Recipes for Cholesterol Free Diet

Cholesterol is an essential building block for cells, and the body makes as much of it as it needs on its own.

A diet that that causes the body to produce too much "bad" LDL cholesterol can cause plaques to form in the arteries, leading to coronary heart disease, heart attack, or stroke.

According to the National Heart, Lung, and Blood Institute, the ideal amount of LDL cholesterol in the blood is 100 milligrams per deciliter (mg/dL) or lower.

If a person's LDL level is greater than this, they might consider trying a cholesterol-lowering diet. This is especially the case if the person is at high risk for heart disease due to obesity, diabetes, or other lifestyle or hereditary factors.

Although it seems counter-intuitive, it is not the cholesterol found in foods that relates to a person's blood cholesterol level. It is the saturated and trans fats that need to be reduced.

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Common diet themes

There are many diets available that claim to lower LDL levels. However, the nutritional plans that work best share the same important elements:
• they cut saturated and trans fat intake
• they replace foods high in cholesterol and saturated fats with unsaturated fats, fruits, vegetables, legumes, and wholegrains
• they keep serving size in check to assure a healthy daily calorie intake

Three cholesterol-cutting diets that follow these guidelines are vegan diets, Mediterranean diets, and the National Institute of Health's TLC diet.

Vegan diet

A vegan diet excludes all animal-based foods and is a true cholesterol-free diet.

A vegan diet prohibits eating animal-based foods, including fish, meat, poultry, eggs, and dairy. Only animal-based foods contain cholesterol. For this reason, veganism is the only truly cholesterol-free diet.
While cholesterol intake does not affect LDL levels as much as saturated fat intake does, many foods that have high cholesterol content also contain a lot of saturated fat. By replacing animal-based foods with plant-based foods, people can avoid both of these LDL-raising factors at once.

However, cutting cholesterol and saturated fat intake is not the only way a vegan diet can reduce LDL levels. To make this diet especially effective, it is important that people include nutrients that actively remove LDL cholesterol from the body.

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The most important of these nutrients are:

• Polyunsaturated fats. These stimulate the liver to dispose of LDL cholesterol. They can be found in natural vegetable oils, such as canola, sunflower, and safflower oils.
• Soluble fibers. These dissolve into a gel in the intestines. The gel binds to cholesterol and fats and carries them off to be removed from the body before they can be absorbed into the bloodstream. Soluble fiber is found in oat-based cereals, whole grains, barley, beans, chia seeds, and eggplant. Apples, grapes, strawberries, and citrus fruits are also rich in a kind of soluble fiber called pectin.
• Stanols and sterols. These also block cholesterol from being absorbed into the bloodstream. They can be extracted from certain plants, and are often used to fortify juices and nutrition bars. They can also be taken in supplement form.

According to the National Heart, Lung and Blood Institute, eating 5 to 10 grams (g) of soluble fiber each day can lead to a 5 percent decrease in LDL cholesterol. Within weeks, a daily intake of about 2 g of either stanols or sterols can reduce LDL by about 5 to 15 percent.

Even a vegan diet fortified with these substances can have shortfalls, though. According to a literature review, cutting all animal products from the diet increases risk for vitamin D, vitamin B-12, and zinc deficiency.

Avoiding fish, eggs, and seaweed also deprives one of omega-3s, which are especially heart-healthy polyunsaturated fats. To reduce these risks, it is recommended that people on a vegan diet include:
• vitamin B-12 fortified foods, such as soy and rice beverages and nutritional yeast - leafy vegetables cannot provide enough B-12 on their own
• vitamin D fortified foods, especially during the winter months
• plant foods rich in omega-3s, such as ground flaxseed, walnuts, canola oil, soy products, and hemp-seed based beverages
• foods rich in zinc, such as whole grains, legumes, soy products, and fortified snacks

As veganism has become more popular, many resources have become available to help develop tasty meals that fit an individual's dietary needs. A recent article in Good Housekeeping suggests a variety of creative vegan recipes.

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The Vegetarian Resource Group also offer a wealth of vegan meal ideas on their website, as well as a directory of vegan and vegetarian-friendly restaurants.

Mediterranean diet

Alongside olive oil and fish, the Mediterranean diet consists of fruits, vegetables, starches, nuts, seeds, eggs, and wine.

If giving up animal-based foods is too difficult, following a Mediterranean diet may be a better option. While the Mediterranean diet does not allow much red meat, dairy products, poultry, and fish are acceptable in low to moderate amounts.

The American Heart Association (AHA) explain that while there are many different versions of the Mediterranean diet, each relies on the same basic nutrients:
• olive oil in place of saturated fats
• high volume of fruits and vegetables
• high-fiber starches, such as potatoes, beans, breads, and whole-grain cereals
• nuts and seeds
• fish and poultry
• eggs, up to four times a week
• wine, in small to moderate amounts
Fatty-fish focused dishes, such as this recipe for salmon with apricots, yogurt, and pistachio sauce, are rich in omega-3 fatty acids. Because vegan diets tend to lack omega-3s, a Mediterranean diet can be more healthful than a vegan diet in this sense.

However, the Mediterranean diet also has shortfalls of its own. The biggest concern is calorie intake. Though unsaturated fats and natural starches are not unhealthful, they contain a lot of calories.

If a person doesn't think about portion size carefully, they could end up gaining more weight from a Mediterranean diet. As being overweight and obesity are also risk factors for heart disease, this would defeat the purpose of lowering one's cholesterol.

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The AHA advise that more than half of the fat calories in a Mediterranean diet should come from monounsaturated fats, such as olive oil. While these are much more healthful than saturated or trans fats, they have not been shown to actively signal the liver to cut LDL levels as polyunsaturated fats can.
The TLC diet

Alongside reducing cholesterol in the diet, the TLC diet pairs dietary adjustments with lifestyle changes.

TLC stands for "Therapeutic Lifestyle Changes," and was created by the National Institute of Health in 2005. It is still considered a very strong low-cholesterol option by health experts.

The diet pairs dietary adjustments with lifestyle changes in order to lower one's risk of heart disease as much as possible. It has fewer restrictions than a vegan diet, but it also follows a much more strict, scientific structure.

According to the TLC handbook, a person should consume the following each day:
• less than 7 percent of calories from saturated fat
• 25 to 35 percent of daily calories from total fat
• less than 200 mg of cholesterol
• a low but healthy number of calories, determined with the help of one's doctor
• an optional 2 g per day of plant stanols or sterols
• an optional 10 to 25 g per day of soluble fiber
For women, 1,000 to 1,200 daily calories are usually recommended for weight loss. For men, 1,200 to 1,600 calories are recommended.
This structure is meant to ensure that LDL levels are not only lowered, but that nutrient intake is well balanced and weight is not gained in the process.

Recipes, menu plans, and tips to make vegetables tastier can all be found in the TLC handbook. The AHA also offer an online collection of heart-healthy recipes that are compatible with the TLC diet.

Health benefits

Regardless of which diet a person chooses, making healthy nutritional changes can do more than just lower cholesterol. Cutting saturated fats and increasing the intake of fruits, vegetables, nuts, seeds, and fibers can help promote healthy vision, as well as brain, muscle, bone, and digestive system health.

Weight loss also relieves stress from the major organs and arteries and reduces the risk of developing type 2 diabetes.

Does the keto diet affect cholesterol?

People who follow the ketogenic, or keto, diet eat high amounts of fat, moderate amounts of protein, and minimal amounts of carbohydrates. Some evidence suggests that following this diet can affect cholesterol levels.

Specifically, the keto diet's daily allowances for fat, protein, and carbohydrates are as follows:
• fat: 55–60% of the day's total macronutrients
• protein: 30–35%
• carbohydrates: 5–10%
Some studies suggest that the keto diet can lower levels of high density lipoprotein (HDL), or "good," cholesterol but raise levels of low density lipoprotein (LDL), or "bad," cholesterol. For this reason, the keto diet may not be appropriate for everyone.

For example, healthcare professionals may advise that people with high cholesterol do not follow the keto diet.

In this article, learn more about the keto diet and its effects on cholesterol. We also describe safety considerations.

What does the research say?

Eating a keto diet may affect cholesterol levels.

An older study in the Annals of Internal Medicine divided participants into a keto diet group and a low fat diet group.

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Throughout the study, people in both groups lost more fat mass than fat free mass. Their LDL cholesterol levels did not change, however.
Those in the keto diet group lost more weight, had more significant reductions in triglyceride levels, and had higher HDL cholesterol levels. HDL levels tend to rise when people replace carbohydrates with saturated, monounsaturated, and polyunsaturated fats.

It is important to note that the researchers only followed the participants for 6 months. As a result, it is not clear whether or how their cholesterol levels changed later on.

The authors mention that in previous studies, researchers have found conflicting results.

For example, they refer to one study in which participants who had followed the keto diet for 2 months experienced an average rise in LDL cholesterol levels of 0.62 millimoles per liter (mmol/L). Another study showed a decrease of 0.26 mmol/L in LDL cholesterol levels after 6 months.

A further study monitored people who had followed either the keto diet or a low fat diet for 1 year.

This was a follow-up study to a previous project. The results of the earlier study had suggested that the keto diet leads to more weight loss and healthier cholesterol levels in people with obesity after 6 months.

The researchers note that after 1 year, participants following the keto diet still had lower triglyceride levels and higher HDL cholesterol levels than those following the low fat diet. They also found that people in both groups lost the same amount of weight, on average.

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However, given that all the participants in these studies had obesity, the results may not apply to people without it.

More recent research has continued to arrive at conflicting results. Research from 2016 observed a rise in LDL cholesterol and a decrease in HDL cholesterol linked with the keto diet.

A paper from 2018 reports the opposite, suggesting that the keto diet could raise HDL cholesterol levels.

Risks of the keto diet

A person on a keto diet may experience headaches, weakness, and muscle cramps.

Some people following the keto diet may experience:
• weakness
• headaches
• constipation
• muscle cramps
• blood pressure changes
• the keto flu

The keto flu is a collection of minor, short term symptoms that some people experience when they start the keto diet. These symptoms

 include:
• nausea
• vomiting
• headache
• fatigue
• dizziness
• sleeplessness
• difficulty tolerating exercise
• constipation

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Safety considerations

Several studies have suggested that the keto diet can affect cholesterol levels.

When people consume low amounts of carbohydrates, the liver produces fewer triglycerides, which may be involved in raising HDL cholesterol levels.

However, the keto diet may raise LDL cholesterol levels in some people. As a result, the diet may not be appropriate for everyone.

It may not be suitable, for example, for people with fat induced lipemia. This condition leads to very high levels of fat in the blood.

If a person with fat induced lipemia follows the keto diet, their triglyceride levels may continue to rise, which may result in pancreatitis. Generally, people with lipemia must follow a low fat diet.

People who want to lose weight should speak with a doctor to identify a suitable diet.

When considering recommending the keto diet, doctors must weigh the risks with the potential benefits, which can include rapid weight loss, reduced triglyceride levels, and increased HDL cholesterol levels.

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The importance of ongoing monitoring

People who follow the keto diet should consult their doctors to arrange frequent monitoring of blood cholesterol and triglyceride levels.
If a doctor notices that LDL cholesterol levels are rising, the diet may no longer be appropriate.

People with high levels of fats, such as cholesterol and triglycerides, in their blood have an increased risk of developing cardiovascular disease.

Foods to eat and avoid

People with high cholesterol should adopt a lifestyle that reduces these levels. This is because high cholesterol is associated with cardiovascular disease.

The keto diet emphasizes high amounts of fat, but not all fats have equal value. For example, replacing saturated fats with unsaturated fats is associated with a lower risk of cardiovascular disease, according to the 2015–2020 Dietary Guidelines for Americans.

Saturated fats occur in foods such as cookies, cakes, and other snacks. Coconut oil, butter, and ghee contain high levels of saturated fats, whereas extra virgin olive oil and margarine are higher in monounsaturated and polyunsaturated fats.

Fish — such as salmon, tuna, and cod — can be an excellent source of protein, and they contain unsaturated fat, such as omega-3 fatty acids, which can be beneficial for the body.

People with high cholesterol who follow the keto diet can snack on certain nuts and seeds that are generally low in carbs and rich in fiber and protein. Chia seeds have a higher content of polyunsaturated fats.
Vegetables, fruits, and legumes are excellent sources of nutrition. However, anyone following the keto diet should be aware of the carbohydrate contents of these foods.

People on the keto diet can consume milk and products containing it, but they may want to choose low fat versions if they have high cholesterol.

Differences between keto and paleo diets

The keto and paleo diets exclude different foods. The keto diet excludes high sugar foods, including most fruits, while the paleo diet allows more fruits and some natural sweeteners. They also have different rules for meats, vegetables, and dairy.

The following sections look into key differences between the keto and paleo diets.

Processed meat

A paleo diet usually excludes processed meats, such as bacon, salami, and ham, as these are the result of modern food processing techniques. Some people believe that minimally processed bacon without nitrates or preservatives is acceptable on the paleo diet, while others do not.

The keto diet allows these types of meat as long as they do not contain sugar or carbohydrates, which could interfere with the body's ability to reach ketosis. Some processed meats, such as bacon or sausage, may contain sugar, so people need to read the labels.

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However, with research indicating that processed meats may increase the risk of cancer and other health issues, people on any diet may wish to focus on eating good quality meats rather than processed ones.
• Paleo: Focuses on natural and grass-fed, no processed meat.
• Keto: Allows any meat that does not contain added sugar or carbohydrates.
Sweeteners and sugar
The paleo diet allows some "natural" sweeteners, such as honey and maple syrup. But, it does not allow artificial sweetener, including sugar alcohols, because they are a result of modern technology.
The keto diet allows some artificial sweeteners as long as they do not contain any sugar (some products contain both sugar and artificial sweeteners). Ideally, a person should choose sweeteners that do not cause spikes in blood sugar, such as stevia and sucralose.
The keto diet does not allow honey, maple syrup, or other products that contain natural sugar or fructose.

• Paleo: Allows raw honey, maple syrup, date sugar, and coconut sugar.
• Keto: Does not allow any sugars, but allows some artificial sweeteners, such as stevia and sucralose.

Starchy vegetables

Some nutrient rich vegetables also have a high starch or carbohydrate content. These "starchy vegetables" are not allowed on the keto diet because they could interrupt ketosis and cause a person to consume more than their allotted total of carbohydrates.

However, the paleo diet allows many of these nutritious vegetables in moderation. A person following the paleo diet can eat foods such as sweet potatoes, beets, and carrots in moderation, but should prioritize lower carb vegetables.

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Fruit

Fruits contain a range of nutrients, vitamins, minerals, fiber, and antioxidants, and are a healthful choice for most people. However, fruits also contain some natural sugar, and some have higher levels of sugar and carbohydrates than others.

A person following a paleo diet can eat all fruits, including fresh, dried, and frozen, but they should generally focus on lower sugar types. A paleo diet includes plenty of berries, citrus fruits, and melons. It can include sweeter fruits, such as bananas, grapes, mangoes, and cherries, but ideally, in lower amounts.

The keto diet is more strict with fruit. It advises that to keep the body in a state of ketosis, a person should only eat lower sugar fruits, and only in small amounts. Berries are a common keto friendly fruit, but a person may also eat small amounts of cranberries, peaches, apricots, apples, and plums.

• Paleo: Allows all fruits, though higher sugar ones in moderation.
• Keto: Allows only lower sugar fruits.
Dairy
The paleo diet excludes all dairy products because Paleolithic humans did not consume them. The paleo diet does not allow a person to consume cheese, milk, cream, or other dairy products.
However, people on the paleo diet can drink unsweetened nut milk, coconut milk, and similar alternatives that do not contain artificial sweeteners or thickeners.

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The keto diet allows some dairy products, especially those that are higher in fat and protein. This allows the person to take in the recommended amounts of these nutrients.

The keto diet does not include any dairy products that may contain sugar, such as ice cream, chocolate milk, or sugar-sweetened coffee creamer. However, a person may consume dairy products that contain artificial sweeteners in moderation.

• Paleo: Excludes dairy products.
• Keto: Allows dairy without sugar, ideally higher fat and higher protein types.

Side effects

People following any diet that eliminates food groups should make sure they are meeting their daily nutrient requirements to avoid deficiencies.
Anyone considering making a new and drastic change to their eating pattern should check in with their healthcare provider first. This is especially important for people who have chronic health conditions, such as heart disease, diabetes, or high blood pressure.

People following the keto diet may experience side effects related to entering a state of ketosis. These include keto breath, a keto skin rash, and the "keto flu." Symptoms off the keto flu include headaches, lethargy, nausea, mental slowness, insomnia, decreased exercise performance, constipation, and low libido. It can be harmful to stay in a state of ketosis for extended periods.

People do not experience these symptoms with paleo diets, as paleo diets do not lead to a state of ketosis.

Certain nutritional supplements can help people following the keto diet to get enough nutrients, ease side effects, and meet their daily macronutrient goals. Read about 7 supplements for the keto diet here.
One article cautions people who follow the paleo diet to make sure they are getting adequate calcium since the diet excludes dairy products. The keto diet lacks fiber and several micronutrients due to the severe restriction of foods that contain carbohydrates.

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Food lists

The following sections provide a list of foods that a person can eat when following the keto or paleo diet.

Keto diet

Common foods that people eat when following the keto diet include:
• fatty fish, such as salmon, tuna, or sardines
• shellfish, including mussels, clams, or oysters
• poultry
• fatty cuts of meat
• game meat
• non-starchy vegetables, such as leafy greens, cruciferous vegetables, asparagus, olives, bell peppers, celery, and
 squash

• mushrooms
• plain Greek yogurt with no sugar or fruit
• plain cottage cheese
• avocados
• eggs, especially egg yolks
• healthful oils, such as olive oil, nut oils, and avocado oil
• nuts, including macadamia nuts, pistachios, peanuts, walnuts, and almonds

• seeds, including chia seeds and flaxseed
• butter, ghee, or cream
• coconut or cocoa butter
• dark chocolate with at least 70% cocoa solids and very little to no sugar added

• nut butters, including almond butter, that contain no added sugar
• cheese
• berries, including raspberries, blueberries, strawberries, and blackberries
• lemons and limes
• tomatoes
• bone broth
• unsweetened tea and coffee
Paleo diet
Common foods that people eat when following the paleo diet include:
• chicken
• turkey
• eggs
• seafood
• pork
• beef
• game meat
• vegetables, especially leafy greens, celery, asparagus, peppers, and cruciferous vegetables
• small-to-moderate amounts of starchy vegetables, such as potatoes and root vegetables
• fruit, emphasizing berries, tomatoes, citrus, and other lower sugar fruits
• avocado
• small or moderate amounts of higher sugar fruits, such as grapes and bananas
• nuts
• seeds
• nut butter
• cocoa butter
• dark chocolate with at least 70% cocoa
• coffee with no dairy cream or refined sugar
• teas
• healthful oils, including nut oils, olive oil, and avocado oil
• honey, maple syrup, and coconut sugar in small amounts

Most common recipes for keto diet

Two weeks ago I wrote about why the ketogenic diet is total B.S., and the internet didn't take it too well. People on Facebook called it "false," "intellectually disingenuous," and even straight-up "terrible." One reader even devoted a whole blog post to dissecting the information line-by-line.

The keto diet — a low-calorie, high-fat eating plan touted by celebrities and Instagrammers alike — aims to activate the metabolic process called ketosis, when our bodies use fat for energy instead of sugar. Followers say it's helped them lose weight and gain energy, and they still get to eat bacon and butter.

My response: The ketogenic diet may work for you personally right now, and if that's the case, then go for it — as long as you inform your physician about your diet, medical history, and medications. It's your choice to eat keto and make it work for you.

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But from a public health standpoint, making a sweeping generalization in support of this diet would be negligent. It's my job as a registered dietitian (RD) to evaluate all the research in the context of scientific consensus, study strength, and long-term risk factors. Collectively, the existing information indicates that the keto diet can lead to nutrient deficiencies and prove difficult to adhere to long-term.

Still, I read through every response to my original article. I've included some of those comments below, ones that represent common opinions about the keto diet, to elaborate on where I stand:

1."There's a ton of research on ketogenic diets."

You're right that there is some research on the ketogenic diet, but not much looks at the long-term effects on overall health and weight maintenance. The best studies conducted for more than one year looked at the impact of keto on pediatric seizure disorders. The benefits for epilepsy in these cases outweigh the potential risks.

In fact, one 10-year study conducted on keto and epilepsy management in children found the following side effects: constipation (65%), high triglycerides (40%), high cholesterol (29%), diarrhea (19%), lethargy (17%), iron deficiency (15%), and vomiting (13%).
As for the Standard American Diet (SAD), I am absolutely not suggesting that we don't have big challenges when it comes to healthier eating habits, but my less-than-enthused stance on keto isn't because I'm comparing it to SAD. Rather, I think it's important to compare a keto plan to its weight-loss counterparts, like the well-substantiated Mediterranean diets and its spin-offs, like DASH, MIND, and TLC. Those plans incorporate wholesome, nutrient-dense foods that encourage improved eating patterns and manageable weight loss.

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2."It's not just butter and coconut oil."

It's true that the diet is not just butter and coconut oil, but it's still quite high in saturated fat. A lack of boredom doesn't imply that it's a health-promoting plan either.

You said it yourself: You take a supplement to protect yourself from deficiencies, including (but not limited to) iron and zinc. You're also at risk for missing potassium, magnesium, folic acid, and beta carotene. Know that the FDA doesn't oversee supplements, so you may not be getting exactly what you pay for. Plus, certain nutrients consumed as supplements can also have a pro-oxidant effect, meaning they do more harm than good. The end result: Increased risk of chronic disease, including heart disease and some cancers.

I'd also encourage you to have a look at photos tagged #keto on social media: beverages loaded with heavy cream, cheeseburgers without buns, and lots o' processed meat. So while it's possible to consume foods both compliant with the diet and nutritious, the messaging surrounding keto is the perceived ability to eat tons of fast food and skimp on sprouts.

3."It's outdated to say that 'low-fat' is good for weight loss."

I couldn't agree with you more that extremism in our diet culture has created undeniable issues as a result of low-fat, high-carb processed foods. But the point of the keto debate is not comparing it to junk food, but rather the benefits of a Mediterranean-style eating plan.

Yes, diets high in refined sugars and breads are linked to obesity, but turning from one extreme to another is not the solution to the obesity epidemic.

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We know that extreme diets such as keto may induce weight loss. However, recent studies indicate that the extreme fat intake required to bring the body into ketosis may also have negative effects. A 2015 review published in Nutritional Neurosciencefound that keto can increase risk of diabetes, heart attack, and strokes in children treated for epilepsy — risks considered less significant than enduring seizures, but ones not beneficial for the overall population, 49% of which is at risk for heart disease.

Another meta-analysis published in the British Journal of Medicinein 2013 evaluated ketogenic diets versus low-fat diets for long-term weight loss. It found that keto works for weight loss short-term and may lower blood pressure, but it can also increase LDL cholesterol.
The authors also say their own research analysis overlooked key indicators of health: Liver function, vascular function, cardiovascular events, and kidney function. In other words, we don't necessarily know the harm that ketogenic diets can cause.

4. "I've lost weight and kept it off."

Your eating habits are personal, and if you wan to lose weight, then you should follow the plans that work best for you! That said, it's still crucial that you look into whether or not you're meeting all of your nutrient needs in food form in order to remain healthy over time. The fact that there's not much research on the overall sustainability of ketogenic diets is what prevents many nutritionists from recommending it universally.

That said, if a particular eating plan causes immediate weight loss, and subsequent gain once you stop, that's not solving any medical or public health issues long-term.

Diet-induced weight fluctuations factor in heavily when healthcare professionals give advice, especially because RD's like me always look to apply the most current, well-researched scientific data to whomever we counsel. A big component of that is weighing benefits versus risks, and what we do know is that there may be some risky long-term effects of frequently gaining and losing weight. Extreme diets promote doing just that.

It may be more helpful to put into this context: If we were talking about a medication instead of food, would you consider it sound advice to say that taking a certain drug "might be safe, but definitely not safe for everyone, and it may only work temporarily and cause damage to other biological systems?" Not so much.

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The point of the keto debate is not comparing it to junk food, but rather the benefits of a Mediterranean-style eating plan.

5. "This diet reversed my type 2 diabetes."

First of all, congratulations! Significant weight loss is a tremendous accomplishment, and I applaud you for getting where you are now.
To your point, this is where the benefits come in: Losing more than 10% of your body weight when you're overweight or obese can significantly improve your metabolic state of health, regardless of how you got there! With that in mind, it's likely your type II diabetes "reversed" course thanks to the weight you lost — not the diet itself.
However, if you are diabetic and considering a ketogenic diet, it's essential that you know this: "Ketogenic diets may help some people with type II diabetes lose weight and therefore reduce blood sugar, but they're not safe for everyone with diabetes," says Dr. Elise Brett, Associate Clinical Professor in the Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai Hospital. "One should always check with a doctor before starting this type of diet."

Many diabetes medications actually require eating some carbohydrates to ensure they work. "Diabetes medications avoid low blood sugar reactions, and people who take insulin and/or [medications] called SGLT-2 inhibitors may put themselves at risk for a life-threatening condition called diabetic ketoacidosis (DKA) in which ketone levels in the blood reach dangerously high levels," Dr. Brett adds.

Is keto diet is good for your skin?

We all know the saying “You are what you eat.” But does that mean you’ll get smooth, perfectly oiled skin by dunking a tablespoon of butter in your morning coffee? Some proponents of the high-fat, very-low-carb ketogenic diet seem to think so — even if it means putting butter on top of their butter.

With the diet rising in popularity, more and more people are starting to ditch the bread and pasta in favor of adopting a keto diet food list replete in fat-laden foods, like meat, avocado, and nut butter. The quick weight loss many people experience on the diet has been a common motivation, but the effect of the diet on skin seems less certain. Some dieters report having a clearer and brighter complexion while on the diet, while many others encounter a strange, itchy red rash across their torsos.

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So the question remains: Is the keto diet healthy for the skin?

What Is the Keto Diet and Why Is It So Popular?

The thinking behind keto, according to U.S. News & World Report, is to train your body to burn fat rather than carbohydrates with the intention of losing weight and increasing feelings of fullness. By adding more fats to your diet and eliminating carbohydrates, you’ll send your body into a natural metabolic state called ketosis, during which the body breaks down fats into ketones. Ketones then become the body’s main source of energy, rather than carbs or protein, theoretically leading to weight loss.

The keto diet began gaining popularity around 2013, says Franziska Spritzler, RD, CDE, who is based in Orange County, California. She credits the fad diet’s growth to books such as The Art and Science of Low Carbohydrate Living and The Art and Science of Low Carbohydrate Performance by Steve Phinney MD, PhD, and Jeff Volek, Phd, RD — two texts that lay out the potential health perks of going low-carb.

What Are the Proposed Benefits of the Keto Diet?

Although, according to previous research, the ketogenic diet was originally developed to help children control epilepsy, an article published in February 2018 in the journal Aging suggested increasing fat and lowering carb intake could be an effective tool for managing cancer, while another study found it to be effective at lowering blood sugar in people with type 2 diabetes. Still, experts aren’t in agreement on those results, and more research is needed.

For the time being, Abbey Sharp, RD, a blogger for Abbey’s Kitchen who is based in Toronto, Canada, points out weight loss is the most popular draw of the keto plan you hear about today. Still, she doesn’t recommend it to her clients due to its restrictive nature and potential for causing nutrient deficiencies. “When it comes to weight management, I don’t believe in taking on any super-restrictive diets that mean cutting out full food groups,” Sharp says. Spritzler, on the other hand, says she has anecdotally seen positive results from keto in her clients with type 2 diabetes and prediabetes.

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Can You Expect Unpleasant or Harmful Keto Side Effects? And Is There a Wrong Way to Do Keto?

On these matters, Spritzler and Sharp agree.

For one, the reduction in carbs could lead you to consume too little fiber, says Sharp. This in turn could goof with your digestive system. “Constipation is very common on a keto diet — or any low-carb diet — because you’re cutting back on fiber-rich whole grains and fruit,” Sharp says. (Whole grains and fruit tend to contain more carbs than keto-friendly foods.) More seriously, the restrictive nature of keto could furthermore lead to disordered eating in some people; thus, it isn’t recommended for people who have a history of eating disorders.
Nutritionally speaking, keto may also be problematic. Spritzler says some people could interpret the fat-forward approach of keto as permission to eat as much processed food as they want — a choice that could affect their overall health, including that of the skin, she notes.

How Cutting Carbs May Affect Your Skin

Although it seems counter intuitive to eat more fats and fewer carbohydrates for clearer skin, to Jennifer Gordon, MD, a dermatologist in Austin, Texas, that’s exactly how keto may help improve your complexion — provided you’re cutting back on the right carbs and upping your intake of the right fats. By eliminating simple carbohydrates in particular, you’re targeting the body’s excess inflammation — which is a huge promoter of acne. “It’s usually simple carbohydrates that create inflammation,” she says. “When you lower inflammation in the body, you can see this in your skin as feeling more radiant, less red, and less congested.”

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But following an anti-inflammatory diet may also be the cause of a side effect called prurigo pigmentosa — commonly referred to as “keto rash.” Sharp says this is “a rare form of inflammatory dermatosis” that often appears on people in the early stages of ketosis.

How Increasing Fat Intake May Affect Your Skin

Omega-3 fatty acids are great for both hair and skin, Dr. Gordon points out. “There are always people who worry that eating too much fat gives you acne,” she says. “This is actually untrue.” But again, that’s not license to go binge on junk food. Sharp and Spritzler agree that increasing healthy-fat intake (especially sources of omega-3s, such as salmon and walnuts) may help soothe dry, itchy, scaly skin. Sharp also adds that avoiding omega-6 fats, such as vegetable oils, has been associated with improvements in inflammatory acne.

Is Keto Good or Bad for the Skin?

The consensus from Spritzler, Sharp, and Gordon is that while the keto diet has the potential to clear up acne, this benefit isn’t guaranteed. After all, everyone’s skin is different.

For instance, Sharp notes that the freedom to eat dairy products (such as butter, cheese, and cream) on keto might be a problem for some. “Some people find dairy triggering for acne,” she says. “The association isn’t the same for everyone. So try to experiment to see if cutting back on dairy makes a difference in your skin.”

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Gordon notes that “this isn’t a diet to do for your skin.” Instead of trying keto to make your skin glow, Gordon suggests making simpler lifestyle changes, such as making sure you’re drinking enough water, avoiding highly saturated “bad” fats (think butter, margarine, and fatty meats, such as pork), and cutting down on simple carbs (like white bread, white pasta, cookies, and cake).

Regardless of your intentions for going keto, be sure to consult your doctor before starting because the keto diet can pose dangers for certain people. Notably, while some people with type 2 diabetes may indeed benefit from the diet, keto isn’t for everyone. Its concentration on protein, for example, may negatively affect people with kidney damage. According to the Mayo Clinic, a dysfunctional kidney would have a hard time digesting protein compounds. Others who may want to avoid the ketogenic diet include expecting mothers, young children, and people on certain kinds of medication.

Ultimately, if you’re hoping to use keto to help clear your skin, talk to your doctor and dermatologist before trying it out to see if it’s safe for you.

Should you try the keto diet?

In the world of weight-loss diets, low-carbohydrate, high-protein eating plans often grab attention. The Paleo, South Beach, and Atkins diets all fit into that category. They are sometimes referred to as ketogenic or "keto" diets.

But a true ketogenic diet is different. Unlike other low-carb diets, which focus on protein, a keto plan centers on fat, which supplies as much as 90% of daily calories. And it's not the type of diet to try as an experiment.

"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.

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How does it work?

The keto diet aims to force your body into using a different type of fuel. Instead of relying on sugar (glucose) that comes from carbohydrates (such as grains, legumes, vegetables, and fruits), the keto diet relies on ketone bodies, a type of fuel that the liver produces from stored fat.

Burning fat seems like an ideal way to lose pounds. But getting the liver to make ketone bodies is tricky:
• It requires that you deprive yourself of carbohydrates, fewer than 20 to 50 grams of carbs per day (keep in mind that a medium-sized banana has about 27 grams of carbs).
• It typically takes a few days to reach a state of ketosis.
• Eating too much protein can interfere with ketosis.

What do you eat?

Because the keto diet has such a high fat requirement, followers must eat fat at each meal. In a daily 2,000-calorie diet, that might look like 165 grams of fat, 40 grams of carbs, and 75 grams of protein. However, the exact ratio depends on your particular needs.

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Some healthy unsaturated fats are allowed on the keto diet — like nuts (almonds, walnuts), seeds, avocados, tofu, and olive oil. But saturated fats from oils (palm, coconut), lard, butter, and cocoa butter are encouraged in high amounts.

Protein is part of the keto diet, but it doesn't typically discriminate between lean protein foods and protein sources high in saturated fat such as beef, pork, and bacon.

What about fruits and vegetables? All fruits are rich in carbs, but you can have certain fruits (usually berries) in small portions. Vegetables (also rich in carbs) are restricted to leafy greens (such as kale, Swiss chard, spinach), cauliflower, broccoli, Brussels sprouts, asparagus, bell peppers, onions, garlic, mushrooms, cucumber, celery, and summer squashes. A cup of chopped broccoli has about six carbs.

Keto risks

A ketogenic diet has numerous risks. Top of the list: it's high in saturated fat. McManus recommends that you keep saturated fats to no more than 7% of your daily calories because of the link to heart disease. And indeed, the keto diet is associated with an increase in "bad" LDL cholesterol, which is also linked to heart disease.

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Other potential keto risks include these:
Nutrient deficiency. "If you're not eating a wide variety of vegetables, fruits, and grains, you may be at risk for deficiencies in micronutrients, including selenium, magnesium, phosphorus, and vitamins B and C," McManus says.

Liver problems. With so much fat to metabolize, the diet could make any existing liver conditions worse.

Kidney problems. The kidneys help metabolize protein, and McManus says the keto diet may overload them. (The current recommended intake for protein averages 46 grams per day for women, and 56 grams for men).

Constipation. The keto diet is low in fibrous foods like grains and legumes.

Fuzzy thinking and mood swings. "The brain needs sugar from healthy carbohydrates to function. Low-carb diets may cause confusion and irritability," McManus says.

Those risks add up — so make sure that you talk to a doctor and a registered dietitian before ever attempting a ketogenic diet.

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What about the other diets?

The popular low-carb diets (such as Atkins or Paleo) modify a true keto diet. But they come with the same risks if you overdo it on fats and proteins and lay off the carbs. So why do people follow the diets? "They're everywhere, and people hear anecdotally that they work," McManus says. Theories about short-term low-carb diet success include lower appetite because fat burns slower than carbs. "But again, we don't know about the long term," she says. "And eating a restrictive diet, no matter what the plan, is difficult to sustain. Once you resume a normal diet, the weight will likely return."