Is a ketogenic diet suitable for individuals with hyperlipidemia?

From the Guidelines

The keto diet is not recommended for individuals with high blood lipids due to its potential to further elevate LDL cholesterol levels and worsen cardiovascular risk factors. Instead, a Mediterranean-style diet that emphasizes healthy fats from olive oil, nuts, and fatty fish while limiting saturated fats is a better approach 1. This diet includes plenty of vegetables, moderate fruit intake, whole grains, lean proteins, and avoids processed foods and added sugars. For those with high lipids who still want to try a lower-carb approach, consider a modified Mediterranean low-carb diet rather than strict keto, with 100-150g of carbs daily, primarily from fiber-rich sources.

Some key points to consider when making dietary changes for individuals with high lipids include:

• Limiting saturated and trans-fatty acids and substituting them with unsaturated fatty acids from fish, vegetables, legumes, and nuts 1
• Increasing intake of soluble fibers, such as oat products, psyllium, pectin, and guar gum, which can help reduce LDL cholesterol 1
• Avoiding diets high in total carbohydrate, which can lead to elevated triglyceride and reduced HDL cholesterol levels 1
• Considering a diet high in unsaturated fat, which can provide cardioprotective effects beyond LDL cholesterol lowering 1

Before making any dietary changes, it is essential to consult with a healthcare provider, especially if taking lipid-lowering medications like statins (atorvastatin, rosuvastatin, simvastatin) 1. Regular lipid panel monitoring is also crucial when changing your diet to ensure that the chosen dietary approach is not adversely affecting lipid profiles.

From the Research

Keto Diet and High Lipids

• The keto diet has been shown to have unfavorable effects on total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) in normal-weight adults 2.
• A study found that a keto diet significantly increased TC by 1.47 mmol/L and LDL-C by 1.08 mmol/L compared to control diets 2.
• However, the same study also found that a keto diet significantly increased high-density lipoprotein-cholesterol (HDL-C) by 0.35 mmol/L, which can compensate for unfavorable changes in lipids 2.
• Another study suggested that combination therapy with statins and omega-3 fatty acids can be an effective treatment for combined dyslipidemia, which may be beneficial for individuals with high lipids on a keto diet 3.

Alternative Treatments for High Lipids

• Omega-3 fatty acids have been shown to be effective in reducing triglyceride levels and preventing cardiovascular disease, and may be a useful addition to statin therapy for individuals with high lipids 3, 4, 5.
• Plant-based diets have been associated with reductions in oncological and cardiovascular diseases, and may be a beneficial alternative to the keto diet for individuals with high lipids 6, 5.
• The Mediterranean diet, which is high in fruits, vegetables, whole grains, and omega-3 fatty acids, has been strongly recommended for lowering cardiovascular disease and total mortality 5.

Considerations for Individuals with High Lipids

• Individuals with high lipids should consider the potential risks and benefits of the keto diet, including the potential for increased TC and LDL-C levels 2, 6.
• It is essential to monitor lipid profiles and adjust treatment as needed to minimize the risk of cardiovascular disease 2, 3, 4, 5.
• A clinician guide to counsel patients on nutrition and heart-healthy diets can provide valuable guidance for individuals with high lipids 5.