top of page

Keto and Cholesterol

Updated: Jan 14

You are more than welcome to read this article, but there have been new studies that have emerged that show the high-fat diet of keto is linked to a greater risk for heart disease and the loss of lean muscle mass.

There are also people who eat "dirty keto", which includes many processed meats like sausage and bacon. Processed red meats have been linked to an increased risk of colorectal cancer.

Yes, the size of your LDL particles still matters, but you can also achieve weight loss, a decreased risk of heart disease, diabetes, and cancer, decrease systemic inflammation, and improve your gut health with a WHOLE-FOOD, PLANT-BASED DIET.

Let’s talk about cholesterol and the keto diet. Now, the Keto Diet isn’t for everyone, but I will attempt to give a general overview on cholesterol and explain why the lipid panels can look a little crazy, especially when you first start the keto diet.

First, why do we even need cholesterol?

1. Cholesterol is an essential component of cell membranes

  • Fluidity – letting things in and out of the cells

  • Rigidity – providing structure for the cell

2. Cholesterol is a building block for naturally occurring steroid hormones

  • Testosterone

  • Estrogens

  • Progestins

3. Cholesterol is a necessary component to make Vitamin D

4. Cholesterol is an important component of bile acids

  • Bile acids help our body digest fats

  • The keto diet includes high amounts of fat

5. Cholesterol is important for calcium homeostasis/regulation

  • Removes calcium from bones

  • Regulates calcium absorption in the intestines

  • Regulates reabsorption of calcium in the kidneys

6. Some lipoproteins (LDL & HDL) have been shown to inactivate endotoxins released by certain bacteria species

Since cholesterol is a lipid, it does not mix well with water (or blood, since it is mostly water) and must be packaged with water loving molecules to move through the blood stream. This packaging is called a lipoprotein. When your doctor measures your cholesterol on blood work, it is the lipoproteins that are being measured.

· LDL – Low-density lipoprotein – travels from the liver through the blood stream to the areas of the body that need cholesterol. LDL is not “bad” as conventional medicine would have you believe. It is a normal function of our body, a transport mechanism. It is the outbound train.

· HDL – High-density lipoprotein – transports cholesterol from the body back to the liver. This is the inbound train. It is called “good” cholesterol because it is bringing cholesterol back to the liver to be destroyed. Both LDL and HDL are necessary to transport cholesterol to where it needs to go. LDL and HDL need to be in balance with each other. When our lipoproteins are out of balance, this is called dyslipidemia.

· VLDL – Very low-density lipoprotein – this is the main transporter of triglycerides and is eventually converted to LDL.

· Triglycerides – Our dietary fats are converted to triglycerides for storage in our bodies. Insulin triggers this process. Insulin also signals the body to store excess carbohydrates as fat. In the absence of carbohydrates or sugar, our bodies can convert triglycerides to ketones to use as energy in the cells instead of glucose.

Our conventional healthcare system follows the Adult Treatment Panel III (ATP-III) recommendations to treat dyslipidemia and set goals for the amounts of lipoproteins that should be seen on the lipid panel. LDL is the primary target of ATP-III, with an optimal level <100. ATP-III also defines a total cholesterol <200 and an HDL of >60 (or at least not <40) as desirable. These values do not consider the genetic variations that people have or specific eating plans like the ketogenic diet. It also does not consider the size of the lipoprotein particles.

Yes, the size of the LDL particles matters!

When we incorporate good fats into our diet, we get nice, big, fluffy LDL particles. These big LDL particles are easily recognized by the liver and cleared out within 24 hours of creation. However, in the 1980’s and ‘90’s, eating fat became stigmatized. Fat was bad, so fat-free and low-fat foods were created: skim milk, low-fat cheese, low-fat yogurt. These were the “healthy” foods. But we replaced fat with sugar to make food taste better and sugar and carbohydrates overtook the grocery store. We wanted convenience with pre-packaged, long-shelf life, processed foods. Obesity, metabolic disorder, heart disease all increased.

Hello, small LDL particles! These small, dense LDL particles are not as easily recognized by the liver due to an altered configuration, so they are not cleared as quickly. They can circulate for 5 days or more, wreaking havoc on our bodies. These particles are more easily oxidized (think about how an apple slice turns brown when exposed to air – that’s oxidation), have increased stickiness (so they stick to arterial walls forming plaques and blocking blood vessels), and are pro-inflammatory. Systemic inflammation is linked to many different disease states (like auto-immune disorders, diabetes, metabolic disorders, and heart disease).

But fat is making a comeback! The Keto Diet has been taking America by storm. The ketogenic diet is an eating plan of very low carbohydrates, moderate amounts of protein, and high fats. It can lead to rapid weight loss, but be careful, the weight can come back very quickly if you abruptly stop. Essentially, you are teaching your body to use ketones for energy instead of glucose. This is more efficient for our bodies because glucose needs a constant carbohydrate source. Most of us eat more carbohydrates than we need, but those extra carbohydrates are converted and stored as fat. Fat that remains stored unless we teach our bodies to use it. With a ketogenic eating plan, those fatty acids are converted to ketones for energy, the body secretes less insulin leading to less fat storage and more fat burning.

But what does the lipid panel look like? Remember, standard lipid panels look at LDL <100, Total Cholesterol <200 and HDL >60. Dramatic changes can happen to these levels on the Keto Diet. Here is an example from a study of a patient with ulcerative colitis that started a ketogenic eating plan:

Total cholesterol soared from 160 mg/dL to 450 mg/dL; LDL more than tripled from 95 mg/dL to 321 mg/dL and HDL more than doubled from 48 mg/dL to 109 mg/dL. Those numbers would probably freak out your conventional healthcare professionals! But why do they happen?

Think about it! We are teaching our bodies to use FAT for FUEL instead of sugar! Look at the HDL; it more than doubled. Besides bringing cholesterol back to the liver to be destroyed, HDL has antioxidant and anti-inflammatory properties, as well as immune functions (blocking endotoxins). What about that LDL? Remember, it is the small, dense LDL particles that are the problem. The ketogenic diet makes big, fluffy LDL particles, which have a high turnover rate and also help block endotoxins. Also, LDL is the outbound train! How are cells supposed to receive the triglycerides to convert to ketones to use as fuel? So, of course, LDL levels are going to increase!

But, like everything else, it is all about balance! LDL and HDL levels need to be in balance, so the numbers themselves should not be the concern. It is the size of the particles and the balance of HDL to LDL that matters!


Braun V, Hantke K. Lipoproteins: Structure, Function, Biosynthesis. Subcell Biochem. 2019;92:39-77. doi: 10.1007/978-3-030-18768-2_3. PMID: 31214984.
Cantrell CB, Mohiuddin SS. Biochemistry, Ketone Metabolism. [Updated 2021 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
Craig M, Yarrarapu SNS, Dimri M. Biochemistry, Cholesterol. [Updated 2021 Aug 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
Feingold KR. Introduction to Lipids and Lipoproteins. [Updated 2021 Jan 19]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA):, Inc.; 2000-. Available from:
Kolluru GK, Bir SC, Kevil CG. Endothelial dysfunction and diabetes: effects on angiogenesis, vascular remodeling, and wound healing. Int J Vasc Med. 2012;2012:918267. doi:10.1155/2012/918267
Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. [Updated 2021 Nov 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
Nijjar PS, Burke FM, Bloesch A, Rader DJ. Role of dietary supplements in lowering low-density lipoprotein cholesterol: a review. J Clin Lipidol. 2010 Jul-Aug;4(4):248-58. doi: 10.1016/j.jacl.2010.07.001. Epub 2010 Jul 8. PMID: 21122657.
Norwitz NG, Loh V. A Standard Lipid Panel Is Insufficient for the Care of a Patient on a High-Fat, Low-Carbohydrate Ketogenic Diet. Front Med (Lausanne). 2020 Apr 15;7:97. doi: 10.3389/fmed.2020.00097. PMID: 32351962; PMC ID: PMC7174731.
Poli A, Barbagallo CM, Cicero AFG, Corsini A, Manzato E, Trimarco B, Bernini F, Visioli F, Bianchi A, Canzone G, Crescini C, de Kreutzenberg S, Ferrara N, Gambacciani M, Ghiselli A, Lubrano C, Marelli G, Marrocco W, Montemurro V, Parretti D, Pedretti R, Perticone F, Stella R, Marangoni F. Nutraceuticals and functional foods for the control of plasma cholesterol levels. An intersociety position paper. Pharmacol Res. 2018 Aug;134:51-60. doi: 10.1016/j.phrs.2018.05.015. Epub 2018 May 30. PMID: 29859248.
Staels B, Dallongeville J, Auwerx J, Schoonjans K, Leitersdorf E, Fruchart JC (November 1998). "Mechanism of action of fibrates on lipid and lipoprotein metabolism". Circulation. 98 (19): 2088–93. CiteSeerX doi:10.1161/01.cir.98.19.2088. PMID 9808609.
Toft-Petersen AP, Tilsted HH, Aarøe J, et al. Small dense LDL particles--a predictor of coronary artery disease evaluated by invasive and CT-based techniques: a case-control study. Lipids Health Dis. 2011;10:21. Published 2011 Jan 25. doi:10.1186/1476-511X-10-21
Uffe Ravnskov, Michel de Lorgeril, David M Diamond, Rokuro Hama, Tomohito Hamazaki, Björn Hammarskjöld, Niamh Hynes, Malcolm Kendrick, Peter H Langsjoen, Luca Mascitelli, Kilmer S McCully, Harumi Okuyama, Paul J Rosch, Tore Schersten, Sherif Sultan & Ralf Sundberg (2018) LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature, Expert Review of Clinical Pharmacology, 11:10, 959-970, DOI: 0.1080/17512433.2018.1519391

16 views0 comments


bottom of page