Can your low-carb diet increase your LDL cholesterol? How to lose weight, yet keep LDL at bay?

Switching over to low carbohydrate diets, particularly those like keto, may have become popular because of visible results in weight loss. But they have side effects in the long run — one of them being a rise in LDL (bad cholesterol) levels.

While there has been a plethora of studies on the efficacy of low carb diets like keto on heart health with mixed results regarding their impact on cholesterol, there seems to be a common agreement. Low carb diets like keto can lead to a sudden surge in LDL and triglycerides, the “bad” cholesterol, when the diet is initiated, a surge that may level out only after weeks and months, doing the damage in between for high risk cases. And apparently while people lose fat mass than fat-free mass, their LDL cholesterol levels did not change. Dr Shobha Itolikar, Consultant, General Medicine, Fortis Hospital, Mumbai, suggests dos and don’ts if one is into a particular diet pattern.

Does a low-carb diet increase cholesterol?

A low carbohydrate diet refers to one in which the amount of carbohydrate consumption is restricted and to that effect, it is high in proteins, fibers and/or fats. This type of diet aims to limit the caloric intake of high “sugar” foods such as sweets, pasta, bread, biscuits, rice and other foods with a high glycaemic index. Such a diet looks to incorporate more non-starchy vegetables, nuts, pulses, dairy products, legumes, meat, fish and poultry. The various low carbohydrate diets practiced across the world are ketogenic diets, Atkins diets and Paleo diets, to name a few. These diets switch our body’s fuel burning engine from one dependent on glucose, to one dependent on fats. As a result, in addition to the effect on weight and blood sugar dynamics, these diets also affect our blood cholesterol levels. A basic low-carb diet, in contrast to a low-carb, high-fat diet, will have a favorable outcome on your cholesterol numbers whereas the latter has detrimental effects on the lipid profile by way of increasing the LDL (bad cholesterol) levels and particle numbers.

How does the increase in LDL cholesterol, as well as increases in advanced (and much more important) markers like LDL particle matter?

LDL particle number ( LDL-P) tells us about the burden of bad cholesterol (LDL) which is present in our bloodstream, and which has a likelihood of getting deposited in our tissues and arteries, leading to future heart attacks and stroke. A low carbohydrate diet increases LDL levels mainly due to the inclusion of dietary fats in the meal plan. On the contrary, a low-carb, low-fat diet might offer a favorable reduction in LDL cholesterol levels.

How to lower LDL cholesterol if you are on a low-carb diet?

We can keep LDL cholesterol in check by incorporating the following category of foods in our meal plan:

(1) Soluble fibers like oats.
(2) Plenty of non-starchy vegetables and pectin-rich fruits liked citrus fruits, apples, grapefruits and strawberries.
(3) Healthy fats like mono and polyunsaturated fats like those found in nuts, fish, chia seeds, flax seeds, olives, avocados and so on.
(4) Plenty of water.
(5) Avoid saturated and trans fats at all costs.

What lipid tests should one take?

Those with or without pre-existing cholesterol abnormalities, if aged 65 years and above, should undergo an annual evaluation of fasting (9 to 12 hours) Lipid Profile including measurement of Apolipoprotein B levels, which is a direct laboratory measure of LDL particle number. Those between 45 to 65 years, who have risk factors such as obesity, hyperlipidemia, diabetes, or a strong family history of vascular diseases, should also undergo an annual screening.

What are the dos and don’ts of a low-carb diet?

To follow a low-carb diet effectively, it’s important to do certain things and avoid others:

(1) Inculcate discipline in matters of diet, sleep and exercise.
(2) Cut down on smoking and drinking.
(3) Eat wisely, slowly and watch the portions you eat.
(4) Say no to white foods like sugars, rice, bread, potatoes, pasta, biscuits and margarine.
(5) Follow a low-carb-low fat diet rather than a low-carb-high fat diet.
(6) Periodic evaluation of weight, blood sugar, blood pressure and lipid profile.
(7) Low carb does not mean no carb. It might lead to a “carbohydrate crash.”
(8) Let your appetite be your guide. Do not overeat “permissible food” because anything in excess is not good for your overall health.


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