Rethinking Cholesterol Concerns on Keto, Paleo, and Carnivore Diets

model of heart
model of heart


Cholesterol has long been a focal point in the discussion of heart health. However, emerging research is challenging this narrative, especially in the context of low-carb, high-fat diets like Keto, Paleo, and Carnivore. This article aims to explore the complexities of cholesterol and cardiovascular health, particularly when multiple markers of health are improved.

The Traditional View on Cholesterol

Traditionally, high levels of LDL cholesterol have been linked to an increased risk of heart disease, leading to dietary guidelines that often recommend low-fat diets.

The New Perspective: Cholesterol in the Context of Improved Metabolic Health

Recent studies suggest that elevated cholesterol may not necessarily be an indicator of poor cardiovascular health when metabolic function is normal(1). Diets like Keto, Paleo, and Carnivore often lead to elevated cholesterol levels but also improve other markers of metabolic health, such as:

  • Reduced Triglycerides: High triglyceride levels are a known risk factor for heart disease. These diets often lead to a significant reduction in triglycerides(2).

  • Improved Insulin Sensitivity: Insulin resistance is a precursor to Type 2 Diabetes and is associated with heart disease. Low-carb diets have been shown to improve insulin sensitivity(3).

  • Lower Inflammation: Chronic inflammation is increasingly recognized as a significant risk factor for cardiovascular disease. These diets often lead to reduced markers of inflammation like C-reactive protein(4).

Elevated Cholesterol in the Context of Improved Health Markers

When cholesterol is elevated in the context of improved metabolic health, its impact on cardiovascular health may be minimal. The body's lipid profile is just one aspect of cardiovascular health, and when other markers are optimized, the overall risk profile can look quite different(5).

Alternative Metrics for Cardiovascular Health

  • Coronary Calcium Scans: This test provides a direct measure of arterial plaque and can be a better indicator of cardiovascular risk(6).

  • Inflammation Markers: Tests for C-reactive protein and other inflammatory markers can offer additional context.

Consult Your Physician

Given the complexities surrounding cholesterol and cardiovascular health, it's essential to consult with your physician for personalized medical advice tailored to your unique health needs and goals.


The relationship between cholesterol and cardiovascular health is complex and influenced by various factors. Elevated cholesterol in the context of improved metabolic markers may not be as concerning as once thought. By considering alternative metrics and consulting with healthcare providers, individuals can make more informed decisions about their cardiovascular health.


  1. Cholesterol and Heart Disease: A Phony Issue

  2. Effects of Low-Carbohydrate Diets on Triglycerides

  3. Low-Carbohydrate Diet Improves Insulin Sensitivity

  4. Anti-Inflammatory Effects of Low-Carbohydrate Diet

  5. Lipid Profile and Cardiovascular Risk

  6. Coronary Artery Calcium Score: Current Status