If you have high cholesterol, the first step to lower it may be changing your diet. But can you still enjoy the foods you like while improving your health?
This question is asked a lot about the keto and carnivore diets. They both allow for juicy steaks and tender pork chops. Keto even allows you to add cheese, butter, and heavy cream to your plate. They include a lot of meat and fat, especially a lot of saturated fat. These diets may actually hurt your heart health, experts say.
“Saturated fat will increase your cholesterol,” says Julia Zumpano, RD, a registered dietitian at Cleveland Clinic. “It’s very important, if you try these diets, you have your cholesterol checked regularly.”
Whether these diets raise your cholesterol depends on several factors. Here’s what you should know.
Keto and Cholesterol: What Science Says
Going keto can lower your weight, but its effects on your health may be unpredictable.
A very low-carb, high-fat diet
A keto diet is a very low-carbohydrate, high-fat eating plan. A typical meal gets most of its calories from fat and protein. Think bacon cheeseburger with lettuce, tomato, mustard, mayo — but with no bun and no ketchup if it contains sugar.
This changes the way your body gets its fuel.
Your body’s key source of fuel is glucose, a sugar produced when you eat carbs. Without carbs, your body goes into ketosis. That means it burns fat to make ketones for energy instead. Some of the fat you burn comes from high-fat foods, but some comes from your own body fat. That’s how keto leads to weight loss.
Keto and your cholesterol: The numbers are mixed
Weight loss doesn’t always lead to lower cholesterol. Your numbers may be mixed.
The keto diet can significantly lower your triglycerides, another type of fat in your blood. High levels of these fats can raise your risk for heart disease. It can also increase your HDL, or “good,” cholesterol. For some people, bad (LDL) cholesterol goes down, too. One small study found that adults with obesity who went keto for six months saw all of these numbers improve.
“But it often causes a spike in bad cholesterol,” Zumpano says. How long that spike lasts and whether it has long-term effects on your heart disease risk is unknown.
“For some, the increase [in LDL] can be temporary or modest,” Zumpano says. “But some have more dramatic, extreme elevations. It is specific to the person and how your body reacts.”
Sometimes, people without obesity can see sharp rises in LDL cholesterol on carb-limiting diets. But there’s not enough research to know how this diet affects your heart risk in the long term.
The benefits of a keto diet also depend on what you eat. A diet built around butter, bacon, red meat, cheese, and cream isn’t the same as one that leans on fish, poultry, olive oil, nuts, seeds, low-carb vegetables, and controlled portions of saturated fat.
Potential benefits of a keto diet may include:
- Drop in triglyceride levels
- Increase in HDL
- Lower blood sugar
- Weight loss
But if your main goal is to lower your LDL cholesterol, it’s hard to know if this diet will help.
The decision to choose this diet should fit your own health needs. If your bad cholesterol rises only modestly but your weight, blood sugar, triglycerides, and HDL all improve, talk to your doctor about the benefits of staying on the diet.
“But if your LDL rises enough that it’s alarming, we may need to go back to a lower-saturated-fat diet,” Zumpano says.
Cholesterol-Healthier Approaches to the Keto Diet
If you have high cholesterol and still want to try keto, you might consider a more heart-friendly version: Limit saturated fats (found in red meat, butter, cream, and cheese) and opt for unsaturated fats.
Better choices may include:
- Fish, seafood, skinless poultry
- Egg whites or fewer whole eggs
- Plain Greek yogurt or cottage cheese
- Olive oil or other plant-based oils
- Nuts and seeds within your carb limit
- Avocado
- Low-carb vegetables, such as leafy greens, broccoli, cauliflower, and zucchini
Another option is to avoid strict keto and choose a low-carb plan. You cut back on sugar, white bread, sweets, sweet drinks, and other refined carbs without going into full ketosis. This may allow room for more fruit, beans, whole grains, and vegetables, which are limited on strict keto but offer many heart-friendly nutrients.
How a Carnivore Diet Affects Cholesterol
This is an extreme keto diet that may jumpstart weight loss.
A zero-carb diet
When you choose this, you’re looking at just meat, poultry, fish, eggs, and some dairy. You completely avoid vegetables, fruits, grains, legumes, nuts, and seeds.
Because it contains almost no carbohydrates, the carnivore diet causes ketosis, which can lead to weight loss and lower blood sugar.
High in saturated fat, low in nutritional value
But when it comes to the diet’s effects on your cholesterol, concerns are huge.
While there isn’t a lot of research focusing on the effects of the carnivore diet, it’s high in animal fat, which is mostly saturated fat. That’s the most unhealthy type of fat and the kind that raises your cholesterol.
This diet isn’t simply a lot of meat. Unlike keto, which allows you to choose more plant oils, nuts, seeds, and vegetables, the carnivore diet removes nearly all plant foods. So this diet lacks fiber and many other nutrients that are good for your heart health and necessary for your body to run well. This diet can raise your risk for gout, osteoporosis, kidney stones, and other kidney problems.
While some people report losing weight, lowering blood sugar, and feeling better on the carnivore diet, there’s no evidence that it improves your heart health.
“We know that high amounts of red meat aren’t good for heart health overall,” Zumpano says.
Cholesterol-Healthier Approaches to the Carnivore Diet
There’s no truly heart-healthy version of a strict carnivore diet because it excludes many foods with heart benefits and cholesterol-lowering properties.
But there are ways to lower your risks.
“Instead of going full carnivore, I recommend at least a low-saturated-fat keto diet,” Zumpano says.
That means limiting fatty red meat and processed meat. Bacon, sausage, hot dogs, salami, and high-fat cuts of beef aren’t part of a cholesterol-friendly diet. Choose leaner options, such as fish, skinless poultry, and lean cuts of meat. Fatty fish, such as salmon and tuna, may be a better choice than fatty red meat because it provides omega-3 fats.
Avoid having large amounts of butter, cream, or other saturated fats. A carnivore diet can already be high in saturated fat.
Another healthier way might be the paleo diet, Zumpano says. “It can create less inflammation and fewer blood sugar spikes, but while allowing for more plant-based foods and oils. It’s a little more inclusive.”
The cholesterol-healthier approach to the carnivore diet is probably not a carnivore diet. It’s a less limiting low-carb plan that includes vegetables, nuts, seeds, berries, legumes, and some whole-food carbs.
What to Monitor With the Keto and Carnivore Diets
If you have high cholesterol and want to try the keto or carnivore diet, consult your doctor to make sure your plan is safe. A registered dietitian can help adapt your food choices to the plan you choose.
Get your baseline numbers before you start. “I think it’d be great to start with a baseline lipid panel to just see where you are before,” Zumpano says.
Ask your doctor about checking:
- Lipids, including LDL, HDL, triglycerides, and total cholesterol
- ApoB, which reflects the number of atherogenic particles that can lead to plaque buildup in your arteries
- Blood pressure
- Blood glucose and hemoglobin A1c
- An inflammatory marker such as C-reactive protein
Give the diet a trial period of one to three months, Zumpano says, then repeat the tests.
If your LDL, blood pressure, or ApoB rises, or your blood sugar worsens, rethink the plan. If your numbers improve, carry on, but stay cautious. Remember that long-term effects may differ from short-term results.
Healthy Alternatives to the Keto and Carnivore Diets
The keto and carnivore diets aren’t good for lowering your cholesterol. The best choice for healthy cholesterol levels and heart health is the Mediterranean diet. It focuses on vegetables, fruits, beans, lentils, whole grains, nuts, seeds, olive oil, fish, and moderate amounts of poultry or dairy. It limits red meat, processed meat, butter, sweets, and highly processed foods.
Other healthy diet options may include:
- The Dietary Approaches to Stop Hypertension (DASH) diet
- The MIND diet, which combines the Mediterranean and DASH diets as a strategy to lower dementia risk
- A low-carb diet that includes lean protein and fiber-rich foods while cutting sugar and refined grains
Before You Start a New Diet
Be aware that the keto and carnivore eating plans may raise your LDL cholesterol — the same thing you’re trying to lower. But they’re not all risk and no reward.
The keto diet comes with some health benefits, too. That may include a drop in your LDL. The overall impact of this diet depends on your health and what you eat. A keto plan high in saturated fat is more likely to cause issues than one built on lean proteins and healthier fats.
The carnivore diet is more concerning. It excludes nearly all plant foods, tends to be high in saturated fat, and there is limited research on its long-term effects. It may help some people lose weight or avoid sugar, but it’s not considered a good way to lower cholesterol.
If you have high cholesterol and want to try either diet, watch your numbers and keep your doctor in the loop. But also keep in mind that the best diet isn’t the one that just improves your numbers for a few weeks. It’s the one that improves your overall health long-term and the one you can keep following.
