At a glance
While a nutrient-focused ketogenic diet is often associated with improved cholesterol balance, it’s not uncommon to see elevated cholesterol levels during the early stages of keto adaptation. Understanding the differences between various types of cholesterol particles and the importance of supporting liver function, as well as choosing high-quality, whole-food fats, can help maintain healthy lipid levels on keto.
It’s a common misconception that a high-fat diet raises cholesterol or that cholesterol is generally harmful. In reality, cholesterol plays essential roles in hormone production, bile formation, and cellular health.
Discover how to lower cholesterol on keto and learn how a nutrient-focused low-carb diet approach can help maintain cholesterol balance and support heart health.
Understanding cholesterol and keto
Cholesterol is a natural, waxy compound that the body utilizes to maintain hormone balance, produce bile acids crucial for fat digestion, and support cell membrane integrity.
Contrary to common belief, the majority of the body’s cholesterol pool is produced in the liver, and only small amounts are derived from dietary sources.
Cholesterol is transported through the bloodstream inside lipoproteins. Low-density lipoprotein (LDL) cholesterol delivers cholesterol from the liver to tissues and cells, while high-density lipoprotein (HDL) cholesterol carries excess cholesterol back to the liver for processing and removal.
When these lipoproteins remain in a healthy ratio and function properly, cholesterol isn’t associated with an increased risk of heart disease and supports a healthy body.
Triglycerides, another type of lipid found in the blood, store unused calories and deposit them into fat cells.
High triglyceride levels often appear alongside low HDL and other cholesterol imbalances, a pattern associated with cardiovascular risk factors and the development of heart disease.
Because the ketogenic diet is naturally high in fat and low in carbohydrates, it changes how the body uses, transports, and metabolizes lipids and cholesterol for energy.
When carbohydrate intake is low, blood sugar and insulin levels decrease, allowing the liver to break down dietary and body fat, including stored triglycerides, as its primary fuel source.
As these fat stores are used for energy, triglyceride levels tend to decrease while HDL rises, reflecting a more effective and balanced lipid metabolism.
LDL levels may fluctuate during the early stages of keto adaptation, and these temporary changes often reflect the body’s transition to fat burning rather than an increase in cardiovascular risk.
These shifts are typically linked to how the body redistributes fats for energy production and transport, an adaptive response that can influence overall cholesterol levels.
This metabolic adjustment supports healthier fat utilization and contributes to long-term cholesterol balance during ketosis.
Watch the video below to learn more about cholesterol balance on keto.
The difference between LDL types
LDL cholesterol isn’t inherently bad, as its impact on cardiovascular health depends on the size and density of its particles.
Smaller, denser, type B LDL particles can penetrate arterial walls and oxidize more easily. This contributes to plaque buildup, arterial stiffness, and inflammation within blood vessels, all of which are risk factors for cardiovascular disease.
In contrast, larger, buoyant type A LDL particles are less likely to cause plaque buildup or inflammation within blood vessels, and aren’t associated with poor cardiovascular health.
“Type A LDL is big and fluffy, so it isn’t involved in plaquing or clotting,” explains Dr. Berg. “However, small-dense LDL particles can enter the epithelial wall and cause plaque formation.”
A review published in Nutrients found that carbohydrate restriction tends to shift LDL toward larger, less harmful type A particles that are less likely to contribute to plaque buildup.
The authors summarize, “Ketogenic diets have been associated with an increase in size and volume of LDL cholesterol particles, which is considered to reduce cardiovascular risk by decreasing atherogenicity.”
These findings suggest that a ketogenic diet can support heart health by improving the overall quality of cholesterol, even if total cholesterol temporarily increases.
This helps explain why evaluating cardiovascular risk factors involves more than just considering overall cholesterol, but requires understanding LDL particle patterns, which provide a more accurate picture of the body’s lipid balance.
Why cholesterol levels may rise when starting keto
Some individuals notice a short-term increase in LDL cholesterol levels after beginning a ketogenic diet. This temporary change typically reflects the body’s adjustment to burning fat for energy, rather than an ongoing imbalance in cholesterol production.
As fat-adaptation progresses, the liver becomes more efficient at processing fats, which can change the demand for LDL particles to transport lipids, including cholesterol, throughout the body.
After metabolic adjustment to fat burning, this increased LDL demand normalizes, which supports balanced cholesterol levels following the initial spike.
A study published in Experimental and Clinical Cardiology found that adults with obesity who followed a ketogenic diet for 24 weeks had lower total cholesterol, LDL, and triglycerides, higher HDL levels, alongside a significant decrease in body weight.
These findings highlight the lipid-balancing benefits of a ketogenic diet and demonstrate that temporary fluctuations are a normal part of adaptation and often precede the long-term benefits.
How to interpret your cholesterol numbers
A standard lipid panel measures total cholesterol, LDL, HDL, and triglyceride levels, which help evaluate how the body processes fat and maintains energy balance.
Generally, total cholesterol below 200 mg/dL, LDL below 130 mg/dL, HDL above 40 mg/dL (for men) or 50 mg/dL (for women), and triglycerides below 150 mg/dL are considered healthy.
Ratios are often more meaningful than single numbers, and a triglyceride-to-HDL ratio below 2 is typically associated with larger, less harmful LDL particles and a lower cardiovascular risk.
Monitoring these values over several months of consistently following a keto diet provides a clearer picture of progress than any single test result alone.
How to lower cholesterol on keto naturally
Improving cholesterol on a ketogenic diet depends on food quality and nutrient balance that support efficient fat metabolism and liver function.
Here are three strategies that can help lower cholesterol on keto naturally.
1. Follow a Healthy Keto® diet
A Healthy Keto® diet emphasizes low-carbohydrate, whole foods that promote ketosis while providing essential nutrients needed for effective fat metabolism and liver support.
Minimally processed foods, such as eggs, wild-caught fish, grass-fed meats, olive oil, avocados, nuts, and seeds, provide a balance of nourishing saturated fats, as well as heart-healthy monounsaturated and polyunsaturated fats.
2. Support optimal liver function
The liver produces bile acids that help remove excess cholesterol from the body, and supporting optimal liver cell function is essential for maintaining balanced cholesterol levels.
Include a variety of non-starchy vegetables, such as leafy greens, broccoli, and cauliflower. These cruciferous vegetables contain glucosinolates, which are compounds that support liver detoxification, promote healthy bile flow, and aid in cholesterol elimination through the digestive tract.
Staying hydrated and limiting alcohol also promotes healthy bile movement, which aids in cholesterol transport and efficient fat processing.
3. Avoid refined seed oils
Refined seed oils, often found in fast foods and ultra-processed foods, are high in omega-6 fats that can disrupt cholesterol metabolism and promote inflammation. These unstable fats oxidize easily, which can contribute to arterial damage and poor lipid balance.
Choosing unrefined, more stable fats such as olive oil, butter, ghee, avocado oil, and coconut oil supports more balanced cholesterol levels and helps promote long-term heart health.
Lifestyle habits that support cholesterol balance
While dietary habits are essential for managing cholesterol, consistent lifestyle habits can also help support the body’s long-term lipid balance.
Here are four lifestyle habits to support cholesterol balance.
1. Stay active
Regular physical activity promotes weight loss, helps the body use fat for energy, improves circulation, and supports higher HDL levels while lowering triglycerides and LDL.
A review published in Sports Medicine found that combining aerobic and resistance training resulted in improved HDL levels while lowering LDL and triglycerides.
Even moderate-intensity movement, such as brisk walking, cycling, or swimming, appears to support cholesterol metabolism and cardiovascular resilience.
2. Manage stress
Chronic stress increases cortisol, the body’s primary stress hormone, which has been found to modulate fat metabolism and can trigger triglyceride and cholesterol imbalances.
Prolonged cortisol exposure also promotes inflammation, thereby contributing to the formation of arterial plaque and impaired cardiovascular health.
Incorporating effective relaxation techniques such as stretching, deep breathing, spending time in nature, or connecting with loved ones can help regulate cortisol and support balanced blood pressure and lipid levels.
3. Prioritize sleep
Insufficient sleep disrupts hormonal balance, impairs insulin sensitivity, and can lead to elevated triglycerides and LDL cholesterol.
Aiming for seven to nine hours of restorative sleep supports metabolic efficiency, helps lower inflammation, and promotes healthy cholesterol balance.
Establishing a consistent bedtime routine and reducing light exposure before sleep further support restful sleep, which in turn benefits cardiovascular and metabolic health.
4. Practice intermittent fasting
Intermittent fasting involves alternating between time-restricted eating windows and fasting periods, which allows the body to rely on stored fat for energy.
Prolonged periods of caloric restriction help lower triglyceride levels, increase HDL cholesterol, and reduce the risk of insulin resistance, all of which support balanced cholesterol levels on keto.
A review published in Nutrition found that intermittent fasting can improve lipid metabolism, increase HDL concentrations, and enhance insulin sensitivity, suggesting significant benefits for both cardiovascular health and metabolic processes.
When to consult a healthcare professional
Routine cholesterol testing helps track how your body responds to diet and lifestyle changes.
A report published by the National Heart, Lung, and Blood Institute (NIH) recommends screening every five years for low-risk adults and more frequently for those over 65 years of age, or individuals with metabolic or cardiovascular concerns.
If LDL remains elevated after several months of consistently following a nutrient-focused keto diet, or if you have conditions such as diabetes, poor thyroid function, or gallbladder issues, it’s crucial to consult your healthcare provider.
Advanced cholesterol testing, such as LDL particle analysis or genetic screening for familial hypercholesterolemia, can provide a more detailed assessment of cardiovascular health and the long-term effects of dietary and lifestyle habits.
It’s also essential to consult a healthcare provider if you are worried about your cardiovascular health or have developed signs of heart disease, such as chest pain, shortness of breath, unusual fatigue, palpitations, or swelling in the legs and feet.
Key takeaways
- Starting a ketogenic diet can temporarily raise cholesterol, but it often improves LDL particle size and increases heart-healthy HDL.
- Cholesterol’s impact on heart health depends on particle type, as large, buoyant type A LDL is less harmful than small, dense type B LDL.
- Following a Healthy Keto diet by prioritizing nutrient-dense, low-carb foods can support balanced lipid metabolism and healthy cholesterol levels.
- Liver support, regular physical activity, stress management, adequate sleep, and intermittent fasting can further help maintain cholesterol balance on keto.
- Persistently high LDL cholesterol or signs of poor cardiovascular function warrant consultation with a healthcare professional.
FAQ
1. Can cholesterol go up when starting keto?
Yes, a keto diet can cause a temporary increase in cholesterol as the body adapts to burning fat for fuel. This is typically a short-term response to a low-carb, high-fat diet that stabilizes as lipid metabolism and liver function adjust to ketosis.
2. What’s the difference between LDL and HDL?
Low-density lipoprotein (LDL) transports cholesterol from the liver to tissues, while high-density lipoprotein (HDL) carries excess cholesterol back to the liver for removal. Balanced LDL and HDL cholesterol levels are essential for maintaining cardiovascular functions and heart health.
3. Is high cholesterol always bad?
The health impact of cholesterol depends on the type and size of the lipoprotein particles. Larger, buoyant LDL particles are less likely to contribute to plaque buildup and atherosclerosis than small, dense LDL particles, which are associated with an increased risk of heart disease.
4. How can I improve my cholesterol naturally?
Following a low-carbohydrate, high-fat diet such as Healthy Keto®, which emphasizes nutrient-dense fats like olive oil, fatty fish, and other saturated and unsaturated fats, can help lower triglycerides, raise HDL cholesterol, and promote healthier LDL particle patterns.
5. Should I stop keto if my cholesterol increases?
Temporary increases in cholesterol are common during the early stages of keto adaptation and usually don’t require stopping the diet. Instead, focus on regular monitoring and choosing nourishing, whole-food sources of fat to help support a healthier lipid profile over time.
However, individuals with preexisting metabolic or cardiovascular conditions or other high-risk groups should consult their healthcare professional for personalized guidance.
