For several decades in the recent past, high-fat animal foods like eggs, cheese, beef, and pork were vilified because of their saturated fat and cholesterol content. It was thought that these foods would increase your bad cholesterol levels, clogging your arteries and drastically increasing your risk of heart disease.
However, the science isn’t as clear-cut as it was once made out to be. Although high-fat foods — and, therefore, the high-fat keto diet — may affect your cholesterol level, that may not automatically be a negative thing.
Still, keto does affect cholesterol levels, and that can be a significant cause of concern in many people.
Here’s a review of how keto affects your cholesterol levels and how to optimize your heart health while eating low carb.
How the Keto Diet Affects Your Cholesterol Levels
Overall, keto appears to have a mostly-positive effect on cholesterol levels. However, it’s important to remember that your body’s response to keto is highly individual.
We also need to remember that there are several different blood lipids (fats) that your physician may be referring to when they talk about a “lipid panel” or a “cholesterol panel.”
First is total cholesterol. According to Sony Sherpa, MD, a physician with Nature’s Rise, total cholesterol may remain stable for many people on keto. Still, your total cholesterol level doesn’t provide a lot of useful information about your overall health and heart disease risk.
Other blood lipids can provide much more specific insights about your heart health. Here’s a quick rundown of these blood lipid types, along with a review of how keto may affect them.
Keto and LDL
Low density lipoprotein (LDL) cholesterol is often considered “bad cholesterol.”
According to Mary Sabat, MS, RDN, LD, a registered dietitian and personal trainer, “Research suggests that high levels of LDL are associated with an increased risk of heart disease.”
On keto, some people may experience no changes to their LDL cholesterol. Still, Sabat says, others may see their LDL levels reduced
Additionally, researchers have identified a subgroup of people on ketogenic diets who may be considered “lean mass hyper-responders.” These people experience huge increases in their LDL levels on keto. Generally, they are already lean and aren’t on keto to lose weight. Their bodies’ powerful responses to keto are thought to be a result of body composition changes rather than what foods they are eating (*).
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However, not all LDL is necessarily bad. Large, fluffy LDL particles are harmless, while small, dense LDL particles are associated with heart disease. Some research suggests that a ketogenic diet may increase concentrations of large, fluffy LDL particles (*).
Keto and HDL
High density lipoprotein (HDL) cholesterol is known as the “good” kind of cholesterol. Higher HDL levels are associated with better heart health.
Numerous studies have shown that ketogenic diets increase HDL cholesterol levels, which can help reduce heart disease risk (*, *).
Keto and VLDL
Very low density lipoprotein (VLDL) cholesterol transports triglycerides, a type of fat, all throughout the body via the bloodstream. High levels of VLDL cholesterol are linked to heart disease.
Very few studies have assessed the effect of the ketogenic diet on VLDL levels, so it’s hard to say with confidence what effect — if any — keto would have on VLDL levels.
Keto and Triglycerides
While triglycerides aren’t a type of cholesterol, they are a type of fat that the body uses. Triglyceride levels are often checked alongside your cholesterol levels, too, as they may be useful for determining heart disease risk.
Generally, higher triglyceride levels are associated with more risk.
However, study after study has shown that keto can effectively reduce triglyceride levels (*, *, *).
With keto’s dual effect of increasing HDL and reducing triglycerides, it can help improve the HDL-to-triglyceride (HDL:TG) ratio. This ratio may be a strong indicator of overall heart health (*, *).
Is Keto Good for Someone with High Cholesterol?
Keto could be helpful for people with high cholesterol, especially if they are overweight or obese, or if they have prediabetes or type 2 diabetes.
Although LDL levels may increase in some individuals when starting keto, other more favorable changes may balance this out.
For instance, keto increases HDL cholesterol and reduces triglycerides. Both of these effects can help reduce your risk of heart disease.
“In general,” Sherpa says, “people with pre-existing high cholesterol should speak to their healthcare provider before starting a ketogenic diet. If you are already following a keto diet, it’s recommended to monitor your cholesterol levels regularly to ensure they are within the normal range.”
Adds Sabat, “The relationship between cholesterol and heart disease is complex, and other factors such as inflammation, blood pressure, and smoking can also play a role.”
Overall, diet is just one part of the equation — but keto isn’t as bad for heart health as we once thought. It may even be positively heart healthy, especially if you’re choosing a variety of minimally-processed, nutrient-rich foods.
Recommended Cholesterol Levels for Keto Dieters
Recommended cholesterol levels for people following a keto diet are the same as everyone else. These targets are recommended by the American Heart Association.
According to Sherpa, “The ideal total cholesterol level is less than 200 mg/dl, while LDL should remain below 100 mg/dl and HDL should remain above 50 mg/dl.”
She adds that triglyceride levels should also remain below 150 mg/dl.
Foods to Eat & Avoid on a Keto Diet for Cholesterol Management
For optimal heart health and cholesterol levels on keto, it’s a good idea to eat mostly whole, natural, minimally-processed foods — or “clean keto.” Here are a few examples of these foods that you can enjoy without worrying about carb count:
- Meat: beef, pork, chicken, fish, shellfish, turkey, duck, eggs, etc.
- Vegetables: zucchini, cauliflower, spinach, kale, salad greens, garlic, onions, tomatoes, broccoli, peppers, etc.
- Fruits: strawberries, raspberries
- Nuts and seeds: walnuts, pecans, macadamia nuts, sesame seeds, chia seeds, flax seeds, sunflower seeds, etc.
- Fats and oils: butter, tallow, lard, bacon fat, olive oil, avocado oil, coconut oil, ghee
- Dairy: heavy cream, half and half, sour cream
- Other: dark chocolate, vinegar, herbs and spices, bone broth
On the other hand, you may want to avoid highly processed keto-friendly foods — sometimes known as “dirty keto” foods. Ultra-processed foods that contain highly refined, industrial ingredients have been linked to heart disease (*).
Even though a food may have keto-friendly macro ratios, it can still be made with highly-processed ingredients that may not be healthy. Here are some examples of highly processed ingredients that may be hiding in some keto foods:
- Artificial sweeteners: sucralose, aspartame, acesulfame potassium, etc.
- Sugar alcohols: xylitol, maltitol, etc.
- Artificial food dyes: red 40, yellow 5, blue 2, etc.
- Industrial seed oils: soybean oil, canola oil, peanut oil, corn oil, sunflower oil, etc.
- Artificial flavors: listed on the label as “artificial flavors”
- Industrial preservatives: sodium nitrite, sodium benzoate, etc.
People who follow a “dirty keto” diet, according to Sabat, “are more likely to see negative effects on their cholesterol levels.”
Tips for Maintaining Healthy Cholesterol Levels on a Keto Diet
If cholesterol is a major concern for you, there are many things you can do to both reduce your total and LDL cholesterol levels, as well as improve your heart health.
Here are a few strategies recommended by Sabat and Sherpa to help manage cholesterol on a keto diet:
- Limit saturated fat intake
- Eat plenty of fiber from vegetables, nuts, and seeds
- Engage in regular exercise
- Maintain a healthy weight
- Avoid smoking
- Get regular check-ups with your doctor
Just remember: according to the most up-to-date research, dietary cholesterol and saturated fat don’t appear to affect heart health in any significant way — so there’s no need to shy away from animal fats on keto.
The Bottom Line
Keto may affect your cholesterol levels. In many cases, it increases HDL and reduces triglycerides — which reduces heart disease risk. However, in some people — particularly people who don’t need to lose weight — it may significantly increase LDL cholesterol levels. High levels of small, dense LDL particles are linked to poorer heart health.
If you have high cholesterol, you should speak to your healthcare provider before starting keto. Additionally, you should have your cholesterol levels checked regularly on keto to determine how the diet is affecting your risk profile for heart disease.
Nicholas N. et al. Hypercholesterolemia “Lean Mass Hyper-Responder” Phenotype Presents in the Context of a Low Saturated Fat Carbohydrate-Restricted Diet. 2022 April 14
Nicholas N. et al. A Standard Lipid Panel Is Insufficient for the Care of a Patient on a High-Fat, Low-Carbohydrate Ketogenic Diet. 2020
Nassib B. et al. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. 2013 October
Christophe K. et al. Effects of Ketogenic Diets on Cardiovascular Risk Factors: Evidence from Animal and Human Studies. 2017 May 19
Chong Z. et al. Ketogenic Diet Benefits to Weight Loss, Glycemic Control, and Lipid Profiles in Overweight Patients with Type 2 Diabetes Mellitus. 2022 August 22
Yeo J. et al. Impact of a Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and with or without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. 2020 July 6
Hyun S. et al. Effects of Combined Exercise and Low Carbohydrate Ketogenic Diet Interventions on Waist Circumference and Triglycerides in Overweight and Obese Individuals. 2021 January 19
Constantine K. et al. The Triglyceride/High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio as a Risk Marker for Metabolic Syndrome and Cardiovascular Disease. 2023 March 1
Roberto S. et al. High TG to HDL ratio plays a significant role on atherosclerosis extension in prediabetes and newly diagnosed type 2 diabetes subjects. 2021 February
19 thoughts on “Keto and Cholesterol: What Happens to Your Cholesterol Levels When You’re on a Keto Diet”
My Cholesterol has gone up to thirteen on Keto . My Dr is freaking out.
He wants me back on Paleo but I feel better on keto.
I’ve been doing keto for 8 months. My cholesterol was 8 6 month ago.
Are you using an app to hit your macros?
My latest blood work showed great HDL, VLDL, my LDL is just a bit high and my doc is saying we should do something about it. I don’t want to go on cholesterol meds they gave me leg cramps and other side effects I didn’t like. I think if he lets me give it more time that number could come down as well. I’ve lost 23lbs since January when I started Keto, my sugars are back to normal all other blood work is great! I’m going to try to add more of the avocado, coconut and olive oil and see what happens.
I’ve been religiously following the keto diet for 3 months. My blood tests came back today. My triglycerides were cut in half, but my good cholesterol went down a point while my bad cholesterol raised 50 points. So explain that.
I love red wine, 2-3 glasses a night, can I continue this on the Keto diet? just looking for honest experiences and results.
Same here. LDL increased by 62 and now at 170 which is high and concerning. I’m enjoying the Keto, healthy (other than high cholesterol) and active, but is it worth it? FYI high cholesterol is hereditary so I’m sure this also plays a role. How can we decrease it if we are already using healthy fates like coconut oil, olive oil, avocado etc?
Ive been strict keto for over 3 months and have lost 20lbs. I got my test results back yesterday and was shocked to see how my levels had changed: total cholesterol went from 230 to 308!! All the bad went up and all the good went down. But I’ve also heard that it can take a bit longer for cholesterol levels to even out and start going down. Is this true? I don’t want to quit keto because I have another 20lbs to lose, but I don’t want to have a stroke either.
To those of you experiencing an increase in LDL cholesterol: are you eating dirty keto or healthy keto?
Why is there no answering all these bad results???
I’ve been Keto for over a year now. I’ve lost 60 lbs. I’m off Metformin for type 2 diabetic and my LDL has improved significantly. In my experience, Keto will show some quick results in some but for others it will take longer. It depends on how long you’ve been on the standard American diet. It will take time for your body to fix “self-heal”. Not everyone will have the same results in the same amount of time.
Hi. Glad to see my bad cholesterol is not the only one that’s gone up. The day before I started Keto my bad cholesterol was 93 and my “good” was 107. A month later, I got my blood taken again and my bad had increased to 137 but my good thankfully had only decreased by 2, to 105. The Dr. said that the good news about that was that the “good” cholesterol was the one that protected the heart so nothing needed to be done, as yet. I also have no intention of taking cholesterol meds. Want to go to my grave with as few meds as possible. However, yes, my plan has been to increase eating more “healthy” fats, like Extra Virgin Olive Oil, avacadoes (one a day is prime) and nuts like manademias (which are considered the “wonder nut”). I still eat bacon, butter and eggs but am hoping the increase in healthy fats will show good results in the cholesterol levels. We’ll see.
Mine too went up a hundred points total. My HDL and TRIs are in range but the biggest shocker was my LDL. I’m glad I’m not the only one! I do want to get the particle count which is the LDL-p. This seems like the more concerning value.
I too will up my good fats and keep going and try not to get discouraged. This Keto diet helped solve my IBS I can’t go back. I’ve tried everything and I’m convinced this is the right path. Just trying to keep the faith in the process and see it through. It all does make sense.
Just from researching that I have been doing, this information seems to make a lot of sense and I may have found some information that is pertinent as to why many of you have experienced a rise in LDL levels. VLDL become LDLs when they drop the triglyceride. So, as we consume less carbs we start to lose triglycerides and the VLDLs start to become LDLs. I am no professional by any means, but as I read that article it made sense as well. It takes a while for some people’s livers to start to get the picture and send out more HDL to round up the LDL and there are things that we can do to aid that process such as adding olive oil and coconut oil to our diets as well as eating purple produce and exercising, but the LDL count will probably rise at first and slowly drop from thereafter. It will probably drop faster if we are taking steps to raise our HDL. The longer our body (liver) has been exposed to an unhealthy diet, the longer it will take to recover from it.
Everyone talks about upping their fats… I do not think that is the key to sweeping LDL out of the system. Upping cruciferous fiberous veggies… the fiber, vitamins and minerals contained in veggies bind with the LDL and move it on out. You would have to eat literally a truck load to make any serious dent in your daily carb allowance since most are very low net carb anyways.
Tyson, can you share the article you referred to? Thank you!
I don’t follow the diet completely. I don’t eat carbs. However, I dont eat recipes with all the butter and cream cheese. I don’t want my cholesterol to go high.
It took 2 years of strict keto to have normal cholesterol numbers. With the refusal of statins & did it with just the ketogenic lifestyle. Be patient, your cholesterol didn’t become high overnight, right?. Keto is not a quick fix, but a lifestyle change.
I’m 46 and just had my cholesterol checked for the first time since I was 30. When I took it at 30 I hadn’t fasted and it was 133. Todays results came in at 242! Ive been doing Keto now for almost 2 years. I freaked out at first but after reading some articles I’m starting to feel better about my numbers. I won’t bore you with them but from all I’ve read I’m not at risk for heart disease as I first thought. Thanks for everyone who commented above, you’ve helped calm me 🙂
I was on keto for 4 months and lost 36 lbs and dropped my cholesterol down 20 points now that i have gone off it and only watch my calories it had skyrocketed 60 points will have to fix that with good fat and more fiber