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Cardiovascular diseases (CVD) are the leading cause of death globally. The risk of a heart attack or stroke increases [1] significantly with excessive carbohydrate intake or improper insulin management in diabetics . This article explores the relationship between the ketogenic diet and heart disease, highlighting its potential benefits and addressing common concerns.

What will you learn from the article?
Often, the ketogenic diet is cited as a cause of increased serum cholesterol levels. However, there is no strong, unequivocal evidence to suggest that dietary cholesterol significantly raises serum cholesterol levels. The body regulates cholesterol absorption based on its needs. For instance, even the consumption of 25 eggs per day for 15 years did not result in an abnormal lipid profile in an 88-year-old patient[2] .

Inflammation plays a crucial role in the development of cardiovascular diseases by initiating the atherosclerotic process. Excessive inflammation causes endothelial dysfunction, increasing the risk of cardiovascular disease. While aging is a natural cause of inflammation, dietary choices significantly impact cardiovascular health.
The ketogenic diet has proven anti-inflammatory effects, which can prevent or treat cardiovascular diseases. The diet promotes the production of ketone bodies, particularly β-hydroxybutyrate (BHB), which mimics the fasting state and exhibits anti-inflammatory properties. BHB influences gene expression, reduces inflammation, and improves mitochondrial function .

BHB also affects myocardial metabolism and function. The heart has the highest energy requirement of all organs, and BHB can be synthesized through fasting, supplementing with medium-chain triglycerides (MCTs), or taking exogenous ketones. MCTs, which do not require pancreatic enzymes for digestion, rapidly convert to ketones in the liver, enhancing mitochondrial biogenesis and benefiting heart health.

Simple sugars are key pro-inflammatory dietary factors. The ketogenic diet eliminates simple sugars to minimize serum glucose and insulin spikes, which inhibit ketosis. To maximize the benefits of a ketogenic diet, incorporating foods rich in omega-3 fatty acids is crucial. Omega-3s have anti-inflammatory effects and reduce the risk of atherosclerosis and cardiovascular diseases by lowering triglyceride levels, reducing plaque growth, lowering blood pressure, and minimizing inflammation.
The ketogenic diet offers promising benefits for cardiovascular health by reducing inflammation, improving mitochondrial function, and lowering triglyceride levels. While concerns about cholesterol levels persist, the body’s regulatory mechanisms ensure that dietary cholesterol does not significantly impact serum cholesterol levels. By eliminating simple sugars and incorporating omega-3-rich foods, the ketogenic diet can be an effective strategy for preventing and managing heart disease.
[1] O’Brien MJ, Karam SL, Wallia A, et al. Association of Second-line Antidiabetic Medications With Cardiovascular Events Among Insured Adults With Type 2 Diabetes. JAMA Netw Open. 2018;1(8):e186125. doi:10.1001/jamanetworkopen.2018.6125
[2] Kern F Jr. Normal plasma cholesterol in an 88-year-old man who eats 25 eggs a day. Mechanisms of adaptation. N Engl J Med. 1991 Mar 28;324(13):896-9. doi: 10.1056/NEJM199103283241306. PMID: 1953841.
[3] Dyńka D, Kowalcze K, Charuta A, Paziewska A. The Ketogenic Diet and Cardiovascular Diseases. Nutrients. 2023 Jul 28;15(15):3368. doi: 10.3390/nu15153368. PMID: 37571305; PMCID: PMC10421332