“Using fat (ketones) for fuel has been shown to increased the hydraulic efficiency of the heart by 28%, and therefore ketones reduce the workload on the heart. So, if you want to decrease the stress on your heart, fats appear to be the way to go.”
So, I was doing the research for my social media posts on ‘Keto For The Heart’ and then I realized this topic is way too large for a short post. Even this blog post will barely scratch the surface. This is because ketogenic diets are popular in medicine, used for a wide variety of conditions and a topic of much debate.
Much of the time this debate ends up turning into an argument of ‘plant vs animal’ based eating because by nature of the ketogenic diet, it does tend to favour more animal-based foods. Animal product get favoured on account of the fact that they tend to be higher in fat and lower in carbohydrates (carbs). This fits well with true ketogenic diets that outline consuming 70% of your food from fat. Of course, there are variations of the ketogenic diet that are less strict, but ultimately this is a high fat diet.
It also heavily focuses on reducing carb intake, making them the lowest percentage of your diet. Some would argue this is a bad thing and others would argue it’s a good thing. We’re going to cover the different viewpoints later on in this blog!
Ultimately, ketogenic diets are used for many conditions, for many different reasons. However, this post is going to look at the ketogenic diet strictly from a cardiovascular perspective. When it comes to therapeutic diets, there is no ‘one size fits all’ approach to heart health so this post will be for informational purposes only.
Ketogenic Diets & Weight Loss
It is well documented at this point that excess weight will increase your risk of cardiovascular disease, especially if that weight is disproportionately carried in the stomach. Ketogenic diets are one of the ways many people successfully lose weight.
This is in part due to the low carbohydrate aspect of the diet. If we keep our carb intake low, there is less stress on the pancreas to produce insulin. The less insulin we produce, the less likely we are to develop metabolic disorders such as type 2 diabetes and resistance to weight loss.
Increased insulin levels has been shown to promote fat storage and this is why it is commonly targeted in therapeutic weight loss.
The reason excess fat is linked to heart disease is in part due to the fact that fat stores are pro-inflammatory. Inflammation is always an important factor when it comes to our cardiovascular system! It an accelerator of unstable plaque build-up that will ultimately lead to conditions such as heart attack and stroke.
Moreover, when studies look at the effects of diets with different macronutrient (carbs, protein and fat) levels they found that higher fat, whole food diets had the best weight loss and the metabolic markers (ie fasting insulin and triglycerides).(1)
Lastly, it is important to consider what type of fat you consume during a ketogenic diet. The majority of the fat you consume will either be saturated or unsaturated fat. There are certain studies that suggest that a higher proportion of unsaturated fats can make your fat cells more insulin sensitive.(4) Inevitably the increased insulin sensitivity can lead to an increase in fat storage. So, if you aren’t having success with weight loss on the keto diet, the ratio of different fats in your diet should be assessed.
In general, ketogenic diets have good research to back up their use for weight loss and are relatively safe in a clinical setting.
Ketogenic Diets & The Work Of The Heart
Our heart has more mitochondria (‘the engine of the cell’) than any other tissue in the body. This is because the heart is a very energy demanding organ and without the mitochondria’s constant supply of energy it would perish to work. Interestingly, the mitochondria’s preferred fuel source is fat. That is why adequate healthy fat intake is so crucial for proper functioning of the heart.
In fact, studies have shown that if the mitochondria is forced to only use carbohydrates for fuel, it will lead to an increased risk of heart attack. Using fat (ketones) for fuel has been shown to increased the hydraulic efficiency of the heart by 28%(5), and therefore ketones reduce the workload on the heart.(2) So, if you want to decrease the stress on your heart, fats appear to be the way to go.
Ketogenic Diets & Cholesterol
When it comes to cholesterol, doctors are most often worried your LDL-cholesterol specifically. This is a type of lipoprotein that is often referred to as ‘bad cholesterol’. In a ketogenic diet, 50% of the time the LDL-cholesterol will go up. Depending on which doctor you talk to they may be worried about this, or they may not. This divide is because there are studies that conflict with the conventional thought that higher LDL-C is always bad for you.
One reason not to worry is because in some cases this increased LDL-C is a product of the weight loss and will go back down once the weight is maintained. Therefore, the worry of high LDL-C can be offset by the benefit of weight loss on the cardiovascular system. If the high LDL-C persist and is of concern, it can also have something to do with your saturated fat intake. Studies have shown that the increase in LDL-C is more linked to saturated fat, rather than unsaturated fat intake.(6)
To further complicate things, generally speaking low-carb diets will lower triglyceride (TG) levels.(6) TG’s are also linked to a higher risk of heart attack and stroke. So on one hand keto can increase LDL-C and on the other hand it lowers TG’s.
Point being, it’s complicated and ketogenic diets have a mixed effects on our blood lipid markers.
Things To Caution When Starting A Ketogenic Diet
When it comes to keto, the first thing I would caution is that hardcore keto can lead to deficiencies of micronutrients and fibre if not done carefully. That is why it is common to give electrolyte supplements alongside a ketogenic diet. You’re trying to prevent an electrolyte imbalance that could lead to things like muscle aches and kidney stones.
If you are forcing yourself to slow down on your vegetables, in an environment where soils are already notoriously nutrient deficient, likelihood of vitamin and mineral deficiency increases.
That being said, if you go the opposite direction and eat a low-fat plant based diet, you can still get deficiencies they will just be in the fat soluble vitamins.
When it comes to fibre, deficiencies can result in things such as constipation and a disturbed microbiome. This is because fibre is fuel for the ‘bugs’ in your gut and helps distend the digestive tract for proper contraction and movement of food. This is a something you definitely want to consider when starting a keto diet and it might be a reason for some flexibility within the diet.
Additionally, depending on your genetic make-up, you may not tolerate a large amount of saturated fatty acids. Like anything, some of us have a higher capacity to process higher than usual amounts of a certain food group. In the case of ketogenic diets, sometimes you need to alter the ratio of specific types of fat in your diet to better suite your unique body.
Another important aspect of this diet is the social aspect. You need to remember that majority of the world does not eat ketogenic, therefore diets such as these can be isolating. You need to take into context the ramifications of a restrictive diet on your mental health. This may or may not be an issue for you, but it is definitely worth considering when deciding what the best diet for you is.
It is for these reasons, among others not mentioned, a ketogenic diet should always be started under the supervision of a doctor. Not everyone is a good fit for keto and this can be assessed by your doctor.
Summary
When it comes to therapeutic diets you need to treat them the same as any other therapy. A person’s health status, unique risk factors and personal goals should all be be taken into account. That means being careful about how you often dose (ie. how often you follow the diet), the duration of the therapy and how you implement it (ie. are there adjustments that need to be made?).
Professionally, I am a fan of flexibility in the diet. I think training your body to dip in and out of ketosis efficiently has many benefits from a metabolic and cardiovascular viewpoint. By not being strict keto all the time you are still able have variety in your diet and you avoid potential deficiencies that can occur if you eliminate an entire food group.
That being said, sticking to a therapeutic diet for a period of time can be necessary to jumpstart your health journey and shift your health quickly. However, the specific diet you use to kickstart your health journey make look different than someone else’s.
Disclaimer
Information can be empowering, but we all have unique health profiles and needs. The health-related information contained in this article is intended to be general in nature and should not be used as a substitute for a visit with a licensed naturopathic doctor. The advice in this article is not intended to provide medical advice, diagnosis or treatment.
If you would like to learn more about your options, what it might look like to work with me and why an individualized approach is best, please feel free to book your 15 minute ‘Meet and Greet’ today.
References
- Gardner, C. D., Kiazand, A., Alhassan, S., Kim, S., Stafford, R. S., Balise, R. R., … & King, A. C. (2007). Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. Jama, 297(9), 969-977.
- Behrend, A. M., Harding, C. O., Shoemaker, J. D., Matern, D., Sahn, D. J., Elliot, D. L., & Gillingham, M. B. (2012). Substrate oxidation and cardiac performance during exercise in disorders of long chain fatty acid oxidation. Molecular genetics and metabolism, 105(1), 110-115.
- Millis, R. M., Austin, R. E., Bond, V., Faruque, M., Goring, K. L., Hickey, B. M., … & DeMeersman, R. E. (2009). Effects of high-carbohydrate and high-fat dietary treatments on measures of heart rate variability and sympathovagal balance. Life Sciences, 85(3-4), 141-145.
- Alvheim, A. R., Malde, M. K., Osei‐Hyiaman, D., Hong, Y. H., Pawlosky, R. J., Madsen, L., … & Hibbeln, J. R. (2012). Dietary linoleic acid elevates endogenous 2‐AG and anandamide and induces obesity. Obesity, 20(10), 1984-1994.
- Veech, R. L. (2004). The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins, leukotrienes and essential fatty acids, 70(3), 309-319.
- Mansoor, N., Vinknes, K. J., Veierød, M. B., & Retterstøl, K. (2016). Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. British Journal of Nutrition, 115(3), 466-479.