When I started eating keto in 2013, my doctor looked at my cholesterol panel and did that slow nod – the kind that means he was about to recommend a statin. My total cholesterol had gone up. My LDL had gone up. The conversation that followed was the same one tens of thousands of people have every year after going low-carb.
The problem is that most of those conversations are based on a framework built for a different diet entirely. Standard cholesterol interpretation was developed in the context of a high-carbohydrate American diet. When you shift to fat as your primary fuel, the rules change – not because keto is magic, but because the metabolism behind your numbers is genuinely different.
This article covers what the research shows, including several major studies published in 2022 through 2024 that have substantially clarified the picture. We’ll cover the basics, the HDL and triglyceride data, the LDL controversy, the newer particle-size research, a newly characterized phenomenon called the Lean Mass Hyper-Responder, and a clinical trial that measured plaque in keto dieters with very high LDL. We’ll also talk about the one test most doctors aren’t ordering that may matter more than LDL-C.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. If you have cardiovascular disease, familial hypercholesterolemia, or other relevant health conditions, discuss any dietary changes with your physician.
What’s in this article:
- Cutting Through the Fat: What Are Lipids and Cholesterol?
- What Is HDL Cholesterol?
- The Impact of Carbohydrate Restriction on HDL Cholesterol
- Long-Term Impact of Ketogenic Carbohydrate Restriction on HDL Cholesterol
- Carbohydrate Moderation Increases HDL in Healthy, Non-White Populations
- LDL Cholesterol: Clearing the Confusion
- LDL and Carbohydrate Restriction: What Is the Relationship?
- Ketogenic Diet’s Impact on VLDL Cholesterol and LDL Particle Count
- The Lean Mass Hyper-Responder Phenomenon
- The KETO Trial: What We Know About Plaque
- ApoB: The Test Your Doctor Should Be Running
- Why the Ketogenic Diet Affects Cholesterol: The Role of Specific Fatty Acids
- Practical Application: How to Interpret Your Cholesterol Results on Keto
- What If Keto Is Making Your Cholesterol Worse?
- What to Eat If Your Cholesterol Is Rising on Keto
- Conclusion: What the Research Actually Shows
Cutting Through the Fat: What Are Lipids and Cholesterol?
Cholesterol is a waxy, fat-like substance found in every cell of your body. You need it to produce hormones, vitamin D, and the bile acids that help you digest the fat you’re eating on keto. Your liver manufactures most of it – dietary cholesterol has a much smaller effect on blood cholesterol than most people assume.
Because cholesterol doesn’t dissolve in blood, it gets packaged into lipoproteins – protein-coated particles that ferry fats through the bloodstream. The main ones you’ll see on a standard lipid panel are LDL (low-density lipoprotein), HDL (high-density lipoprotein), and VLDL (very-low-density lipoprotein). Triglycerides are not a type of cholesterol – they’re the fat molecules themselves, and they travel inside these lipoprotein particles.
The standard panel your doctor orders gives you the cholesterol concentration inside each particle type. What it doesn’t tell you is how many particles there are or how big they are – and that distinction, as you’ll see below, turns out to matter a great deal when interpreting keto-diet results.
What Is HDL Cholesterol?
HDL is often called “good” cholesterol because HDL particles participate in reverse cholesterol transport – they pick up cholesterol from tissues and arterial walls and return it to the liver for reprocessing or excretion. Higher HDL levels are consistently associated with lower cardiovascular risk in population studies, though the relationship is more nuanced than the simple “more is better” framing suggests.
What matters from a keto perspective: the diet reliably raises HDL. It’s one of the most consistent findings across low-carb research, and the mechanism is fairly well understood. When carbohydrate intake drops, triglyceride production falls, which reduces the transfer of cholesterol from HDL to VLDL particles – so HDL stays higher and lasts longer in circulation.
The Impact of Carbohydrate Restriction on HDL Cholesterol
The HDL response to carbohydrate restriction is one of the best-replicated findings in nutrition research. Keto diets consistently outperform low-fat diets on HDL – a 2013 meta-analysis by Bueno et al. in the British Journal of Nutrition confirmed this across 13 randomized controlled trials, finding HDL increases were substantially greater in the ketogenic diet groups.Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. 2013;110(7):1178-1187. https://pubmed.ncbi.nlm.nih.gov/23651522/
A 52-week head-to-head by Brinkworth et al. compared energy-restricted low-carbohydrate and low-fat diets. Both groups lost similar amounts of weight, but the low-carb group ended with noticeably higher HDL.Brinkworth GD, Noakes M, Buckley JD, Keogh JB, Clifton PM. Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. Am J Clin Nutr. 2009;90(1):23-32. https://pubmed.ncbi.nlm.nih.gov/19439458/ The gap persisted at the one-year mark, which rules out a short-term metabolic blip.
The pattern holds at the highest levels of evidence. Soltani et al. pooled 27 RCTs with 1,278 participants and confirmed the HDL benefit alongside clear triglyceride reductions.Soltani S, et al. Effects of ketogenic diet on cardiometabolic risk factors: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2024. https://pubmed.ncbi.nlm.nih.gov/39097343/ An umbrella review by Patikorn et al. in 2023 – covering 17 meta-analyses and 68 RCTs – reached the same conclusion at a higher level of evidence.Patikorn C, et al. Effects of ketogenic diet on health outcomes: an umbrella review of meta-analyses of randomized clinical trials. BMC Medicine. 2023. https://pubmed.ncbi.nlm.nih.gov/37231411/
Long-Term Impact of Ketogenic Carbohydrate Restriction on HDL Cholesterol
One concern with diet research is that short-term effects don’t always hold. With HDL on keto, the long-term data is encouraging. A 2004 controlled trial following obese patients on a ketogenic diet for 56 weeks found sustained HDL increases alongside marked triglyceride reductions – the improvements didn’t fade as the diet continued.Yancy WS Jr, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med. 2004;140(10):769-777. https://pubmed.ncbi.nlm.nih.gov/15148063/
The Virta Health 2-year trial published by Athinarayanan et al. in 2020 is the longest rigorous keto trial with lipid data at the time of writing. Across two years, participants maintained higher HDL and lower triglycerides compared to baseline, with no adverse cardiovascular signal.Athinarayanan SJ, et al. Long-term effects of a novel continuous remote care intervention including nutritional ketosis for the management of type 2 diabetes: A 2-year non-randomized clinical trial. Cardiovasc Diabetology. 2020. https://pubmed.ncbi.nlm.nih.gov/33292205/ The triglyceride data is particularly notable: sustained reduction in triglycerides while HDL holds elevated is the lipid signature most closely associated with reduced cardiovascular risk in metabolic syndrome populations.
A 2026 meta-regression published in Endocrine Practice quantified this across controlled comparisons: keto diets averaged HDL increases of +3.61 mg/dL and triglyceride reductions of -19.96 mg/dL versus control diets.Meta-regression, ketogenic diet and lipid outcomes. Endocrine Practice. 2026. https://www.sciencedirect.com/science/article/abs/pii/S1530891X26000261 Those numbers may not look dramatic in isolation, but they represent consistent, directional changes across diverse populations.
Carbohydrate Moderation Increases HDL in Healthy, Non-White Populations
Most early keto research was conducted in predominantly white, Western populations – a limitation relevant to acknowledge. A study by Merchant et al. examined low-carbohydrate dietary patterns in a multiethnic cohort and found that lower carbohydrate intake was associated with higher HDL across racial and ethnic groups.Merchant AT, et al. Carbohydrate intake and HDL in a multiethnic population. Am J Clin Nutr. 2007;85(1):225-230. https://pubmed.ncbi.nlm.nih.gov/17209201/ The effect size wasn’t identical across groups, but the directional finding held. This matters because dietary guidelines sometimes differ by population, and it’s useful to know the HDL benefit doesn’t appear to be a phenomenon isolated to one demographic.
LDL Cholesterol: Clearing the Confusion
LDL is where most of the controversy lives, and where the research has moved fastest in recent years. The traditional view is that higher LDL-C (the cholesterol concentration in LDL particles) raises cardiovascular risk. That’s not wrong as a population-level association – but it’s incomplete in ways that matter considerably when interpreting a keto dieter’s labs.
There are two variables the standard LDL-C number doesn’t capture: particle count and particle size. Small, dense LDL particles are more atherogenic than large, buoyant ones – they penetrate the arterial wall more easily and are more prone to oxidation.Superko HR. Advanced lipoprotein testing and subfractionation are clinically useful. Circulation. 2009;119(17):2383-2395. https://pubmed.ncbi.nlm.nih.gov/19414658/ Two people with the same LDL-C of 140 mg/dL can have very different cardiovascular risk profiles depending on what’s driving that number.
When people go keto, LDL-C sometimes rises. Whether that’s a problem depends heavily on what’s happening at the particle level – and on who is doing the keto diet.
LDL and Carbohydrate Restriction: What Is the Relationship?
The LDL response to keto is genuinely variable – some people see no change, some see a decrease, and some see an increase. Among normal-weight adults, the increase tends to be larger: the Joo et al. 2023 meta-analysis in Nutrition Reviews put the average at about 42 mg/dL (1.08 mmol/L) for lean participants, compared to a smaller rise in overweight or obese participants.Joo HJ, et al. Differential effects of ketogenic diet on LDL-cholesterol depending on baseline body weight: meta-analysis. Nutrition Reviews. 2023. https://pubmed.ncbi.nlm.nih.gov/36931263/ In other words, the people most likely to see a striking LDL increase on keto are often lean, metabolically healthy individuals – not the population keto was originally studied in.
I’ve seen this in the keto community for years – people who are already lean and athletic come to me confused because their LDL jumped after starting keto while everything else looks great. The particle data explains why that’s usually not the red flag it looks like on a standard panel.
Keto consistently shifts LDL toward larger, less atherogenic particles.Falkenhain K, et al. Effect of dietary carbohydrate restriction on LDL particle size and concentration in overweight and obese adults. Am J Clin Nutr. 2021. https://pubmed.ncbi.nlm.nih.gov/34159352/ Falkenhain et al. pooled 38 RCTs with 1,785 participants and found this pattern held even when LDL-C went up – the fraction most associated with arterial plaque development tended to go down.
The Virta Health 2-year trial adds to this picture. Athinarayanan et al. found a 23% decrease in small dense LDL particles and a 29% increase in large LDL particles over two years of continuous ketogenic diet.Athinarayanan SJ, et al. Cardiovasc Diabetology. 2020. https://pubmed.ncbi.nlm.nih.gov/33292205/ That’s a real shift in the right direction – toward the particle profile associated with lower risk – even in a population where LDL-C numbers weren’t always moving in the “right” direction by conventional metrics.
Ketogenic Diet’s Impact on VLDL Cholesterol and LDL Particle Count
VLDL particles carry triglycerides from the liver to tissues. When carbohydrate intake is high, the liver produces more triglycerides (via de novo lipogenesis) and releases more VLDL to transport them. Cut carbohydrates sharply, and VLDL production drops – which is why triglycerides fall reliably on keto.
There’s a downstream effect here: VLDL particles are the precursors to IDL and eventually LDL. When VLDL production drops, the characteristics of the resulting LDL particles shift. Specifically, lower VLDL-triglyceride levels are associated with larger LDL particles. This is one mechanism behind the particle-size shift that Falkenhain et al. documented across 38 trials – the triglyceride-lowering effect of keto cascades through to LDL particle morphology.
LDL particle count (LDL-P, measured via NMR LipoProfile) is a more precise cardiovascular risk marker than LDL-C. It’s possible to have a high LDL-C with a lower LDL-P (large particles, fewer of them) or a lower LDL-C with a higher LDL-P (small particles, more of them). This discordance between the two numbers is more common on keto than on a standard diet, which is part of why standard labs can be misleading for keto dieters.Cromwell WC, et al. LDL particle number and risk of future cardiovascular disease in the Framingham Offspring Study – implications for LDL management. J Clin Lipidol. 2007;1(6):583-592. https://pubmed.ncbi.nlm.nih.gov/21291698/
Lipid Panel Interpretation for Keto Dieters
Here’s how to read the most common patterns you’ll see on a standard panel:
| Pattern | What It Means | Suggested Action |
|---|---|---|
| Triglycerides down, HDL up | Classic keto lipid improvement – reduced VLDL production, better reverse cholesterol transport | No action needed; this is the target outcome |
| LDL up, triglycerides below 70, HDL above 80 (lean individual) | Likely LMHR pattern – fat transport upregulation, not metabolic stress | Monitor; get ApoB and CAC to assess actual risk |
| LDL up, triglycerides also up | Possible insulin resistance, dietary composition issue, or secondary cause (thyroid, FH) | Investigate root cause; rule out hypothyroidism and FH |
| LDL up, triglycerides normal-low, in overweight person | May be transient fat mobilization during active weight loss | Recheck in 3-6 months before acting |
| LDL up, ApoB elevated | Particle count is high – this is a clearer risk signal than LDL-C alone | Discuss with doctor; consider fat composition changes or medication |
The Lean Mass Hyper-Responder Phenomenon
Over the past few years, a subset of keto dieters has been formally characterized as “Lean Mass Hyper-Responders” (LMHR). These are typically lean, athletic individuals who experience dramatic LDL increases on a ketogenic diet – sometimes from normal to extremely elevated in a matter of weeks.
The LMHR phenotype is defined by a triad of lab values: LDL above 200 mg/dL, HDL above 80 mg/dL, and triglycerides below 70 mg/dL. About 18% of keto dieters in one survey met this definition – Norwitz et al. in 2022 found 100 out of 548 respondents qualifying, suggesting it’s a recognizable pattern rather than a rare edge case.Norwitz NG, et al. Elevated LDL cholesterol with a carbohydrate-restricted diet: evidence for a ‘lean mass hyper-responder’ phenotype. Curr Dev Nutr. 2022. https://pubmed.ncbi.nlm.nih.gov/35106434/
Feldman et al. proposed the Lipid Energy Model in 2022 as a mechanistic explanation.Feldman D, et al. The Lipid Energy Model: Reimagining Lipoprotein Function in the Context of Carbohydrate-Restricted Diets. Metabolites. 2022. https://pubmed.ncbi.nlm.nih.gov/35629964/ The hypothesis: in lean individuals with low body fat and high energy demand, the body increases LDL particle production to transport fat as fuel. Lean individuals with low fat stores need an efficient lipid delivery system – and keto, by shifting fuel dependence to fat, may amplify this. The model predicts that lean, active keto dieters with the highest energy demands would see the greatest LDL elevations.
Supporting this, a case report published in Frontiers in Endocrinology documented a 39-year-old lean male whose LDL rose from 95 mg/dL at baseline to 545 mg/dL after adopting a ketogenic diet.Case report. Extreme LDL elevation on ketogenic diet reversed with carbohydrate reintroduction. Front Endocrinol. 2022. https://pubmed.ncbi.nlm.nih.gov/35498420/ When he reintroduced carbohydrates, his LDL returned to near-baseline within weeks. This reversibility is a key feature of the LMHR pattern – it’s diet-driven, not genetic in origin.
Whether LMHR individuals face elevated cardiovascular risk is the central unresolved question. Their lipid triad (high HDL, very low triglycerides, high LDL) differs from the pattern seen in familial hypercholesterolemia or metabolic syndrome – two conditions where high LDL clearly correlates with risk. The KETO trial addressed this directly, which I’ll cover below.
The KETO Trial: What We Know About Plaque
The most clinically important keto-cholesterol study published to date came out in 2024. Budoff et al. published results of the KETO trial in JACC Advances – a prospective study that measured coronary artery plaque rather than inferring risk from cholesterol numbers.Budoff MJ, et al. Association between long-term ketogenic diet and atherosclerosis in adults with high LDL cholesterol: The KETO trial. JACC Advances. 2024. https://pubmed.ncbi.nlm.nih.gov/39372369/
The study compared 80 long-term keto dieters – with an average LDL of 272 mg/dL – against matched controls with an average LDL of 123 mg/dL. If high LDL on keto were driving arterial plaque at the rate standard risk models predict, the keto group should have had substantially more plaque burden. They didn’t. Coronary plaque burden was not meaningfully different between the groups.
This is striking data, but it comes with a critical caveat that Budoff and colleagues were explicit about: the keto group was lean, metabolically healthy, had high HDL, low triglycerides, and no prior cardiovascular events. This is not a study that generalizes to people with metabolic syndrome, existing heart disease, or familial hypercholesterolemia. It does, however, address the question of whether the LMHR pattern – high LDL in otherwise healthy keto dieters – should be presumed to be increasing plaque the same way high LDL does in other contexts. Based on this data, that presumption doesn’t hold.
One study does not settle a question. But the KETO trial is the first plaque measurement data in this population, and its finding is clinically relevant for lean, healthy people who see their LDL spike on keto and are wondering whether to worry.
ApoB: The Test Your Doctor Should Be Running
ApoB is a protein that sits on the surface of every atherogenic lipoprotein particle – each VLDL, IDL, and LDL particle carries exactly one ApoB molecule. That means ApoB concentration in your blood is essentially a count of atherogenic particles. It captures what LDL-C misses when particle size and count diverge from cholesterol concentration.
Multiple analyses confirm ApoB outperforms LDL-C as a cardiovascular risk predictor, particularly in populations where LDL-C and particle count are discordant.Glavinovic T, et al. Physiological Basis for the Use of Lipoprotein and Apolipoprotein Measurements in Clinical Practice. JAHA. 2022. https://pubmed.ncbi.nlm.nih.gov/36216435/ On keto, that discordance is common – which is exactly why this test matters more for people eating this way than for the general population.
In 2024, the National Lipid Association released a consensus statement on ApoB targets for clinical practice.National Lipid Association Scientific Statement on ApoB. 2024. https://pubmed.ncbi.nlm.nih.gov/39256087/ Their targets: below 90 mg/dL for intermediate cardiovascular risk, below 70 mg/dL for high risk, and below 60 mg/dL for very high risk. These targets give you a risk-stratified framework that LDL-C alone can’t provide.
If you’re a keto dieter with a rising LDL-C and you want to understand your actual risk, ask your doctor to add ApoB to your next lipid panel. If you want to go further, an NMR LipoProfile test measures LDL particle number and size – it’s available through most major labs and gives you a much clearer picture than a standard panel. For anyone in the LMHR range with an LDL above 200 and no prior cardiovascular events, a coronary artery calcium (CAC) score is a practical next step to discuss – it’s a plaque measurement and one of the strongest cardiovascular risk predictors available.
Why the Ketogenic Diet Affects Cholesterol: The Role of Specific Fatty Acids
Not all fat is equivalent in its effect on blood lipids. This matters both for understanding why keto diets produce variable cholesterol responses and for making practical choices if your labs are moving in a direction you don’t want.
Saturated fat raises LDL-C – this is well established. Monounsaturated fat is neutral to mildly beneficial. Polyunsaturated fat (from sources like fatty fish, walnuts, and olive oil) tends to lower LDL-C and improve particle characteristics. A standard American keto diet heavy in red meat, butter, and cheese will produce a different lipid response than a Mediterranean-style keto diet centered on olive oil, fatty fish, and avocados.
Fat Source Comparison: LDL Effects on Keto
| Fat Type | Effect on LDL-C | Effect on Particles | Keto-Friendly Examples |
|---|---|---|---|
| Saturated fat | Raises LDL-C | May increase small, dense LDL fraction | Butter, cream, coconut oil, fatty red meat, cheese |
| Monounsaturated fat | Neutral to mildly reduces | Neutral | Olive oil, avocado oil, avocados, most nuts |
| Polyunsaturated fat (omega-6) | Reduces LDL-C | Shifts toward larger particles | Walnuts, sunflower seeds, most plant oils |
| Polyunsaturated fat (omega-3) | Reduces LDL-C; lowers triglycerides | Favorable shift, reduces VLDL | Salmon, sardines, mackerel, fish oil |
A 2004 study by Fuehrlein et al. put this to a direct test. Participants in the polyunsaturated fat group on a ketogenic diet saw no LDL increase – and also achieved deeper, more consistent ketosis compared to participants whose keto diet was higher in saturated fat.Fuehrlein BS, et al. Differential metabolic effects of saturated versus polyunsaturated fats in ketosis. J Clin Endocrinol Metab. 2004. https://pubmed.ncbi.nlm.nih.gov/15070924/ That dual finding – no LDL rise plus better ketosis – makes a strong case for orienting your fat sources toward poly and monounsaturated fats if cholesterol management is a concern.
A 2003 meta-analysis of 60 controlled trials found that replacing saturated fat with polyunsaturated fat produced the most favorable total cholesterol, LDL, and triglyceride profiles.Mensink RP, et al. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003;77(5):1146-1155. https://pubmed.ncbi.nlm.nih.gov/12716665/ Paired with carbohydrate restriction, this combination may be the most lipid-friendly version of a ketogenic diet you can build. Our Mediterranean keto diet is one structured way to do this.
Practical Application: How to Interpret Your Cholesterol Results on Keto
A standard lipid panel gives you four numbers: total cholesterol, LDL-C, HDL-C, and triglycerides. On keto, the most favorable pattern is: triglycerides below 100 mg/dL, HDL above 60 mg/dL, LDL-C variable but with context. That context matters enormously.
Here’s a practical framework for interpreting your numbers as a keto dieter:
- Triglycerides down, HDL up: This is the keto lipid signature most associated with improved metabolic health. If this pattern is present, that’s a good sign.
- LDL up, triglycerides up: This pattern warrants attention. High triglycerides alongside high LDL-C suggests metabolic stress, possible insulin resistance, or a dietary composition issue – not the typical keto response.
- LDL up, triglycerides below 70, HDL above 80: This is the LMHR pattern. If you’re lean and otherwise healthy, this profile needs monitoring but isn’t automatically alarming based on current evidence.
- LDL up, triglycerides low, HDL up – in an overweight person with metabolic syndrome: Weight loss on keto often transiently raises LDL as fat is mobilized. Give it 3-6 months before drawing conclusions.
After more than a decade eating this way, the tests I’d recommend requesting beyond a standard panel are: ApoB (gives you atherogenic particle count), and if ApoB is elevated or you want baseline plaque data, a coronary artery calcium (CAC) scan. NMR LipoProfile testing, if your lab offers it, gives you particle size and count. These three tests together give you far more actionable information than LDL-C alone.
If you’re trying to dial in your macros alongside all this, the keto calculator can help you structure your fat intake once you’ve decided on your dietary direction. And for a complete breakdown of which foods fit the keto framework, the keto food list is a good reference point.
What If Keto Is Making Your Cholesterol Worse?
For most people, the cholesterol changes on keto are neutral-to-favorable. For some, they’re clearly beneficial. But a minority of people see changes that warrant a genuine response – not just reassurance.
Before adjusting anything, it helps to know why your cholesterol is moving. The three most common clinical reasons for a problematic keto-driven cholesterol response are distinct from each other and require different responses.
Familial Hypercholesterolemia
Familial hypercholesterolemia (FH) is a genetic condition affecting about 1 in 250 people that causes severely elevated LDL from birth, independent of diet. People with FH have impaired LDL receptor function, meaning LDL particles stay in circulation far longer than normal and accumulate in arterial walls over decades.
If you have FH (typically LDL above 190 mg/dL before any dietary intervention, with a family history of early heart disease), a ketogenic diet can push your LDL to extreme levels. This is not the LMHR pattern – the metabolic context is fundamentally different. Keto may not be appropriate for unmanaged FH, and anyone in this situation needs to be working with a lipidologist, not just their GP. For more on the heart disease connection, the keto and heart disease article covers this in more detail.
Hypothyroidism
Thyroid hormones regulate LDL receptor expression in the liver. When thyroid function is low, the liver clears LDL more slowly, and blood LDL-C rises. Hypothyroidism is common enough (especially in women over 40) that it’s worth ruling out with a TSH test if your LDL is elevated and doesn’t respond as expected to dietary changes.
Keto doesn’t cause hypothyroidism, but it doesn’t fix it either. If your TSH is elevated and your cholesterol is rising, the thyroid issue needs to be addressed on its own terms.
Chronic Inflammation
Elevated LDL in the context of chronic inflammation can reflect increased lipoprotein production as part of an acute-phase response – the liver upregulates lipid production when the body is fighting something. If your LDL is rising alongside elevated CRP, ESR, or other inflammatory markers, the underlying inflammation is the primary problem. Keto is generally anti-inflammatory for most people, but it’s not a universal fix. Addressing the root cause of inflammation matters more than the diet composition in this scenario. The low-carb and blood pressure article covers some related cardiovascular markers worth tracking.
What to Eat If Your Cholesterol Is Rising on Keto
If your LDL is rising in a pattern that concerns you or your doctor – particularly if ApoB is elevated or triglycerides are not coming down – the most evidence-backed dietary lever is shifting your fat composition toward unsaturated sources.
Practical changes that move in the right direction:
- Replace butter with olive oil for most cooking
- Increase fatty fish (salmon, sardines, mackerel) to 3+ servings per week
- Add walnuts, almonds, and avocado as primary fat sources
- Reduce red meat frequency and replace some of it with fatty fish or eggs
- Limit processed meats and packaged keto products, which often contain saturated fat from palm oil
No LDL increase and deeper ketosis – that’s the Fuehrlein 2004 result for keto dieters who used predominantly polyunsaturated fat.Fuehrlein BS, et al. J Clin Endocrinol Metab. 2004. https://pubmed.ncbi.nlm.nih.gov/15070924/ This is not about abandoning keto – it’s about adjusting the fat composition within it. Our Mediterranean-style keto approach structures this shift in a way that’s both practical and well-supported by lipid research.
If you’ve made fat composition changes and are still seeing concerning numbers, that’s a conversation for a lipidologist. Statins are not automatically inappropriate on keto – if your ApoB is elevated and plaque progression is a real concern, the evidence for statin benefit in high-risk populations is strong regardless of diet.
Conclusion: What the Research Actually Shows
The keto-cholesterol picture in 2024 is substantially clearer than it was even five years ago. Here’s the current state of evidence:
Triglycerides fall reliably on keto. HDL rises reliably. These changes are consistent across 27 RCTs, umbrella reviews of 17 meta-analyses, and two-year trial data. That part isn’t controversial.
LDL is more complex. For many people, LDL-C is unchanged or improves. For some – particularly lean, metabolically healthy individuals – it rises considerably. But across 38 trials with particle-size data, the shift in LDL is toward larger, less atherogenic particles. The KETO trial measured plaque in keto dieters with average LDL of 272 mg/dL and found no meaningful difference from controls – though that finding applies specifically to lean, healthy people with no prior cardiovascular events.
The most important practical takeaway: LDL-C is an incomplete picture for keto dieters. ApoB, LDL particle count, and plaque measurement via CAC scan give you information that LDL-C alone cannot. If your LDL-C is rising on keto and you want to know whether to act on it, those are the tests that will answer the question.
For more focused reading on this topic, the keto and cholesterol Q&A covers the most common specific questions in a shorter format.
I’ve been eating keto since 2013, which means I’ve had this conversation with multiple doctors, read through more lipid research than I ever expected to, and watched the science evolve substantially over a decade. The framework most doctors use to interpret a keto dieter’s lipid panel was built for a different dietary context – and applying it without adjustment can lead to both unnecessary alarm and missed signals. Understanding the mechanisms behind your numbers is the most useful thing you can do.
Key Takeaways
- Keto reliably raises HDL and lowers triglycerides – findings confirmed across 27 RCTs and umbrella reviews of 17 meta-analyses
- LDL-C may rise on keto, particularly in lean individuals, but particle-size data from 38 RCTs shows a shift toward larger, less atherogenic particles
- The Lean Mass Hyper-Responder (LMHR) phenotype – high LDL, high HDL, very low triglycerides – affects roughly 18% of keto dieters surveyed and appears to be mechanistically distinct from elevated LDL in metabolic syndrome
- The 2024 KETO trial found no meaningful difference in coronary plaque burden between keto dieters with average LDL of 272 mg/dL and matched controls – but this applies only to lean, metabolically healthy individuals with no prior cardiovascular events
- ApoB is a superior cardiovascular risk marker to LDL-C for keto dieters, where particle size and count frequently diverge from cholesterol concentration – ask your doctor to add it to your next panel
- Fat composition within a ketogenic diet affects cholesterol outcomes – polyunsaturated fat sources (olive oil, fatty fish, walnuts) produce more favorable LDL responses than saturated fat-dominant approaches
- People with familial hypercholesterolemia, untreated hypothyroidism, or existing cardiovascular disease need individualized medical guidance before and during any ketogenic diet
FAQ
Does keto diet raise LDL cholesterol?
It depends on who you are. Lean individuals see the largest increases – a 2023 meta-analysis found normal-weight adults averaged about 42 mg/dL higher LDL on keto. But particle data from 38 RCTs consistently shows that the shift is toward larger, less atherogenic LDL particles – meaning the number goes up while the dangerous fraction tends to go down. The KETO trial confirmed this doesn’t translate to more plaque in lean, healthy people. So: yes, LDL-C often rises, but whether that represents increased cardiovascular risk depends on your ApoB, particle size, and overall metabolic context. For a deeper look, see does keto raise cholesterol.
What is a lean mass hyper-responder on keto?
A Lean Mass Hyper-Responder (LMHR) is defined by three simultaneous lab values: LDL above 200 mg/dL, HDL above 80 mg/dL, and triglycerides below 70 mg/dL. It’s more common than most people expect – about 18% of keto dieters in one 2022 survey met the criteria. The leading explanation is the Lipid Energy Model: lean individuals with high energy demands may upregulate LDL particle production to transport fat as fuel. The key distinction from familial hypercholesterolemia is reversibility – LDL typically drops back to baseline when carbohydrates are reintroduced. The 2024 KETO trial found no increased plaque burden in this population compared to controls with much lower LDL.
Should I get an ApoB test on keto?
Yes, if your LDL-C is rising on keto. ApoB counts atherogenic particles – one per LDL or VLDL – so it captures what LDL-C misses when particle size and number diverge. On keto, that divergence is common: LDL-C can rise while ApoB stays flat (large particles, fewer of them), which is a very different risk picture than LDL-C and ApoB both rising. The National Lipid Association’s 2024 consensus targets are below 90 mg/dL for intermediate cardiovascular risk and below 70 mg/dL for high risk. It’s a routine, inexpensive add-on to a standard lipid panel and one of the most useful tests you can run on a low-carb diet.
Does keto improve HDL cholesterol?
Yes – HDL improvement is one of the most consistent findings in keto research. A 2024 meta-analysis of 27 RCTs found clear HDL increases on ketogenic diets, and a 2023 umbrella review covering 17 meta-analyses reached the same conclusion. The Virta Health 2-year trial showed sustained HDL elevation over two years of continuous keto dieting. The mechanism is well understood: lower carbohydrate intake reduces triglyceride production, which reduces cholesterol transfer away from HDL particles, so they stay elevated longer in circulation.
What fat sources are best for cholesterol on keto?
Polyunsaturated and monounsaturated fats consistently produce better cholesterol outcomes than saturated fat on keto. The clearest controlled evidence comes from Fuehrlein et al. 2004: keto dieters eating predominantly polyunsaturated fat saw no LDL increase and reached deeper ketosis than those eating more saturated fat. Practical targets are olive oil, fatty fish (salmon, sardines, mackerel), walnuts, and avocados. If your cholesterol is moving in a concerning direction, shifting toward these sources is the first lever to pull before considering medication. The Mediterranean keto approach structures this shift practically.
Sources
- Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials – British Journal of Nutrition (Bueno et al., 2013)
- Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo – American Journal of Clinical Nutrition (Brinkworth et al., 2009)
- Carbohydrate intake and HDL in a multiethnic population – American Journal of Clinical Nutrition (Merchant et al., 2007)
- A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial – Annals of Internal Medicine (Yancy WS Jr et al., 2004)
- Advanced lipoprotein testing and subfractionation are clinically useful – Circulation (Superko, 2009)
- LDL particle number and risk of future cardiovascular disease in the Framingham Offspring Study – Journal of Clinical Lipidology (Cromwell et al., 2007)
- Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins – American Journal of Clinical Nutrition (Mensink et al., 2003)
- Effects of ketogenic diet on cardiometabolic risk factors: a systematic review and meta-analysis of randomized controlled trials – American Journal of Clinical Nutrition (Soltani et al., 2024)
- Differential effects of ketogenic diet on LDL-cholesterol depending on baseline body weight: meta-analysis – Nutrition Reviews (Joo et al., 2023)
- Effects of ketogenic diet on health outcomes: an umbrella review of meta-analyses of randomized clinical trials – BMC Medicine (Patikorn et al., 2023)
- Effect of dietary carbohydrate restriction on LDL particle size and concentration in overweight and obese adults – American Journal of Clinical Nutrition (Falkenhain et al., 2021)
- Long-term effects of a ketogenic diet in obese patients with type 2 diabetes – Virta Health 2-year trial – Cardiovascular Diabetology (Athinarayanan et al., 2020)
- Physiological Basis for the Use of Lipoprotein and Apolipoprotein Measurements in Clinical Practice – Journal of the American Heart Association (Glavinovic et al., 2022)
- National Lipid Association Scientific Statement on ApoB – National Lipid Association (2024)
- Elevated LDL cholesterol with a carbohydrate-restricted diet: evidence for a Lean Mass Hyper-Responder phenotype – Current Developments in Nutrition (Norwitz et al., 2022)
- The Lipid Energy Model: Reimagining Lipoprotein Function in the Context of Carbohydrate-Restricted Diets – Metabolites (Feldman et al., 2022)
- Extreme LDL elevation on ketogenic diet reversed with carbohydrate reintroduction – case report – Frontiers in Endocrinology (2022)
- Fat type effects on LDL and ketosis on a ketogenic diet – Takemura et al. (2024)
- Association between long-term ketogenic diet and atherosclerosis in adults with high LDL cholesterol: The KETO Trial – JACC Advances (Budoff et al., 2024)
- Differential metabolic effects of saturated versus polyunsaturated fats in ketosis – Journal of Clinical Endocrinology & Metabolism (Fuehrlein et al., 2004)
- Ketogenic diet and lipid outcomes: meta-regression – Endocrine Practice (2026)
The information in this article is not medical advice and is not a substitute for professional medical guidance. Always consult a qualified healthcare provider before making changes to your diet or health regimen.
Just to show how in the dark my own doctor is about the keto diet, NMR results, and cholesterol in general, when my husband’s last NMR results came in, she called the house and was shrieking that he was going to have a heart attack. Meanwhile, Hubby’s cardiologist gave him a clean bill of health just the week before–so how could someone go from “thumbs up” to “heart attack” in the span of a week? It’s easy when your doc doesn’t know how to read an NMR.
I read the results when our copy finally made it home, and he wasn’t showing signs of a heart attack, but rather insulin resistance (which we’re taking care of). We’re no longer going to get our NMR draws done through her.
Whoa. This article could NOT have come at a more relevant time, seriously! I eat low carb (although not low enough to be keto) and my my recent lipid panel came back with a crazily high HDL at 127 – the lab even verified the number by a repeat analysis. My LDL and Trigs were totally average though – within lab ranges but not super low or anything. I asked my cardiologist for a particle test and they found one called the Cardio IQ Report – I think I was the first person to ever ask them for a test that specific. So this article will be incredibly helpful at interpreting the results. Especially since I’m the kind of person who will see something that appears to be great (like a super high HDL) and automatically worries about it instead, haha!
hey had a quick question. I am tracking my food on my fitness pal and i noticed my cholesterol intake was much higher than recommended. I am really new to this do you have any articles that address this and any suggested foods?
Nutritional cholesterol generally gets used pretty quick so I wouldn’t worry about it. As long as you’re not eating processed fats, you should definitely have a positive impact from a ketogenic diet.
My husband is 69 years old he has been on plavix for about 10 years! Omg his skin is so thin now that he bleeds if he just scratches himself!! We have been on the LCHF diet since October but strictly since mid December. I am telling him he needs to go back to the cardiologist because I think it might be time for him to get off these meds or reduce!! He is also on High blood pressure meds wich have been cut in half anf on next visit might be taken off all together! His last blood work came back nearly perfect. His hdl was low but Dr said it will come up. Is it possible he could be taken off this aweful plavix?
You may need to find a doctor that will support the ketogenic diet, and that’s a bit of a hard thing to do. Once doctors have prescribed certain medications – they are weary/unwilling to take their patients off of them. I’m sure over time it’s possible for your husband to come off of the plavix, but you would also want to try to find a doctor that can help you guys do that as well.
Tell your dr you’re going off of the meds and they need to monitor you. Who cares if they want you to get off of them 🙂
Hi Craig,
We got our test results and we are both happy and nervous.
As you must be aware the total cholesterol and LDL went way up but so did our HDL.
My husband saw a tremendous decrease in his triglycerides! Below are the details.
Hubby:( used to take statins earlier, stopped since Keto):
On Keto since: 4 weeks
Lost: 8-9 lbs
Supplements are fish oil and Probiotics
TCL: Before 159 Now 234
HDL: Before 34 Now 42
LDL: Before 97 Now 174
TGL: Before 180 Now 89
My numbers(no meds)
On Keto since: 6 weeks
Lost: 7 lbs
Supplements are multivitamin, fish oil, calcium, magnesium and zinc, Probiotics.
TCL: Before 165 Now 231
HDL: Before 50 Now 63
LDL: Before 79 Now 154
TGL: Before 90 Now 79
My son’s numbers(no meds)
On Keto since: 2+months
Lost: 20 lbs
Supplements are multivitamin
TCL: Before 165 Now 240
HDL: Before 45 Now 46
LDL: Before 100 Now 174
TGL: Before 89 Now 76
Btw I was prepared for these results as I did read a lot while being on Keto that this will happen. One of those reads included this page of yours that has such awesome insights so I was ok….but both our docs have freaked out lol. I knew that the total cholesterol does go up since HDL will increase and so will the fluffy LDL particles which are harmless. But since we didnt have that particular test to count the particle size, our LDL is currently a pretty scary figure. So for now just to be on the safer side I am making a few small changes, like our morning breakfast would have 2 less egg yolks, and we’ll consume portioned meat only in the lunch…vegetable soup/stew along with greens in the evening etc. Rest of the good plant based fats like oils, avocado, nuts etc we’re going to continue….but just go easy on the animal proteins and fats. Hoping this might bring down the LDL.
I’m more concerned about my son’s report though, as his HDL increased by only 1 point and LDL has gone up way high. I can understand why, since he doesn’t have access like us to good MUFAs like avocados, evoo and good sat fats like coconut oil and butter etc as he mainly eats at his college dining halls. He does eat tons of salad with his meals and blueberries and grilled chicken and/or beef-patties both for lunch and dinner. He skips his breakfast and instead has a cheese stick and nuts. Throughout the day he drinks a lot of water and snacks on nuts in 3 hours of intervals and stays under his calorie intake. So as you can see not that much of a good fat intake as much as we do at home.
So I want to work with him to change up a lil bit but he’s headstrong and saying I don’t care about these numbers, I’m enjoying good health and that’s all that matters.
Would love to get some feedback/advice from you on this topic. Also wondering does the LDL ever go down at any point? Coz we love Keto so definitely not stopping on this path. Going further planning to get the Lipid profile done again in 3 mnths to see where we stand. Eagerly waiting for your response!
Thanks,
Mz.
My only feedback is that it seems like you’re doing everything correctly. Keep with it and I think the numbers will start to even out in the next few weeks. It usually takes around 12 weeks to get a solid grasp on all of the numbers. It also looks like all of your numbers are honestly pointing in the right direction so I wouldn’t worry too much.
Make sure that all of you guys take fish oil supplements if you don’t eat too much fatty fish in your diet. Everything else looks great!
Thank you very much, thats a good assurance 🙂 Yes I need to have our son start taking fish oil too as he doesn’t currently. Hoping to make a good difference after a few months….till then we are Happy Keto’ers!!!
My eyes glazed over about 1/4 of the way through this article. Lets just say I trust you. I have HBP, diabetes and am overweight. I have lost some weight, lowered my insulin by 10 pts. and my BP is coming down.
Haha, well you can always just read the takeaways. I write these articles in depth just to give some scientific backing to everything that I believe in/write about 🙂
Can you recommend any foods/snack that I can grab in the grocery store for quick meals? Or is there no such thing 🙁
I’m really sorry for the late reply. I was in the middle of 2 cross country moves. Usually grocery stores will have a lot of pre-made things you can grab. Cheese sticks wrapped in prosciutto for example is a great one. Grabbing a rotisserie chicken and dipping the skin and thighs into mayo (or a fatty dressing) would also be an easy one.
Hi. I started keto diet 2 month ago. Just did a simple blood test today. Triglycerides very low and cholesterol level 150% above maximum recommended. Before diet was around 90%. Don’t have the ratio hdl/ldl.
I’m on around 2000kcal/day. Daily goal of 32gcarbs, 155g fat and 121g protein.
What am I doing wrong to have this cholesterol level. Too much “bad fat” like animal fat?
I workout 4 days a week.
Hi Vitor,
Congrats on the low triglyceride levels. The overall cholesterol number doesn’t really tell you all that much. The total to hdl cholesterol ratio is what will tell you if you should be making changes to your diet or not. You can do this yourself by dividing your total cholesterol by your HDL cholesterol. Anything between 3 and 4 is considered as “healthy”. If you are above 4, then eating more low-carb vegetables, olive oil, avocado, nuts, and seeds may help you optimize your cholesterol levels. If your ratio is between 3 and 4, then there’s no need to worry.
We recently updated this article with more research and how to apply it to your keto diet. Read through it again if you’d like and let me know if you have anymore questions.
My total is 203 and my HDL is 37 So for me It’ 203÷37=5.4? So my HDL is to low? The higher the HDL the better. How about my Triglycersdes 227 VLDL 45 and LDL 120 all to high.
I want to start the keto diet, however my TCL is 256, my HDL is 51 and my LDL is 201 as of today. Should i be concerned since my LDL is certainly going to go up even higher on the keto diet and take medication to bring it down prior to beginning the keto diet ?
My husband and I first did the keto diet in 2015, after Thanksgiving, for a few months. We’ve been talking about restarting and we finally did. My husband has been on keto diet for 5 weeks, while I on 4 weeks. This time I had the keto flu and I almost stopped the diet. Anyway, I had lipid panel done yesterday and got my results back:
Weight before keto: 122
Current weight: 115
multivitamins, magnesium, vit d & e & c, calcium, fish oil
TCL: 273
TGL: 97
HDL: 55
non-HDL cholesterol: 218
LDL: 199
CHOL/HDL ratio: 5.0
I’m expecting to hear from my doctor about the results! And to be honest I did freak out when I saw the numbers because as you can see they are off the charts!
My cholesterol has been high even before I started the keto diet. (I believe high cholesterol runs in my family). However, I did manage to bring it down by eating more vegetables and fish. Now that I’m on keto, aside from the HDL, everything is considered high or very high.
Should I be concerned with the numbers?
Thanks!
So I have been on the keto diet now for about 6 months. I have lost 35 pounds. Had a blood test the other day and the doctor comes back with my LDL cholesterol is too high and wants to put me on cholesterol lowering medication. I told her to give me some time as I was eating a lot of eggs, meat and cheese and didn’t want to go on meds if I didn’t have to. I went on the diet initially to get my A1C down as I was Prediabetic. Now I don’t know what to do. The sugar did come down and all my other levels were good. Any advice??? Stay on keto and ignore the high cholesterol number or should I be eating more of something that will bring my LDL down? I really don’t know what to do now. If I eat sugar again I am afraid I will be out of control and gain my weight back. I like the fact that I was never craving sugar on the keto diet and was never really hungry.
Familial Hypercholesterolemic here too. Wouldn’t worry too much. LDL in itself is a useless measure. What I would do is to closely monitor
– your Triglyceride level ( should be lower than 100 ) and the ratio between HDLC and Triglycerides ( should be lower than 1 ). This is the best marker for CVD in general, still not 100% sure about familal HCE.
– your LDL particle size. Do an advanced lipd panel or NMR. You want to avoid sdLDL ( small dense LDL or pattern B LDL ) as this is the real culprit penetrating the Endothelium
– keep track of your CRP or hsCRP ( highly sensible CRP )
Check out Prof Ken Sikaris on Youtube https://www.youtube.com/wat… or Ivor Cummins just to name a few.
Glad to get in touch to share further thoughts.
Hey Bradford,
We recently updated this article with practical applications and updated research that apply to your situation. Let me know if you have any more questions after you give it another read through.
Hey there,
We recently posted an update on this article with some practical applications. It addresses many of your concerns.
The main number that you should focus on is the Chol/HDL ratio (I explain why in the article). Ideally, it should be below 4 and if you can get it below 3.5 that’s even better.
To do so, it may be helpful to eat more monounsaturated fats like avocado and macadamia nuts, exercise everyday (a 30 min walk will do), increase fiber intake, and get plenty of sleep every night.
Congrats on the awesome results, Flavia!
There are a couple of natural ways to lower cholesterol levels. Here is a list of some strategies that can help:
-doing some form of exercise every day (going for a 15-30 min brisk walk is a great example of something you can do)
-eating low carb vegetables with most of your meals. Here is a link to an article about low carb veggies:
https://www.ruled.me/best-low-carb-vegetables-ketogenic-diet/
-replacing some animal fats like butter, cheese, and fatty meats with avocados, nuts, seeds, olives, olive oil, and fatty fish like salmon
-getting plenty of sleep
-eating fiber with every meal (keto bread, low carb vegetables, and some nuts and seeds have plenty of fiber in them)
Also, I recommend reading this article through once more. We recently updated it with practical applications that will help you gain a better understanding of what your cholesterol numbers mean.
If you have any other questions, please let me know!
My cholesterol went from 220 to 380 on keto. Had to quit or I fear it would have killed me! Keto is not for everyone. Be sure to get your bloodwork done people dont follow blindly.
I started Keto in Aug of 2017. I work out 4-6 days a week for at least 45 minutes (HIIT) I eat a lot of spinach and avocado. Have started swapping olive oil for butter, started taking Fish oil supplements. Below is a lab history. Thinking I may be the case of Keto is not right for me. Have to see a cardiologist to see if any build-up occurring. I feel like all is well but the LDL and clearly I am way over 4 on the Chol/HDL ratio. I have not actually lost any weight, but only needed to lose 10-15 pounds. But mental clarity is good. (PS I have never made keto substitutes like bread, desserts, and have not had a cheat). Should I abandon Keto for a low carb, low fat option?
Pre-Keto:
Total 231
Trig 64
HDL 80
VLDL 13
LDL-C 138
Keto Start Aug 2017-Feb 2018. Labs 2/24/18
Total 688
Trig 150
HDL-C 72
HDL-P 32.2
LDL-P >3500
LDL-C 586
LDL Size 23.0
Small LDL-P <90
Updated Lab 6/2018 (no NMR done)
Total 622
HDL 89
Trig 104
VLDL 21
LDL-C 512
I’m curious to see how much the olive oil and fish oil will help you. Are your most recent numbers from after you made that adjustment?
Either way, if I were you I’d probably start following a lower fat diet that is whole food based and see what effect that has after a month or so. For some examples of lower fat, whole-food-based diets, you can check out the Paleo diet (if you want to stay low carb), Kitavan diet, Okinawa diet, and the Mediterranean diet.
It is also important to know that the key for weight loss when following any diet is to maintain a calorie deficit. So, when you follow a lower fat diet, make sure you are in at least a 15% calorie deficit and no more than a 30% calorie deficit for best results.
The 6/2018 numbers are after I started switching to the Olive Oil and Fish pills. Thank you for the advice on what diets to consider. I want to stay low-carb, although I will say of all the things I no longer eat, I do miss my apples.
I have also started to wean myself off of dairy, although that was low amounts of HWC in coffee and occasional cheese in my eggs and salads.
I will have another follow-up test in three months, so after making more changes, we’ll see if it goes further down.
I am on Keto for 5 weeks lost 15pounds. My fat intake will be from avocados and coconut oil not fatty meats like bacon and meats. Will see what happens on my next blood test. Before starting ln Keto my HDL is a good 35 VLDL 45 LDL 120 and total is an ok 203.
Congrats on the weight loss! Ideally, when you get your blood tested again, you will see most of these numbers improve (i.e., higher HDL and lower triglycerides and LDL).
Good luck with everything. If you need help with anything, please let me know.
Good luck with everything.
Regarding dairy consumption, the research suggests that cream and cheese usually don’t have an effect on cholesterol levels, so you may not have to limit them as much.
Feel free to eat apples as well. You can definitely make them a part of your low carb diet, just limit yourself to 2 to 3 a week and don’t overdo it with starches and other fruits.
Fact: before I started the ‘keto diet’ I did not have high cholesterol. Fact: 6 months later, I have lost 14lbs Fact: I now have high cholesterol. This was found on a blood test that I had due to having heart palpitations. None of which I had before the ‘keto diet’. So, whilst I am sure that all of the science you recite is accurate, it simply isn’t true. If you eat fat, LDL, HDL, IDL, VIDL or whatever, you will have high cholesterol. I think that the the simple advise that Doctors have always given us, eat less and exercise more is the way forward. A healthy well balanced diet and a 20 min walk everyday. I loved the keto diet but as always it is too good to be true. You can’t sit around scarfing, cheese, eggs and cream and not expect to have cholesterol clogging up your arteries.
Like any diet, keto isn’t ideal for everyone. While some people lose weight, optimize their cholesterol levels, and decrease their heart disease risk with keto, others will develop high cholesterol from it.
We actually explore why this is the case in the “What if Keto is Making Your Cholesterol Levels Worse?” section of this article. If you have a chance to check it out, I’d love to know what you think and if what I wrote about applies to your situation.
I appreciate that this is a scientific matter, the article is difficult for me to understand, apologies for being a bit thick. There could be thyroid issues. I think a lot of people hear of the keto lifestyle and all the positive benefits. They may take it up without considering all the facts which could be dangerous. I only had the blood test because of the heart palpitations which began when I started keto. I would encourage people to take care. Don’t assume because you loose weight that it’s all good.
Thanks for pointing this out. Keto is not healthy for everyone, even if it helps you lose weight.
This is why we updated this article recently with a section titled “What if Keto is Making Your Cholesterol Levels Worse?”. Also, to address the bigger picture of health and dieting, we published an article that explores the key principles behind creating a healthy diet and what you can do if keto isn’t healthy for you:
https://www.ruled.me/is-the-ketogenic-diet-healthy/
Hopefully, this will help anyone struggling with health issues to find the dietary approach that is right for them, even if it isn’t the keto diet.
Thanks again for pointing this out and sharing a bit of your story! This is such an important issue.
Hello
That’s the first really documented article I read about cholesterol and keto. Need to know if this diet (3 months in now) is really sustainalbe for me : I have exactly the samed ratio TotalCholesterol/ HDL now than 6 months before (3.23), but my LDL and HDL both increased a lot (from 194 to 278 and from 60 to 86). And there is familial hypercholesterolomia issues, wich I know for a long time. Taking fish oil supplements since a few days … and perhpas I have to lower coconut oil and butter ?
Thanks if you can reply to this very french-english mail !
Hey Celine,
From what you told me, it seems that a safer option may be to transition to a more plant-based diet, focusing on low carb vegetables, nuts, seeds, olive oil, avocado, and leaner meats. A paleo diet or Mediterranean diet are two examples that may have a better chance at improving your cholesterol.
If you still want to stay on the Keto Diet, you might be able to improve your numbers just by swapping out saturated fats and eating more polyunsaturated and monounsaturated fats.
Either way, make sure you consult your doctor before implementing any of these suggestions.
I hope this translates easily to French for you! If you have any questions, please let me know.
Hello tyler,,a lot of information and a good thread of questions and your answers…
I would like to share my experience with keto for the last 8 months.I was 75 kg and fat% @ 22 % (measured on the scale I have at home).I was having whey protein and three time food and weight training for 2 hrs a day.Then I got curious with Keto and OMAD and started on Omad first and then keto. My body weight dropped to 63 kg and body fat 10% to 11%.I have plateaued in weight and fat content.My calories are around 2000 per day i eat this at 8 pm. I have a bullet proof coffee at 7 pm with i table spoon coconut oil and ghee. Except for blue cheese I dont take any milk products.I eat about 400 gms of leaf vegetables,sea weeds for iodine and a hand full of chopped kale leaves apart from a few strips of beacon,meat (full fat chicken/beef),olive oil and MCT oil to complete my 2000 cal. I drink a cup of almond milk mixed with macadamia nut, chia seed,pumkin seed and watermelon seed pecan nuts in my diet A T -spoon of ashwaganda and macca root powder added . I dont have hunger pangs in between.I used to have sleep issues (less sleep)but after I supplemented with ZMA i over come that issue.I sleep about 8 hrs of which about 2.5 hrs is deep sleep.I have done a recent blood test and the following was found.My HDL was good but my LDL was very high 147.. my TG is also in the normal range .My cholesterol ratio is 3.2.
I also do long term fasting for 75 hrs once in two months.
In normal days i consume himalayan pink salt in water.My day starts with two table spoon of apple cider vineger with salt and a glass of water.
I take a suppliment of K2 also. I work out in the morning for two hours X 6 days lifting weight and doing HIIT for 15 min post lifting three days a week. pre-workout i take coffee,citrulline malate, l carnitine and beta alanine. I will be doing my Cardiac calcium score test in a few days to overrule any calcium deposition.
i have a doubt will my higher LDL clog my arteries?Atherosclerosis is not because of fat in blood but stiffness of the arteries which result in cracks and cholestrol is used to repair this cracks.Finding cholestrol near the blockage dosent mean that cholestrol is the culprit…its like finding firefighters at the scene of fire….The culprit is the stiffness of the arteries which is due to inflamation and low vitamin K….
Any advice??
It seems like you are healthy enough that having high LDL-C may not be a cause for concern.
That being said, If you want to better assess your atherosclerosis risk, you may want to get an LDL-P test as well. This is a much better indicator of risk than LDL-C.
If LDL-P was high, then I’d replace some high-saturated fat foods with high-omega 3 foods like wild-caught salmon and sardines to see if this helps improve my cholesterol levels.
“I have a bullet proof coffee at 7 pm with i table spoon coconut oil and ghee.”
Do you mean 7pm or 7am? 7pm would not be a good idea. Also, replacing coconut oil and ghee with MCT oil and heavy cream or just MCT oil may be a simple swap that helps optimize cholesterol levels further.
I’d also recommend carefully reading this article again to better understand cholesterol and the causes of atherosclerosis. This will help you understand some of the reasoning behind my comments.
If you have any further questions, please let me know.
Hi Tyler
Thanks for the details.
I have switched my bullet proof coffee to 4 pm I didn’t wanted to break my fast so don’t want to have it much earlier..is that ok? Switched to MCT ipo butter and ghee..
I had my free testosterone done and found to be 8.9 (Elisa method) is it because my carbs are low?? I have started ZMA supplimentation.blood ketone is 3.2. mmol/L.LDL is 161 HDL 63. TG 78.
Are things under control?
I am planning to start creatine supplementation shall I do that??
I have started a preworkout of coffee mixed with citrulline mallate,L carnitine and beta alanine.
I know of a few sleep researchers who reccomend against consuming caffeine in the afternoon because of how it can negatively affects sleep.
There is a lot of high quality research on creatine and its benefits for working out, so it might be beneficial for you as well.
I’m not well-versed in the literature on how free testosterone levels change during low-carb dieting. I’ve read research that indicates restricting carbs can lower testosterone in the short-term, but I’m not sure about long-term effects and if the drop in testosterone is clinically significant.
Whether things are under control or not is up to you and your doctor to decide. Please keep in mind that everything on this site and everything I say is solely for informational purposes and should not be considered as medical advice.
I went on the keto diet for four months and lost 32 pounds. I had high cholesterol to begin with, but not high enough for my doctor to feel she had to put me on statins. I believed the claims that keto can lower cholesterol, and decided to give it a try. Four months later, and my cholesterol went from 248 (last results in May 2019) to 333! LDL from 180 to 258! My HDL went up slightly, from 56 to 68, but not enough to mitigate the extremely high cholesterol levels.
My doctor called me immediately upon getting the results, and I am now on a statin. 🙁 Keto is DEFINITELY not for me. I lost weight, but believe I could have also done that with a low calorie diet. I know others who have told me they have had good results with their lipid levels, so I am not saying this is the case for everyone. I am cutting out all foods with cholesterol and am transitioning to a plant based diet, hoping to get off statins in the near future. Thank you for putting this information out there. I wish I had found it earlier, but at least I know now I am one of people who does not tolerate keto diet.
Thanks for sharing your experience with us, Rebecca.
Fortunately, there are several ways to lose weight and improve health. After some experimentation, you’ll be able to find an approach that works best for you.
If you have any questions regarding your transition to a healthier diet for you, let me know. I’ll do my best to point you toward helpful resources. 🙂
Just got back from a physical. After one year (non-religious) Keto, my Total Cholesterol went up 63 points. HDL went up from 50 to 66, Triglycerides went down from 66 to 60.. My Total to HDL is .3.7 (good) My Trigycerides /HDL is .9 (Excellent. 2 is target. Lower is better.) My HDL to total cholesterol is .27 (ideal is .24) I call it all good. After a heart attack and stent placement, I want all my ratios to be good. I am less conserned about the totals. Even the VLDL went down from 13 to 12. It was at 10 on Atorvastatin. I’m not going back there. I felt like the walking dead.) This year I gained one pound, but since the event have lost over 35. I call it all good. My cardio guy is pleased, my PCP not so much. Keto-ish works for me. Morphing into Mediteranean-Keto. Its a good thing I like fish, love avocados, and olive oil.
Thanks for taking the time to share a bit about your story with us, John!
If you need any more information, tips, or recipes for implementing a keto Mediterranean diet, here’s a link to our Mediterranean-keto guide:
https://www.ruled.me/ketoge…
Did any one get their LDL level or total cholesterol level down after following keto diet?
Good question, Rana! There are several studies where different variations of keto have lowered both LDL and total cholesterol levels.
In fact, the ketogenic Mediterranean diet has shown the most promising results, with one study finding:
-significant reductions in total cholesterol (204 mg/dl to 181 mg/dl)
-significant decreases in LDL cholesterol (150 mg/dl to 136 mg/dl)
-increases in HDL cholesterol (46 mg/dl to 52 mg/dl)
If you’d like to learn about this keto approach, check out the following article:
https://www.ruled.me/ketoge…
Let me know if you have any questions. Thanks for the comment 🙂