For every person who talks up the ketogenic diet, there’s another person warning about its ill effects on your heart. The worry is that a very high-fat, moderate-protein, and very low carbohydrate diet will create a subsequent spike in cholesterol levels, which could, in turn, raise your risk for heart disease.
The worry is certainly valid. On the keto diet, each day you’re eating up to 80 percent of your calories from fat and sticking with 20 to 50 grams (g) of net carbs, a guideline used in popular diets, including keto and Atkins, but one that is not officially recognized in the medical community. (To calculate net carbs, subtract fiber and sugar alcohols from the total carb amount.) This all means you’ll be eating a lot of fat per day, and in the name of meeting that quota, that may include choices like butter, coconut oil, and animal fat, which may lead to spikes in cholesterol. These are all sources of saturated fat, which is linked to poor heart health.
(The point of keto is to shift your body from a carb-burning state to a fat-burning one, which is called ketosis.)
But the effect of keto on heart health isn’t as straightforward as it sounds. Indeed, the keto diet may not have as detrimental an effect on your cholesterol as previously thought.
“When you review the data, a couple things are clear. Looking at population studies and clinical trials, the impact the keto diet has on lipids is modest,” says Daniel Soffer, MD, an internist and lipidologist at Penn Medicine in Philadelphia. Dr. Soffer is a member of the National Lipid Association, an organization dedicated to managing lipid problems.
Whether cholesterol numbers — particularly high-density lipoprotein (HDL) — go up or down largely depends on the quality of your keto diet. “One problem is that there’s not a single ketogenic diet. There are different ways to follow it, and some people are careful about the types of fats they eat, while others are not,” says Soffer.
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