High Cholesterol, Low Carb, and Ketogenic Diets: What You Need to Know

High Cholesterol, Low Carb, and Ketogenic Diets: What You Need to Know

  • Genes, lifestyle, and insulin resistance influence how you metabolize dietary fat, so people with identical diets can have different cholesterol numbers.
  • Cholesterol does not cause heart disease. Inflammation does.
  • Total cholesterol does not even predict cardiovascular disease (CVD) risk.
  • If you have “high cholesterol” you need to know your inflammation markers, ratio of total cholesterol to HDL cholesterol, cholesterol particle count, and triglycerides before you’ll have a real picture of your risk of CVD.
  • If your doctor tries to put you on mitochondria-damaging statin drugs based on total cholesterol or LDL cholesterol alone, find a better doctor.
  • If the more indicative lab tests show a truly elevated risk, you can modify the Bulletproof Diet for three months and re-test to see if your body’s fat metabolism regulates itself.
  • It is common for people to have higher cholesterol for several months after switching to a high-fat diet as the liver sheds built-up fat.
  • If you’ve had a recent injury or infection, your cholesterol levels will jump temporarily.

You’ve started a Keto-genic diet. You’re eating a ton of vegetables, a little high-quality protein, and the good fats from avocados, grass-fed butter and MCT Oil are turning your brain on like never before. You now know what it feels like to “crush it” on a daily basis — there’s no other way to describe it.

Then, you go in for some routine blood work and see a bunch of changes, and maybe higher cholesterol numbers. Maybe you’re worried. And confused.

If this happened to you, back away from the oatmeal and fat free margarine. With all of this newfound clarity and energy, do you really believe going back to your old ways will fix things?

More than likely, you don’t have the complete story of how your blood lipids actually look. Here’s an explanation of what’s going on:

This is personal to me. Nearly 5 years ago, I was shocked when my blood work results indicated that I was developing insulin resistance and elevated CRP with a high risk for heart attack and stroke. I thought I was healthy but the early detection markers suggested otherwise.  It’s one of the reasons I switched to a modified Keto diet.  Today, my insulin sensitivity is a 2 (out of a scale of 160) and I have control over the real risk factors for heart disease. After tracking my data for the last 5 years on a high-fat diet made of the right type of fats, I’ve lost all fear of cholesterol.

In fact, here’s a huge meta study[1] of nearly 350,000 people showing that saturated fat intake is simply not associated with heart attack risk. I’d been duped.

Cholesterol and cardiovascular disease risk

Before we dive in, here’s an easy way to keep your lipoproteins straight: remember that you want high numbers for high-density lipoproteins (HDL). Low-density lipoproteins (LDL) are simplistically called “bad cholesterol.” The problem is that some LDL cholesterol can be good, and some can be bad, and details matter. Basic cholesterol tests don’t measure these distinctions. This article will show you what details to watch.

When people restrict carbs to 50 grams or less per day, as many people do when they start the Bulletproof Diet, they often see in an increase in HDL cholesterol.

This is a good thing. High HDL activates anti-inflammatory pathways and protects your heart from disease. Even though higher HDL keeps you alive, it will still bump up your total cholesterol numbers, and your blood work may raise eyebrows in the doctor’s office. But, it shouldn’t. Low HDL correlates strongly with a higher risk of metabolic syndrome and cardiovascular disease (CVD).[2] So is total cholesterol an indicator for CVD?

Conventional medicine doctors consider 200 mg/dL to be high, while integrative doctors tend to consider 240 mg/dL to be high. If you think outside the box big pharma has defined for you, then you’re on Team Integrative Medicine for prevention. Still, most MDs acknowledge that total cholesterol does not accurately predict CVD, so they will order a complete lipid panel before doling out statins. Or at least they should.

Increasing saturated fat consumption can cause a beneficial shift in the types of LDL-particles, from small, dense LDL particles (the kind that are correlated with heart disease in some studies)[3] to higher numbers of larger, more buoyant LDL particles (which are not harmful and can be useful metabolically). When this happens, your LDL cholesterol will go up. This is what freaks people out — but hold onto your seat, because this shift is a good thing.

Read on to find out how to find out your particle composition. This really matters because in a small minority of people, saturated fat can increase the number of LDL particles (a metric called LDL-P which is not reflected in standard LDL cholesterol tests). But for the vast majority of people, insulin resistance brought about from high sugar and damaged vegetable oils is what raises these harmful particles.

Doc says you have ‘high cholesterol’. Now what?

Don’t panic. As mentioned before, total cholesterol doesn’t tell you much about your CVD risk. Doctors started tracking it a long time ago because it was one of the first things they could find in blood with primitive lab tests. Seriously!

One study found that nearly 75% of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event. These patients had LDL cholesterol levels that met current guidelines, and close to half had “optimal” LDL levels (less than 100 mg/dL).[4] Doctors would have told these folks that everything is hunky-dory and sent them away to eat more low-fat, high-fructose foods.

You can get one slightly useful piece of data from a standard cholesterol test. Specifically, you want to know whether the ratio of the total cholesterol (TC) to HDL cholesterol is high. In most cases, you’ll find that it hasn’t changed much since you started the Ketogenic diet.

If your total cholesterol to HDL ratio is higher, especially after 6 months on a higher-fat diet, you’ll want to dig deeper to see if you have high LDL-P. If you do, you’ll want more data.





Oxidized LDL Cholesterol

These are the particles that stick to your arteries.  Your immune system mistakes them as invaders which causes inflammation in your arteries  


< 120mg/dL



·          Stop frying your food.

·          Stop eating sugar

·          Keep your inflammation down


Low HDL cholesterol

HDL is “good cholesterol,” and assists in transporting cholesterol from the arteries and tissues for metabolism.  



Eat more high-quality saturated fats



Small dense LDL cholesterol

LDL cholesterol that is smaller and heavier than other LDL particles. This type of LDL spends more time in the bloodstream and is more likely to oxidize. Lower proportion is better. Study participants with no CAD had a mean of 40% small dense LDL; participants with CAD had a mean of 50.1% small dense LDL.  


Elevated levels are associated with risk of atherosclerosis.


High Triglycerides

Fatty acid molecules bonded to a glycerol, measured in the bloodstream.  

70-110 mg/dL


Elevated levels indicate CVD risk or metabolic syndrome.



High Triglycerides/HDL ratio

One of the more important numbers to keep an eye on.  Too much fat in the blood and not enough HDL to transport it for metabolism increases risk.  


<2.0 (the smaller the better)


Higher ratios increase risk of CVD.



Non HDL cholesterol

HDL subtracted from total cholesterol. Without HDL to transport cholesterol for metabolism, other forms can build up  in the arteries.  

Depends on total cholesterol and triglycerides


Particularly concerning if triglycerides are high.


Fasting Insulin/-glucose

Measures your insulin sensitivity – how well you metabolize the sugar you consume. 75-95mg/dL

(>125 mg/dL is a diabetes diagnosis


Higher numbers indicate insulin resistance.


Alphalipoprotein A-1

Plays a role in cholesterol transport. Adult men: > 120 mg/dL

Adult women: >140mg/dL

High levels are associated with lower incidence of CVD.


Alphalipoprotein B

The protein component of LDL Depends on other risk factors.  For low risk individuals, <130 ml/dL is a good range.  

Low levels are associated with lower incidence of CVD.

hsCRP (inflammatory marker)

high sensitivity

c-reactive protein

The liver makes C-reactive protein when there is inflammation in the body.  



Chronic elevation is associated with CVD risk.



Indicates impaired conversion of methionine to cysteine.  


Chronic elevation indicates inflammation and is associated with CVD risk.


Lipoprotein associated phospholipase A2

Lipoprotein-associated phospholipase A2 is an enzyme that marks inflammation of blood vessels, which plays a role in atherosclerosis  




If anything is harming your arteries, Lp-PLA2 goes up as a reaction to that occurring.





For a better picture of your CVD risk, get a detailed cardiovascular blood test that measures particle number and size, as well as other markers of CVD.[6][7][8] You’re getting poked anyway, so go ahead and assess the markers that will give you the full picture. These are all signs that you’re at risk for CVD.

So, what’s the real reason your cholesterol could be high?

Your body’s response to dietary fat will likely be different than your mom’s or your neighbor’s. That’s why some people’s cholesterol lowers when they increase dietary fat and some people experience a spike.  In addition to your individual wiring, other factors affecting LDL cholesterol response include:

  • Obesity
  • Insulin resistance
  • Diabetes
  • Hypertriglyceridemia
  • Gender[9]
  • Recent injury or infection

You and I deal with fats differently because there are so many influences in play. But saturated fat has been the fall-guy when it comes to serum cholesterol levels and diseases like CVD and cancer. Remember the other, more prominent things that contribute to heart disease:

  • Insulin resistance / metabolic syndrome
  • Inflammation
  • Excessive consumption of refined carbohydrates
  • High-fructose corn syrup (HFCS)
  • Smoking
  • High blood pressure
  • Obesity
  • Physical inactivity
  • Pre-diabetes/diabetes
  • Unmanaged stress
  • Family history
  • Cholesterol is a protective metabolic response to toxin exposure or infection

All of these are tied to mitochondrial function.

High fat diets reduce your risk of heart disease

An abundance of evidence shows that high-fat, low-carb diets improve cardiovascular risk factors when you eat the right kinds of fats. A comprehensive review of high-fat ketogenic diets says:

“There are nevertheless several lines of evidence that point to beneficial effects of [ketogenic diets] on these cardiovascular risk factors. The majority of recent studies seem to amply demonstrate that the reduction of carbohydrates can actually lead to significant benefits in total cholesterol reduction, increases in HDL and reduction of blood triglycerides.[10][11] Furthermore [ketogenic diets] have been reported to increase the size and volume of LDL-C particles which is considered to reduce CVD risk since smaller LDL particles[12] have a higher atherogenicity. There is a biochemical rationale behind the effects of KDs on endogenous cholesterol synthesis. A key enzyme in cholesterol biosynthesis is HMGCoA reductase (the target for statins), which is activated by insulin, which means that an increase in blood glucose and consequently of insulin levels will lead to increased endogenous cholesterol synthesis. Thus a reduction in dietary carbohydrate together with a correct intake of cholesterol will lead to an inhibition of cholesterol biosynthesis.”[13]


For more information please go to https://pinnacleintegrative.com/lifestyle-wellness-programs/



[1] https://www.ncbi.nlm.nih.gov/pubmed/20071648…

[2] https://www.ncbi.nlm.nih.gov/pubmed/23651522

[3] http://circ.ahajournals.org/content/95/1/69

[4] http://newsroom.ucla.edu/releases/majority-o…

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PM…

[6] http://www.questdiagnostics.com/home/physici…

[7] https://www.spectracell.com/clinicians/prod…

[8] https://www.bulletproof.com/diet/healthy-eating/high-cholesterol/#ref-8

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PM…

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PM…

[11] https://www.ncbi.nlm.nih.gov/pubmed/23651522

[12] https://www.ncbi.nlm.nih.gov/pubmed/15930434

[13] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC…

[14] https://www.ncbi.nlm.nih.gov/pubmed/17341711

[15] https://www.ncbi.nlm.nih.gov/pubmed/20880415

[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PM…

[17] https://www.ncbi.nlm.nih.gov/pubmed/24739093

[18] https://www.ncbi.nlm.nih.gov/pubmed/24739093

[19] https://www.ncbi.nlm.nih.gov/pubmed/24739093

[20] https://www.ncbi.nlm.nih.gov/pubmed/17291990

[21] http://ajcn.nutrition.org/content/90/5/1138