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High Cholesterol on a Keto Diet
Should You Be Concerned?

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High Cholesterol on a Keto Diet - Should You Be Concerned?ShareFollow us 261.1k

Quick Summary tl;dr

The connection between elevated LDL cholesterol and heart disease remains controversial.

It seems fairly clear that those on keto and very-low-carb diets who get most of their energy from fat – including their own fat stores – tend to have more LDL particles circulating in their bloodstream, delivering triglycerides to cells and transferring cholesterol to other lipoproteins. Whether this is harmful remains to be seen.

Until we have more data on very high LDL cholesterol and LDL-P in keto and low-carb dieters, it's up to each person to decide the levels he or she is comfortable with, based on everything we know at this point.

Table of Contents

As keto and low-carb diets have become increasingly popular, some people who follow this way of eating have noticed a sharp rise in their LDL cholesterol.

Understandably, most have become concerned, since elevated LDL is typically considered a major heart disease risk factor. However, the reason for this response - and whether it poses significant health risks – isn't completely understood or agreed upon by experts. This article takes a balanced look at the issue and its potential implications for cardiovascular disease and overall health.

What is Cholesterol and Why Do We Need It?

Cholesterol is a waxy, fat-like substance that is essential for life. It plays an important role in maintaining the integrity of your body's cells. Cholesterol is used to make hormones like vitamin D, testosterone, and estrogen. Cholesterol is also needed for the production of bile acids that help you digest fat.

Your liver, intestines, and other organs produce most of the cholesterol found in your body. In addition, it can be obtained from eating animal foods like meat, cheese, eggs, and butter.

How Is Blood Cholesterol Connected to Heart Disease?

High Cholesterol on a Keto Diet - Should You Be Concerned?

Historically, elevated blood cholesterol levels have been linked to atherosclerosis, a condition involving deposits of plaque that cause the arterial lining to thicken and potentially impair blood flow to the heart. The process of plaque deposition is complex but involves white blood cells, calcium, cholesterol, and other substances converging at the site of inflamed or damaged arteries.

However, cholesterol doesn't travel on its own in your bloodstream. Instead, it's carried in lipoprotein particles, which contain special proteins called apoproteins, triglycerides, fat-soluble vitamins and other compounds in addition to cholesterol.

Different types of lipoproteins are formed as they move through your bloodstream and drop off or pick up triglycerides and cholesterol.

Low-density lipoprotein (LDL)

Low-density lipoprotein (LDL) particles contain Apolipoprotein B. LDLs are formed from very-low-density lipoproteins (VLDLs), which are made by your liver.

An LDL's primary function is to carry energy and nutrients through your bloodstream and deliver them to cells that need them. LDL particles provide the cells with triglycerides to use as an energy source and cholesterol to use for repair and other functions, as needed.

High Cholesterol on a Keto Diet - Should You Be Concerned?

High-density lipoprotein (HDL)

High-density lipoprotein (HDL) particles contain Apolipoprotein A as their main protein. HDL is synthesized in your intestine and your liver.

One of HDL's main functions is to carry cholesterol back to your liver. HDL contains a higher proportion of protein to lipids than other lipoproteins. This results in a denser molecule, hence the name “high-density lipoprotein.”

High Cholesterol on a Keto Diet - Should You Be Concerned?

LDL Particles and Heart Disease

Many experts believe that the longer LDL particles remain in the bloodstream, the more likely they are to become oxidized, enter the arterial wall, and initiate the process of atherosclerosis.

For this reason, the cholesterol in LDL particles is often referred to as “bad” cholesterol, whereas the cholesterol in HDL particles is considered “good” cholesterol. However, there is really only one type of cholesterol that is transferred among different lipoproteins.

Moreover, the extent to which elevated LDL levels contribute to cardiovascular disease (CVD) risk – particularly in individuals who follow a keto or low-carb diet – remains a topic of debate.

What Are “Normal” Lipid Values?

Traditional Lipid Profile

The following are typical reference ranges for lipid values in those without preexisting heart disease, after a water-only fast of 10-12 hours.

Total Cholesterol < 200 mg/dL (5.2 mmol/L)
LDL Cholesterol < 130 mg/dL (3.4 mmol/L)
VLDL Cholesterol < 40 mg/dL (1.04 mmol/L)
HDL Cholesterol (Men) > 40 mg/dL (1.04 mmol/L)
HDL Cholesterol (Women) > 50 mg/dL (1.3 mmol/L)
Triglycerides < 150 mg/dL (1.7 mmol/L)

Advanced Lipoprotein Values

In recent years, more advanced lipid testing known as the NMR LipoProfile has become available. Below are the values for the reference range indicative of low to moderate risk.

LDL-P < 1300 nmol/L This value reflects the total number of LDL particles in your bloodstream.
HDL-P > 30.5 umol/L This value reflects the total number of HDL particles in your bloodstream.
Small LDL-P < 527 umol/L This value reflects the number of LDL particles that are small and dense. Elevated levels of small LDL-P are associated with insulin resistance and increased heart disease risk.
LDL Size > 20.5 nm This value reflects the size of your LDL particles. People with large, buoyant LDL are said to have Pattern A, which is typically considered less artherogenic, meaning less likely to cause plaque buildup in the arteries. than Pattern B, which is characterized by higher concentrations of small LDL.

Cholesterol Hyper-responders: A Common Keto Phenomenon?

A person's blood cholesterol levels may increase from previous values for a number of reasons.

Temporary Elevation in LDL Cholesterol

A fairly common one is the temporary elevation in LDL cholesterol that frequently occurs during and after major weight loss ( 1). Other factors that can raise cholesterol levels include hypothyroidism, age-related hormone changes, injury, and infection.

Significantly Increased LDL Cholesterol

Finally, cholesterol levels may increase dramatically in some people who follow a keto or low-carb diet.

However, this doesn't happen in every case or even most cases. In fact, many people see little to no increase in their LDL cholesterol while experiencing beneficial changes in other markers, such as an increase in HDL cholesterol and a decrease in triglycerides, blood sugar, and insulin levels – all of which are associated with reduced risk of CVD.

High Cholesterol on a Keto Diet - Should You Be Concerned?

By contrast, some people have seen their total, HDL and LDL cholesterol levels increase anywhere from 50% to 200% or more after switching to a low-carb or keto diet. Although a few are overweight or metabolically unhealthy, many of these individuals belong to a group that Dave Feldman at Cholesterol Code calls Lean Mass Hyper-responders (LMHRs): healthy, thin and/or athletic people with LDL cholesterol values of 200 mg/dL (5.2 mmol/L) or higher.

Over the past two years Feldman, a software engineer with a strong interest in science, has performed several dozen experiments on himself and collected data from a number of other keto and low-carb dieters whose cholesterol levels have increased far beyond the “optimal” range. However, whether this is problematic or not isn't entirely clear, especially since their other biomarkers typically improve or remain stable.

Feldman believes that his findings thus far demonstrate that the combination of higher energy demands, lower body fat stores, and lower glycogen stores in LMHRs trigger increased production of LDLs for the purpose of carrying energy (triglycerides) to cells that need them, with cholesterol mainly along for the ride but also used by the cells for repair and other purposes, as needed.

Indeed, Feldman has performed a number of experiments demonstrating that manipulating calorie and fat intake and/or carb and fat intake can dramatically increase or decrease LDL cholesterol levels in just three days.

On the other hand, most lipidologists, including Dr. Thomas Dayspring, believe that extremely high LDL cholesterol and LDL-P increase heart disease risk independently of other risk factors, as discussed in the MESA study that measured risk of coronary artery disease – the most common form of CVD – in more than 5,000 people (2).

What Are the Major Risk Factors for Heart Disease?

Although many experts believe that elevated LDL cholesterol and LDL particles are the main risk factors for developing CVD, recent and older research suggests there are others that contribute equally, if not more.


High Cholesterol on a Keto Diet - Should You Be Concerned?

Insulin has a number of important functions in the body, including storing glucose in liver and muscles and stimulating muscle protein synthesis. However, having too much insulin in the bloodstream (hyperinsulinemia) is strongly linked to CAD (3, 4, 5).

In a 1998 study looking at data from more than 2,100 middle-aged and older men, researchers reported that those with the highest fasting insulin levels were found to be at greatest risk for heart disease. What's more, this appeared to be independent of lipid values (3).

A recent 2017 study of over 2,500 adults looked at fasting insulin and high-sensitivity C-reactive protein (hs-CRP), an inflammatory marker considered a strong predictor of heart attack risk. In this study, people with the highest insulin levels were more than four times as likely to have an elevated hs-CRP value compared to those with the lowest insulin levels. By contrast, elevated LDL cholesterol levels showed no association with hs-CRP (4).

High Levels of Small LDL-P

Most lipidologists and cardiologists agree that that high numbers of small, dense LDL particles increase cardiac risk. These particles are also strongly associated with insulin resistance (5).

In a 2017 study looking at data from over 18,00 people, higher concentrations of small LDL particles were linked to increased CVD risk in people with lipid values in the normal range, as well as those already considered at high risk ( 6).

However, other observational studies suggest that higher levels of large LDL particles could potentially also be problematic – although it must be pointed out that presumably few to none of the people studied were following ketogenic or very-low-carb diets. (2,  7).

The MESA study authors concluded:

“Contrary to current opinion, both small and large LDL were significantly associated with subclinical atherosclerosis independent of each other, traditional lipids, and established risk factors, with no association between LDL size and atherosclerosis after accounting for the concentrations of the two subclasses" (2).

Subclinical atherosclerosis is the period when early changes are happening in the arteries but hallmarks of atherosclerosis like calcified plaque haven't developed to the point where the disease can be diagnosed.

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Familial hypercholesterolemia (FH) is a condition characterized by extremely elevated total and LDL cholesterol levels, strong family history of heart disease, and fatty deposits under the skin, including the eyelids. People with FH are at very high risk of heart attack. It's a fairly common condition currently estimated to affect one out of every 150 people ( 8).

Another group at increased CVD risk are those with one or two copies of the apoE4 allele (gene). These individuals tend to have higher VLDL cholesterol but lower HDL cholesterol. In addition to heart disease, they have greater risk for Alzheimer's disease, cancer and other diseases ( 9). The Apo-E4 forums provide helpful information, guidance and support for those with the apoE4 allele.

In addition to ApoE4, researchers have have identified other genetic mutations that increase CAD risk, although less is known about them at this time ( 10).


As people get older, their risk for heart disease increases. This may be due to being less active, having other chronic diseases, and developing arterial stiffness that impairs function.


Additionally, research suggests that during menopause, women may experience an increased thickening of the carotid intima and media layers of the arteries, a marker of subclinical atherosclerosis. In a study of 249 middle-aged women, those who were postmenopausal or in the late stages of perimenopause were much more likely to show progression of carotid intima-media thickness (CIMT) than those in early perimenopause ( 11).

Does Saturated Fat Increase LDL Cholesterol and Raise Heart Disease Risk?

The President of the American Heart Association (AHA) recently issued a statement that lowering saturated fat intake by replacing it with unsaturated fats will lower total and LDL cholesterol and decrease risk of CVD (12).

High Cholesterol on a Keto Diet - Should You Be Concerned?

However, several large reviews haven't been able to establish an association between saturated fat intake and heart disease, including a 2010 meta-analysis looking at 21 studies totalling more than 340,000 people ( 13).

It's true that certain saturated fatty acids have been reported to raise LDL cholesterol levels, including palmitic, myristic and lauric acid, which make up a large portion of milk fat ( 14). On the other hand, high-fat dairy has been shown to provide several cardioprotective benefits as well ( 15).

Therefore, although avoiding all dairy fat may lower LDL cholesterol, it may not be a good strategy for protecting heart health. (You can read more about health benefits of dairy in this post: Dairy on a Ketogenic Diet).

Moreover, it appears that the LDL cholesterol response to saturated fat intake is individualized, with some people experiencing an increase and others seeing little to no change.

Is Elevated LDL Cholesterol a Concern if You Follow a Keto Diet?

Whether extremely high LDL cholesterol and elevated LDL particles increase heart disease risk in people who follow a keto lifestyle isn't known. Dave Feldman isn't entirely convinced that it's a completely benign phenomenon, although his ongoing research suggests that it may be.

High Cholesterol on a Keto Diet - Should You Be Concerned?

The main problem is that there haven't been any long-term formal studies in this population that provide data assuring us that LDL elevations of this magnitude are safe. It's something that just can't be said with absolute certainty at this time.

In addition, although small, dense LDL particles are the type most strongly associated with heart disease risk, as mentioned earlier, there are some observational studies suggesting that high concentrations of large LDL particles may also increase CVD risk. However, the subjects' diets weren't included when risk factors were assessed.

On the other hand, higher HDL cholesterol levels have been linked to less carotid artery intima-media thickness. In a large meta-analysis of data from more than 20,000 people, CIMT tended to decrease as HDL cholesterol increased – regardless of LDL cholesterol values ( 16). Importantly, although LDL response to carb restriction varies from person to person, HDL virtually always increases.

What's more, insulin-resistant people who follow very-low-carb or ketogenic diets often show more favorable reductions in insulin levels, inflammation, and arterial dysfunction compared to those on “heart-healthy” low-fat diets ( 17,  18).

Overall, the many cardiovascular health benefits of very-low-carb diets for metabolically compromised individuals are impressive. In addition, Lean Mass Hyper-responders often report feeling better and having more sustained energy as a result of following a keto lifestyle.

How to Reduce Cardiovascular Risk While Remaining Keto or Low-Carb

If your LDL cholesterol has significantly increased on a keto or low-carb diet, it's completely understandable if you're at least somewhat concerned. However, you might be reluctant to make any changes to your diet given the benefits you've experienced. On the other hand, you may decide that you want to try to lower your LDL values while still following a keto/low-carb lifestyle.

Here are some tips that may help manage cardiovascular risk, including potentially lowering LDL. However, keep in mind that the effects may vary from person to person, and your LDL may not change much.

Eat More Fatty Fish

High Cholesterol on a Keto Diet - Should You Be Concerned?

Although the long-chain omega-3 fatty acids found in fish typically reduce triglycerides more than LDL cholesterol, they're anti-inflammatory and may help protect against heart attacks ( 19).

Fish highest in omega-3 fats include salmon, sardines, mackerel, herring, and anchovies.

Increase Fiber Intake

High Cholesterol on a Keto Diet - Should You Be Concerned?

Fiber, especially the soluble type, may be beneficial for heart health. It's been shown to help lower cholesterol levels, yet it doesn't seem to interfere with the absorption of fat-soluble vitamins and other nutrients ( 20).

Excellent keto-friendly sources of soluble fiber include avocado, blackberries, broccoli, brussels sprouts, and flaxseed.

Increase Net Carb Intake

Dave Feldman recently demonstrated that increasing net carb intake from 30 grams to 95 grams per day – (going from 4% of total calories to 13% of total calories) led to a significant drop in his LDL cholesterol level. Obviously, this level of carb intake isn't ketogenic; however, it is still moderately low carb. On the other hand, this will likely increase your blood sugar and insulin levels to some extent.

Eating about 50-60 grams of net carb daily (15-20 grams per meal) may be enough to help lower LDL without jeopardizing blood sugar and insulin stability.

Consume Fat-Soluble Antioxidants

High Cholesterol on a Keto Diet - Should You Be Concerned?

Getting plenty of antioxidants in your diet like vitamin E and the phytochemicals lycopene and beta carotene may help protect your LDL cholesterol from becoming oxidized, thereby reducing CAD risk (21).

Leafy greens, almonds, sunflower seeds, hazelnuts, tomatoes, avocado, and red peppers are good sources that meet keto criteria.

Get a CAC or CIMT test

High Cholesterol on a Keto Diet - Should You Be Concerned?

Having a coronary artery calcium (CAC) scan or CIMT test can provide information about actual heart disease that lab tests can't. Some people with extremely high levels of LDL cholesterol have calcium scores showing no plaque accumulation in the arteries and normal intima-media thickness, whereas others demonstrate mild to moderate atherosclerosis even when LDL cholesterol is within the normal range.

A zero CAC score is typically associated with very low risk of heart attack or other adverse cardiac event within 10 years (22).

However, some experts like Dr. Dayspring believe CAC scores are only meaningful in middle-aged and older adults. On the other hand, CIMT evaluation can identify early signs of heart disease in young to middle-aged people, including those with zero CAC scores ( 23).

Recommended Reading and Viewing

In addition to Dave Feldman's posts linked to earlier, there are several other articles and videos discussing diet, lipids, and cardiovascular risk. Here are just a few:

Articles and Websites


My Own Experience with the Cholesterol Drop Protocol

To date, more than 50 people have successfully completed Dave Feldman's Cholesterol Drop Protocol, which consists of 3.5-10.5 days of keto/LCHF eating and 1-4 blood tests. I've done the 6.5-day experiment twice, once in early May and again in mid-September of this year.

Although 86% of people who have undergone the protocol have experienced a decrease in LDL cholesterol after ramping up their calorie and fat intake for three days, my own LDL cholesterol increased, the first time by 47 mg/dL and the second time by 15 mg/dL. At this point, I'm the only one who had both an increase in LDL and a decrease in triglycerides after the high-fat, high-calorie portion of the experiment. All of my other markers, including HDL and small LDL particle counts, were excellent for both the low-calorie and high-calorie days.

For reference, I'm a Lean Mass Hyper-responder and have been following a low-carb diet for more than 6 years. My net carb intake typically ranges from 20-40 grams per day, and I remained at the lower end of this range during the experiment.

If you follow a keto or low-carb diet, please consider doing the Cholesterol Drop Protocol – especially if your lab results indicate you're a hyper-responder. Be sure to keep detailed food records and share all data back to Dave Feldman on his website at Cholesterol Code.

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Franziska Spritzler, RD, CDE
Registered dietitian, certified diabetes educator and creator of

Franziska Spritzler

Franziska Spritzler, a registered dietitian and certified diabetes educator, is a strong proponent of carbohydrate restriction for people struggling with diabetes, insulin resistance, obesity, and PCOS.

She follows a very-low-carbohydrate, ketogenic diet for blood sugar control and has experienced many improvements in her health as a result of making this change.

Expert Article

This article was written by Franziska Spritzler, RD, CDE who is a qualified expert. At KetoDiet we work with a team of health professionals to ensure accurate and up-to-date information. You can find out more on the About us page.

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Comments (69)

I’ve been on the KETO diet for 2 yrs. I thank God I met my doctor who suggested the diet. I have an autoimmune disease and following KETO has helped me 100%. I still have high LDL and high HDL. However I feel so much better in every way. No more aches and pains after exercising, no more gastro problems, energy to spare, lost 30 pounds. This cannot be bad. I am 80 yrs old. My doctor supervises my progress and I will stay on the KETO diet indefinitely as long as my doctor approves. Life is good!

I've been eating low-carb/high-fat (keto) since January.  My stubborn triglycerides (miraculously) went from 222mg/dL to 128mg/dL since then and I've lost 17 lbs.  I was given the results of my most recent Comp. Blood Panel yesterday, 06/13/2019.  My total cholesterol is at 257mg/dL (42 HDL & 189.4 LDL).  I've been on simvastatin 5mg/day for a few years but my new doctor, pretty fresh from doctor school, has upped the simvastatin to 10mg/day.  Should I tell him to go jump in a lake then find a new doctor?  He kinda scared me with all kinds of talk about the latest recommendations for people my age (64yo).  Any advice would be appreciated.  👍

Congratulations on the many health improvements! Unfortunately, I cannot provide medical advice, nor tell you what to say to your doctor. However, as stated in the article, losing weight often leads to a temporary increase in LDL cholesterol. Best of luck!

Ask your doctor who is pushing you to take more pills if HE has investments in any statin drug company. I would guess yes!
I let common sense lead me and have extremely high LDL also high HDL. I take no statins because they make life miserable.
I am better on the Keto diet than I have ever been in my entire life. I could never be convinced to purposely make myself miserable taking more and more drugs. Best thing I ever did throw all of the pills out! It’s my decision. I go to the gym 3x a week, do all kinds of house and garden work,, shop and cook every day and still drive to see children and grandchildren. Most people feel trapped into feeling bad, because of too many pills. You know what is best for you!

I eat one egg and full cream omelette a day with mushrooms tomatoes and bacon mixed in and fast one day a week I have veges soup long cook stew sometimes when started 210 kilo now am 104 kilo never hungry have heaps of energy and feeling great

I too am a lean mass hyper responder and have FH with very high levels of LDL and HDL but have never had the tests to separate out the different types of LDL. I thought my relatively low fat diet with high fibre would be good for me and help prevent plaque build up, although I have read some excellent articles and books relating to the link between high cholesterol and heart disease being very fabricated. When I recently had a well-man check up and discovered that I was pre type II diabetic, I thought, WTF! I have been so careful for so many years not to have simple sugars in my diet and only complex carbs with plenty of fibre - and yet, there I am with my Dr telling me I'm on the verge of diabetes! So, I'm going on the side of plenty of good fats are really good for me - even with really high cholesterol levels - and am now two weeks into a Keto diet - lost a bit of weight, so boy am I skinny now - but feeling great with much more energy and clarity of thought / consciousness. My gout is subsiding, my eczema is not flaring up so much and not so itchy in other areas either! Also the keto diet feels and tastes so good - I love eating fish and meat and avocados and love to simply eat teaspoons of coconut oil. I tend to snack on nuts and seeds during the day after a morning fast so I only eat between midday and about 6-7pm in the evening. Who knows whether or not I will have a heart attack in my late fifties like my mum or a stroke at 65 like my father!

I'm looking for some researches that have demonstrated that Ketogenic Diet is at least "Safe" to be adopted for long-term (haven't found any yet). Please help.

There are several studies indicating that ketogenic diets are safe for a variety of conditions on a short-term basis. A very strict form of the ketogenic diet has been used in epileptic patients longer term (several years) and is considered safe for that purpose. The keto diet recommended on this blog for weight loss and overall health is much less restrictive, including being higher in protein and carbs than a standard ketogenic diet for epilepsy. As the diet grows in popularity, at some point we will have long-term data on people that follow a keto lifestyle for diabetes, weight loss, and other conditions.

I have my lab report back.
Since being on the keto diet for 1&1/2 months , the report said:
Total cholesterol 193 to 230
LDL 122 to 153
HDL - 56 - 62
Triglycerides - 80 - 77
Uric acid - 5.5-6.0
I’m very concerned about this jump in my cholesterol .
Any advise?

I'm sorry, but I cannot provide individual advice other than to say that your cholesterol changes are modest at this point and may or may not change as you continue the diet.

Hey there.  I am so glad I found this blog.
I am very nervous about the increase of my cholesterol, but am trying to make modifications.  I do not want to abandon the KETO diet.
I am small, physically fit and a runner.  I have a strong family history of atherosclerosis and coronary artery disease.  My cholesterol was 212 last year, 339 this year after 5 months of keto.  Of course my doctor immediately wants me to abandon keto.  My 339 # was fasting.  I have ready that in the fasting state when you are lean, your cholesterol can be high.
What are your thoughts?
Of course I do not want to me clogging my arteries, but I feel so good.  My joints don't hurt and I have more energy.
Thoughts and opinions wanted.
Thank you!

I am in a very similar situation as you with LDL increase. I am being seen by a cardiologist who is very positive on Keto and attempting to control everything through supplements and diet.
I would be interested in any further information you come up with.

This has been very comforting for me to read as I’ve been on a Keto diet for 8mo, loving my results which were weight loss (initially) but now the sustained clarity & sharpness of mind. I am lean (58kg) and very active. I had a blood test last week just to see where I’m at & my LDL is very high. Of course my doctor wants me to stop Keto but I just feel so great. I’m torn...

I'm sorry, but I cannot provide individual advice about your cholesterol levels on this blog. Please look at the "Recommended Reading and Viewing" articles section above for information.

What are the general recommendations for someone who is a lean-mass hyper-responder (which I feel I may be)?  To forgo medication and it's okay to have the higher large LDL-P levels?  What if you're boardline (high LDL but not HDL response)? Is the recommended test a VAP or something more specific?  
I feel my diet is fairly clean and hard to reduce the LDL level by 100+ points w/out help but I've seen tremendous improvements and don't want to stop the KD.  
Thank you.

Hello Tyler,
I cannot provide any individualized recommendations for lean mass hyperresponders. Please look at the "Recommended Reading and Viewing" articles section above for information.

I was introduced to the benefits of Keto diet by one of my friend at work this week and I ave spent the weekend trying to research on reading pro’s and con’s , there is so much information and the more I am reading makes me feel overwhelmed.
I am 40 year male, weigh about 187 lbs. Here are my recent lipid profile readings ( which certainly don’t look too promising.
Component                                        Your Value  Standard Range
CHOLESTEROL                                 218 mg/dL  100 - 199 mg/dL
TRIGLYCERIDE                                 316 mg/dL  0 - 149 mg/dL
HDL                                                            30 mg/dL  >39 mg/dL
VLDL CHOLESTEROL, CALCULATED   63 mg/dL    5 - 40 mg/dL
LDL CALCULATED                                   125 mg/dL   0 - 99 mg/dL
Now is there a recommended Keto diet  plan where I can loose weight and also better my overall cholesterol levels.

Hi Prateek, Although I cannot provide individualized nutrition guidance, keto diets generally lower triglycerides and raise HDL cholesterol levels, which would improve your overall lipid profile. Best, Franziska

Since being on the keto diet for 2&1/2 months , my cholesterol has risen from 230 to 370.
(I’m 54 and have only lost 10 lbs. and want to lose 10 more.)
I’m very concerned about this jump in my cholesterol .

I live in New York City and would like to get CMIT and CAC you have any information on where I could get these tests?

Hi Patricia,
I found a facility in NYC that offers both CMIT and CAC testing:
Best of luck,

Thanks for that information. I'm a 17 year old female and I've been on the keto diet for
Its hard to find any information about hyper responders, even harder for me as my total cholestorl levels increased extremely after I went on the keto diet, from an already high 5mmol/dL to extremely high (14mmol/dL or 538mg) which is unheard of, even in the many hyper responder cases I've studied. But my HDL increased to 2.7mmol and my trigicerides stayed the same at good 0.9. Nobody 've seen has such a high total cholestrol. Even as i research how cholestrol doesn't have much link to heart disease mortality, there's no research on anything as high as my case.
Also, the keto diet does seem to be healthier as I've learnt a lot through reading labels but I don't see many other claimed benefits. I went on it for cognitive improvement and longevity but I'm not seeing many differences beside a decrease in stamina during workouts.
I still have my worries about my approach.

Hi Victoria,
Your current cholesterol levels l is higher than I would personally feel comfortable with. I would consider making a few dietary changes (i.e., increasing fiber and net carbs, reducing saturated fat, and increasing protein), especially given your lack of improved cognition and decreased ability to work out. I wish you the best of luck going forward. - Franziska

I am a 49 year old man who has been on Keto for over two years. I've lost 40 lbs and feel fabulous. I have sustained energy. I eat about 210g of fat each day. Recently, I had my blood tests done and discovered that my Cholesterol was crazy high: Total Cholesterol was 330. LDL was 255. HDL was 60. Triglycerides was 77. I am a thin, weighing about 166 lbs at 5ft 10in.
Your article gave me some comfort knowing that I am not alone. I now realize that I too am a hyper responder. Great article. Thank you!

Hi,  my pre-keto cholesterol was 199 and it jumped to 294 after 2 months of keto.
LDL was 132 before keto and 229 after keto.
Uric acid also increased from 5.9 to 8.
I averaged only 20g of fat during the 2 months of keto and tracked my macros religiously, almost always have a deficit in fat.  That’s why I was really shocked to see the elevated LDL, even thought of quitting keto despite losing 10 pounds so far.

Tony, I'm not sure how you were only eating 20 grams of fat on a keto diet; in fact, if this is true, that may be the reason. A keto diet should provide a minimum of 70 grams of fat daily, but generally 100+ grams for most people, especially men. Be sure to include nuts, olive oil, avocados, fatty fish, and other healthy sources of fat in your diet on a daily basis in order to prevent problems. - Franziska

Actually a ketogenic diet is high fat (75% fat and up), moderate protein, very low carb at 20 grams TOTAL carbs (not net)

I beg to differ - you are referring to Dr Westman's approach (20 g total carbs) which is not the only way to follow a keto diet: Total Carbs or Net Carbs: What Really Counts?

i am on keto diet last 2 weeks. eating 3-4 eggs, coconut oil, ghee, cheese, broccoli, spincach.. i felt very dizzy in the mornings. felt like my muscle is breaking up, felt on my shoulder a piece is moving. after checking my lipid panel, after 2 weeks; my total cholesterol went up to 210 from 180. ldl from 120 to 140, hdl 42 to 39.
what should i do? stop keto diet ?

HI Narendra,
Your lipid changes are minimal and not very concerning. However, I cannot diagnose your health problems or symptoms or provide personalized advice for them. Continue to follow up with your doctor for further testing. I wish you all the best - Franziska

I want to get blood tests done before starting my plan. Are there any nontypical tests I should request to track my progress?

I have been on Keto diet for about a 18 months . Went from 200 lbs to hovering around 165 lbs. I just got my blood test back and found out that my Cholesterol is 307 LDL 229 and HDL 55.
I have been drinking coffee twice a day with grass fed butter and MCT oil. I also eat a lot of Cheese and good amount of fat including avocados,bacon etc..
Every other blood test is great. I am 55 years old and always had borderline high cholesterol even as a younger man.
I stopped buttering/mct my coffee. Any Ideas how to  drive the LDL lower without leaving keto.

Hi Mark,
You can try reducing the amount of cheese you eat and increasing your fiber intake from nuts, seeds, and vegetables. Best of luck to you - Franziska

I would have complete lipid, thyroid, hepatic, and renal panels prior to starting keto.  - Franziska

Thank you so much for your informative article.
I have been eating LCHF since 22July 2017 &
Have increased energy, weight loss of nearly 20 lbs & no more low blood sugar.
My recent blood tests showed an increase in total cholesterol to 7.8 (from 5.2).
Increase in LDL to 5.7 (unsure of previous test result). My triglyceride = 0.5.
HDL cholesterol 1.9.
My doctor advised to eat less saturated fat (butter, cheese, cream) & to use olive oil in cooking.
Liver & kidney results good, HbA1C 5.5. Glucose fasting 4.3.
I’m to be tested again beginning of March 2018.
I average approx 12,000 steps per day & feel very well so this was quite a shock.
I’m 64 1/2 years & had gestational diabetes in 1 pregnancy.
I’m loathe to stop LCHF but may increase my carbs a little & cut back on saturated fats.
I was always hungry on a low fat diet & experienced hypoglycaemia.
Your article has helped immensely.
Thank you
Kay (Australia)

I am a 53 year old male. I just had my numbers back from lab work.
Total Cholesterol is 201.
HDL is 64. I am excited about this number. Up from 52 in 01/17.
Triglycerides are 52. Down from 82 in 01/17.
LDL is 123. Not so excited. It was 160 in 01/17.
Direct LDL is 134.
Glucose is 76.
HS CRP is 0.7. Low Cardiovascular disease risk.
Insulin is 3.4. really low.
I have been on Keto for about 2 years now. And I do IF every day of the week.
I have family history of deaths from heart attacks and some have had bypasses. I had CT Scan about 10 years ago and no blockages seen. But that test isn't as accurate as an MRI of the arteries which I haven't gotten yet.
I am going to keep at it. Not backing off Keto due to LDL number.

Hi Mike,
All of your numbers seem to have improved, and your LDL isn't very high compared to what many others see on a keto diet. Keto seems to be working very well for you.

Great article. I started keto in May and lost 32 lbs and blood sugar became normal. I started a blog to share my story and inspire others.

Great article! I have been diagnosed with familial hypercholesterolemia, however, I am not concerned at all. I continue to follow a restricted calorie, zero carb ketogenic diet, that I have been doing strictly for the last year and a half. All of my health markers are excellent, except for LDL particle number and total, and it is the large buoyant type. I am middle-aged (46). I did get both a CT scan and tri-vascular scan, and got perfect scores for both. That alleviated any concerns that I might have previously had. Since this diet has improved my gut issues, bodyfat, blood pressure, insulin, blood glucose, mood, energy, A1C, CRP, etc., - basically every single health parameter I have tested, I am sticking with it! Thank you for clearing up the confusion surrounding LDL!

Thank you, Thank you, Thank you!!!!! Your article couldn't have been timed any better. I got my blood panel back from my "western" doctor two days ago and the numbers had me very worried. After reading your post yesterday I felt so much better and sent the results off to my naturopath knowing that everything should be fine. I printed it out for my own reference and for any others, doctors included, who may have doubts and questions. Again, a big thanks for all your research and putting it out there for the rest of us trying to live a longer, healthier life!!

Thank you for your kind words, Rhonda! I wish you the best of luck with everything. - Franziska

What an excellent and helpful article! I had great cholesterol numbers before starting Keto and now my cholesterol is high. My HDL is good and my Triglycerides are low, but my LDL is high. I'm really questioning what I'm doing. I do experience many benefits of Keto, but I have a family history of heart disease and I'm worried and confused. Unfortunately my doctor is no use. She just says follow a Mediteranean Diet. End of story. Or go on Statins, which I would never do. Thanks to your article, I have some new resources to research.
You really provide such a service with your thoughtful, easy to understand, balanced articles. You have my admiration and my gratitude!

Thank you so much for your kind words! I'm glad you found my article helpful.

Hi Franziska,
thanks for summing up this debate. I have a couple of ideas about mechanisms;
firstly, the LMHR profile also applies to long-term fasting studies - this is perhaps where it can be observed in its natural, unconfounded state - LDL rises in lean healthy individuals during a fast, but drops or stays stable in those with obesity or atherosclerosis (period varies from 3-21 days). This is consistent with the keto pattern; this evidence clearly shows that LDL divergence is related to burning a high % of fat, and not to eating it, which is to some extent a confounder with keto (as shown by the cholesterol drop protocol and the possible different effects of different fat types and amounts).
No-one I hope thinks fasting causes atherosclerosis.
Secondly, the Scandinavian Simvastatin Survival Study (4S) determined that elevated LDL was associated with 2 phenotypes. One type featured high rates of cholesterol (re)absorption with low rates of cellular cholesterol synthesis. This was associated with high HDL, low event rates, and little or no added benefit from statin treatment.
The other type featured low rates of cholesterol (re)absorption and high rates of intracellular cholesterol synthesis, associated with low HDL, high event rates, and a significant benefit of statin treatment, which lowered event rates to those of the first group on or off statin.
Needless to say the second group was hyperinsulinaemic and IR; insulin stimulates cholesterol synthesis and inhibits (re)absorption, while glucagon has the opposite effect; enterohepatic bile cycling is increased by glucagon.
The second group will, I think, tend to see LDL drop if fasting because intracellular cholesterol synthesis will drop faster than cholesterol (re)absorption will increase. The first group will see it rise because (re)absorption can only increase, and synthesis is not excessive so has nowhere to fall to.
Hyperinsulinaemia also promotes macrophage cholesterol retention, so the risk in the IR group is also elevated for this and very numerous other reasons not seen in the naturally euinsulinaemic.
I don't think this difference explains the whole LMHR phenomenon yet, but it does I think help to characterise divergence in the responses to keto, and I think it possible that keto will eventually shift the phenotype in a low (re)absorber.
Residual risk of CHD also comes from factors such as smoking, pollution, autoimmune diseases (e.g. lupus, psoriasis, RA), infections, and nutritional deficiencies which may not make much impact on a basic lipid panel. Psoriasis for one is usually improved significantly by keto and weight loss.

George, thanks so much for commenting. As usual, you provide exceptional  insight into the complex mechanisms on this topic (and others as well). I will ask Dave Feldman to take a look at your comments, as he will no doubt find them as intriguing as I do. Thank you again!

You're welcome!
I'd also like to suggest that this has to relate to the extreme divergence in gallstone risk on a low fat vs high fat calorie restricted weight loss diet.
Increased enterohepatic circulation on high fat means that cholesterol is kept "in play" - bounced back into the bloodstream in ApoB particles - while low enterohepatic circulation, in people with with higher synthesis rates, during weight loss - when cholesterol is being dumped by shrinking cells - means that cholesterol can pile up in the gall bladder faster than it can be conjugated to bile salts and bile acids and faster than it can be extracted by the weak stimulus of low fat food.

Thanks so much for sharing this additional information, George! I've worked with many women who developed gallstones during previous weight loss experiences on low-fat diets. Great to know the mechanism behind LCHF's protective effect.

Hi George,
Seems like i belong to the first type "One type featured high rates of cholesterol (re)absorption with low rates of cellular cholesterol synthesis. This was associated with high HDL, low event rates, and little or no added benefit from statin treatment."  
Would it be better for me to eat my carbs? I have a relatively fit and muscular physique. Body fat at around 12%. Find that low carb/ keto stresses me out. My stools tend to float to when I do not intake enough carbs. I also have hard time falling asleep when on keto/ low carbs

I was surprised that there was no discussion on the two primary risk factor markers which are total cholesterol / HDL and triglycerides / HDL. My HDL and LDL-P both increased with a decrease in triglycerides. As a result both Total / HDL and Trig / HDL decreased while on a ketogenic diet so overall the risk factors decreased.
There is also no need to measure LDL if triglycerides have decreased since there will be a decrease in apoB because triglycerides are the transporter.
Having said that. Given the significantly increased risk of heart disease as a result of hyperinsulinimea and cigarette smoking which far eclipses all other risk factors, if one were to reduce or eliminate both there would be no need to worry about the others.
While I can appreciate Mr. Feldman's efforts and I am also a hyper responder, I have no doubt that cholesterol levels are merely an artifact / symptom of the real cause of CVD which is hyperinsulinemia which for type 2 diebetics or pre-diabetics (which are simply undiagnosed diabetics) is due to high carbohydrate diets causing high blood glucose levels as well as other known causes of infllammation such as trans fat and high omega 6 to omega 3 ratios. In other words, there is no need to try and cure the symptom which is controlling lipoprotein levels directly.  
Given that the consumption of a high carbohydrate diet promotes inflammation and in turn causes CVD, is it any wonder then that our bodies would produce LDL particles which work to repair vascular damage, as they are needed to patch up the damage? Unfortunately LDL can only do so much under the constant onslaught of inflammation but had it not been there in the first place the person would not have survived as long as they did.
Again, I am surprised that there was no discussion regarding these obviously key aspects.  

Hi Don, Thanks for your comments. I actually did discuss keto's benefits on the markers you mentioned, although I didn't go into the ratios:
"In fact, many people see little to no increase in their LDL cholesterol while experiencing beneficial changes in other markers, such as an increase in HDL cholesterol and a decrease in triglycerides, blood sugar, and insulin levels – all of which are associated with reduced risk of CVD."
On the other hand, there are LMHRs like myself who started off with high HDL, low TG, and low inflammatory markers; those values didn't change, while LDL increased to >200 mg/dL and LDL-P well outside of normal range.

So Don-the fact that I have both high cholesterol (213 overall) and high fasting blood sugar (100) while on a Keto diet means...what????? I've been following a LCHF/Keto diet for the last 2-3 year. I just found this out in the last day or so. Now I'm getting confused and worried.  

Hi Rhonda,
Neither I nor anyone else reading this can provide personal medical advice, so I am glad you are discussing your results with your naturopath, as you mentioned above. However, the values you shared don't sound high and are in fact quite normal on a keto diet, so I wouldn't be concerned.
Best, Franziska

Good to know. I see my naturopath next week!

I saw that the American Heart Association recently added coconut oil to its "Avoid" list. As you know, us keto-heads eat a lot of coconut oil, coconut butter, and other coconut derivatives. What's your take on the AHA's stance on coconut oil and what would you recommend for die-hard ketoers?

Hello Rai,  I disagree with the AHA. I believe coconut products can definitely be included on a keto or low-carb diet, aside from those with an allergy or sensitivity. In fact, virgin coconut oil is one of my favorite fat sources, along with olive oil and butter  😊

I just got to know too that my Cholesterol raised a lot, I've been on keto for a little more than 3 months and before that always had a low carb diet. I don't know if the 3 day fast I did before taking the blood test only " aggravated" the situation. The total is 302, LDL is 214! But since the triglycerides are 94 and HDL 57, it seems to be OK. I read that a low rate of TG/HDL may indicate that the LDL particles are of the bigger, fluffier type less dangerous.
I had the same doubt about coconut oil, I read someone recommending that the first thing to do would be dropping bulletproof coffee and changing to olive oil. Do you think is that valid? My father also has high cholesterol and had a heart attack, though he also had a smoking/drinking record. I never drink/smoke and always exercise, so I hope that compensates, since all the other markers seem to be normal..,though I'm worried and thought if I should just eat more fiber and come back to a Paleo diet including some fruit ( the same guy that recommended the olive oil instead of coconut said that, I don't know if it's valid)

Hi Romulo,
Thanks for sharing your story. As I said in the article, everyone has to decide what is best based on the available research, which isn't clear cut at this time. I personally would stop the bulletproof coffee and eat more monounsaturated fat to see if your LDL decreases. I wish you the best of luck.

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