HomeHealth articlesheart diseaseHow Is Keto-Like Diet Linked to Doubling of Heart Disease Risk?

Keto-Like Diet Linked to Doubling of Heart Disease Risk

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Keto-like diet is linked to higher bad cholesterol levels and a doubled risk of cardiovascular events.

Medically reviewed by

Dr. Yash Kathuria

Published At November 17, 2023
Reviewed AtNovember 17, 2023


Currently, one of the most complex and significant challenges is treating obesity and cardiovascular diseases. A common form of therapy that aims to improve some of the symptoms of metabolic syndrome is weight loss. Several lines of research demonstrate that eating more healthful plant-based foods is linked to a lower risk of cancer and cardiovascular disease (CVD) and a longer life span. The popularity of ketogenic diets (KD), typically high in fats and proteins and very low in carbohydrates, has recently increased. However, results on the effects of these diets on cardiovascular risk factors are debatable.

What Is the Classification of the Keto Diet?

KD has been broadly classified into four types.

  1. First is the conventional or classic type, which has a 4:1 ratio of fat to protein plus carbohydrates. The public may find it challenging and intolerable that 90 % of the energy in this diet comes from consuming fat.

  2. The second type includes medium-chain triglycerides (MCT) such as caprylic, capric, caproic, and lauric acids. In this type, 70 % of the energy is derived from fat, including 10% from long-chain triglycerides (LCT) 60 % from MCT, 20 % from carbohydrates, and 10% from protein. Early absorption occurs as a result of MCT's faster membrane diffusion. Ketone bodies are produced more frequently than the previous type, so less fat must be consumed for an equivalent formulation.

  3. In 1970, Dr. Robert Atkins created the third type of KD, which relies on carbohydrate restriction to help people lose weight. It has a 1.1:1 ratio of 65 % fat, 10 % carbohydrate, and 25% protein. A higher carbohydrate restriction, a high fat intake, and no limitations on calories or protein distinguish it. It was referred to as the Atkins-modified diet.

  4. The fourth type is the low glycemic index (GI) diet, which suggests consuming foods with a GI below 50 and a 6:1 fat-to-carbohydrate ratio.

What Is the Mechanism of the Keto Diet?

Fasting or starvation lowers blood sugar levels, prompting the liver to start gluconeogenesis and break down glycogen stores to produce glucose. As a result, prolonged low blood sugar causes the preferential breakdown of fat, with decreased insulin levels playing a significant role in increased lipolysis.

However, under these circumstances, acetyl-coenzyme A production is hardly the limit of energy metabolism (CoA). This results from the limited capacity of hepatocyte's tricarboxylic acid (TCA) cycle to oxidize oxaloacetate. The liver creates ketone bodies in this manner to provide extrahepatic tissues with metabolic energy. Ketosis is brought on by the preferential breakdown of fats for energy production due to a lack of carbohydrates, which results in low systemic insulin levels.

What Is the Effect of the Keto Diet on Cardiovascular Risk?

The effect of diet on the cardiovascular system has received more attention than any other physiological function. Recent research has looked into the therapeutic effect of the keto diet in cardiovascular disease, particularly in heart failure with a low ejection fraction. Many studies have shown that KD affects cardiovascular health. Numerous risk factors have been linked to the onset and progression of cardiovascular diseases, including:

  1. Age.

  2. Gender.

  3. Genetic heritage.

  4. Smoking.

  5. High blood pressure.

  6. Unhealthy eating habits.

  7. Type 2 diabetes mellitus.

  8. Dyslipidemia.

  9. Obesity.

Dietary interventions have become a crucial part of controlling cardiovascular risks because nutritional factors that profoundly impact human health are linked to cardiovascular disease and other chronic metabolic conditions like obesity and type 2 diabetes.

According to a recent meta-analysis, consuming more carbohydrates was directly linked to an increased risk of CVD and stroke but not for coronary heart disease (CHD) or CVD mortality. However, some studies produced contradictory results. According to Lagiou et al., regular use of low-carbohydrate, high-protein diets without considering the type of protein or the source of the carbohydrates was linked to an increased risk of cardiovascular events in women.

Risk for cardiovascular disease has been determined using carotid intima-media thickness (cIMT). Numerous studies have shown no significant change in cardiac indexes after short- and long-term KD in epilepsy children, including cIMT and the elastic properties of the carotid artery, aortic strain, stiffness index, and distensibility.

According to Kapetanakis et al., a year of KD treatment reduced the carotid artery's distensibility. Carotid artery compliance and cIMT, however, did not improve. The positive effects of KD on the cardiovascular system also disappeared after two years.

What Is the Positive Effect of the Keto Diet on Cardiovascular Disease?

Despite the fact that KD's effects on the cardiovascular system are debatable, numerous studies have shown that the condition may play a role in the prevention, treatment, and reversal of CVD through enhancements in energy induction, endothelial function, mitochondrial function, inflammatory state, and antioxidant effect.

Ketone bodies may specifically increase cardiac efficiency and have cardio-protective effects in patients with heart failure and a low ejection fraction due to improvements in the cardiac metabolic state. Mobilizing fatty acids, glucose, lactate, ketones, and amino acids produces cardiac energy. Ketone bodies have recently come to light as a crucial source of heat energy. Fasting, starvation, uncontrolled diabetes, heart failure, prolonged exercise, and KD consumption provide energy sources. The link between carbohydrate intake and CVD is another potential mechanism for the protective effect of KD on CVD.


KD may reduce oxidation by boosting mitochondrial biogenesis, and have anti-inflammatory effects that lower the risk of cancer and cardiovascular disease, and improve shared risk factors for several conditions (Hypertension, obesity, diabetes mellitus, and dyslipidemia). On the other hand, it is well known that the composition and type of macronutrients in KD may affect its outcomes.

Furthermore, because no study has specifically examined the effects of KD in patients with several illnesses, it is impossible to determine how it interacts with the different pathophysiological pathways involved in each disease. There are people who have undoubtedly been on a ketogenic diet for years without experiencing any negative effects. Debunking some of the myths that this is extremely risky, unsustainable, or not advised by the medical community is necessary. Following such a restrictive diet is also challenging for kids, seniors, and even adults over the long term. In light of this, a different diet may be a better strategy for managing the metabolic disease.

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Dr. Yash Kathuria
Dr. Yash Kathuria

Family Physician


ketogenic dietheart disease
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