Keto Diet: Cholesterol Control And Weight Loss

The ketogenic diet is a popular, low-carb, high-fat, and moderate-protein diet that helps the body burn fat quickly, which results in weight loss. While the keto diet has been shown to have benefits for people with epilepsy, diabetes, and Alzheimer's, it has also been linked to an increased risk of heart disease due to its high-fat content. The keto diet's effect on cholesterol levels is still under investigation, with some studies showing a decrease in LDL (bad) cholesterol and others showing an increase. The impact of the keto diet on an individual's cholesterol levels may depend on the quality of the diet and genetic factors.

The effect of keto on heart health

The keto diet is a popular one, but its effect on heart health is not straightforward. The diet is very high in fat, moderately high in protein, and very low in carbohydrates. This means that up to 80% of your calories come from fat, and only 20 to 50 grams from net carbs. This can lead to a high consumption of saturated fats, which have been linked to poor heart health.

The impact of keto on cholesterol

The keto diet may not be as detrimental to cholesterol levels as previously thought. Research shows 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). However, some studies have shown an increase in LDL on low- or very-low-carb diets.

The impact of keto on heart health

The impact of the keto diet on heart health depends on the quality of the fats consumed. Consuming mostly unsaturated fats, such as plant oils, fatty fish, nuts, and seeds, can improve cholesterol levels, especially LDL cholesterol levels. On the other hand, consuming high levels of saturated fats, such as butter, coconut oil, and animal fats, can lead to high LDL cholesterol levels, which contribute to plaque buildup in the arteries, increasing the risk of heart attack and stroke.

Who should avoid keto?

Doctors do not recommend the keto diet to people with pancreatic, liver, thyroid, or gallbladder issues. People with an inherited condition called familial hypercholesterolemia, which is marked by very high LDL cholesterol levels, should also avoid the keto diet, as it can further increase their risk of heart disease.

The bottom line

The keto diet may be safe for some people, but it is important to speak to a doctor before starting this or any new diet, especially if you have other health conditions. More research is needed to fully understand the effects of the keto diet on heart health, and larger, longer-term studies are required.

The impact of keto on good and bad cholesterol

The ketogenic diet is a popular, very high-fat, moderate-protein, and very low-carbohydrate diet. It involves eating up to 80% of your calories from fat and limiting carbohydrates to 20 to 50 grams of net carbs per day. This can include sources of saturated fat such as butter, coconut oil, and animal fat, which have been linked to poor heart health and higher cholesterol levels.

The impact of the keto diet on cholesterol levels is complex and depends on various factors. Here is an overview of how the keto diet can affect "good" High-Density Lipoprotein (HDL) and "bad" Low-Density Lipoprotein (LDL) cholesterol:

The Impact of Keto on "Good" HDL Cholesterol:

The keto diet has been found to have a positive impact on HDL cholesterol levels in some cases. Research suggests that replacing carbohydrates with saturated, monounsaturated, and polyunsaturated fats can lead to an increase in HDL levels. This effect was observed in a study where participants following a keto diet for a year had higher HDL cholesterol levels than those on a low-fat diet. Additionally, a small study on older adults with obesity found that a very low-carb diet resulted in improved HDL cholesterol levels compared to a low-fat diet.

The Impact of Keto on "Bad" LDL Cholesterol:

The effect of the keto diet on LDL cholesterol is less clear and can vary depending on the quality of the diet and individual factors. Some studies suggest that the keto diet can lead to a modest increase in LDL cholesterol levels, especially when the diet includes unhealthy sources of saturated fat. However, other studies have shown a decrease or no significant change in LDL levels. The impact of the keto diet on LDL cholesterol may depend on the types of fat consumed, with healthier unsaturated fats having a more favourable effect.

Individual Factors Affecting Cholesterol Levels on Keto:

It is important to note that the impact of the keto diet on cholesterol levels can vary from person to person. Individual factors such as genetics, weight, and existing health conditions can influence how the keto diet affects cholesterol. For example, people with a genetic mutation affecting LDL regulation may experience a significant increase in LDL cholesterol levels when following a keto diet. Additionally, those with insulin resistance, type 2 diabetes, or abdominal obesity may see improvements in their cholesterol levels due to the low-carb nature of the keto diet.

Overall Impact of Keto on Cholesterol:

While the keto diet may not have as detrimental an effect on cholesterol as previously thought, it is important to consider the quality of the diet and individual factors. The types of fat consumed on a keto diet can significantly impact cholesterol levels. Incorporating heart-healthy, unsaturated fats, such as nuts, seeds, avocado, and extra virgin oils, is recommended. Additionally, consulting a healthcare professional before starting the keto diet is essential, especially for those with existing health concerns.

The long-term effects of keto on obese patients

The ketogenic diet has been shown to be effective in reducing weight in obese patients. However, its long-term effects on various physical and biochemical parameters are not yet fully understood. Here is a summary of the current knowledge about the long-term effects of keto on obese patients:

Weight Loss and Cardiometabolic Benefits

The keto diet has been found to produce significant weight loss in obese patients over time. In one study, 83 obese patients who followed a 24-week ketogenic diet experienced a significant decrease in body weight and body mass index (BMI). This weight loss effect was also observed in other studies with similar durations. Additionally, the keto diet has been linked to improvements in cardiometabolic parameters. For example, the 24-week study mentioned above showed a decrease in triglyceride, LDL cholesterol, and blood glucose levels, while HDL cholesterol levels increased. These positive changes in lipid profiles were also observed in other studies with shorter durations.

Safety Profile

The safety of long-term keto diets has been a subject of debate. While some studies suggest that the keto diet can be safely followed for extended periods without significant side effects, others caution that the high-fat content may lead to an increased risk of heart disease. The impact of keto on heart health is complex and depends on various factors, including the quality of fats consumed. Consuming unhealthy sources of saturated fat, such as butter, coconut oil, and animal fat, may negatively affect heart health. On the other hand, choosing heart-healthy unsaturated fats, like nuts, seeds, and olive oil, can provide cardioprotective benefits.

Individual Variation

It is important to recognize that the effects of the keto diet can vary from person to person. The impact on cholesterol levels, for example, may depend on individual factors such as starting triglyceride levels and the presence of conditions like insulin resistance or type 2 diabetes. For those with elevated triglycerides and specific health conditions, the keto diet may even help improve triglyceride and insulin sensitivity. However, for individuals with a genetic predisposition, such as familial hypercholesterolemia, the keto diet could potentially be hazardous and lead to a significant increase in LDL cholesterol.

Sustainability and Adherence

While the keto diet can be effective for short-term weight loss, its long-term sustainability and adherence are questionable. Weight loss on keto tends to peak at five months, followed by a slow weight regain. Additionally, the highly restrictive nature of the keto diet makes it challenging for many individuals to maintain in the long term. This lack of long-term adherence may impact the sustainability of any health benefits achieved.

Research Limitations and Future Directions

The current research on the long-term effects of keto on obese patients has some limitations. Many studies have focused on surrogate outcomes rather than clinical endpoints, such as cardiovascular events or mortality. Additionally, there is a need for larger, longer-term studies with more diverse participant populations, including elderly patients, individuals with nonalcoholic fatty liver disease, and those with polycystic ovarian syndrome. These expanded populations and outcomes would provide a broader understanding of the potential benefits and risks of the keto diet.

In conclusion, while the keto diet has shown promising results in obese patients in terms of weight loss and improvements in certain cardiometabolic parameters, more research is needed to fully understand its long-term effects. The available evidence suggests that the keto diet can be a safe and effective option for some individuals, but it may not be suitable for everyone. It is essential to consult with healthcare professionals before starting the keto diet or any other dietary intervention to ensure it aligns with individual health needs and goals.

The impact of keto on people with diabetes

The ketogenic diet is a high-fat, very-low-carbohydrate diet. Typically, the keto diet limits carbohydrates to less than 50 grams per day, with calories primarily derived from fat and moderate amounts from protein. The body, by necessity, shifts away from burning carbohydrates for fuel and instead uses fat for energy, resulting in a process called ketosis.

For people with diabetes, the keto diet may have some benefits, but it is important to note that it also comes with risks and potential complications.

Benefits

People with type 2 diabetes have a problem with the hormone insulin, which is produced in the pancreas. When you eat, the pancreas releases insulin into the bloodstream, allowing sugar to enter your cells and lowering the amount of sugar in the blood. However, with type 2 diabetes, the pancreas does not make enough insulin or the body cannot use insulin effectively.

The keto diet may help people with type 2 diabetes by reducing weight. When an individual weighs less, their pancreas can better keep up with the body's need for insulin. In some cases, weight loss may be sufficient to restore blood sugar to a normal level, thereby eliminating diabetes. Even if it does not completely normalise blood sugar, weight loss may still reduce the need for insulin therapy or other diabetes medications. It also lowers the risk of other serious diabetes-related complications, such as heart problems, kidney disease, and nerve damage.

Risks and Complications

The keto diet is very restrictive and difficult to follow long-term. It may lead to short-term health issues such as headaches, bad breath, and constipation. The long-term health risks are unknown, but there is a concern for deficiencies of certain micronutrients, including vitamins and fibre, as well as an increased risk of kidney stones and liver disease.

Additionally, people with diabetes need to be cautious of a serious complication called diabetic ketoacidosis (DKA). DKA occurs when the body cannot produce enough insulin, causing it to break down fat as fuel, which leads to a buildup of ketones in the blood and, eventually, in the urine. If left untreated, DKA can be life-threatening.

Precautions

It is important for individuals with diabetes to consult a healthcare professional before starting the keto diet, as it may not be suitable for everyone. While the keto diet may offer some benefits for people with type 2 diabetes, it is not a cure, and managing diabetes requires a holistic approach that includes healthy eating, physical activity, and adhering to prescribed medications or insulin therapy.

The impact of keto on people with high blood pressure

Keto is short for ketogenic. A ketogenic diet helps the body burn fat quickly, which results in weight loss. Ketogenic diets are low in carbs and high in proteins and fats. Typically, the body converts carbohydrates into energy. The keto diet makes the body go into ketosis, a physical state that forces the body to convert fat stores into energy.

Weight loss and improved metabolic markers

When an obese or overweight person loses weight on keto, their blood pressure generally improves. Keto can be an effective weight loss diet, especially for obese people and people with diabetes. The mechanisms by which keto may promote fat loss include appetite suppression, increased energy burn, and increased fat burning due to low insulin levels.

Diet composition

A diet high in processed carbohydrates and refined sugars leads to arterial inflammation, which can cause elevated blood pressure. A keto diet low in carbs and sugars will decrease insulin levels and arterial inflammation. However, a "dirty keto" diet, high in processed meat and low in vegetables, may be short on potassium, leading to high blood pressure.

Exercise

Regular mild to moderate aerobic exercise is well-documented to lower blood pressure in people with hypertension.

Sleep

Short sleep, insomnia, and other sleep disorders are independent risk factors for high blood pressure.

Sodium and potassium intake

Too much sodium without enough potassium will raise blood pressure. Too little sodium can also raise blood pressure as the body releases the blood-pressure-raising hormone aldosterone to retain sodium.

Fibre intake

Higher fibre intakes seem to be protective against heart disease, and certain fibres have been shown to lower arterial blood pressure.

Individual characteristics and health conditions

The impact of keto on blood pressure may vary depending on individual characteristics and health conditions. For example, keto may not improve blood pressure in people with a genetic mutation that affects LDL regulation. Additionally, people with certain health conditions, such as pancreatic, liver, thyroid, and gallbladder issues, should not follow a keto diet.

Studies on keto for high blood pressure

Several studies suggest that keto may help treat or prevent hypertension.

Study #1: Keto vs. three other diets

A study comparing the Atkins diet (similar to keto) to the Zone diet, LEARN diet, and Ornish diet found that overweight premenopausal women had greater reductions in systolic and diastolic blood pressure on the Atkins diet.

Study #2: Keto vs. low-fat diet plus medication

A study comparing a low-carb diet to a low-fat diet plus Orlistat (a drug for weight loss and high blood pressure) found that blood pressure fell in the keto group but rose in the low-fat group.

Study #3: Mediterranean keto

A Spanish Mediterranean keto diet was found to lower the average systolic blood pressure from 126 to 109 and the average diastolic blood pressure from 85 to 75 in a group of 40 obese people over 12 weeks.

Risks and considerations

While keto may help lower blood pressure in some cases, there are a few considerations and potential risks to keep in mind.

Stress

Adapting to keto or any new diet may increase stress levels, which can lead to higher blood pressure.

Genes

Certain genes can cause higher sodium intake to increase blood pressure.

Calorie intake

Not consuming enough calories on keto can impact blood pressure.

Sodium and potassium intake

As mentioned earlier, the balance of sodium and potassium intake is crucial for blood pressure regulation.

Long-term effects

There is limited research on the long-term effects of keto, and it may not be a sustainable diet for everyone due to its restrictiveness.

Tips to improve blood pressure

• Exercise regularly.
• Get enough sleep.
• Maintain a healthy weight.
• Consume adequate sodium and potassium.
• Increase fibre intake.
• Try a low-carb diet, but ensure it is a clean keto diet with plenty of low-carb vegetables.

Frequently asked questions