Are you afraid to eat a lot of healthy fat on a ketogenic diet?

For decades, the prevailing wisdom of modern science has been that dietary fat causes cardiovascular disease. Therefore, it is no surprise that many people are skeptical of adopting a high-fat low-carb diet.

So is it true that a high-fat diet leads to heart disease? It turns out there is more to the story.

The Truth About Heart Disease

Heart disease is the leading cause of death in the entire world. In the U.S., about 1 in every 4 deaths is due to heart disease. This is a major public health problem.

About half of all heart disease deaths in the U.S. are due to coronary heart disease.

Coronary Heart Disease

Coronary heart disease is a result of a buildup of arterial plaque which restricts blood flow and stresses the heart. Arterial plaque is a wax-like substance that consists primarily of calcium and cholesterol among smaller amounts of various other biological substances.


Arterial plaque forms as a result of damage to the arterial wall. Arterial walls are damaged by free radicals in the blood. The plaque acts as a sort of bandage to plug up the damaged area of the arterial wall.  But when this process becomes pathological, the plaque can buildup to a point that it begins to restrict blood flow in the arteries.

The process or plaque formation is called atherosclerosis.

So what causes atherosclerosis?

Fat and Cholesterol

High fat diets are linked to atherosclerosis.¬† Due to dietary fat’s tendency to raise cholesterol levels in the blood, this is a reasonable conclusion. Certainly it is true that cholesterol is one of the primary constituents that makes up arterial plaques. Therefore, it makes sense that lower cholesterol levels will lead to less coronary heart disease.

Yet the truth is not so simplistic. There is another factor in the equation: inflammation.

Remember, cholesterol is only a problem when you have a damaged arterial wall. The primary cause of arterial damage is inflammation in the body. Furthermore, whether or not inflammation leads to atherosclerosis depends on what type of cholesterol is present in the blood.

Types of Cholesterol

There a multiple types of cholesterol particles found in the bloodstream. These different types of particles have different shapes, sizes, and functions.

You have probably heard of “good cholesterol” and “bad cholesterol.” So what is the difference?

HDL “Good” Cholesterol

The acronym HDL stands for “high density lipoprotein.” HDL cholesterol is typically characterized as “good” because it is generally associated with a lower risk of heart disease.

These particles are small and dense. Their primary function is to absorb cholesterol and transport it to the liver to be flushed from the body.

LDL “Bad” Cholesterol

The acronym LDL stands for “low density lipoprotein.” These particles are associated with an increased risk of heart disease. This is the cholesterol that can build up as plaque on the arterial walls. However, not all LDL particles are dangerous.

There are two types of LDL cholesterol particles. LDL subtype A is a large fluffy cholesterol particle that is considered less problematic. While LDL subtype B on the other hand is a small dense particle that is considered a risk factor for heart disease.

So why is LDL B more dangerous than LDL A? The small and dense LDL B particles are more prone to stick to the arterial wall and build up as plaque.

Thankfully, a healthy ketogenic diet can help. Low-carb diets will increase LDL A while decreasing LDL B in the blood.

Keto Diet and Cardiovascular Health

Small dense LDL particles can accumulate on the arterial wall in atherosclerotic plaques. These plaques form in response to arterial damage. Therefore, in order to prevent the formation of atherosclerotic plaques, you must prevent damage to the arterial walls.

A low-carb ketogenic diet will decrease inflammation in the body. Less inflammation leads to less arterial damage.

Additionally, keto diets help regulate blood sugar. Chronically elevated blood sugar is a risk factor for diabetes. Those with diabetes have a higher risk for heart disease.

Similarly, another strong risk-factor for heart disease is obesity. Low-carb diets often lead to weight loss and overall better health.

Eat Good Fat

If you want to use a ketogenic diet for heart health, you need to eat the right fats.

Good fats include: Olive oil and avocado oil – these fats raise good cholesterol

Fats to eat in moderation include: Grass-fed ghee and butter, coconut oil, palm oil, egg yolks, and pasture-raised beef tallow – these fats raise good and bad cholesterol

Fats to avoid include: Canola oil, soybean oil, safflower oil, grapeseed oil, and vegetable oil – these fats raise bad cholesterol

Include Low-Carb Vegetables

You also want to make sure you consume an abundance of low carb vegetables. Vegetables provide fiber, vitamins, minerals, and phytonutrients that help protect the cardiovascular system. It is particularly important to consume foods high in vitamin C. Because vitamin C is essential is the repair of blood vessels, it is one of the most important nutrients to prevent atherosclerosis.

The Bottom Line

You do not need to be afraid of eating healthy fat! While dietary fat does increase cholesterol, it depends on the type of fat you eat. Furthermore, inflammation in the body ultimately determines whether or not cholesterol will accumulate in to atherosclerotic plaques.

If you go to the doctor for blood work, make sure your doctor runs an NMR lipid profile when you get your cholesterol checked. This will separate out your LDL sub particles and give you a better idea of your heart disease risk.

Eat plenty of low-carb vegetables, watch your stress levels, and get plenty of sleep. These lifestyle habits combined with a low-carb ketogenic diet are likely to support a healthy cardiovascular system.