Keto and blood lipids
When you do a keto lifestyle, your metabolism changes because your body is now burning fat for its primary fuel. Burning fat for fuel means that you are also burning ketones, and ketones substitute for glucose in most of the cells where glucose was used before when you were eating carbohydrates. That’s why this is called a “keto diet,” or a diet that has ketosis. The term for this sort of diet is called nutritional ketosis. That’s to keep it separate from other kinds of ketosis and ketoacidosis, which are significant health problems. Nutritional ketosis just means that you’re a fat burner or a fat-burning machine.
Things will look different in your body on a keto diet
When you change the metabolism, the lipid or blood cholesterol levels also change. Most of the time, the change in lipids is favorable in the way that you would normally expect the cholesterol to change, but sometimes it’s not. You have to understand that the metabolism is so different, it’s like expecting that what we see here on Earth is the same as what would be seen on the moon. The metabolism is so different that even cholesterol, glucose, and ketone levels are different. This causes some consternation and conflict when a traditional doctor looking at a blood lipids profile sees something that is, in their minds, abnormal or outside the “normal” range.
LDL can change its form
The “normal range” is derived from everyone who’s eating carbohydrates. When you don’t eat carbohydrates and follow a keto lifestyle, two-thirds of people will have improvements in the total cholesterol, the LDL, the triglyceride, and HDL – they’ll go in the direction that the traditional doctors want or think is favorable. However, that leaves a third of people for whom the change in the cholesterol levels or LDL, for example, is not the way you would expect. Some people will have an elevation in LDL cholesterol when they follow a keto lifestyle, but I don’t think that’s abnormal, even though it’s not what doctors want or would think is best. The reason for this is that the kind or type of LDL changes. When you follow a keto lifestyle, the small, dense LDL cholesterol goes away or reduces significantly, and the large, fluffy LDL increases. There’s a change in the quality of the LDL cholesterol to a more favorable pattern, even if the number on the lab test goes up. Even so, some people don’t have total elimination of the small LDL cholesterol and still some doctors think that that’s not healthy.
Inflammation is a greater risk factor than cholesterol levels
You have to understand that the current thinking about cholesterol and heart disease is that it starts by this process called inflammation. Inflammation sets the stage for cholesterol to become a problem. If you don’t have inflammation, the cholesterol levels won’t become the same bad guys that we traditionally think of them. Fortunately, on a keto lifestyle, inflammation goes down because you’re having less sugar and you’re having fewer inflammatory elements in your food. With less inflammation, even if the cholesterol isn’t totally fixed, I’m less worried about it as a cause of heart disease.
There’s actually a subset of people – including elite athletes – who have a very high elevation in LDL cholesterol in the way that traditional doctors would become alarmed about and would want to treat it with medication. I have to explain that cholesterol is not a disease; it’s actually an element in the blood that we need for life. Lots of doctors will have a knee-jerk reaction to treat the cholesterol level when really it’s just one element of risk and the whole patient should be considered for risk.
Considering metabolic syndrome is a more holistic approach
The idea of metabolic syndrome is the new way of looking at all of the different elements of risk for cardiovascular disease, not just the LDL cholesterol. Many people come to me today with an elevation in LDL cholesterol thought to be “bad” by the traditional view of how to look at the blood and often they’re even exhorted to start taking medication to treat the cholesterol, but if there’s no other risk factor for heart disease and the risk is actually low, I don’t think a drug is necessary. When you look at a “poor” lipid profile, it may not be as bad as you think. Consult a doctor or health provider who understands how the keto lifestyle changes cholesterol levels and the metabolism and they can explain to you why it’s not something to be worried about.
The keto lifestyle can be straightforward
A simple way to start a keto lifestyle, which is what I use in my clinic, involves really just asking people to eat meat, poultry, fish, shellfish, eggs, a few leafy greens, and non-starchy vegetables until they are comfortably full. The hunger goes away after a day or two and it’s clear sailing from there. Watch the full video here.