Keto and Cholesterol: What Happens to Your Cholesterol Levels When You’re on a Keto Diet

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Keto and Cholesterol: What Happens to Your Cholesterol Levels When You’re on a Keto Diet


For several decades in the recent past, high-fat animal foods like eggs, cheese, beef, and pork were vilified because of their saturated fat and cholesterol content. It was thought that these foods would increase your bad cholesterol levels, clogging your arteries and drastically increasing your risk of heart disease.

However, the science isn’t as clear-cut as it was once made out to be. Although high-fat foods — and, therefore, the high-fat keto diet — may affect your cholesterol level, that may not automatically be a negative thing.

Still, keto does affect cholesterol levels, and that can be a significant cause of concern in many people.

Here’s a review of how keto affects your cholesterol levels and how to optimize your heart health while eating low carb.

How the Keto Diet Affects Your Cholesterol Levels

Overall, keto appears to have a mostly-positive effect on cholesterol levels. However, it’s important to remember that your body’s response to keto is highly individual.

We also need to remember that there are several different blood lipids (fats) that your physician may be referring to when they talk about a “lipid panel” or a “cholesterol panel.”

First is total cholesterol. According to Sony Sherpa, MD, a physician with Nature’s Rise, total cholesterol may remain stable for many people on keto. Still, your total cholesterol level doesn’t provide a lot of useful information about your overall health and heart disease risk.

Other blood lipids can provide much more specific insights about your heart health. Here’s a quick rundown of these blood lipid types, along with a review of how keto may affect them.

Keto and LDL

Low density lipoprotein (LDL) cholesterol is often considered “bad cholesterol.”

According to Mary Sabat, MS, RDN, LD, a registered dietitian and personal trainer, “Research suggests that high levels of LDL are associated with an increased risk of heart disease.”

On keto, some people may experience no changes to their LDL cholesterol. Still, Sabat says, others may see their LDL levels reduced

Additionally, researchers have identified a subgroup of people on ketogenic diets who may be considered “lean mass hyper-responders.” These people experience huge increases in their LDL levels on keto. Generally, they are already lean and aren’t on keto to lose weight. Their bodies’ powerful responses to keto are thought to be a result of body composition changes rather than what foods they are eating (*).

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However, not all LDL is necessarily bad. Large, fluffy LDL particles are harmless, while small, dense LDL particles are associated with heart disease. Some research suggests that a ketogenic diet may increase concentrations of large, fluffy LDL particles (*).

Keto and HDL

High density lipoprotein (HDL) cholesterol is known as the “good” kind of cholesterol. Higher HDL levels are associated with better heart health.

Numerous studies have shown that ketogenic diets increase HDL cholesterol levels, which can help reduce heart disease risk (*, *).

Keto and VLDL

Very low density lipoprotein (VLDL) cholesterol transports triglycerides, a type of fat, all throughout the body via the bloodstream. High levels of VLDL cholesterol are linked to heart disease.

Very few studies have assessed the effect of the ketogenic diet on VLDL levels, so it’s hard to say with confidence what effect — if any — keto would have on VLDL levels.

Keto and Triglycerides

While triglycerides aren’t a type of cholesterol, they are a type of fat that the body uses. Triglyceride levels are often checked alongside your cholesterol levels, too, as they may be useful for determining heart disease risk.

Generally, higher triglyceride levels are associated with more risk.

However, study after study has shown that keto can effectively reduce triglyceride levels (*, *, *).

With keto’s dual effect of increasing HDL and reducing triglycerides, it can help improve the HDL-to-triglyceride (HDL:TG) ratio. This ratio may be a strong indicator of overall heart health (*, *).

Is Keto Good for Someone with High Cholesterol?

Keto could be helpful for people with high cholesterol, especially if they are overweight or obese, or if they have prediabetes or type 2 diabetes.

Although LDL levels may increase in some individuals when starting keto, other more favorable changes may balance this out.

For instance, keto increases HDL cholesterol and reduces triglycerides. Both of these effects can help reduce your risk of heart disease.

“In general,” Sherpa says, “people with pre-existing high cholesterol should speak to their healthcare provider before starting a ketogenic diet. If you are already following a keto diet, it’s recommended to monitor your cholesterol levels regularly to ensure they are within the normal range.”

Adds Sabat, “The relationship between cholesterol and heart disease is complex, and other factors such as inflammation, blood pressure, and smoking can also play a role.”

Overall, diet is just one part of the equation — but keto isn’t as bad for heart health as we once thought. It may even be positively heart healthy, especially if you’re choosing a variety of minimally-processed, nutrient-rich foods.

Recommended Cholesterol Levels for Keto Dieters

Recommended cholesterol levels for people following a keto diet are the same as everyone else. These targets are recommended by the American Heart Association.

According to Sherpa, “The ideal total cholesterol level is less than 200 mg/dl, while LDL should remain below 100 mg/dl and HDL should remain above 50 mg/dl.”

She adds that triglyceride levels should also remain below 150 mg/dl.

Cholesterol Levels for Keto Dieters

Foods to Eat & Avoid on a Keto Diet for Cholesterol Management

For optimal heart health and cholesterol levels on keto, it’s a good idea to eat mostly whole, natural, minimally-processed foods — or “clean keto.” Here are a few examples of these foods that you can enjoy without worrying about carb count:

  • Meat: beef, pork, chicken, fish, shellfish, turkey, duck, eggs, etc.
  • Vegetables: zucchini, cauliflower, spinach, kale, salad greens, garlic, onions, tomatoes, broccoli, peppers, etc.
  • Fruits: strawberries, raspberries
  • Nuts and seeds: walnuts, pecans, macadamia nuts, sesame seeds, chia seeds, flax seeds, sunflower seeds, etc.
  • Fats and oils: butter, tallow, lard, bacon fat, olive oil, avocado oil, coconut oil, ghee
  • Dairy: heavy cream, half and half, sour cream
  • Other: dark chocolate, vinegar, herbs and spices, bone broth

On the other hand, you may want to avoid highly processed keto-friendly foods — sometimes known as “dirty keto” foods. Ultra-processed foods that contain highly refined, industrial ingredients have been linked to heart disease (*).

Even though a food may have keto-friendly macro ratios, it can still be made with highly-processed ingredients that may not be healthy. Here are some examples of highly processed ingredients that may be hiding in some keto foods:

  • Artificial sweeteners: sucralose, aspartame, acesulfame potassium, etc.
  • Sugar alcohols: xylitol, maltitol, etc.
  • Artificial food dyes: red 40, yellow 5, blue 2, etc.
  • Industrial seed oils: soybean oil, canola oil, peanut oil, corn oil, sunflower oil, etc.
  • Artificial flavors: listed on the label as “artificial flavors”
  • Industrial preservatives: sodium nitrite, sodium benzoate, etc.

People who follow a “dirty keto” diet, according to Sabat, “are more likely to see negative effects on their cholesterol levels.”

Tips for Maintaining Healthy Cholesterol Levels on a Keto Diet

If cholesterol is a major concern for you, there are many things you can do to both reduce your total and LDL cholesterol levels, as well as improve your heart health.

Here are a few strategies recommended by Sabat and Sherpa to help manage cholesterol on a keto diet:

  • Limit saturated fat intake
  • Eat plenty of fiber from vegetables, nuts, and seeds
  • Engage in regular exercise
  • Maintain a healthy weight
  • Avoid smoking
  • Get regular check-ups with your doctor

Just remember: according to the most up-to-date research, dietary cholesterol and saturated fat don’t appear to affect heart health in any significant way — so there’s no need to shy away from animal fats on keto.

The Bottom Line

Keto may affect your cholesterol levels. In many cases, it increases HDL and reduces triglycerides — which reduces heart disease risk. However, in some people — particularly people who don’t need to lose weight — it may significantly increase LDL cholesterol levels. High levels of small, dense LDL particles are linked to poorer heart health.

If you have high cholesterol, you should speak to your healthcare provider before starting keto. Additionally, you should have your cholesterol levels checked regularly on keto to determine how the diet is affecting your risk profile for heart disease.

10 References

Nicholas N. et al. Hypercholesterolemia “Lean Mass Hyper-Responder” Phenotype Presents in the Context of a Low Saturated Fat Carbohydrate-Restricted Diet. 2022 April 14

Nicholas N. et al. A Standard Lipid Panel Is Insufficient for the Care of a Patient on a High-Fat, Low-Carbohydrate Ketogenic Diet. 2020

Nassib B. et al. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. 2013 October

Christophe K. et al. Effects of Ketogenic Diets on Cardiovascular Risk Factors: Evidence from Animal and Human Studies. 2017 May 19

Chong Z. et al. Ketogenic Diet Benefits to Weight Loss, Glycemic Control, and Lipid Profiles in Overweight Patients with Type 2 Diabetes Mellitus. 2022 August 22

Yeo J. et al. Impact of a Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and with or without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. 2020 July 6

Hyun S. et al. Effects of Combined Exercise and Low Carbohydrate Ketogenic Diet Interventions on Waist Circumference and Triglycerides in Overweight and Obese Individuals. 2021 January 19

Constantine K. et al. The Triglyceride/High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio as a Risk Marker for Metabolic Syndrome and Cardiovascular Disease. 2023 March 1

Roberto S. et al. High TG to HDL ratio plays a significant role on atherosclerosis extension in prediabetes and newly diagnosed type 2 diabetes subjects. 2021 February

Filippa J. et al. Ultra-processed Foods and Cardiovascular Diseases: Potential Mechanisms of Action. 2021 October 1


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