, while a diet that includes healthier unsaturated fats may have a more favourable effect.
• Genetic factors: Some individuals with an inherited genetic mutation that affects LDL regulation may experience a significant increase in LDL levels on a keto diet. This can be dangerous for those with a predisposition to heart disease.

Impact on triglycerides

Keto diets are generally associated with a decrease in triglyceride levels. This is beneficial as high triglyceride levels can lead to fatty deposits in the arteries, increasing the risk of heart disease.

Overall impact on heart health

While the keto diet may have favourable effects on some cholesterol markers, such as increasing HDL and decreasing triglycerides, its impact on LDL levels is less certain. Therefore, it is important to consult with a healthcare professional before starting a keto diet, especially if you have existing heart health concerns or other risk factors.

Additionally, the long-term effects of the keto diet on cholesterol levels and heart health are not yet fully understood, and more research is needed in this area.

The safety of keto for people with high cholesterol

The keto diet is a high-fat, moderate-protein, and very low-carbohydrate diet. It involves getting up to 80% of your calories from fat and sticking to 20 to 50 grams of net carbs per day. This means that you will be eating a lot of fat, and there is a worry that this will lead to a subsequent spike in cholesterol levels, which could increase the risk of heart disease.

However, the effect of keto on heart health is not as straightforward as it sounds. Research shows that the keto diet may not be as detrimental to cholesterol levels as previously thought. Studies have shown that keto produces modest reductions in triglycerides, modest changes in heart-protective high-density lipoprotein (HDL, or "good" cholesterol), and minimal changes in low-density lipoprotein (LDL, or "bad" cholesterol) levels.

The impact of keto on cholesterol levels largely depends on the quality of the diet. If the diet is high in saturated fat, this is likely to lead to an increase in LDL cholesterol. However, if the diet is high in unsaturated fats, this can improve cholesterol levels, especially LDL cholesterol levels.

For people with normal triglyceride levels, the keto diet is likely safe to try, as it will have minimal or no impact on cholesterol levels. For people with insulin resistance, type 2 diabetes, and/or abdominal obesity, keto may help to decrease insulin resistance and improve triglycerides.

However, for people with a genetic mutation that affects the way LDL particles are regulated, the keto diet may cause LDL levels to skyrocket. This condition is called familial hypercholesterolemia and is marked by very high LDL cholesterol levels and an increased risk of premature heart disease. Only about 10% of people with this condition are aware that they have it.

Overall, the keto diet may be safe for people with high cholesterol, but it is important to consult with a healthcare provider before starting the diet, especially if there are other risk factors present. Frequent monitoring of blood cholesterol and triglyceride levels is also recommended to ensure that the diet is not having a negative impact on cholesterol levels.

The types of fat to consume on keto

The keto diet is a high-fat, low-carb diet. However, not all fats are created equal, and some types of fat are healthier than others.

Healthy Fats for the Keto Diet

• Oily fish, such as salmon, tuna, anchovies, and sardines
• Avocados and avocado oil
• Nuts, such as walnuts, macadamias, almonds, and Brazil nuts
• Seeds, such as flax and pumpkin seeds
• Olives and cold-pressed extra virgin olive oil
• Coconuts and unrefined coconut oil
• Full-fat Greek yogurt
• Eggs
• Butter
• Cheese

Fats to Limit on Keto

• Artificial trans fats, found in highly refined oils and commercially prepared processed foods
• Processed meats, such as deli meat, sausages, salami, and hot dogs
• Deep-fried foods

How to transition off keto

Transitioning off the keto diet has its benefits. The keto diet is restrictive, and many people will find that they can't stay on it for very long. Long-term keto diets can also result in nutritional deficiencies, especially when it comes to fibre.

• Gradually increase your carb intake: Start by adding an additional 10g of carbohydrates per day for the first week. Opt for carbs from healthy sources like whole grains, beans, fruits, and starchy vegetables. Track your weight and how you feel, and increase your carb intake weekly or every other week, depending on your goals.
• Find your desired carb range: The number of carbs recommended varies depending on your goals and activity levels. Aim for a number that allows you to eat a greater variety of foods so that you don't feel restricted but can maintain your weight and feel good.
• Add more protein to your plate: Consider increasing your intake of lean proteins, such as beans, tofu, chicken, fish, and lean cuts of red meat. This will help you take advantage of the thermic effect of food, which is the number of calories it takes to digest food.
• Focus on complex carbs: As you transition off keto, choose a diet rich in lean proteins, healthy fats, and complex carbs. The Mediterranean diet is a good model to follow. Complex carbs are found in whole, unprocessed foods, including vegetables, whole grains, legumes, nuts, seeds, leafy greens, and fruits. They are higher in fibre and take longer to digest than simple carbs.
• Be aware of the sugar pitfall: Avoid trading keto fat bombs for sugar bombs! Focus on the quality of the carbs you're eating and choose kinds that take more time to digest. Avoid anything with more than 4 grams of added sugar, and be aware of too much naturally occurring sugar in things like honey and certain fruits.

Frequently asked questions