Cholesterol on Keto: LDL Changes and What to Ask Your Doctor

Summary: On low-carb and keto diets, triglycerides usually fall and HDL usually rises, but LDL goes up in some people and not others, so the only way to know your response is a lipid panel before you start and again a few months in.

The short answer

Triglycerides: tend to fall on low-carb diets.
HDL ("good") cholesterol: tends to rise.
LDL ("bad") cholesterol: varies. It rises in some people.
Test, do not guess. Get a lipid panel before you start and repeat it after a few months.
If you have heart disease or high LDL already, plan keto with your doctor. See Who should talk to a doctor.

These summary points come from the National Lipid Association's 2019 statement (Kirkpatrick et al., 2019).

KetoDick on this: he tells viewers to get their lipids checked after starting, and says he plans to watch his own (video cTGYIFOTPl8; video 1m1hPgaRIg4).

The four numbers on a lipid panel

Number	What it is	Usual direction on low-carb
Total cholesterol	All cholesterol carried in the blood	Varies
LDL-C	Cholesterol carried in low-density lipoproteins; linked to heart disease	Varies; rises in some people
HDL-C	Cholesterol carried in high-density lipoproteins	Tends to rise
Triglycerides	Fat carried in the blood; closely tied to carb intake	Tends to fall

Many labs also report a ratio, such as total cholesterol to HDL. Your doctor reads the panel as a whole, along with your blood pressure, blood sugar, smoking status and family history.

What the National Lipid Association says

The National Lipid Association (NLA) is a US group of doctors and scientists who specialise in blood fats. Its 2019 scientific statement on low- and very-low-carbohydrate diets says (Kirkpatrick et al., 2019):

Low-carb diets are not better than other diets for long-term weight loss.
They may give more weight loss in the short term.
They lower triglycerides and raise HDL.
Their effect on LDL is variable.

"Variable" is the key word. Averages hide individuals. One person's LDL may barely move, while another's climbs a lot. You need your own numbers.

What the trials found

Study	Who and how long	Lipid finding
Bueno et al., 2013	Meta-analysis of 13 trials lasting 12 months or more	Very-low-carb vs low-fat: lower triglycerides, higher HDL, higher LDL
Shai et al., 2008 (DIRECT)	322 adults, 2 years	Low-carb gave the largest improvement in the total-cholesterol-to-HDL ratio
Samaha et al., 2003	132 adults with severe obesity, 6 months	Larger falls in triglycerides on low-carb

Put together, the pattern is consistent: triglycerides and HDL tend to improve, while LDL tends to go up on average. Whether a given LDL rise matters for you is a question for your doctor, using your full risk picture.

His account: early spikes and checking

KetoDick's view, in his own words and videos, differs in part from the trials above. Both are stated here so you can see where they agree and where they do not.

What he says:

Long-term studies, as he reads them, find keto generally well tolerated. He says cholesterol "tends to go up a little bit" (from the video), that the HDL-to-LDL ratio improves, that LDL shifts toward larger particles, and that cholesterol "may spike for your first cholesterol reading" but typically improves over six months to a year (video UygKGoP_BtA).
He credits most of the heart-risk improvement to weight loss (video UygKGoP_BtA).
In an earlier video, he says he read that about one in four people on a low-carb, high-fat diet develop a problem with blood lipids, and tells viewers to get tested even if under 30 (video cTGYIFOTPl8).
He says that for some people, lipid levels become a problem around six months into the diet (video 1m1hPgaRIg4).

Where it lines up with the literature: the rise in HDL, the fall in triglycerides and the improved ratio match the NLA statement and the DIRECT trial.

Where it differs: the Bueno meta-analysis found LDL higher on very-low-carb diets at 12 months or more, so "improves over six months to a year" does not describe the average LDL result in that analysis. The evidence pages used for this guide do not report LDL particle size or a one-in-four figure, so those points rest on his reading, not on a source cited here.

His practical advice and the NLA agree on the main action: check your lipids, and do not assume.

Diet choices that may matter

The trials above compared whole diets, not single foods. Still, what fills the fat side of your plate can differ a lot from one keto plan to another.

Fat bombs, butter coffee and heavy cream can add large amounts of saturated fat. See Bulletproof coffee and Fat bombs.
Fat is the flexible part of a keto day. You do not have to hit a high fat number, especially while losing weight. See How much fat.

KetoDick on this: he says he eats only about 10 g more fat a day than before keto, while total intake fell from about 2,000 calories a day to about 1,000 to 1,200, because his appetite dropped (video uXzscHudgt0), and he warns against leaning on fat bombs and daily bulletproof coffee (video cTGYIFOTPl8).

What to ask your doctor

Can I get a full lipid panel before I start, and again in about three months?
Should I fast before the test, and for how long?
Is my insurance going to cover the test? (He suggests checking this first; video cTGYIFOTPl8.)
Given my family history and other numbers, what LDL change would concern you?
Are there other tests you would add for my situation?
If my LDL rises, what would you want me to change first?

Bring the answers back to your plan. If your LDL climbs a lot, you and your doctor may change the type of fat you eat, the size of your carb cut, or the plan itself.

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Last verified: 2026-10-31