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If a doctor notices that LDL cholesterol levels are rising, the diet may no longer be appropriate. Medically reviewed by Steve Kim, MD. We do see temporary increases in cholesterol levels often as individuals transition onto a ketogenic diet. Effects of low-carbohydrate and low-fat diets: a randomized trial.
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The most common heart disease risk factors tend to improve greatly, for most people 1, 2, 3. According to these improvements, low-carb diets should reduce the risk of heart disease. But even if these risk factors improve on average, there can be individuals within those averages that experience improvements, and others who see negative effects. There appears to be a small subset of people who experience increased cholesterol levels on a low-carb diet, especially a ketogenic diet or a very high fat version of paleo. This includes increases in Total and LDL cholesterol… as well as increases in advanced and much more important markers like LDL particle number. However… it is better to be safe than sorry and I think that these individuals should take some measures to get their levels down, especially those who have a family history of heart disease. Some simple adjustments will do just fine and you will still be able to reap all the metabolic benefits of eating low-carb. People who have mostly small LDL particles have a high risk of heart disease, while those with mostly large particles have a low risk 4, 5. However, science is now showing that the most important marker of all is the LDL particle number LDL-p, which measures how many LDL particles are floating around in your bloodstream 6.