Keto And High Cholesterol: A Healthy Combination?

The ketogenic diet is a popular weight-loss diet that involves eating a high-fat, moderate-protein, and very low-carbohydrate diet. While the keto diet is generally considered healthy and safe for most people, some are concerned that it may negatively impact those with high cholesterol due to the high-fat content. However, the effect of keto on cholesterol is complex and depends on various factors.

The keto diet may increase HDL (good) cholesterol

The keto diet may not be as detrimental to cholesterol levels as previously thought. Research suggests that the keto diet 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 the keto diet on HDL levels depends on the quality of the diet. Some studies have shown that in human subjects with normal weight and obesity, keto diets are associated with an increase in HDL levels. However, other studies have shown a rise in LDL levels or no change.

In one study, a low-calorie diet was compared to a very low-carb, high-fat keto diet in over 360 overweight and obese participants, some with diabetes. After about a year, the keto group saw a decrease in total cholesterol, triglycerides, and LDL, while HDL levels rose.

Another study of 83 obese patients with high glucose and cholesterol levels found that a 24-week ketogenic diet resulted in a significant increase in HDL cholesterol levels, while LDL cholesterol levels decreased.

The relationship between triglycerides and HDL cholesterol is important to consider. When triglyceride levels are high, HDL levels tend to be low. Therefore, anything that reduces triglycerides will also tend to increase HDL.

Overall, while the keto diet may not have a significant impact on HDL levels, it is important to note that the quality of the diet and individual factors, such as starting triglyceride levels, can play a role in the impact on cholesterol levels.

The keto diet may decrease LDL (bad) cholesterol

The impact of the keto diet on LDL cholesterol depends on the quality of the diet and individual genetic factors. A keto diet that is high in healthy unsaturated fats and limited in unhealthy saturated fats may decrease LDL cholesterol.

In one study, a group of patients on a keto diet for an average of 12.3 months experienced an average increase in their LDL cholesterol level of 187 mg/dL, representing a 245% increase. However, when these patients discontinued the keto diet, their LDL cholesterol levels decreased by an average of 174 mg/dL, representing a 220% decrease.

Another study found that a 56-year-old female patient who followed a strict keto diet for 30-40 days experienced a rapid increase in LDL cholesterol, followed by a rapid correction after discontinuing the diet.

It is important to note that the keto diet may not be suitable for everyone, and some people may need to adjust their keto diet to avoid raising their cholesterol levels. If you have high cholesterol, it is recommended to consult a healthcare professional before starting the keto diet to determine if it is suitable for you.

The keto diet may increase LDL cholesterol in people with a genetic mutation

The ketogenic diet is a popular, very-low-carb, high-fat, and moderate-protein diet that people use to lose weight and improve their overall health. On the keto diet, people restrict their total carbohydrate intake to 20–50 grams per day, which forces the body to shift from using glucose as its main source of energy to using ketone bodies, a type of chemical formed from the breakdown of fat.

While the keto diet is generally considered safe and suitable for most people, it may not be the best option for those with certain pre-existing health conditions, such as kidney disease, liver disease, familial hypercholesterolemia (high cholesterol levels inherited from family), or fat-induced lipemia, as the diet may worsen these conditions.

One concern related to the keto diet is its potential impact on cholesterol levels. The high-fat content of the keto diet, including saturated fats, has been linked to poor heart health and an increased risk of heart disease. However, the effect of the keto diet on cholesterol and heart health is complex and may vary depending on individual factors.

Some studies have shown that the keto diet can lead to a modest increase in total cholesterol and low-density lipoprotein (LDL) cholesterol, also known as the "bad" cholesterol. This effect may be more pronounced in individuals with a genetic predisposition to cholesterol metabolism dysregulation or a genetic mutation that affects LDL regulation, such as the APOE gene mutation. In these individuals, the keto diet may cause a significant increase in LDL cholesterol levels.

However, the impact of the keto diet on LDL cholesterol can vary depending on the quality of the diet and individual genetic factors. Choosing healthier sources of fat, such as unsaturated fats, and avoiding unhealthy saturated fats may help mitigate the potential negative impact on LDL cholesterol. Additionally, the impact of the keto diet on cholesterol may also depend on the baseline triglyceride levels of the individual.

It is important to consult with a healthcare professional before starting the keto diet, especially for those with pre-existing health conditions like high cholesterol. Adjustments to the standard keto diet, such as avoiding artificial trans fats, processed meats, and fried foods, may be necessary to prevent an increase in cholesterol levels.

The keto diet may not be suitable for people with high cholesterol

The effect of keto on cholesterol is complex and depends on various factors. Some studies suggest that keto can lead to a modest reduction in triglycerides and an increase in HDL ("good") cholesterol, while having minimal effects on LDL ("bad") cholesterol. However, other studies have shown a rise in LDL cholesterol levels, especially in the short term. The long-term effects of keto on cholesterol are not yet fully understood, and more research is needed.

It is important to note that the type of fats consumed on a keto diet can significantly influence cholesterol levels. Consuming mostly saturated fats, such as butter, coconut oil, and animal fat, can lead to higher LDL cholesterol levels, which is a risk factor for heart disease. On the other hand, choosing healthier unsaturated fats, such as plant oils, fatty fish, nuts, and seeds, may improve cholesterol levels, especially LDL levels.

Additionally, people with certain health conditions, such as familial hypercholesterolemia, a rare genetic condition that affects LDL regulation, should be cautious about following a keto diet as it may cause a significant increase in their LDL cholesterol levels.

If you have high cholesterol and are considering the keto diet, it is crucial to consult with your healthcare provider first. They can evaluate your individual health, cholesterol levels, and risk factors to determine if keto is a safe and suitable option for you. Adjustments to the standard keto diet may be necessary to prevent raising your cholesterol levels further.

The keto diet may be safe for people with high cholesterol

The keto diet is a popular, strict low-carb, high-fat, and moderate-protein diet that people use to lose weight and improve their overall health and well-being. It involves restricting your total carbohydrate intake to 20–50 grams per day, which forces your body to shift from using glucose as its main source of energy to using ketone bodies, a type of chemical formed from breaking down fat.

There is a concern that following a very high-fat diet will create a subsequent spike in cholesterol levels, which could, in turn, raise your risk for heart disease. However, the effect of keto on heart health is not as straightforward as it sounds.

The impact of keto on cholesterol levels

The keto diet may not have as detrimental an effect on your cholesterol as previously thought. Most research suggests that keto diets can help lower total cholesterol and LDL ("bad") cholesterol levels while raising HDL ("good") cholesterol levels.

In some cases, the keto diet may raise total and LDL cholesterol levels in the short term. However, research suggests that both total and LDL cholesterol levels fall in the long term, while HDL cholesterol levels appear to rise.

The impact of keto on people with high cholesterol

Having high cholesterol does not automatically disqualify you from keto. Doctors will want to look at the overall picture with the goal of improving biomarkers like triglycerides, A1C, blood pressure, and body mass index (BMI). If patients lose weight, get their BMI closer to or under 30, and these biomarkers improve, keto may reduce their cardiovascular risk.

If you have high cholesterol levels and are interested in trying the keto diet, it’s important to ask a healthcare professional whether the diet is suitable for you, based on your particular cholesterol levels and overall health.

How to follow keto in a heart-healthy way

One of the draws of a keto diet is the idea that you can eat any and all fats that you want. However, this is not a healthy mindset to step into. It is recommended that patients choose cardioprotective (unsaturated) fats, like nuts, nut butter, seeds, avocado, and extra virgin oils, such as olive oil. Similarly, it is best to avoid foods that are high in saturated fat (like butter) as your primary fat sources.

It is also important to maximize the small amount of carbohydrates you’re allowed. Getting enough fiber can be a challenge, and you’ll want to make sure you’re eating plenty of low GI-index veggies (non-starchy choices such as spinach and broccoli). Ultimately, the benefits come from replacing foods, like processed carbs, with those that are heart-healthy, like unsaturated fats.

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