Does the keto diet raise your cholesterol levels or improve them? Let’s dive into the science behind how a ketogenic lifestyle impacts your lipid profile and what it means for your heart health.
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When I first started researching the keto diet, one question kept popping up: “Will all this fat clog my arteries?” It’s a valid concern. After all, the ketogenic diet is famous for its high-fat approach to eating—roughly 70-80% of daily calories come from fat sources. For decades, we’ve been warned about the dangers of dietary fat on cholesterol levels and heart health.
But here’s the thing—the relationship between the keto diet and cholesterol isn’t as straightforward as you might think. In fact, many people experience surprising improvements in their cholesterol profiles after adopting this low-carb, high-fat lifestyle.
I’ve spent years researching this topic and speaking with countless keto dieters about their experiences. What I’ve found might surprise you, especially if you’re concerned about your heart health while following this popular eating pattern.
Before we dive into how keto affects your cholesterol, let’s get clear on what cholesterol actually is. Despite its bad reputation, cholesterol is essential for your body to function properly.
Cholesterol is a waxy, fat-like substance that your body uses to build cells, make hormones, and produce vitamin D. Your liver naturally produces all the cholesterol your body needs, but we also consume it through animal-based foods.
When doctors talk about cholesterol, they’re usually referring to these key components:
| Measurement | Optimal Level | Borderline | High Risk |
|---|---|---|---|
| Total Cholesterol | Less than 200 mg/dL | 200-239 mg/dL | 240 mg/dL and above |
| LDL Cholesterol | Less than 100 mg/dL | 100-129 mg/dL | 160 mg/dL and above |
| HDL Cholesterol | 60 mg/dL and above | 40-59 mg/dL | Less than 40 mg/dL |
| Triglycerides | Less than 150 mg/dL | 150-199 mg/dL | 200 mg/dL and above |
What many people don’t realize is that the traditional ratios and numbers might not tell the whole story—especially when you’re on a keto diet.
Many keto beginners experience a temporary increase in cholesterol levels during the first 3-6 months. I call this the “keto-adaptation period,” and it’s actually a normal part of the metabolic shift that occurs.
During this time, your body is learning to use fat as its primary fuel source instead of carbohydrates. This often means more fat is being transported into your bloodstream—which can temporarily elevate cholesterol markers.
Dr. Sarah Hallberg, a leading researcher in low-carb diets, explains it this way: “When people lose weight rapidly, which often happens in the initial stages of keto, stored fat is released from fat cells. This can temporarily increase cholesterol levels until weight stabilizes.”
In most cases, this initial spike settles down as your body becomes more efficient at using fat for fuel. However, if elevated levels persist beyond 6 months, it’s worth discussing with your healthcare provider.
Here’s where keto often shines. Many studies show that a well-formulated ketogenic diet typically raises HDL cholesterol—the “good” kind that helps protect against heart disease.
In a 2020 study published in the Journal of Clinical Lipidology, participants following a keto diet for 12 weeks saw an average increase of 7-10% in their HDL levels. Higher HDL levels are associated with lower cardiovascular risk, which is why doctors get excited when these numbers go up.
I’ve seen this benefit firsthand with many keto dieters—their HDL numbers improve, sometimes dramatically, especially when they focus on healthy fat sources like avocados, olive oil, and fatty fish.
LDL cholesterol—traditionally viewed as the “bad” cholesterol—often tells a more nuanced story on keto. Many people see an increase in LDL cholesterol when they start a ketogenic diet, which might seem concerning at first glance.
However, recent research suggests we need to look deeper than just the total LDL number. There are different types of LDL particles:
Several studies indicate that low-carb, high-fat diets like keto tend to increase the larger, less dangerous LDL particles while reducing the smaller, more harmful ones—even if total LDL numbers go up.
That said, not everyone experiences the same LDL response on keto. Some people, especially those with the APOE4 gene variant (which affects roughly 25% of the population), may see more problematic changes in their LDL levels.
If there’s one consistent cholesterol benefit from keto, it’s the impact on triglycerides. These blood fats typically plummet on a well-formulated ketogenic diet.
A 2018 review of multiple studies found that low-carb diets consistently reduced triglycerides by 15-50% in participants. This makes sense when you consider that triglycerides are heavily influenced by carbohydrate intake—especially sugar and refined carbs.
High triglycerides are linked to an increased risk of heart disease and metabolic syndrome, so this reduction represents a significant health benefit for many people.
Rather than focusing on individual cholesterol numbers, many doctors now look at ratios that may better predict cardiovascular risk:
Interestingly, these ratios often improve on keto, even when total or LDL cholesterol increases. This suggests that the overall cholesterol profile might be becoming more favorable, despite certain individual measurements going up.
Dr. Jeff Volek, a prominent researcher in ketogenic diets, notes: “The triglyceride to HDL ratio is one of the best predictors of heart disease risk, and it almost always improves dramatically on a well-formulated ketogenic diet.”
It’s important to separate the cholesterol changes caused by weight loss from those caused specifically by the ketogenic diet.
Weight loss from any diet typically improves most lipid markers. Since keto often leads to significant weight loss, especially in the beginning, some of the positive cholesterol changes may be attributed to dropping pounds rather than the specific macronutrient ratio.
However, studies that control for weight loss still show the unique benefits of ketogenic diets on lipid profiles, particularly for HDL and triglycerides.
Perhaps the most important thing to understand about keto and cholesterol is that individual responses vary tremendously. While most people see improvements in their overall lipid profile, some experience unfavorable changes that might increase cardiovascular risk.
Factors that influence your personal response include:
This variability is why monitoring your lipid panel before and during a ketogenic diet is crucial—especially if you have pre-existing cholesterol concerns.
The answer is: it depends. Most people see an increase in HDL (good) cholesterol and a decrease in triglycerides. LDL cholesterol may increase for some individuals, particularly in the early adaptation phase. However, the increase often involves the larger, less harmful LDL particles rather than the small, dense particles associated with heart disease.
About 15-25% of people are what researchers call “hyper-responders,” who see more significant increases in LDL cholesterol. If you fall into this category, working with a healthcare provider knowledgeable about low-carb diets is essential.
While keto typically raises HDL and lowers triglycerides, its effect on LDL varies. Some people do experience lower LDL, especially after the initial adaptation period and once weight stabilizes. Others may see a persistent elevation.
Focusing on monounsaturated and polyunsaturated fats rather than saturated fats can help minimize LDL increases. Incorporating sources like olive oil, avocados, and fatty fish rather than relying heavily on butter, cream, and bacon may lead to more favorable LDL outcomes.
One of the most consistent benefits of a ketogenic diet is improved HDL cholesterol levels. Most studies show increases of 5-15% in HDL, which is associated with reduced cardiovascular risk.
HDL acts like a cleanup crew for your arteries, helping remove excess cholesterol and return it to your liver for processing. Higher HDL levels generally indicate better cardiovascular protection.
This requires an individualized assessment. For many people with high triglycerides, low HDL, and metabolic syndrome (a common pattern in obesity and type 2 diabetes), keto can significantly improve these markers.
However, for those with familial hypercholesterolemia or very high LDL levels, especially if accompanied by existing cardiovascular disease, a standard ketogenic diet might not be the best approach without medical supervision.
I always recommend getting a complete lipid panel before starting keto and then monitoring your levels at regular intervals (typically 3, 6, and 12 months after beginning).
Quite the opposite. One of the most reliable effects of a ketogenic diet is a significant reduction in triglycerides. This happens because:
Many people see reductions of 30-50% in their triglyceride levels within just a few months of starting keto, which is a significant benefit for heart health.
Some people experience a temporary increase in cholesterol, particularly LDL when they first start keto. This is often referred to as the “keto-adaptation period” and typically occurs within the first 3-6 months.
This initial spike usually reflects your body’s transition to using fat as its primary fuel source. For most people, cholesterol levels stabilize or improve after this adaptation phase, but regular monitoring is important.
Long-term studies on ketogenic diets and cholesterol are still emerging, but the available data is encouraging for most people. After the initial adaptation period, many individuals maintain improved HDL levels and triglycerides while LDL tends to stabilize.
A 2-year study published in the journal Nutrients found that participants who stayed on a ketogenic diet maintained their improved HDL and triglyceride levels throughout the study period, while initial LDL increases tended to moderate over time.
That said, we still need more comprehensive long-term studies (10+ years) to fully understand the cardiovascular impacts of sustained ketosis.
Beyond just cholesterol, keto affects several markers related to heart health:
A 2021 review in the Journal of the American College of Cardiology concluded that well-formulated ketogenic diets appear beneficial for cardiovascular health in most individuals, particularly those with insulin resistance, though they emphasized the importance of individualized assessment.
Familial hypercholesterolemia (FH) is a genetic disorder that causes extremely high LDL cholesterol levels from birth. People with FH may need to approach keto with caution.
Some FH patients report that keto significantly worsens their LDL levels, while others find they can maintain a modified keto approach with careful attention to fat sources. If you have FH, working closely with a lipid specialist who understands low-carb approaches is crucial.
This is one of the most debated topics in the keto community. Traditional dietary guidelines recommend limiting saturated fat for heart health, while many keto advocates argue that saturated fat isn’t harmful in the context of very low carbohydrate intake.
The research suggests a nuanced approach:
If you’re concerned about cholesterol, a smart approach is to emphasize monounsaturated fats (olive oil, avocados) and omega-3 polyunsaturated fats (fatty fish) while moderating your intake of saturated fats.
The foods you choose on keto can significantly impact your cholesterol levels. Here are some of the best options for maintaining healthy cholesterol while staying in ketosis:
Fatty fish like salmon, mackerel, and sardines are high in omega-3 fatty acids, which have been shown to increase HDL, lower triglycerides, and help reduce inflammation. Aim for at least 2-3 servings weekly.
Product recommendation: Wild Planet Wild Alaskan Salmon provides convenient access to high-quality omega-3s.
Rich in monounsaturated fats and fiber, avocados can help improve your LDL/HDL ratio while providing essential nutrients. Studies show that regular avocado consumption is associated with healthier cholesterol profiles.
Product recommendation: Chosen Foods Avocado Oil makes it easy to incorporate this healthy fat into cooking and dressings.
Extra virgin olive oil is a cornerstone of the heart-healthy Mediterranean diet and works perfectly in keto cooking. Its high content of monounsaturated fats and polyphenols supports healthy cholesterol levels.
Almonds, walnuts, flaxseeds, and chia seeds provide a perfect combination of healthy fats, fiber, and plant sterols that can help manage cholesterol. Just be mindful of portion sizes, as the carbs can add up.
Product recommendation: Thrive Market Organic Walnuts and Chosen Foods Chia Seeds offer convenient, high-quality options.
Non-starchy vegetables provide soluble fiber, which helps reduce cholesterol absorption. Focus on options like broccoli, Brussels sprouts, asparagus, and leafy greens.
Medium-chain triglycerides are quickly metabolized and less likely to be stored as fat. They provide clean energy for keto dieters without the potential cholesterol impact of some other fats.
Product recommendation: Perfect Keto MCT Oil Powder or Bulletproof Brain Octane Oil are excellent options for incorporating MCTs.
If you’re concerned about cholesterol while following keto, consider these modifications:
Not all keto diets are created equal. Focus on unsaturated fat sources (olive oil, avocados, nuts) while moderating saturated fats (butter, cream, fatty meats).
Many keto dieters don’t get enough fiber, which can help lower cholesterol. Include plenty of non-starchy vegetables and consider a fiber supplement if needed.
Product recommendation: NOW Foods Psyllium Husk Powder provides soluble fiber that can help reduce LDL cholesterol.
This variation emphasizes olive oil, fish, nuts, and vegetables while limiting red meat and processed foods. Research suggests this approach offers superior cardiovascular benefits while maintaining ketosis.
Some people find that periodic higher-carb days (still moderate, around 100g) help normalize cholesterol levels while maintaining most of the keto’s benefits.
Regular lipid testing is crucial when following keto, especially if you have pre-existing cholesterol concerns. This allows you to make evidence-based adjustments to your approach.
Product recommendation: Keto Mojo Glucose & Ketone Testing Kit helps you monitor your metabolic health at home.
| Food Category | Standard Keto | Mediterranean Keto |
|---|---|---|
| Primary Fats | Butter, coconut oil, animal fats | Olive oil, avocado oil, fish oils |
| Protein Sources | Bacon, sausage, fatty cuts of meat | Fish, poultry, limited red meat |
| Carb Sources | Limited vegetables | Abundant non-starchy vegetables |
| Nuts & Seeds | Limited | Emphasized |
| Dairy | Heavy cream, cheese | Limited to fermented options like yogurt |
For those interested in the deeper mechanisms, here’s how keto affects cholesterol at the metabolic level:
Your liver uses acetyl-CoA to produce both ketones and cholesterol. When in ketosis, more acetyl-CoA is directed toward ketone production, which can affect cholesterol synthesis. However, the body typically compensates through various regulatory mechanisms.
Insulin plays a crucial role in cholesterol metabolism. Lower insulin levels on keto alter how your body processes various lipids, generally leading to improved triglyceride clearance and higher HDL production.
The LDL receptor is responsible for removing LDL from the bloodstream. Some research suggests that very low-carb diets might temporarily reduce LDL receptor activity in some individuals, contributing to elevated LDL levels.
Many people wonder about combining keto with cholesterol-lowering medications. Here’s what you should know:
Yes, many people successfully combine statins with a ketogenic diet. However, there are some important considerations:
Always discuss medication adjustments with your healthcare provider rather than making changes independently.
Beyond statins, medications like ezetimibe, PCSK9 inhibitors, and bile acid sequestrants can be used alongside a ketogenic diet. Each has different interactions with fat metabolism and ketosis, so medical supervision is important.
Your genetic makeup significantly influences how keto affects your cholesterol. The APOE gene, which comes in several variants (E2, E3, and E4), is particularly important:
About 25% of the population carries at least one copy of the E4 variant. If you’re in this group, you might need a more modified approach to keto that emphasizes unsaturated fats and includes more fiber.
People with familial hypercholesterolemia (FH) have genetic mutations affecting their ability to clear LDL cholesterol from the bloodstream. Traditional keto might not be appropriate for those with FH, but some find success with:
How does keto stack up against other popular diets when it comes to cholesterol management?
| Diet Approach | Effect on LDL | Effect on HDL | Effect on Triglycerides | Overall Impact |
|---|---|---|---|---|
| Standard Keto | Variable (may increase) | Usually increases | Usually decreases | Favorable for most |
| Mediterranean | Usually decreases | Modest increase | Modest decrease | Favorable for most |
| Low-Fat | Variable decrease | May decrease | May increase | Mixed results |
| Paleo | Variable | Usually increases | Usually decreases | Generally favorable |
| Plant-Based | Usually decreases | Variable | Variable | Favorable for most |
Before starting keto, get a complete lipid panel that includes:
This provides a crucial reference point for monitoring changes.
Prioritize nutrient-dense whole foods rather than processed “keto products.” Quality matters as much as macronutrient ratios.
Product recommendations: Garden of Life Raw Protein & Greens provides nutrient-dense protein, while KetoLogic Keto Meal Shake offers a balanced meal option.
Regular exercise improves several aspects of cholesterol metabolism, particularly HDL function and triglyceride clearance. Even moderate activity like walking can make a significant difference.
Some supplements have evidence for supporting healthy cholesterol levels:
Product recommendation: Barlean’s Omega Swirl Fish Oil provides omega-3s in a pleasant-tasting form.
Monitor your lipid profile at 3, 6, and 12 months after starting keto, then annually if stable. This allows you to make evidence-based adjustments to your approach.
While individual results vary, many people experience remarkable improvements in their cholesterol profiles on keto. Here are three representative examples:
Before keto, Sarah had the classic “metabolic syndrome” lipid pattern:
After six months on a well-formulated ketogenic diet:
Mark saw his LDL cholesterol jump from 130 mg/dL to 230 mg/dL after three months on keto, despite improvements in other markers. After working with a low-carb friendly doctor, he:
Six months later, his LDL had decreased to 155 mg/dL while maintaining the benefits of improved HDL and triglycerides.
Linda has heterozygous familial hypercholesterolemia, with baseline LDL over 220 mg/dL despite statin therapy. She wanted keto’s benefits for her type 2 diabetes but worried about her cholesterol.
Working with a lipid specialist, she implemented a modified approach:
This allowed her to achieve good glycemic control while managing her genetic cholesterol condition.
The relationship between the ketogenic diet and cholesterol is complex and highly individualized. While most people see improvements in their overall cardiovascular risk factors, some experience changes that require careful monitoring and adjustment.
The key takeaways from current research and clinical experience:
Your personal cholesterol response to keto depends on your genetics, baseline health, food choices, and lifestyle factors. By taking a thoughtful, individualized approach and monitoring your results, you can determine whether keto is the right fit for your metabolic health.
I encourage you to use this information as a starting point for discussion with your healthcare provider, especially if you have existing cholesterol concerns. With the right approach, many people can enjoy the benefits of ketosis while maintaining—or even improving—their cardiovascular health.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before making significant dietary changes, especially if you have existing health conditions or take medications.
Have you tried keto and noticed changes in your cholesterol? Share your experience in the comments below!
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