Cholesterol and Keto - Navigating Test Results

Sharyn Carter

Navigating Cholesterol Test Results on Keto 

So you’ve had a blood test and found out you have high cholesterol. Don’t panic, a lot of New Zealanders have ‘high cholesterol’ so you’re not alone. But that doesn’t mean you can sit back and relax either, as high blood cholesterol is a major health concern in New Zealand.

It’s important to get on top of your cholesterol as you get older and particularly if you’re already at risk of heart disease. And doing this requires understanding cholesterol tests beyond single numbers, as well as keeping perspective  depending on where you are at in your Keto Journey. 

New to Keto with Cholesterol?

While high cholesterol test results at the start of a keto diet may be concerning, it's essential to view them in the context of overall health and to approach dietary changes with a holistic perspective. With proper monitoring and guidance, many individuals can successfully manage their cholesterol levels while reaping the potential benefits of the keto diet.

What typically happens is that cholesterol levels do go up and then soon after settle back down again, typically to a baseline lower than a person's original measurements. Should you receive high cholesterol test results at the beginning of starting a ketogenic (keto) diet, it's understandable for you to feel concerned. However, there are several reassuring points to consider:

Initial Response to Diet Changes: It's common for cholesterol levels to fluctuate, especially during the initial phase of adopting a new diet like keto. When transitioning to a low-carbohydrate, high-fat diet such as keto, your body undergoes metabolic changes that can temporarily affect cholesterol levels.

Focus on Overall Health: While cholesterol levels are important indicators of cardiovascular health, they are just one piece of the puzzle. Remember that the keto diet offers numerous potential health benefits beyond cholesterol management, such as weight loss, improved blood sugar control, and increased energy levels.

Consider the Big Picture: High cholesterol levels on their own may not necessarily indicate an increased risk of heart disease. Factors such as family history, lifestyle habits, and other health markers also play a significant role in assessing cardiovascular risk. 

Potential Short-Term Changes: Some individuals may experience transient increases in LDL cholesterol levels when starting the keto diet. However, this doesn't necessarily mean that their overall cardiovascular risk has increased. For many people, these changes may stabilize or even improve over time as the body adapts to the new dietary pattern.

Monitor Progress: Regular monitoring of cholesterol levels is essential when making dietary changes. Continue to track your cholesterol levels over time, ideally with the guidance of a healthcare provider. This will help you assess how your body is responding to the keto diet and make any necessary adjustments.

Focus on Healthy Fats: Emphasize consuming healthy sources of fats while following the keto diet, such as avocados, nuts, seeds, and fatty fish. These fats can have positive effects on cardiovascular health and may help balance cholesterol levels over time.

Consult a Professional: If you have concerns about your cholesterol levels or overall health while on the keto diet, don't hesitate to seek guidance from a healthcare professional. They can offer tailored advice based on your individual health status and help you navigate any challenges along the way.

Understanding cholesterol components

When we talk about cholesterol it's easy to think it's one thing inside your body. Yet it has three distinct components and each is affected differently by a Keto way of eating. After the components are understood, then it's much easier to make sense of your personal test results. 

Triglycerides: The keto diet often leads to a significant reduction in triglyceride levels. Triglycerides are a type of fat found in your blood. When you consume fewer carbohydrates, your body produces fewer triglycerides, which can result in lower levels in your bloodstream.

HDL Cholesterol: High-density lipoprotein (HDL) cholesterol is often referred to as "good" cholesterol because it helps remove other forms of cholesterol from your bloodstream. Some studies suggest that the keto diet can increase HDL levels, which is generally considered beneficial for heart health.

LDL Cholesterol: Low-density lipoprotein (LDL) cholesterol is often dubbed "bad" cholesterol because high levels can lead to plaque buildup in your arteries. The effect of the keto diet on LDL cholesterol levels can vary among individuals. While some people experience an increase in LDL cholesterol, others may see no change or even a decrease. However, it's crucial to note that the type of LDL particles matters. Some individuals on the keto diet may experience an increase in larger, less harmful LDL particles, while others may see an increase in smaller, denser LDL particles, which are more concerning for heart health.

So those doing Keto are advised to not pay much attention to the individual numbers, what's important is the ratio. 

Calculating your Cholesterol Ratios

Here's a calculator online that allows you to calculate yours based on your test results.
Note: You may need to first convert your test results into mmol format in order to key in data to make this calculator work. Google can assist you with this math.    

Healthy Range of Cholesterol Ratios

Healthy test results in terms of ratios from the NZ Guidelines for blood cholesterol levels are: 

Total Cholesterol to HDL Ratio: This ratio compares total cholesterol to high-density lipoprotein (HDL) cholesterol, often considered the "good" cholesterol. A lower ratio indicates lower cardiovascular risk, as HDL cholesterol is protective against heart disease.
Ideal: Less than 4      Acceptable: 4 to 5      High Risk: Above 5

LDL to HDL Ratio: This ratio compares low-density lipoprotein (LDL) cholesterol, often considered the "bad" cholesterol, to HDL cholesterol. A lower ratio suggests a lower risk of heart disease, as higher levels of LDL cholesterol relative to HDL cholesterol are associated with increased cardiovascular risk.
Ideal: Less than 2.5      Acceptable: 2.5 to 3.5      High Risk: Above 3.5

Triglycerides to HDL Ratio: This ratio compares triglyceride levels to HDL cholesterol levels. Higher levels of triglycerides relative to HDL cholesterol are associated with increased cardiovascular risk.
Ideal: Less than 2      Acceptable: 2 to 3.5      High Risk: Above 3.5

Note: These ratios are used alongside absolute cholesterol levels and other risk factors to assess overall cardiovascular risk.

Interpreting Cholesterol Ratios in Context

It's important to interpret cholesterol ratios in the context of individual health profiles and consider other risk factors such as age, gender, blood pressure, smoking status, and family history of cardiovascular disease.

Individuals with specific health conditions or risk factors may have different target ratios or cholesterol goals, so it's essential to consult with a healthcare professional for personalized guidance and recommendations.

Individual Cholesterol Components and their Healthy Ranges  

LDL - less than 2.0 mmol - often called 'bad' cholesterol.
It takes cholesterol from your liver to different parts of your body.
When there's too much LDL cholesterol, it builds up on the inside of your blood vessels. This makes your blood vessels narrow, putting you at risk of heart disease or stroke.

HDL: Greater than 1.0 mmol/L - often called "good" cholesterol.
It takes extra cholesterol away from your arteries to your liver, to prepare it to be removed from your body. Higher levels of HDL lower your risk of heart disease or stroke.

Triglycerides: Less than 1.7 mmol/L - these store and transport fat in your blood.
Energy from food and alcohol that your body doesn't use is changed to triglycerides. High triglycerides increase your risk of heart attack and stroke.

Total cholesterol: Less than 4.0 mmol/L - This is a rough measure of all the cholesterol and triglycerides in your blood.

Keto Diet and the Links to Cholesterol 

The relationship between dietary fat intake and cholesterol levels is complex and has undergone significant scrutiny and refinement over the years. While it was once widely believed that dietary fat, particularly saturated fat, directly increases cholesterol levels in the blood, understanding has evolved. The topic remains an area of ongoing research and debate within the scientific community. In the Cholesterol Clarity book by Jimmy Moore, he explores more recent learnings and challenges conventional wisdom about cholesterol markers, and debunks the idea that fat increases cholesterol. 

Role of Saturated Fat: Saturated fat intake has been historically linked to increased levels of LDL (low-density lipoprotein) cholesterol, often referred to as "bad" cholesterol. However, more recent research suggests that the relationship between dietary saturated fat and blood cholesterol levels is not as straightforward as previously thought. Some studies have found that the effects of saturated fat on blood cholesterol levels can vary among individuals, with factors such as genetics, overall dietary patterns, and metabolic health playing significant roles. 

Types of Dietary Fat: Not all fats have the same impact on cholesterol levels. While saturated fats may raise LDL cholesterol levels in some individuals, other types of fats, such as monounsaturated and polyunsaturated fats, may have neutral or even beneficial effects on cholesterol profiles. For example, foods rich in omega-3 fatty acids, such as fatty fish, have been shown to reduce triglycerides and lower the risk of heart disease.

Context Matters: The overall quality of the diet and lifestyle factors, such as physical activity levels, also influence cholesterol levels and cardiovascular health. Consuming a diet high in processed foods, refined carbohydrates, and added sugars may contribute to adverse lipid profiles, regardless of fat intake. Therefore, it's essential to consider dietary patterns holistically rather than focusing solely on individual nutrients like fat.

Individual Variability: People respond differently to dietary fats based on various factors, including genetics, metabolic health, and baseline cholesterol levels. Some individuals may experience significant increases in LDL cholesterol in response to saturated fat intake, while others may not. Personalized dietary recommendations based on individual health status and risk factors are crucial for optimizing cholesterol levels and overall cardiovascular health.

In summary, while the idea that dietary fat directly increases cholesterol levels, particularly saturated fat, has been revisited in light of emerging evidence, the relationship is more nuanced than previously believed.

The type of fats you consume matter

This article published in The Lancet was a systematic review and meta-analysis across multiple studies that aimed to assess all the associations between dietary saturated fat intake and heart disease.

The study included data from observational studies and randomized controlled trials (RCTs) and found that different types of fatty acids have varying effects on heart disease risk. 
  • Saturated fats were associated with an increased risk of heart disease, particularly when they replaced polyunsaturated fats or carbohydrates in the diet.
  • Omega-3 and omega-6 polyunsaturated fats, as well as monounsaturated fats, were associated with a reduced risk of heart disease when they replaced saturated fats or carbohydrates in the diet.

Healthy Sources of Omega 3 Fats

Golden Flaxseeds are an excellent source of alpha-linolenic acid (ALA), a plant-based omega-3 fatty acid. 

Chia seeds contain ALA and are a good plant-based source of omega-3s.

Basil seeds are high in fibre, a good source of minerals, and rich in plant based omega-3 fats. 

Products Keto Store NZ sell that lower cholesterol 

Multiple studies have shown the following products are known to reduce total cholesterol, reduce LDL (bad) cholesterol and increase HDL (good) cholesterol. 


INULIN (Unflavoured as well as the extensive Flavour It range) 
Meta-analysis by Causey et al. (2003): This meta-analysis examined the results of 16 randomized controlled trials involving the effects of inulin on blood lipids. The analysis found that inulin supplementation significantly reduced total cholesterol levels, reduced LDL cholesterol levels, and lowered triglyceride levels, while also increasing HDL cholesterol levels.
• Brighenti et al. (1999): This study investigated the effects of inulin supplementation on blood lipids in healthy volunteers. Participants consumed either a control diet or a diet supplemented with inulin for three weeks. The results showed that inulin supplementation significantly reduced total cholesterol and LDL cholesterol levels compared to the control diet. Additionally, inulin supplementation led to an increase in fecal excretion of bile acids, indicating a potential mechanism for its cholesterol-lowering effects.

PSYLLIUM HUSK (powdered as well as flakes
• Anderson et al (2000) This meta-analysis looked at 8 randomized controlled trials involving psyllium fiber and its effects on lipid levels. The researchers found that psyllium supplementation significantly reduced total cholesterol and LDL cholesterol levels. They concluded that psyllium fibre, as a dietary supplement, could be beneficial in lowering blood lipid levels, particularly in individuals with high cholesterol levels.

• Jenkins et al (2002) This study investigated the cholesterol-lowering effects of psyllium-enriched cereals in hypercholesterolemic men and women. Participants consumed either a psyllium-enriched cereal or a control cereal for 6 weeks. The results showed that the psyllium-enriched cereal significantly reduced total cholesterol and LDL cholesterol levels compared to the control cereal.

Foods like garlic and to a lesser studied onion have allicin compounds that also have the effect of lowering cholesterol. Both our Garlic Powder and Onion Powder products are 100% pure, with no fillers. So their usage sprinkled into your meals would add to the every little bit helps approach.

• Bordia et al. (1998): This study investigated the effects of garlic powder supplementation on lipid levels in patients with elevated cholesterol levels. The results showed that garlic powder supplementation led to significant reductions in total cholesterol, LDL cholesterol, and triglyceride levels, with simultaneous increases in HDL cholesterol levels.
• Brull et al. (2007): This randomised double-blinded placebo-controlled cross-over trial investigated the effects of onion consumption on lipid profiles. The results showed that consuming a diet supplemented with onion powder led to improvements in total cholesterol and LDL cholesterol levels compared to a control diet. 

The medical bit

There is a lot you can do when it comes to improving your cholesterol and of course the key is to tweak and have consistently scheduled tests to monitor your improvements over time. And always, this is not meant to replace medical advice. 

These guidelines are subject to updates and variations based on evolving research and expert consensus within the medical community.

Individuals with specific health conditions or risk factors may have different target ratios or cholesterol goals, so it's essential to consult with a healthcare professional for personalised guidance and recommendations. Stress undermines any attempt at health, so if you are worried, then do seek out health care information from reputable sources.