The ketogenic diet is somewhat of a whistleblower. Its very nature and proven efficacy expose many dietary myths and debunk several assertions of the established health organizations, while flying in the face of the nutritional guidelines set forth and propagated by the food industry and its regulating bodies, for decades.
Despite the mixed, and in some cases outdated, information disseminated to the masses about which is the healthiest diet for human consumption, people in society appear to naturally be turning away from the Standard American Diet (SAD); instead of consuming highly-processed foods, seeking out healthier and often lower carb alternatives.
Many seeking refuge from the perils of the western diet find an oasis when they discover the ketogenic diet because of its many metabolic, cognitive, and physiological benefits.
Also, a keto diet is a great way to 'let thy food be thy medicine,' as nutritional ketosis regulates every system in the body.
With all its noted benefits you may be curious about exactly how to begin a ketogenic eating protocol and how doing so may impact your health if you have a pre-existing condition, with many wondering about the effects regarding high cholesterol.
In general, living in a ketotic state reduces inflammation and improves overall physiological, cognitive, and metabolic functions.
However, those who may be predisposed to high cholesterol, or have heightened sensitivity known as hyper-responders—those who experience a very dramatic increase in cholesterol after starting a low-carb, high-fat diet— may need to tweak the diet to prevent dangerously-elevated cholesterol levels and other associated health markers.
Fortunately, there are some simple but impactful steps you can take as you approach the keto lifestyle to support optimal cholesterol health.
We’ll get into said tips and delve a bit more into cholesterol, its effect, and function in the body, and how keto directly impacts cholesterol health to provide a comprehensive review of the matter. You’ll be fully prepared to begin your keto journey with ease.
Does Keto Cause Cholesterol?
First, we'd be remiss if we did not touch on what cholesterol is and its crucial role in the body. Cholesterol is a wax-like substance that's absent from fruits and vegetables and only produced by humans and animals.
Many reduce the conversation to HDL (a.k.a., good cholesterol) and LDL (a.k.a. bad cholesterol) when discussing cholesterol.
However, cholesterol is many times more complex and responsible for making essential substances like estrogen and testosterone, as well as the strengthening of cell membranes in the body.
Furthermore, cholesterol helps the body absorb vitamins and nutrients by transporting them and therefore helping to absorb more nutrition from the foods we eat.
Here's the exciting thing, the body makes enough endogenous cholesterol to function without an exogenous supplement. So those who may be predisposed to a cholesterol disorder can also safely follow a ketogenic diet while keeping saturated fat consumption moderate.
A ketogenic diet does not cause high cholesterol, but hyper-responders, who will be disproportionately affected if they consume vast amounts of fat in their diet, may be well served to reduce fat intake and increase consumption of low-glycemic, fibrous, foods when eating a low-carb, high-fat diet.
Are Your Levels Really High?
Analyzing cholesterol health is often relegated to limited scope, primarily contrasting our Total, HDL (or 'good cholesterol') and LDL (or 'bad cholesterol'), but gaining real insight into the highly-nuanced picture of overall cholesterol health requires taking a more in-depth look.
For instance, even within the realm of the maligned LDL cholesterol, it's important to note that the smaller, dense, particles, as opposed to the larger and fluffier particles, are associated with a higher risk of heart disease. There's a lot of complexity to the variations of cholesterol and the effects on the body.
Furthermore, recent studies suggest that using Total and LDL cholesterol levels as accurate indicators of coronary health risk is a flawed approach. One study observing 231,986 patients showed half those hospitalized with heart disease during the study had normal LDL levels!
Other markers, like the Triglyceride: HDL ratio over the standard HDL/LDL comparative paradigm are often leaned upon to tell a complete story, when they only represent the picture of our cholesterol health, in part.
What's also interesting is emerging information related to higher levels of cholesterol proving to have a protective effect as we age, even reducing the risk of death caused by cancer or suicide, which appears to increase in risk when cholesterol levels are too low.
Unfortunately, modern medicine's determining markers of cholesterol health (e.g., Total cholesterol and LDL levels) are leading to many doctors medicating patients unnecessarily.
In addition to the excessive prescription of statins, most deemed at risk for coronary disease are often advised to switch to a low-fat, high-carb, calorie-restricted diet to improve heart health.
Sadly, most fail miserably and unnecessarily on a low-fat, high-carb, calorie-restricted diet because it limits energy intake and lacks enough healthy fat to keep you satiated.
Luckily, a ketogenic diet is an excellent option that naturally promotes heart and overall health—and the diet can easily be modified to suit those suffering from cholesterol-related issues.
Eating Cholesterol Doesn’t Give You Cholesterol
The idea for years was that eating foods rich in saturated fat (butter, bacon fat, eggs, tallow) were detrimental to our health and responsible for clogging our arteries.
This is not what's been found in available scientific studies, however, and anecdotal data related to how eating a ketogenic diet affects one's cholesterol and lipid profile. Let's be clear, cholesterol does matter and is vital to optimal health.
The types of cholesterols you consume—similar to the case with the intake of quality as opposed to trans fats—also contribute to the vitality of the mind and body.
What is Bad Cholesterol?
In the context of modern medicine, LDL cholesterol is the bad cholesterol and at the root of all our cholesterol-related woes.
Now, don't get us wrong, high levels of Total and LDL cholesterol are commonly associated with those suffering from heart disease, but those elevated markers don't showcase the entire picture of our cholesterol health.
Also, the regulatory food agencies like the FDA and USDA have waged war on all saturated fats for years, demonizing butter and bacon among other low-glycemic foods that are found to be excellent options to regulate blood sugar and promote a ketotic state.
It’s now up to the industry to catch up to what people are figuring out on their own.
Unfortunately, despite much research that shows no evidence of a connection between consuming saturated fat and an increase in heart disease among studied populations, the government and health organizations have yet to change their stance on the benign nature of saturated fat.
Don't believe the hype: grass-fed butter is perfectly fine to eat on a healthy and balanced keto diet, and all fats are not created equal. Stick to healthy saturated fats like MCT oil, fish oil and that found in avocado, but avoid all forms of trans fat.
A Word on Trans Fat vs. Saturated Fat
It's worth adding another note concerning trans fats. This subset of fats has earned a bad reputation in recent years and with good reason. It's essentially a saturated fat that's been chemically modified to extend shelf life and create a more robust product.
The negative chatter surrounding trans fats is well deserved. These partially-hydrogenated fats are incredibly unhealthy, manufactured using high pressure, high heat, hydrogen gas, and a metal catalyst—not at all something suitable for human consumption.
Interestingly enough, several major health organizations are at the heart of some consumer confusion between healthy saturated fats like coconut oil, grass-fed butter, and avocado oil and trans fats found in most processed foods.
Simply put, saturated fat is nutritive to the body while trans fat is associated with increased inflammation and posing some potential health risks long-term.
Steer clear of all trans fats and manufactured fats like margarine that the body cannot metabolize. Stick to heart-healthy saturated and monounsaturated fats like MCT oil or olive oil, instead.
Medical Conditions That Can Raise Cholesterol
It's important to rule out any underlying medical conditions that may be the cause of your increased cholesterol.
A rapid loss of weight, which may or may not be attributed to keto, diminished thyroid function, and genetically-tied conditions like Familial Hypercholesterolemia—a condition that affects about 1 in 500 people and is characterized by very high cholesterol levels and a high risk of heart disease—can all contribute to elevated levels of cholesterol and other related markers.
It's important to coordinate with your primary physician, preferably in conjunction with a registered dietitian who specializes in advising dietary choices that optimize cholesterol health, to ensure you’re eating a heart-healthy and well-rounded keto meal plan.
How to Lower Cholesterol on Keto
A ketogenic diet offers many health benefits, from accelerating fat loss to increasing mental sharpness and regulating our hormones, to create balance in the body.
However, the massive amounts of fat consumption generally promoted on a ketogenic diet may be more than those predisposed to issues with cholesterol, need or can handle.
Consider the following dietary adjustments to bring your fat intake to a level ideal to support your cholesterol health.
Remove Bulletproof Coffee From Your Diet
Bulletproof coffee—generally coffee that includes grass-fed butter, MCT oil, and heavy cream—is quite popular among those eating a keto diet, but it isn't necessary and may pack too hard a fatty punch for those compromised by high cholesterol.
Although all current studies point to saturated fat being safe when consumed in 'normal' amounts, more research is required to determine how consuming massive amounts of fat, while already compromised by high cholesterol, may affect health long-term.
Consider eliminating or limiting items like Bulletproof coffee for a bit and monitor your cholesterol and lipid levels to determine what works best for your health goals.
Replace Some Saturated Fats With Monounsaturated Fats
Grass-fed butter is an excellent source of healthy saturated fat, and those of us on keto are eternally grateful for the endorsement.
However, you may want to incorporate higher amounts of monounsaturated fats like olive oil and coconut oil if you're suffering from a cholesterol condition.
Also decadent, fatty, fruit like avocado or low-glycemic nuts (e.g., macadamia, pine, almonds, etc.) are all excellent dietary sources of monounsaturated fat, so dig in!
Eat More Fiber-Rich, Real Food Carbs
There are many variations, even within the ketogenic dietary protocol, that can accommodate people's differing nutritional needs and health goals.
For instance, women who are pregnant or breastfeeding are advised to eat slightly higher amounts of carbs and calories to support the health of mom and her growing baby, while those using keto as a therapeutic means to remediate cancer and other diseases would likely be advised to eat a considerably more restrictive keto protocol, utterly void of sugar.
Consuming fiber-rich, real food carbs is essential for hyper-responders while on keto. Go ahead and eat nutrient-dense foods like sweet potatoes or a small serving of brown rice with your meals to round out your macros and support heart health, as well.
Add in one or two servings of low-glycemic fruits like berries or green apples to your diet and seek to hit a carbohydrate macronutrient goal of between 100-150 total grams a day. Experiment a bit to see which level of carb intake leaves you feeling your best.
There's no one-size-fits-all solution when it comes to nutrition. Each person's dietary needs and goals will vary.
However, if suffering from a cholesterol condition, rest assured that eating a balanced ketogenic diet is possible.
Rest assured though, if suffering from a cholesterol condition, eating a balanced ketogenic diet can be easy.
Read our detailed article, packed with tips and resources, that outlines how to successfully start the ketogenic diet, here.