New research challenges the long-held belief that ketogenic diets increase heart disease risk, suggesting that despite raising cholesterol levels, this high-fat, low-carb approach might not elevate cardiovascular dangers as previously feared.
At a Glance
- A recent study indicates the ketogenic diet may lower overall mortality by 24% without increasing heart health risks
- The keto diet involves consuming approximately 75% fats, 20% protein, and just 5% carbohydrates
- Despite raising LDL cholesterol in some people, new evidence suggests this may not translate to increased cardiovascular disease
- Medical experts are reevaluating the relationship between ketosis, inflammation, and heart health
- Long-term studies are still needed to fully understand keto’s cardiovascular effects
Understanding the Ketogenic Diet
The ketogenic diet has gained substantial popularity for weight loss, but its origins lie in treating epilepsy in children. This eating approach dramatically restricts carbohydrates to around 5% of daily calories while increasing fat intake to approximately 75% and maintaining moderate protein at about 20%. This macronutrient ratio forces the body into ketosis, a metabolic state where fat becomes the primary energy source instead of carbohydrates. For many following this diet, the result is often rapid weight loss as the body efficiently burns stored fat while experiencing reduced hunger due to the satiating effects of high fat consumption.
While weight loss benefits attract many to the ketogenic approach, healthcare professionals have traditionally expressed concern about its cardiovascular implications. The diet’s high fat content, particularly when those fats come from processed foods or animal products high in saturated fat, has raised red flags about potential heart health consequences. Additionally, the restriction of whole food groups means followers often consume significantly less fiber from fruits, vegetables, legumes, and whole grains—all foods traditionally associated with heart health benefits.
The Cholesterol Paradox
One of the most contentious aspects of the ketogenic diet involves its impact on cholesterol levels. Many individuals experience an increase in LDL (low-density lipoprotein) cholesterol—often called “bad” cholesterol—when following keto. This has been a primary reason medical professionals have cautioned against the diet, particularly for those with existing cardiovascular conditions. However, emerging research suggests this cholesterol increase might not translate to increased heart disease risk as previously assumed, creating what some researchers now call the “keto cholesterol paradox.”
Recent research indicates that the ketogenic diet may improve several cardiovascular risk factors despite potential LDL increases. These improvements include better blood sugar control, reduced triglycerides, increased HDL (“good”) cholesterol, and decreased inflammation markers. One study suggested that individuals following a ketogenic diet experienced a 24% reduction in overall mortality risk without corresponding increases in heart disease. This has prompted researchers to examine whether traditional cholesterol metrics fully capture cardiovascular risk in the context of ketosis.
Professional Perspectives and Practical Considerations
Medical opinions on the ketogenic diet’s heart health implications remain divided. Some nutrition experts continue to express concern about the diet’s long-term sustainability and potential risks. Tracy Severson, a registered dietitian, notes that even when selecting healthy fat sources, keto followers may still consume more saturated fat than is considered heart-healthy. Additionally, she emphasizes that many people misunderstand the true ketogenic approach: “So many people think it’s about eating bacon and meat, but often they are eating too much protein to be on a true ketogenic diet. It’s about fat, not protein.”
For those considering a ketogenic approach, especially adults with existing health conditions, consulting with healthcare providers remains essential. Certain medications, including SGLT-2 inhibitors used for diabetes and heart failure, may be incompatible with a ketogenic diet. Additionally, the restrictive nature of keto makes it challenging to maintain long-term, often resulting in weight regain when the diet is discontinued. Some medical professionals suggest considering less extreme low-carbohydrate approaches that still allow for fiber-rich fruits, vegetables, and whole grains while restricting refined carbohydrates.
Looking Forward: Research Gaps and Individual Approaches
Despite growing evidence suggesting the ketogenic diet may not increase heart disease risk as previously feared, significant research gaps remain. Most studies examining keto’s cardiovascular effects are relatively short-term, leaving questions about long-term impacts unanswered. Individual responses to the diet also vary considerably—some people experience dramatic cholesterol increases while others see improvements across all metrics. These variations suggest genetic factors, baseline health status, and specific food choices within the keto framework may all influence cardiovascular outcomes.
As research continues to evolve, the most balanced approach may involve personalizing dietary recommendations based on individual health profiles, preferences, and responses. Regular monitoring of cardiovascular markers while following a ketogenic diet can help identify potential problems early. For those who experience significant cholesterol elevations, adjusting the types of fats consumed or transitioning to a less restrictive low-carbohydrate approach might provide a middle ground that balances metabolic benefits with heart health considerations.
