Low carb and ketogenic diets are incredibly healthful.
They offer apparent, lifesaving advantages for some of the world’s most critical illnesses.
Obesity, type 2 diabetes, metabolic syndrome, epilepsy, and many other conditions fall under this category.
Most persons have significant improvements in the most major heart disease risk factors (1).
According to these advancements, low carb diets should lower the risk of heart disease.
However, even if these risk variables improve on average, some individuals within those averages may benefit while others suffer.
A tiny minority of persons tend to have higher cholesterol levels after following a low carb diet, particularly a ketogenic diet or a very high fat variant of paleo.
This includes higher levels of total and LDL cholesterol and more advanced indicators like LDL particle number.
Of course, most of these “risk factors” were developed in the context of a high-carb, high-calorie Western diet, and it is unclear if they have the same consequences on a healthy low carb diet that minimizes inflammation and oxidative stress.
It’s better to be safe than sorry. Therefore, persons with a family history of heart disease should take steps to reduce their levels.
Fortunately, you do not need to follow a low-fat diet, consume vegetable oils, or use statins to reduce your levels.
Some minor changes will suffice, and you will still be able to get the metabolic benefits of eating low carb.
The Breakdown: Are Your Levels High?
Interpreting cholesterol levels can be challenging.
Most individuals are aware of total HDL and LDL cholesterol.
People with high HDL (the “good”) have a lower risk of heart disease, but those with high LDL (the “bad”) have a higher risk.
However, the genuine picture is more complex than just “good” or “bad”… The “bad” LDL contains subtypes determined mainly by the particle size.
People with tiny LDL particles are likelier to develop heart disease, whereas those with mostly big particles are less likely (2, 3).
However, research now demonstrates that the most crucial marker is the LDL particle number (LDL-p), which assesses the amount of LDL particles floating about in your circulation (4).
This score differs from LDL concentration (LDL-c), which assesses the amount of cholesterol your LDL particles carry. This is the most common measurement in basic blood testing.
Getting these items professionally checked is critical to determine whether you have something to be concerned about.
Have your doctor assess your LDL-p (LDL particle number) if possible. ApoB is another method for determining the number of LDL particles.
If your LDL cholesterol is high but your LDL particle number is average (referred to as discordance), you should be fine (5).
On a low carb diet, HDL increases, triglycerides decrease, while total and LDL cholesterol remain constant. LDL particle size tends to rise, while LDL particle number tends to decrease. All are excellent (6, 7).
However, this is an average outcome. Within those averages, a subset of persons following a low carb ketogenic diet have an increase in total cholesterol, LDL cholesterol, and LDL particle count.
None of the suggestions in this article should be taken as medical advice. You should consult with your doctor before making any changes.
Please remember that I am not saying saturated fat or low carb diets are “bad.”
This is merely a troubleshooting help for the limited number of people who experience cholesterol issues when following a low carb and paleo diet.
I have not changed my opinion on low carb diets. I still follow a non-ketogenic, real food-based, low carb diet containing around 100 grams of carbs per day.
At the end of the day, low carb diets are still extremely healthy, and the advantages far exceed the drawbacks for most people, but others may need to make some changes to make the diet work for them.
Dr. Thomas Dayspring, one of the world’s most distinguished lipidologists, details this phenomenon in depth (hat tip to Dr. Axel Sigurdsson). Lipidaholics Anonymous Case 291: Does decreasing weight aggravate lipids?
If you want to learn more about the science underlying the counterintuitive rise in cholesterol on a ketogenic diet, read this article (you must first create a free account).
Unfortunately, sophisticated markers such as LDL-p or ApoB cannot be assessed for everyone because of their high cost and availability in not all countries.
Non-HDL cholesterol (Total Cholesterol – HDL) is a reasonably accurate marker that may be assessed using a conventional lipid panel (8, 9).
If your Non-HDL levels are high, you should take steps to reduce them.
Medical Conditions That Can Raise Cholesterol
It’s also vital to rule out any medical disorders that might produce high cholesterol. These have nothing to do with the diet itself.
One example is decreased thyroid function. When thyroid activity is suboptimal, total and LDL cholesterol levels might rise (10, 11).
Another factor to consider is weight loss. In certain people, reducing weight might temporarily raise LDL cholesterol.
If your levels rise when you quickly lose weight, you should wait a few months before measuring them again once your weight has stabilized.
It’s also critical to rule out a hereditary illness called Familial Hypercholesterolemia, which affects around one in every 500 people and is characterized by extremely high cholesterol levels and an increased risk of heart disease.
Other subtle genetic variations between humans might influence our reactions to various diets, such as different variants of the ApoE gene (12).
Now that we’ve covered all that let’s examine some practical measures you can take to lower your cholesterol levels.
Remove Bulletproof Coffee From Your Diet
“Bulletproof” coffee is quite popular in the low carb and paleo communities.
It consists of adding 1-2 teaspoons of MCT oil (or coconut oil) and two tablespoons of butter to your daily cup of coffee.
I haven’t tried it personally, but many others say it tastes great, gives them energy, and suppresses their hunger.
Well… I’ve written extensively about coffee, saturated fats, butter, and coconut oil. I adore all of them and believe they are healthy.
However, just because “normal” amounts of something are beneficial for you does not indicate that large quantities are better.
All studies demonstrating the safety of saturated fat utilized typical quantities comparable to those consumed by the average person.
There is no way to predict what will happen if you start consuming large amounts of saturated fat, especially if you do so instead of other more healthy meals. Humans did not evolve to do this.
I’ve also heard tales from low carb doctors (Drs. Spencer and Karl Nadolsky). They had low carb individuals with significantly elevated cholesterol readings, which reversed after they quit drinking bulletproof coffee.
If you drink bulletproof coffee and have cholesterol issues, the first thing you should do is attempt to eliminate it from your diet.
Replace Some Saturated Fats With Monounsaturated Fats
In the most extensive and rigorous research, saturated fat has not been connected to increased heart attacks or mortality from heart disease (13, 14, 15).
If you have cholesterol issues, consider replacing some saturated fats with monounsaturated fats.
This easy tweak may lower your levels.
Cook using olive oil rather than butter or coconut oil. Consume more nuts and avocados. These foods are all rich in monounsaturated fats.
If this doesn’t work, consider substituting part of the fatty meat with leaner meat.
I cannot recommend olive oil enough… Quality extra virgin olive oil provides several heart-health advantages beyond cholesterol levels.
It prevents LDL particles from oxidation, decreases inflammation, enhances endothelial function, and may even lower blood pressure (16, 17, 18).
Olive oil is a heart-healthy superfood, and everybody at risk of heart disease should use it regardless of cholesterol level.
Consuming fatty fish rich in Omega-3 fatty acids at least once a week is also recommended. If you cannot consume fish, consider supplementing with fish oil instead.
Drop the Ketosis and Eat More Fiber-Rich, Real Food Carbs
There is a prevalent misconception that a low carb diet must be ketogenic.
Carbs should be low enough for the body to generate ketones from fatty acids.
This diet appears to be the most beneficial for people with epilepsy. Many individuals say that being in ketosis produces the best outcomes, both mentally and physically.
However, even minor carb restriction might be termed low carb.
Although there is no precise definition, anything between 100 and 150 grams per day (often more) might be considered a low carb diet.
Some people may experience a rise in cholesterol while in ketosis but improve when they eat just enough carbs to prevent ketosis.
Try eating 1-2 pieces of fruit daily. How about a potato or sweet potato for supper or modest quantities of healthy carbs such as rice and oats?
You might follow a higher-carb paleo diet instead, depending on your metabolic health and personal preferences.
This may also be a highly healthful diet, as evidenced by long-lived populations such as the Kitavans and Okinawans, who consumed a lot of carbs.
Although ketosis can have several benefits, it is not for everyone.
Other natural cholesterol-lowering methods include eating meals high in soluble fiber or resistant starch and taking a niacin supplement.
Exercising, getting enough sleep, and reducing stress levels can all help.
The Bottom Line
None of the suggestions in this article should be taken as medical advice. You should consult with your doctor before making any changes.
Please remember that I am not saying saturated fat or low carb diets are “bad.”
This is merely a troubleshooting help for the limited number of people who experience cholesterol issues when following a low carb and paleo diet.
I have not changed my opinion on low carb diets. I still follow a non-ketogenic, real food-based, low carb diet containing around 100 grams of carbs per day.
At the end of the day, low carb diets are still extremely healthy, and the advantages far exceed the drawbacks for most people, but others may need to make some changes to make the diet work for them.
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