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Keto Diet & Heart Disease 2024: Is There A Link Between Them?

Heather Freudenthal

Updated on - Written by
Medically reviewed by Brittany Ferri, Ph.D.

Keto Diet & Heart Disease
Research on the keto diet and heart disease is ongoing. Photo: EZ-New Africa/Shutterstock

The ketogenic diet, or “keto” for short, is a diet low in carbohydrates and high in fat. The goal of the keto diet is to help the body burn fat rather than carbs for energy, also known as ketosis. By restricting carbohydrate intake to small amounts (around 50 grams per day), the body essentially runs out of glucose (the sugar from carbs) to burn, deferring to fat. While this can be helpful for losing weight the fact remains that this diet is high in fat and low in fiber, and if not done properly, could pose serious consequences for heart health. Learn what is the link between the keto diet and heart disease, and how to protect your heart on the keto diet, including understanding kiwi benefits, exercising, and regularly including more vegetables with your meals, because cooked vegetables reduce heart disease.

Keto Diet And Heart Disease 

When it comes to the keto diet and heart disease, both dieticians and cardiologists need to weigh in on the link. Research is ongoing and although there isn’t a conclusive link yet, evidence suggests that the keto diet may have long-term health consequences, particularly as it pertains to the heart.

Keto Diet And Heart Disease: Is There A Link Between Them?   

On the one hand, research shows that the keto diet could have a positive effect on heart health due to weight loss.[1] By losing weight and increasing insulin sensitivity (helping insulin to function better), an individual can lower their blood pressure, and LDL cholesterol, and in turn, protect themselves from heart disease. 

That being said, the keto diet is high (around 70%) in saturated fat, a suspected culprit in damaging the heart, clogging arteries, and increasing the risk of stroke. While some studies have not linked saturated fat with heart disease, they do suggest that saturated fat increases overall mortality risk.[2] All the more reason why, if you’re going to eat a keto diet, it’s essential to choose high-quality, healthy sources of fat such as nuts, seeds, avocados, eggs, grass-fed and organic meats, wild-caught fish, and olive oil, rather than unhealthy saturated fats. 

Additionally, a keto diet tends to be lower in fiber than some other diets because the emphasis is placed on fat, rather than fruit, vegetables, and whole grains (good sources of fiber). Fiber plays a crucial role in not only digestion but heart health as well. Therefore, not getting enough fiber may have unfortunate implications for the heart.

Does The Keto Diet Cause Heart Disease? What Research Says 

Although the keto diets alone do not directly cause heart disease (or at least, it has yet to be proven), there are aspects of this dietary approach that can indirectly contribute to poor heart health. For example, those who tend to follow a more “dirty” keto diet in which high-fat/low-carb is prioritized over the quality of the food, are more likely to ingest unhealthy, inflammatory fats[3] which can raise blood pressure and cholesterol, as well as contribute to obesity. Over time, these symptoms can lead to stroke and heart attack. Furthermore, a keto diet tends to minimize or overlook the need for dietary fiber which can help prevent heart disease.

Overall, it’s always best to consult your healthcare provider to establish if a keto diet is right for you, as well as a nutritionist or dietician who can help you tailor the diet to a more heart-healthy version. There are also Individual differences that play a role in whether or not a keto diet will contribute to heart disease, such as a personal history of heart disease, other pre-existing conditions, and any medications you may be taking.

Recommendations For Heart Patients On A Keto Diet

Recommendations For Heart Patients On A Keto Diet
There are some notes for heart patients on a keto diet. Photo: EZ-Stock Studio/Shutterstock

Control Portions

If a strict ketogenic diet is important to you, at the expense of healthier food choices, then watching your portion sizes can be a great asset. In other words, you may choose to include saturated fats in your diet for the sake of getting enough fat, but as long as you keep those portion sizes small and include healthier fats, you’ll reduce your risk for heart disease.

Choose Fresh Produce 

Don’t overlook fresh fruits and vegetables while on the keto diet. These essential foods are too often overlooked on the keto diet because the focus tends to be on only two things: keeping fats high and carbs low. However, there are plenty of low-sugar fruits and non-starchy vegetables that are perfectly acceptable on the keto diet. Eating these foods can help you not only adhere to the diet, but protect your heart with their antioxidants, vitamins, minerals, and fiber.

Choose Fats Wisely

If you’re concerned about your heart health, it’s crucial to be discerning about your dietary fat. To put it bluntly, you’ll need to steer clear of saturated fats in processed foods, fried foods, fast foods, and the various unhealthy snacks on the market: chips, ice cream, donuts, etc. Instead, you’ll need to focus on healthy, omega-3 fats which have the opposite effect: they are anti-inflammatory and enhance heart health rather than decrease it. This has important implications for managing weight and diabetes,[4] as well as heart health.

Exercise

Aside from tweaks you can make to food, including regular exercise,[5] particularly cardio, in your routine will make a huge, positive impact on your health. Exercise has been shown to improve blood flow and cardiovascular health and reduce cardiovascular disease, as well as help lose weight (another component of maintaining a healthy heart), manage diabetes, and reduce high blood pressure. So go for a swim, bike ride, jog, or dance around your living room a few times a week to get your heart rate up.

Sleep Well

Recurring poor sleep can have detrimental effects on health, including heart health. While on the keto diet, especially, potentially taking high amounts of unhealthy fats and little fiber, it’s crucial not to add fuel to the flame by skipping out on sleep. Practice good sleep hygiene such as giving yourself a phone curfew, going to bed earlier, and sleeping in pitch dark to ensure you’re getting not just enough sleep, but good quality sleep every night.

Keto Foods That Are Good For The Heart

Kiwi

Kiwis come packed with vitamin C, which is essential for not only boosting immunity and reducing cancer risk,[6] but also keeping blood pressure at healthy levels. In this way, kiwis can reduce the risk of heart disease and stroke. Additionally, kiwis provide decent amounts of dietary fiber, keeping things regular, and feeding the beneficial bacteria in the gut which help to support our overall health, including heart health.

Dark Chocolate

Who says you have to skip dessert on a keto diet? Dark chocolate[7] (70% or higher) contains relatively little sugar and a specific type of antioxidant called flavonoids, which have been shown to improve heart health. This doesn’t mean we should eat an entire chocolate bar every day, but having a few squares a day can help satisfy your sweet tooth while adhering to the keto diet, and of course, boost heart health.

Leafy Greens

Keto Foods That Are Good For The Heart
Vegetables are essential for optimal health. Photo: Carve Bit/Shutterstock

Vegetables are essential for optimal health. Simply put, humans cannot thrive without enough veggies in their diet. However, the keto diet is hyper-focused on getting enough fats and reducing carbs, and often, vegetables are overlooked. Additionally, some starchy vegetables are to be avoided on the keto diet, such as potatoes, carrots, and squash because their starchiness offer unwanted carbs. 

That’s why non-starchy vegetables such as leafy greens[8] (which contain very few carbs) can be enjoyed without worry on a keto diet. These include kale, lettuce, spinach, collard greens, bok choy, dandelion greens, arugula, and Swiss chard, which all provide numerous benefits for the heart by way of added nutrients, lowered cholesterol, added fiber, and better blood flow.

Berries

Many fruits need to be avoided or at least limited on a keto diet, due to their high sugar/carbohydrate content. However, berries are low-glycemic, which means they contain less sugar than other fruits. Berries are filled with antioxidants that help fight off free radicals that can damage the heart, fight inflammation, and increase the beneficial bacteria in our gut (which also helps improve heart health). So, enjoy small portions of berries as part of a healthy keto diet.

Olive Oil

Oils are a controversial food and it can be confusing to know which oils are healthy and which ones should be avoided. Olive oil is not only one of the healthiest oils available, it’s a healthy food in general! We need fats from healthy sources to help us absorb nutrients better (in fact, some vitamins and minerals can only be absorbed when you ingest them with fat). So be sure to add an olive oil-based salad dressing to your salad for its anti-inflammatory properties,[9] and enjoy!

Avocado

Avocados are an excellent source of healthy fat. What’s more, they contain a decent amount of fiber as well as vitamins and minerals, such as magnesium and potassium, which have great heart health benefits. Adding avocados to the keto diet helps to increase fat, while also filling in nutrient gaps that the diet tends to lend itself to.

Nuts And Seeds

There are so many different nuts and seeds to choose from – almonds, cashews, walnuts, pecans, pumpkin seeds, chia seeds, flax seeds, sesame seeds, sunflower seeds, hemp seeds – the list is endless! Nuts and seeds contain high amounts of healthy, omega-3 fats which help to lower cholesterol levels and reduce inflammation. While it’s good to include nuts in the keto diet, remember that they also contain some carbohydrates, so just be mindful of portion size.

Fatty Fish

The fats found in fatty fish, think: as salmon, sardines, and mackerel, contain mostly omega-3 fats, which are the healthier sources of fat that protect the heart as opposed to harm it. Omega-3s help to lower inflammation and reduce the levels of LDL cholesterol. Be sure to include these fish in your diet regularly to maximize your health on the keto diet.

Conclusion

The keto diet offers health benefits for certain individuals, particularly regarding weight, however, it may pose serious heart health complications if done incorrectly. The keto diet tends to be effective short-term for weight loss but is not easily maintained over long periods of time. This is due to, not only its nutritional deficits, but its restrictive nature, making it hard to stick to and having risk factors.

The keto diet should not be done without medical guidance, as the long-term consequences are not fully understood by the scientific community. For those looking to try the keto diet but want to protect their heart, it’s important to be diligent about the fat sources to include, opting for less saturated fat and more healthy forms such as seeds, nuts, olives, avocados, as well as organic meat and fish.


+ 9 sources

Health Canal avoids using tertiary references. We have strict sourcing guidelines and rely on peer-reviewed studies, academic researches from medical associations and institutions. To ensure the accuracy of articles in Health Canal, you can read more about the editorial process here

  1. O’Neill, B.J. and Raggi, P. (2020). The ketogenic diet: Pros and cons. Atherosclerosis, [online] 292, pp.119–126. doi:https://doi.org/10.1016/j.atherosclerosis.2019.11.021.
  2. Clifton, P.M. and Keogh, J.B. (2017). A systematic review of the effect of dietary saturated and polyunsaturated fat on heart disease. Nutrition Metabolism and Cardiovascular Diseases, [online] 27(12), pp.1060–1080. doi:https://doi.org/10.1016/j.numecd.2017.10.010.
  3. Monteiro, R. and Azevedo, I. (2010). Chronic Inflammation in Obesity and the Metabolic Syndrome. Mediators of Inflammation, [online] 2010, pp.1–10. doi:https://doi.org/10.1155/2010/289645.
  4. Brouns, F. (2018). Overweight and diabetes prevention: is a low-carbohydrate–high-fat diet recommendable? European journal of nutrition, [online] 57(4), pp.1301–1312. doi:https://doi.org/10.1007/s00394-018-1636-y.
  5. Domenico Di Raimondo, Buscemi, S., Gaia Musiari, Rizzo, M., Edoardo Pirera, Davide Corleo, Pinto, A. and Antonino Tuttolomondo (2021). Ketogenic Diet, Physical Activity, and Hypertension—A Narrative Review. Nutrients, [online] 13(8), pp.2567–2567. 
  6. Lippi, G. and Mattiuzzi, C. (2019). Kiwifruit and Cancer: An Overview of Biological Evidence. Nutrition and Cancer, [online] 72(4), pp.547–553. doi:https://doi.org/10.1080/01635581.2019.1650190.
  7. Asimina Kerimi and Williamson, G. (2015). The cardiovascular benefits of dark chocolate. Vascular Pharmacology, [online] 71, pp.11–15. doi:https://doi.org/10.1016/j.vph.2015.05.011.
  8. Bondonno, C.P., Croft, K.D. and Hodgson, J.M. (2015). Dietary Nitrate, Nitric Oxide, and Cardiovascular Health. Critical Reviews in Food Science and Nutrition, [online] 56(12), pp.2036–2052. doi:https://doi.org/10.1080/10408398.2013.811212.
  9. Nocella, C., Vittoria Cammisotto, Luca Fianchini, D’Amico, A., Novo, M., Castellani, V., Stefanini, L., Violi, F. and Carnevale, R. (2017). Extra Virgin Olive Oil and Cardiovascular Diseases: Benefits for Human Health. Endocrine, metabolic & immune disorders, [online] 18(1), pp.4–13. doi:https://doi.org/10.2174/1871530317666171114121533.‌
Heather Freudenthal

Medically reviewed by:

Brittany Ferri

Integrative Nutrition Health Coach and Wellness Writer with a holistic and functional medicine/root cause mindset. My writing style is engaging, relatable, and educational, designed to help readers digest and relate to complex topics in nutrition, gut health, hormone health, mental health, and spiritual health, then inspire them to take action.

Medically reviewed by:

Brittany Ferri

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