Leena Watts
The ketogenic (keto) diet has been popularised as a weight-loss solution, but its safety, particularly for heart patients, has been questioned. The keto diet is high in fat and protein and low in carbohydrates, and while it may lead to rapid weight loss, it may not be safe for those with heart disease. Previous research has shown that a low-carb, high-fat (LCHF) keto-like diet can lead to elevated levels of LDL cholesterol, a risk factor for heart disease. More recent studies have also found a correlation between keto diets and a higher risk of heart disease and cardiovascular events, such as heart attacks and strokes. However, other sources suggest that keto diets can have heart health benefits, such as lowering blood pressure and increasing good cholesterol (HDL).
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What You'll Learn
Potential heart health benefits
While ketogenic diets have been associated with a higher risk of heart disease, there are a few potential heart health benefits that have been observed. Firstly, ketogenic diets can lead to an initial drop in LDL, the "bad" cholesterol, although this effect was not sustained over a 12-month period in two studies. Additionally, the “good” cholesterol, HDL, may increase, depending on the level of fat consumption.
Ketogenic diets can also aid in weight loss, which can help lower blood pressure and manage other risk factors that impact heart health. Intermittent fasting, which is often paired with ketogenic diets, has been shown to decrease abdominal fat and increase insulin sensitivity. Fasting may also contribute to lower blood pressure and a reduced resting heart rate.
While these potential benefits exist, it is important to note that the overall consensus is that ketogenic diets may not be safe for heart patients. The diets are typically very high in fat, which can lead to increased consumption of saturated fat, even when focusing on healthy fat sources. Additionally, the extreme carbohydrate restrictions may lead to the avoidance of fruits and vegetables, resulting in potential nutrient deficiencies and interference with certain medications commonly taken by heart patients. Furthermore, previous research has indicated that ketogenic diets can elevate LDL cholesterol levels, a known risk factor for heart disease. Thus, while there may be some initial positive effects, the long-term implications for heart health are less clear and potentially detrimental.
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Risks for people with heart disease
While the ketogenic diet has been associated with several health benefits, there are some risks involved, especially for people with heart disease. Here are some of the potential risks for heart patients considering a ketogenic diet:
Elevated LDL Cholesterol Levels: The ketogenic diet is typically low in carbohydrates and high in fat. This dietary pattern can lead to increased levels of LDL cholesterol, also known as the "bad" cholesterol. Elevated LDL cholesterol is a risk factor for heart disease as it can contribute to atherosclerosis, a buildup of plaque in the coronary arteries. While there may be an initial drop in LDL levels when starting the diet, this effect is not sustained over time, as seen in some studies.
Cardiovascular Events: Studies have suggested a correlation between ketogenic diets and an increased risk of cardiovascular events, including heart attacks, strokes, peripheral artery disease, and clogged heart arteries. People following a ketogenic diet over a nearly 12-year period had significantly higher rates of these cardiovascular events compared to those on a standard diet.
Interference with Medications: The extreme carbohydrate restrictions in a ketogenic diet may lead to the avoidance of fruits and vegetables. However, these foods contain vitamin K, which can interfere with anti-clotting medications like warfarin, commonly taken by heart patients.
High Saturated Fat Intake: The keto diet recommends getting a significant portion of calories from fat, which may result in a higher intake of saturated fat than is considered safe and healthy. Even when choosing healthy fats like olive oil and fish, the overall fat consumption may still be too high, potentially impacting heart health negatively.
Short-Term Focus: The ketogenic diet is challenging to maintain over the long term, and many people may find it difficult to sustain the dietary restrictions. This can lead to a cycle of rapid weight loss followed by weight gain when the diet is discontinued. Instead, a more sustainable approach focused on choosing healthier foods and making lifestyle changes is generally recommended for long-term heart health.
It is important to consult with a healthcare professional before starting any dietary regimen, especially for individuals with heart disease or other underlying health conditions.
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Short-term vs long-term effects
The ketogenic diet has been associated with several short-term benefits, including rapid weight loss, reduced body mass, lower triglyceride levels, and decreased blood pressure. These factors can positively impact overall health and reduce the risk of cardiovascular disease (CVD). However, the long-term efficacy of the keto diet for weight loss and metabolic changes is less significant, and there is scarce evidence of its long-term benefits.
In the long term, the extreme carbohydrate restrictions of the keto diet may lead to nutritional deficiencies and an increased risk of cardiovascular disease. The diet's high fat and protein content can lead to elevated levels of LDL ("bad") cholesterol, which is a known risk factor for heart disease. Additionally, the keto diet may interfere with certain medications commonly taken by heart patients, such as the anti-clotting drug warfarin.
While the keto diet has shown some promising short-term results, the long-term effects on heart health are less clear and may even be detrimental. Some studies suggest that the continuous use of the keto diet may impair hepatic ketogenesis capacity, while intermittent use may have a protective effect against heart failure. However, the overall consensus is that the keto diet should be approached with caution, especially by individuals with heart disease or high cholesterol.
It is important to note that the keto diet is not a sustainable solution for long-term weight loss or heart health. Instead, a balanced approach that includes a variety of food groups, such as the Mediterranean diet, is recommended for maintaining a healthy weight and reducing the risk of heart disease. Additionally, lifestyle changes, such as increasing physical activity and managing stress, are crucial for long-term heart health.
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Side effects and mitigation
Ketogenic diets may lead to an increase in LDL cholesterol, which is a risk factor for heart disease. This is due to the high-fat content of the diet, which can lead to a build-up of plaque in the coronary arteries. Additionally, the extreme carbohydrate restrictions of the keto diet may lead to a deficiency in vitamin K, which can interfere with the anti-clotting drug warfarin taken by some heart patients. The diet may also cause an initial drop in blood pressure, which could be dangerous for those with already low blood pressure. Other potential side effects include constipation, mood swings, and clouded thinking from inadequate carbohydrates, as well as sluggishness or "keto flu", poor energy and mental function, increased hunger, sleep issues, nausea, digestive discomfort, and decreased exercise performance.
To mitigate these side effects, it is recommended to gradually lower carbohydrate consumption over a few weeks instead of completely cutting them out. This can help reduce the severity of the "keto flu" and other side effects. It is also important for those considering the keto diet to address any additional risk factors such as diabetes, high blood pressure, inactivity, poor sleep, and smoking. A balanced Mediterranean-style diet is often recommended for heart health, focusing on fresh vegetables, low-glycemic fruit, lean fish, whole grains, and moderate amounts of healthy fats such as nuts and olive oil. While the keto diet may lead to rapid weight loss in the short term, it is not sustainable for most people in the long term and does not provide any unique long-term benefits. Thus, it may be more effective to focus on making sustainable lifestyle changes, such as improving diet quality and increasing physical activity, rather than following restrictive fad diets like keto.
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Alternative diets for heart health
The ketogenic diet has been associated with several potential heart health benefits, such as a reduction in LDL ("bad" cholesterol) and an increase in HDL ("good" cholesterol). Additionally, any diet that promotes weight loss can positively impact heart health by lowering blood pressure. However, the keto diet's high-fat content has raised concerns, particularly regarding the consumption of saturated fats, which may negatively affect heart health.
A Cardiovascular Dietitian's Approach
UC Davis Health's cardiovascular dietitian, Margie Junker, recommends several dietary habits to improve heart health:
- Consume a diet rich in fruits and vegetables, including fresh, frozen, dried, or low-sodium canned options. Avoid canned fruits in heavy syrup and foods with high-fructose corn syrup.
- Incorporate whole grains like quick oats and quinoa into your meals.
- Include plant protein in your diet, such as a daily serving of nuts.
- Enjoy blueberries as a healthy snack or dessert, as they are rich in antioxidants and offer multiple heart health benefits.
- Indulge in spinach, either fresh in salads or sautéed with garlic and onions, as it is a versatile leafy green that provides various vitamins, minerals, and antioxidants.
The Mediterranean Diet
The Mediterranean diet has long been recognized for its heart-healthy benefits. This diet is inspired by the traditional eating patterns of the countries bordering the Mediterranean Sea, emphasizing:
- An abundance of plant-based foods, including fruits, vegetables, whole grains, legumes, nuts, and seeds.
- The use of olive oil as the primary source of added fat.
- Moderate consumption of fish, poultry, and dairy, opting for lean proteins and healthy fats.
- Limited intake of red meat and processed foods.
- The inclusion of red wine in moderation (optional).
The DASH Diet
The DASH diet, or Dietary Approaches to Stop Hypertension, is specifically designed to lower blood pressure and improve heart health. This diet involves:
- Emphasizing fruits, vegetables, and whole grains.
- Including low-fat or non-fat dairy products, lean proteins, and plant-based proteins.
- Choosing healthy fats, such as olive oil, avocados, and nuts, while limiting saturated and trans fats.
- Reducing sodium intake and limiting processed foods.
- Staying hydrated by drinking plenty of water.
Heart-Healthy Foods
In addition to adopting a specific diet, incorporating certain heart-healthy foods into your diet can be beneficial:
- Fatty fish like salmon, mackerel, sardines, and tuna are rich in omega-3 fatty acids, which have been linked to a reduced risk of heart disease, improved vascular function, and lower blood pressure.
- Walnuts and other nuts can help reduce cholesterol and blood pressure, contributing to a healthier heart.
- Beans have been found to reduce certain risk factors for heart disease and improve blood sugar management.
- Dark chocolate, when consumed in moderation, is rich in antioxidants and may help decrease the risk of coronary heart disease.
- Berries, particularly blueberries, are rich in antioxidants and can help protect against inflammation and oxidative stress, contributing to heart health.
It is important to remember that while these diets and food choices can promote heart health, they should be adapted to suit individual needs and preferences. Consulting with a healthcare professional or a registered dietitian can help tailor a heart-healthy diet that is safe and effective for your specific circumstances.
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Frequently asked questions
A ketogenic diet may not be safe for some people with heart disease. It is also not sustainable and should not be done by people with high cholesterol.
A ketogenic diet may lead to elevated levels of LDL cholesterol, which is a risk factor for heart disease. The extreme carbohydrate restrictions in a ketogenic diet may lead to an interference with the anti-clotting drug warfarin, which is taken by some heart patients.
A ketogenic diet can result in weight loss, which can help lower blood pressure. There is often an initial drop in LDL cholesterol, and the \"good\" cholesterol, HDL, may increase depending on the level of fat consumption.
A better-balanced, Mediterranean-style diet is recommended for heart health, focused on fresh vegetables, low-glycemic fruit, lean fish, and white meat. Limiting sugar, salt, alcohol, red meat, and processed foods is also recommended.
