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“Summarizing the extensive scientific evidence, the ketogenic diet is a promising nutritional model in the context of cardiovascular disease prevention and therapy. Through its pleiotropic properties, it is able to influence the cardiovascular system on multiple levels. Scientific evidence mostly confirms its beneficial (even more beneficial compared to other diets) effects on the lipid profile and other CVD risk factors.” (Dyńka et al., 2023)
When Dr. Robert Atkins published his first book over fifty years ago, the common refrain was that, sure, the very-low-carb Atkins diet would help you lose weight, but at the expense of giving yourself heart disease. Well, medical research and popular opinion alike have come a long way since then. A paper published recently in the journal Nutrients provides a detailed review of multiple mechanisms by which very-low-carbohydrate ketogenic diets are actually beneficial for cardiovascular function.
Rather than “clogging the arteries” or being a “heart attack on a plate,” ketogenic diets induce numerous changes that reduce risk for cardiovascular disease and may even improve heart failure. Moreover, the beneficial effects induced by keto diets appear to be of greater magnitude compared to those seen with other approaches.
The factors cited included things that are well-known to many keto diet adherents and their medical professionals, such as impressive reductions in blood sugar and blood pressure. (Type 2 diabetes and hypertension, respectively, were shown to confer ten times and quadruple the risk for early coronary heart disease in women.) Keto diets are also effective for reversing metabolic syndrome (insulin resistance), which confers six times greater risk for heart disease.
The paper also emphasized improvements in lipid profiles induced by ketogenic diets, such as decreased triglycerides, increased HDL-C, and a shift in LDL particle size from predominantly small, dense particles to predominantly larger, buoyant particles (“pattern B” to “pattern A” lipoproteins). The latter change is considered to be favorable even when the total cholesterol or LDL-C increases.
The anti-inflammatory effects of keto diets and keto’s beneficial effects on vascular endothelial function were also discussed, as was the fact that the failing cardiac muscle increases its dependence on ketones and that ketones appear to be a preferred energy source for the heart muscle. The paper notes that for patients with heart failure with reduced ejection fraction, ketone bodies are “a very good, and, in many cases, perhaps better, energy substrate for the acquisition of ATP.”
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