Does Keto Affect Cholesterol?

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Written by Edibel Quintero, Medical Doctor and medically reviewed by Jennifer Olejarz

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So many years fighting against cholesterol-rich foods because of the potential damage they could cause to the cardiovascular system and suddenly... a new dietary trend steals everyone's interest.

It seems like a fantasy come true that a high-fat diet has health benefits and can be positive even if you have some elevated numbers on your most recent blood test.

But is keto good for cholesterol? Although a low-carbohydrate diet has many benefits, it is important to follow certain rules so that you can achieve them without affecting your overall health.


What is cholesterol?

Before getting into this complex subject of cholesterol on keto, it is necessary to understand what it is and what its functions are, since it has been demonized for a long time.

Cholesterol is a small molecule that is part of the membrane of all human cells. It plays an important role in the functioning of cells and without it, it would be impossible to synthesize hormones1 (estrogen, testosterone, and aldosterone).

This is where a lot of questions begin to emerge since we need an adequate amount of cholesterol to survive, but too much can be dangerous for our health. Quite a dilemma.

But it is important to know that cholesterol levels do not only depend on food since it is synthesized in the liver within the endoplasmic reticulum of the hepatocytes. A healthy person is able to synthesize (produce) 800 mg of cholesterol in a single day!

Cholesterol is found in animals and their derived products such as red meat, chicken, pork, liver, seafood, eggs, butter, and fatty cheeses.


Keto and cholesterol

Many people wonder how it is possible to lose body fat when the recommended intake of this macronutrient in the ketogenic diet is 75% of total calories.

It is easier to understand once you know that our body's metabolism takes a completely different path when we enter nutritional ketosis.

When carbohydrate intake is very low, the metabolism obtains its energy through the catabolism of fats. In this process, ketone bodies are released from fats to enable the functioning of all bodily systems.

When the fat stores of adipose tissue are called upon, cholesterol is released into the blood. This does not mean that the keto diet is detrimental to health. The elevation at the beginning of the diet is a sign that the body is adapting to the change and is putting the new metabolic pathway into action.

On the other hand, it is not only the fats fault, there are carbs bad for cholesterol too. When carbohydrate intake is very high (as in the typical American diet) cholesterol rises due to the high glycemic index2 of the "bad carbs," which includes highly processed products, sugar, soft drinks and sweets. These foods also affect triglyceride concentration.

Cholesterol levels on a ketogenic diet

Because the body is able to synthesize cholesterol in the liver to meet all needs, there is no evidence that it is necessary to consume it through the diet. However, a recommended level of 100 - 300 mg of cholesterol per day has been established according to the Dietary Guidelines for Americans, following the guidelines for the Healthy U.S. Style Eating Pattern3.

It doesn't matter if you start keto with "optimal" levels, they will still go up as this is part of the fat-burning process.


Does keto cause high cholesterol?

Yes, increased cholesterol is an expected consequence of a high-fat diet. In a recent study of healthy women, it was shown that by following a diet high in saturated fat and low in carbohydrates and dietary fiber, there was a significant increase in LDL4 ("bad" cholesterol).

However, the type of diet was key to these results indicating an increased health risk. When the source of cholesterol comes entirely from saturated fat and no fiber is ingested, total cholesterol increases due to low-density lipoprotein (LDL), which is responsible for the risk of cardiovascular disease.


Does the keto diet help lower cholesterol?

After the body has adapted in the long term, the levels return to normal (<200 mg/dl). This is achieved by following a keto plan that does not exceed 20% saturated fat5.

75% of the fat requirement to meet the ketogenic dietary guidelines must be met by consuming polyunsaturated fats (salmon, mackerel, herring, tuna, sunflower seeds, flaxseed, and soybean oil) and monounsaturated fats (olive oil, walnuts, avocado, and sesame oil).

Lowering cholesterol levels by consuming "good fats" prevents blood clotting, irregular heartbeat, and can reduce blood pressure.


How to do keto without raising cholesterol

Although higher cholesterol levels are an expected effect at the beginning, it is necessary to avoid high concentrations by not eating too much saturated fat (fatty meat, fatty cheese, butter, highly processed foods).

In addition, it is important to practice regular physical activity in order to use the fats released into the blood and prevent them from being oxidized.

Unsaturated fat has the particularity of being protective of the cardiovascular system, especially Omega 3. Unsaturated fat is divided into monounsaturated and polyunsaturated fats6. These are known as good fats and can be found in different plant and animal sources.


Ketogenic foods to prevent high cholesterol

How to eat low carb without raising cholesterol? It's as simple as knowing how to select your fat sources. Try to include the options listed below on your plate every day, combined with a fresh, fiber-rich salad.

  • Avocado
  • Nuts
  • Peanut butter
  • Soybean oil
  • Sunflower oil
  • Flaxseed
  • Sesame seed
  • Fatty fish (salmon, sardines, herring)
  • Chicken


Benefits of the ketogenic diet for cholesterol

Several studies have shown that cholesterol levels improve more when you consume a diet high in good fats than those diets low in fat and high in carbohydrates.

The main benefit of keto is that the body uses your body's fat stores for energy. Although you may momentarily have high levels, in the long run, it is regulated and you begin to enjoy a strengthened cardiovascular system thanks to the consumption of high-quality fats.

Also, keto is an excellent ally to fight insulin resistance, obesity, and diabetes.


Risk of doing keto with high cholesterol

The keto diet is not the enemy of cholesterol, it is actually a good pal. If you have elevated cholesterol when you start practicing this method, the best thing you can do is to add moderate physical activity to your daily routine.

The cholesterol released into the blood to be used as energy will be used by your active muscles. The risk occurs when you eat a lot of saturated fats and remain sedentary, as that is the perfect combination to escalate your risk of cardiovascular events.

There are other factors that would increase cardiovascular risk in combination with a diet high in saturated fat, such as smoking cigarettes, elevated blood glucose and chronic inflammation.


Should people with high cholesterol do keto?

Some studies have shown that cholesterol elevation during a ketogenic diet occurs not only from LDL, but also from HDL, better known as "good cholesterol." This means that increased levels are not entirely negative. Furthermore, the increase in LDL cholesterol that has been reported is specifically from a larger molecule (LDL-C) that is not associated with cardiovascular risk7.

If there is one thing to always keep in mind, it is that everyone is unique. But, this does not change the fact that there are some very important rules to follow on the keto diet to avoid complications.

A person with high cholesterol can start keto without problems as long as they follow these recommendations:

  1. Have authorization from your medical doctor and nutritionist
  2. Avoid losing weight too fast. The 24-hour caloric requirement should be completed, i.e., the user should not eat a low number of calories during the day as this could speed up the elevation of cholesterol and cause troublesome symptoms7
  3. Exercise regularly at a moderate - high intensity
  4. Do not consume more than 15-20% saturated fat


Is keto good or bad for cholesterol?

Keto is a great tool to lose weight and to lower cholesterol in people with normal and high levels8.

In many cases, the cardiovascular risk is more due to the bad practices of this method than to the diet itself, since it has great support in the scientific community.

As long as the dietary and physical activity recommendations are followed, the person can achieve their weight goals while gaining great energy and vitality.

The best part is that the health benefits last for years8 as it is a diet that can be followed as long as the person requires until reaching their ideal weight with optimal blood values.



  1. Cholesterol: Properties, Processing Effects, and Determination”. T. Dinh, L. Thompson, in Encyclopedia of Food and Health, 2016.
  2. National Center for Biotechnology Information (NCBI): “Influence of dietary carbohydrate and fat on LDL and HDL particle distributions”.
  3. Dietary Guidelines for Americans Eighth Edition 2015 - 2020
  4. A Ketogenic Low-Carbohydrate High-Fat Diet Increases LDL Cholesterol in Healthy, Young, Normal-Weight Women: A Randomized Controlled Feeding Trial”. National Center for Biotechnology Information (NCBI). Read the full article to get more information about it..
  5. National Center for Biotechnology Information (NCBI): “Long-term effects of a ketogenic diet in obese patients”. Exp Clin Cardiol. 2004 Fall; 9(3): 200–205.
  6. Mayo Clinic: “Dietary fat: Know which to choose”
  7. Significant Impact of the Ketogenic Diet on Low-Density Lipoprotein Cholesterol Levels”. Cureus. 2020 Jul; 12(7): e9418. Published online 2020 Jul 27. doi: 10.7759/cureus.9418
  8. Long term effects of ketogenic diet in obese subjects with high cholesterol level”. Mol Cell Biochem. 2006 Jun;286(1-2):1-9. doi: 10.1007/s11010-005-9001-x. Epub 2006 Apr 21.