Keto Diet and High Cholesterol: The link between saturated fat and cholesterol is outdated, and the use of statin drugs to solve high cholesterol problems does not line up with the latest science. Today we explore the history of this old paradigm, what you need to know about cholesterol and diet, and how to successfully use keto to help fight cholesterol problems.
Keto Diet and High Cholesterol: The Old Paradigm
Cardiovascular disease affects over 65 million Americans, and nearly a million Americans have a heart attack each year. Heart disease is the leading cause of death in America, with one person dying every 36 seconds.  One in four deaths is heart-related.  With a disease costing so many lives and costing the healthcare system approximately $300 billion per year, addressing this issue is paramount when it comes to the sustainability and success of healthcare in America. 
The historical narrative that still holds a grip on many people today is that saturated fat (think eggs, bacon, and red meat) is at the root of the elevated blood cholesterol problem. This story took off during the late 1950s – 1970s when studies demonstrated a correlation between high-fat diets and high-cholesterol levels, sending America into a low-fat (and subsequently a high-sugar) diet craze. 
By the 1980s, the low-fat movement became embedded in the American culture as the healthy way to eat, a dogma promoted by physicians, the federal government, the food industry, and the popular health media. Despite the “science” and push from various agencies, it was during this period that an obesity epidemic erupted. This epidemic happened because science was fraudulent and corrupt. 
A 2016 study published in the Journal of Internal Medicine into the low-fat studies discovered that the reviews were funded by the sugar lobby to demonize fat and promote sugar (carbohydrates) instead.  This bribe cost approximately $50,000 in today’s American dollars and has derailed appropriate dietary recommendations ever since.
The health food pyramid has promoted low-fat consumption to this day holds the lingering lies of fraudulent science.
From the 1990s to 2005, the pyramid suggested to use fats and oils sparingly, and the updates 2005 pyramid does not mention them at all. 
One of the significant problems with our healthcare system is a significant lag between new science and implementation through doctors’ recommendations. By the time most doctors finish medical school, their knowledge is already out of date, and working physicians simply don’t catch up with the latest science because they’re busy.
Food is the building block of our human bodies, providing us with the nutrients we need to survive and thrive. Understanding the critical role that diet plays in generating health is key to thriving, as studies show that over 90% of cardiovascular disease is preventable by diet and lifestyle choices.  It’s time debunk the myth that cholesterol is caused by fat consumption. This myth has been harming the health of millions of Americans.
Keto Diet and High Cholesterol: HDL vs. LDL: Understanding Cholesterol
One of the significant issues with cholesterol as a tool for predicting heart disease is that mainstream medicine’s diagnostic metrics are outdated. Simply put: cholesterol is a type of fat found in your blood. However, it contains two components: high-density lipoprotein (HDL) and low-density lipoprotein (LDL).
HDL is known as the “good” cholesterol, it transports cholesterol around the body and plays a crucial role in bringing back old or unused cholesterol to the liver to be and recycled. In doing so, HDL prevents clogged arteries!  It also has anti-inflammatory effects on the body by helping to regulate immune system cells known as macrophages, as well as cancer reducing properties. [9-10]
LDL also transports cholesterol produced by your liver and cells through the body, but unlike HDL, it moves very slowly.
This makes HDL more susceptible to oxidizing agents known as free radicals. Once LDL oxidizes, it can become a threat to heart health by burrowing into the endothelium, or the walls or your arteries, which also causes an inflammatory response. As a result, LDL is related to an elevated risk of cardiovascular disease. [11-12]
When total cholesterol levels are tested for a common mainstream metric, the picture of “elevated cholesterol levels” does not paint the whole picture. Knowing specific ratios is imperative to understand more about cholesterol as a predictor for heart disease, and even with the HDL to LDL ratio, the science is still not completely clear as a diagnosis tool.
Keto Diet and High Cholesterol: Cholesterol and Modern Science
The hypothesis that consuming saturated fat and high cholesterol foods raise blood cholesterol levels is simply inaccurate. More recent (and better conducted) studies completely debunk the outdated and corrupt studies from before the turn of the century.
Our liver naturally produces approximately 75% of our blood cholesterol levels, and the other 25% is through diet. The body regulates cholesterol vigilantly, producing less when dietary intake is higher, and producing more when less is consumed.
Well-designed cholesterol studies highlight that approximately 75% of the population’s blood cholesterol levels do not change at all with the introduction of high cholesterol foods into the diet, due to this self-regulating method. The 25% of the population who are “hyper-responders,” and although their levels do increase, so does the ratio of “good” (HDL) to “bad” (LDL) cholesterol: meaning that they are not at an increased risk of heart disease. 
Furthermore, most studies that suggest that saturated fat increases blood cholesterol levels are short term (only a few weeks), whereas longer-term studies don’t. [14,15]
A large meta-analysis of over 350,000 people found absolutely no causation between the consumption of dietary saturated fat and an increased risk of heart disease.  A study that followed participants for 14 years found, on the other hand, that there was an inverse association between saturated fat consumption and stokes! 
In 2004, Sylvan Lee Winberg, the former president of the American College of Cardiology, stated that “the low-fat, high-carbohydrate diet… may well have played an unintended role in the current epidemics of obesity, lipid abnormalities, type 2 diabetes, and metabolic syndromes. This diet can no longer be defended by appeal to the authority of prestigious medical organizations.” 
Enough is enough! The science is clear that dietary fat in itself is not only the cause of heart disease but that consuming healthy fats is actually highly beneficial when it comes to heart and whole-body health.
Keto Diet and High Cholesterol: Addressing High Cholesterol
Now that we’re finished breaking down the old paradigm, let us step into the new. Fighting cholesterol requires a functional medicine approach. Hypercholesterolemia can be caused by an array of lifestyle factors that include: 
- Metabolic dysfunction
- Chronic infections
- Gut dysbiosis (leaky gut)
- Poor functioning thyroid
- Environmental toxins
- Genetic factors
Most mainstream physicians prescribe the outdated low-fat vegetarian diet, and when that fails to yield results, tack on a statin drug… which only suppresses symptoms and comes with an array of unfavorable side-effects.
Keto for High Cholesterol
A common misconception that lingers from the old narrative of low-fat diet culture is that the high-fat ketogenic diet is harmful to those dealing with cholesterol issues. As we have seen, there is a difference between HDL (good) and LDL (bad) cholesterol, and studies actually suggest not that saturated fat can help improve HDL levels in the blood and promote heart health.
The ketogenic diet is at the epicenter of this debate because it promotes a high-fat, moderate-protein, and low-carbohydrate macronutrient balance. This diet goes exactly counter to the long-held belief that a low-fat vegetarian diet was healthy. Studying the keto diet is highlighting again and again that saturated fat is your friend!
One study followed 1,1415 subjects over the period of an entire year to study the impact of very-low-carbohydrate ketogenic diets (under 50 grams of carbohydrates per day), only to conclude that carbohydrate-restricted diets confer cardiovascular benefits because they improve levels on HDL (“good” cholesterol) in the body. 
Another study followed 118 obese men and women and separated them into two groups for a year-long intervention study.
Divided into two groups, the first consuming a 46%, 24%, and 30% carb-to-protein-to-fat ratio diet, and the second consuming a 4%, 35%, and 61% carb-to-protein-to-fat ratio diet. At the end of the year, the low-fat group increased their good (HDL) cholesterol on average by 4.9%, while the high-fat group increased it by 20.6%! Almost four times as much as the low-fat group! 
It is worth noting that as individuals, we are all in need of a tailored diet to our specific needs. The low-fat vegan diet has undoubtedly been debunked. However, if you are dealing with heart disease or illness, we recommend working with a functional medicine practitioner who can help you connect all the dots between genetics, lifestyle, diet, stress management, etc.
Keto Diet and High Cholesterol: Finding A Healthcare Practitioner
When dealing with cholesterol or any health issues, it’s important to find a practitioner that sees the bigger picture. For starters, you want to make sure your physician is testing accurately for cardiovascular markers.
The conventional lipid markers that general practitioner medical doctors test for (total cholesterol and LDL levels) are not accurate predictors. Physicians testing for relative LDL particle number and lipoprotein(a) are getting much more predictive results when it comes to cardiovascular problems.
Moreover, the story of cardiovascular disease includes an array of factors including family history, inflammatory markers like C-reactive protein, fibrinogen, Lp-PLA2, oxidized LDL, and metabolic markers (like fasting insulin, fasting glucose, fasting leptin, post-meal blood sugar, hemoglobin A1c, and more).  It’s not as simple as one test and a conclusion.
In other words: find yourself a functional medicine practitioner who goes beyond simply testing for “total cholesterol levels”. Understanding health and wellbeing requires a whole-person approach, and one test will not predict your likelihood of heart disease.
Remember: everyone you work with is a tool in your toolbelt.
Empowering yourself with knowledge about your body and the way it works will help you ask more questions, and challenge your healthcare providers to include you in their prognosis. The advice given to you by any healthcare practitioner ultimately has to be approved by you, so get involved in the process of educating yourself so that you can actively participate in generating vibrant, whole-body health.
The low-fat craze that swept the nation as a result of corrupt science has led to the destruction of American health and is one of the causes of the American obesity epidemic. The low-fat vegetarian diet that is still being prescribed to address cholesterol and cardiovascular problems has no basis and valid science. Addressing lifestyle factors is a key part of having healthy cholesterol levels, and good fats play an integral role in finding that balance too.
Understanding the HDL to LDL ratio of cholesterol is key to understanding good vs. bad cholesterol, and finding a practitioner that can help you integrate ketosis for heart health may require you to branch out into the realms of functional medicine practitioners instead of a conventional GP.
- Virani, Salim S., et al. “Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association.” Circulation, vol. 141, no. 9, 2020, doi:10.1161/cir.0000000000000757.
- Fryar, Cheryl, et al. “Https://Www.cdc.gov/Nchs/Data/Databriefs/db103.Pdf.” NCHS Data Brief, Aug. 2012, www.cdc.gov/nchs/data/databriefs/db103.pdf.
- Berge, A. F. La. “How the Ideology of Low Fat Conquered America.” Journal of the History of Medicine and Allied Sciences, vol. 63, no. 2, 2007, pp. 139–177., doi:10.1093/jhmas/jrn001.
- Domonoske, Camila. “50 Years Ago, Sugar Industry Quietly Paid Scientists To Point Blame At Fat.” NPR, NPR, 13 Sept. 2016, www.npr.org/sections/thetwo-way/2016/09/13/493739074/50-years-ago-sugar-industry-quietly-paid-scientists-to-point-blame-at-fat.
- Kearns, Cristin E., et al. “Sugar Industry and Coronary Heart Disease Research.” JAMA Internal Medicine, vol. 176, no. 11, 2016, p. 1680., doi:10.1001/jamainternmed.2016.5394.
- “Is The USDA’s New Food Plate Any Better?” HuffPost, HuffPost, 7 Dec. 2017, www.huffpost.com/entry/food-pyramid-usda_n_870375.
- Yusuf, Salim, et al. “Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries (the INTERHEART Study): Case-Control Study.” The Lancet, vol. 364, no. 9438, 2004, pp. 937–952., doi:10.1016/s0140-6736(04)17018-9.
- Barter FJ, et al. Anti-inflammatory properties of HDL. Circulation Research. 2004; 95: 764-772
- De Nardo D, et al. (2014) High-density lipoprotein mediates anti-inflammatory reprogramming of macrophages via the transcriptional regulator ATF3. Nature Immunology. 15,152–160
- Jafri, Haseeb, Alawi A. Alsheikh-Ali, and Richard H. Karas. “Baseline and on-treatment high-density lipoprotein cholesterol and the risk of cancer in randomized controlled trials of lipid-altering therapy.” Journal of the American College of Cardiology 55.25 (2010): 2846-2854.
- Germano, Giuseppe, et al. “European Guidelines on cardiovascular disease prevention in clinical practice (version 2012).” European Heart Journal 33 (2012): 1635-1701.
- Neaton, James D., et al. “Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial.” Archives of internal medicine 152.7 (1992): 1490-1500.
- Djoussé, Luc, and J Michael Gaziano. “Dietary cholesterol and coronary artery disease: a systematic review.” Current atherosclerosis reports vol. 11,6 (2009): 418-22. doi:10.1007/s11883-009-0063-1
- Mensink, Ronald P, et al. “Effects of Dietary Fatty Acids and Carbohydrates on the Ratio of Serum Total to HDL Cholesterol and on Serum Lipids and Apolipoproteins: a Meta-Analysis of 60 Controlled Trials.” The American Journal of Clinical Nutrition, vol. 77, no. 5, 2003, pp. 1146–1155., doi:10.1093/ajcn/77.5.1146.
- Guyenet, Stephan. “Does Dietary Saturated Fat Increase Blood Cholesterol? An Informal Review of Observational Studies.” Whole Health Source, 1 Jan. 1970, wholehealthsource.blogspot.com/2011/01/does-dietary-saturated-fat-increase.html.
- Siri-Tarino, Patty W et al. “Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.” The American journal of clinical nutrition vol. 91,3 (2010): 535-46. doi:10.3945/ajcn.2009.27725
- Yamagishi, Kazumasa et al. “Dietary intake of saturated fatty acids and mortality from cardiovascular disease in Japanese: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC) Study.” The American journal of clinical nutrition vol. 92,4 (2010): 759-65. doi:10.3945/ajcn.2009.29146
- Weinberg, Sylvan Lee. “The Diet–Heart Hypothesis: a Critique.” Journal of the American College of Cardiology, vol. 43, no. 5, 2004, pp. 731–733., doi:10.1016/j.jacc.2003.10.034.
- Kresser, Chris. “The Functional Medicine Approach to High Cholesterol – RHR.” Chris Kresser, 16 Apr. 2019, chriskresser.com/functional-medicine-approach-to-high-cholesterol/.
- Bueno, Nassib Bezerra, et al. “Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials.” British Journal of Nutrition 110.07 (2013): 1178-1187.
- Brinkworth, Grant D et al. “Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo.” The American journal of clinical nutrition vol. 90,1 (2009): 23-32. doi:10.3945/ajcn.2008.27326