Is Ketosis Good for High Cholesterol?

Medically Reviewed on 1/23/2023

What is the keto diet?

On the keto diet, 75% of your calories should come from fat. Information on ketosis and cholesterol is still quite limited as only short-term trials have been done.
On the keto diet, 75% of your calories should come from fat. Information on ketosis and cholesterol is still quite limited as only short-term trials have been done.

In the age of fad diets, new ones keep popping up all the time to address different health concerns. One diet that’s become quite popular in recent years is the keto diet — a low-carb way of eating that many people follow for rapid weight loss. While many people find success on this diet, what are the risks and benefits that you should know about? When it comes to ketosis and cholesterol, here’s what you need to know about eating on keto.

While many low-carb diets focus on protein, the ketogenic diet, or keto, is based on fats. In fact, at least 75% of your daily calories should come from fat if you’re correctly following a keto diet. You need to eat a variety of high-quality fats, a good amount of protein, and a low number of net carbs. 

To calculate your net carb intake, take the total number of carbs in grams and subtract the grams of fiber in the product. By cutting out most carbs, your body will use fat as its main energy source. For many, this results in weight loss, while for others, there can be many other positive health effects.

Normally, your body uses glucose, a type of sugar, as its primary fuel source. Glucose is in all kinds of carbs, including grains, legumes, and fresh produce. If you’re on the keto diet, your liver creates ketone bodies from stored fat that your body can use as energy. And if you’re going to follow this diet, you need to track your macronutrients, especially proteins, fats, and carbs, to make sure you’re eating the right amount of each.

What do you eat in ketosis?

To stay in ketosis, your body should have the following macronutrients:

  • 75% of your total calories should be from fat
  • 5% should be from carbs, from 20 to 50 grams a day
  • 15% from protein

Once you start on this diet, it may take about 2-4 days for your body to transition to using sugar instead of fat for energy. Keep in mind that these guidelines work for most people, but every body is different. To reach ketosis, you may need to make some changes with these proportions.

The keto diet can be quite restrictive since you need to cut out foods like legumes, whole grains, and many different kinds of fruit. While on the keto diet, you’ll be eating:

  • Meat
  • Poultry
  • Organ meat
  • Fatty fish and seafood
  • Processed meats, including sausage and bacon
  • Eggs
  • Full-fat dairy
  • Non-starchy vegetables
  • Salad greens
  • Fats like avocado, olives, oil, and butter
  • Some fruit in small portions, like berries

Keep in mind that there are many kinds of keto diets, but all of them discourage eating foods rich in carbs. Consuming sugary foods, starchy vegetables (potatoes, sweet potatoes, corn), rice, pasta, and fruit juice will not get you into ketosis. Since keto is a high-fat diet, people can end up eating large amounts of food high in saturated fat that can raise cholesterol levels in your body. 

Ketosis and cholesterol

Information on ketosis and cholesterol is still quite limited as only short-term trials have been done. Most studies compare keto to the Mediterranean diet and other low-carb diets.

One study showed that low-carb diets are more successful in achieving long-term weight loss than low-fat diets. Low-carb diets like keto and the Mediterranean diet can be more helpful in managing health conditions like diabetes. However, studies have different results regarding heart health on keto.

Research findings are also mixed on the effect of keto on LDL cholesterol, the cholesterol associated with heart disease and stroke. Some studies show that people on the keto diet may experience an increase in LDL. 

However, experts think this could be due to genetic factors. Others believe that it could be due to the amount of saturated fat, the bad kind of fat, that some people may choose to eat on the keto diet.

Conversely, some studies report overall lower cholesterol on keto. In one study, people had lower triglyceride levels on a keto diet than when they were on other low-carb diets. Triglycerides are particles that carry fat into your bloodstream.

The keto diet can also give your body a boost of HDL cholesterol, the good kind of cholesterol that protects your heart and can lower your risk of heart disease. People on low-carb diets see the best changes in their cholesterol levels when they incorporate more healthy fats and proteins.

What to consider if you have high cholesterol

If you have high cholesterol, you shouldn’t eat high amounts of saturated fat. Saturated fat is found in lots of animal products, including beef, dairy, and processed meat. An alternative to the keto diet in this case could be the Protein-Sparing Modified Fast (PSMF), a low-carb diet that also puts your body into ketosis. On this diet, you can eat:

  • Lean meat
  • Lean poultry
  • Seafood
  • Low-carb vegetables

This diet doesn’t call for high-fat foods or those that have saturated fats, like the keto diet.

Apart from the classic keto diet, there are other diets that you can follow to get into ketosis. They are all modified to fit different needs and lifestyles. These include:

  • MCT oil diet
  • Modified Atkins
  • Intermittent fasting
  • Low Glycemic Index Diet (LGIT)
  • Modified ketogenic diet


Foods That Aren't as Healthy as You Think See Slideshow

Starting out on the keto diet

You may notice some brief side effects when you begin the keto diet. It’s common to experience symptoms of the "keto flu" in the first 2 to 4 days into the diet as your body adapts. Some keto flu symptoms include:

These symptoms can last anywhere from a few days up to one week.

Even though many people find success in following keto for weight loss, many experts agree that the ketogenic diet can be hard to sustain in the long term because of its restrictive nature. You may also be at risk for a nutrient deficiency because of the various food groups that are cut out of the keto diet.

Medically Reviewed on 1/23/2023

Harvard Health Publishing: "Should you try the keto diet?"

Harvard T.H. Chan: "Low-Carbohydrate Diets."

HEART UK: "Ketogenic Diet and Lipids."

Regional West: "Protein Sparing Modified Fast."

Stanford Medicine News Center: "Keto and Mediterranean diets both help manage diabetes, but one is easier to maintain."

The Charlie Foundation: "Learn About Ketosis."

UCDavis Department of Nutrition: "Nutrition & Health Info Sheets for Health Professionals - The Ketogenic Diet."

UChicagoMedicine: "Ketogenic diet: What are the risks?"