Keto And Heart Disease: What's The Real Risk?

The ketogenic diet, or keto, is a popular weight-loss diet that involves eating low amounts of carbohydrates and high amounts of fats. The body's primary source of energy is carbohydrates. By depriving the body of carbohydrates, it is forced to start breaking down fat for energy instead. This breakdown of fat in the liver produces ketones, chemicals that the body uses as energy in the absence of carbohydrates.

The keto diet is linked to an increased risk of heart disease and cardiac events. It may lead to elevated levels of LDL cholesterol, a known risk factor for heart disease. The diet may also cause a rise in cholesterol levels, even if weight loss is achieved. For people with a history of heart disease or high cholesterol, this can be especially dangerous.

The keto diet is not considered a healthy long-term solution. There is scarce evidence for any long-term benefit. It may lower blood levels of triglycerides but there is a lack of evidence to suggest it does not increase the risk of heart disease. The extreme carbohydrate restrictions may also lead people to shun vegetables and fruits, which can provide protection against heart disease.

The keto diet is not recommended for some people with heart disease. The vitamin K in leafy greens may interfere with the anti-clotting drug warfarin. The keto diet may also be incompatible with drugs known as SGLT-2 inhibitors, which are used to treat diabetes and heart failure.

The keto diet may increase the risk of heart disease and cardiac events

The ketogenic or "keto" diet is a popular weight-loss diet that involves consuming low amounts of carbohydrates and high amounts of fats. However, recent studies suggest that the keto diet may be linked to a heightened risk of heart disease and cardiac events.

The keto diet and its impact on cardiovascular health

The keto diet restricts the consumption of carbohydrates, which are the body's primary source of energy. By depriving the body of carbohydrates, it is forced to break down fat for energy, leading to a state known as ketosis. While the keto diet can lead to rapid weight loss, there are concerns about its potential impact on cardiovascular health.

Increased risk of heart disease and cardiac events

A study presented at the American College of Cardiology's Annual Scientific Session in 2023 found that a "keto-like" diet, consisting of no more than 25% of total daily calories from carbohydrates and more than 45% of total daily calories from fat, was associated with higher levels of LDL ("bad") cholesterol and a twofold heightened risk of cardiovascular events such as chest pain, blocked arteries, heart attacks, and strokes.

The study analyzed data from the UK Biobank, a large-scale database with health information from over half a million people. It found that 9.8% of participants on an LCHF diet experienced a new cardiac event, compared to 4.3% of those on a standard diet, indicating a doubling of risk for those on the keto-like diet.

Impact on cholesterol levels

The keto diet appears to lower blood levels of triglycerides but raise levels of LDL cholesterol, which is a known risk factor for heart disease. The extreme carbohydrate restrictions of the keto diet may also lead people to shun vegetables and fruits, resulting in a potential lack of essential nutrients.

Shortcomings and limitations

It is important to note that the study was observational, meaning it can only show an association between the keto diet and increased risk of cardiac events, not a causal relationship. Additionally, the participants provided dietary information at one point in time, which may impact the interpretation of the findings.

While the keto diet may lead to rapid weight loss, the available evidence suggests that it may also increase the risk of heart disease and cardiac events. Further research is needed to fully understand the long-term impacts of the keto diet on cardiovascular health.

The keto diet may lead to higher levels of LDL cholesterol

The ketogenic diet, a high-fat, low-carbohydrate eating pattern, has become increasingly popular as a weight-loss tool. However, there are concerns about its long-term implications for cardiovascular health.

The impact of the keto diet on cholesterol levels

The keto diet has been linked to an increase in total cholesterol and low-density lipoprotein (LDL) cholesterol levels. LDL cholesterol is often referred to as "bad" cholesterol because elevated levels are a known risk factor for heart disease.

Some individuals on the keto diet may experience a dramatic increase in LDL-cholesterol levels. These individuals, known as "Lean Mass Hyper-Responders", are often lean and fit and may exhibit LDL cholesterol levels greater than 200 mg/dL.

A 2020 case report described a 56-year-old woman who showed a rapid increase in LDL-cholesterol after following a strict ketogenic diet for 30-40 days. Her LDL-cholesterol level increased from a baseline of 129 mg/dL to 316 mg/dL while on the keto diet.

Factors influencing the impact of the keto diet on LDL cholesterol

The impact of the keto diet on LDL cholesterol levels may vary depending on individual factors.

Dietary composition

The composition of the keto diet may influence LDL cholesterol levels. A well-formulated ketogenic diet that includes a significant proportion of unsaturated fatty acids from sources such as olive oil, avocado, and fish may have a more favourable impact on LDL cholesterol levels.

Weight loss

Weight loss is another factor that may influence LDL cholesterol levels. In some cases, weight loss associated with the keto diet may contribute to a reduction in LDL cholesterol levels.

Genetic factors

Genetic factors may also play a role in the impact of the keto diet on LDL cholesterol levels. Some individuals with a genetic predisposition to cholesterol metabolism dysregulation may experience a disproportionate elevation in cholesterol levels when following a ketogenic diet.

The link between the keto diet and cardiovascular disease

While elevated LDL cholesterol levels are a risk factor for heart disease, the direct link between the keto diet and cardiovascular disease is not yet fully understood.

Some studies have suggested that the elevation in LDL cholesterol associated with the keto diet may not necessarily increase cardiovascular complications. This could be due to the larger particle size of LDL cholesterol associated with the keto diet.

However, a recent study presented at the American College of Cardiology's Annual Scientific Session suggested a possible link between a "keto-like" diet and a heightened risk of cardiovascular events such as chest pain, blocked arteries, heart attacks, and strokes. This study found that individuals on a keto-like diet had a more than twofold higher risk of cardiovascular events compared to those on a standard diet.

While the keto diet may lead to higher levels of LDL cholesterol, the direct impact of this increase on cardiovascular disease risk is not yet fully understood. Further research is needed to determine the long-term implications of the keto diet on cardiovascular health.

The keto diet may not be safe for people with heart disease

The ketogenic (keto) diet is a popular weight-loss diet that involves eating low amounts of carbohydrates and high amounts of fat. However, the keto diet may not be safe for people with heart disease.

The keto diet and heart disease risk

The keto diet may be linked to a higher risk of heart disease and cardiac events such as chest pain, blocked arteries, heart attacks, and strokes. The keto diet restricts the consumption of carbohydrates, which are the body's primary source of energy. By depriving the body of carbohydrates, it is forced to break down fat for energy, leading to weight loss. However, this extreme restriction of carbohydrates may lead to the shunning of vegetables and fruits, which are important sources of nutrients andsection_break>dietary fiber that helps protect the heart.

The keto diet and cholesterol

The keto diet has been found to lower blood levels of triglycerides but raise levels of LDL ("bad") cholesterol, a known risk factor for heart disease. The keto diet's restriction of carbohydrates and high fat content may lead to increased levels of LDL cholesterol, which can increase the risk of heart disease.

The keto diet and blood pressure

The keto diet's extreme restriction of carbohydrates may lead to an increase in blood pressure. The diet's low carbohydrate content may lead to a decrease in insulin levels, which can affect sodium retention and water retention in the body. Additionally, the diet's impact on the vascular endothelium, which plays an important role in regulating blood pressure, may also contribute to changes in blood pressure.

The keto diet and weight loss

The keto diet may lead to dramatic weight loss over the short term due to its extreme restriction of carbohydrates. However, there is scarce evidence for any long-term weight loss benefits.

The keto diet and people with heart disease

The keto diet's extreme restriction of carbohydrates and high fat content may lead to increased levels of LDL cholesterol, weight loss, and changes in blood pressure. While the keto diet may be effective for short-term weight loss, it may not be safe for people with heart disease due to the potential increase in LDL cholesterol and interference with heart disease medications.

The keto diet may not be a healthy long-term option

The ketogenic (keto) diet is a popular weight-loss diet that involves eating very few carbohydrates and a high amount of fat. However, there are concerns about the diet's long-term health effects, particularly its impact on heart health. Here are some reasons why the keto diet may not be a healthy long-term option:

Potential Risks to Heart Health

• Increased Risk of Heart Disease: A study presented at the American College of Cardiology's Annual Scientific Session in 2023 suggested that a "keto-like" diet may be linked to a higher risk of heart disease and cardiac events such as chest pain, blocked arteries, heart attacks, and strokes. The study found that participants on a keto-like diet had twice the risk of these cardiac events compared to those on a standard diet.
• Elevated LDL Cholesterol: The keto diet has been shown to increase levels of LDL cholesterol, the so-called "bad" cholesterol that is a known risk factor for heart disease. While some studies suggest that not everyone responds to the keto diet in the same way, with some people's LDL levels staying the same or decreasing, the potential for elevated LDL cholesterol is a concern.
• Incompatible with Certain Medications: The keto diet's extreme carbohydrate restrictions may interfere with the effectiveness of certain medications, such as the anti-clotting drug warfarin and SGLT-2 inhibitors used to treat diabetes and heart failure.
• Lack of Long-Term Evidence: There is limited evidence for the long-term benefits of the keto diet. While it may lead to dramatic weight loss and fat mass reduction in the short term, these benefits may fade over time.
• Nutritional Imbalances: The keto diet's strict carbohydrate restrictions may lead people to avoid fruits and vegetables, resulting in nutritional imbalances and a lack of essential vitamins and minerals.
• Sustainability and Lifestyle Impact: The keto diet can be challenging to maintain over the long term and may not be compatible with a normal lifestyle. It may also lead to a cycle of weight loss and gain as people struggle to stick to the restrictive nature of the diet.

Alternative Approaches

Instead of following a restrictive diet like keto, it's recommended to adopt a balanced and sustainable approach to eating that focuses on whole foods, including a variety of fruits, vegetables, lean proteins, healthy fats, and whole grains. This type of dietary pattern, along with regular physical activity, can help maintain a healthy weight and lower the risk of heart disease and other chronic conditions.

The keto diet may not be suitable for people taking warfarin or SGLT-2 inhibitors

Warfarin

Warfarin is a medication used to treat and prevent blood clots. It is an anticoagulant, which means it helps to thin the blood and prevent clots from forming. Warfarin works by reducing the body's ability to recycle vitamin K, which is needed for blood clotting.

The keto diet is a high-fat, low-carbohydrate diet. It involves reducing carbohydrate intake and replacing it with fat. This can increase the risk of blood clots because the body will have less vitamin K to recycle. As a result, warfarin may not be as effective when taken with the keto diet.

SGLT-2 Inhibitors

SGLT-2 inhibitors are a class of medications used to treat type 2 diabetes. They work by blocking the reabsorption of glucose in the kidneys, which promotes the excretion of glucose in the urine. This leads to a reduction in blood glucose levels and is associated with weight loss and cardiovascular and renal benefits.

However, when combined with the keto diet, SGLT-2 inhibitors can lead to a rare but serious side effect called diabetic ketoacidosis (DKA). DKA occurs when the body doesn't have enough insulin and there is an increase in counter-regulatory stress hormones, leading to high blood sugar, ketosis, and electrolyte abnormalities.

DKA can be life-threatening and requires immediate medical attention. Therefore, people taking SGLT-2 inhibitors should avoid the keto diet and be aware of the signs and symptoms of DKA.

Frequently asked questions