The ketogenic or "keto" diet has surged in popularity. It's favored by individuals seeking to lose weight and improve their health. However, it's crucial to understand the potential side effects, including the possible link between the keto diet and chest pain. This article explores the relationship between the keto diet and cardiovascular health, examining recent research and offering guidance on minimizing potential risks.
What is the Keto Diet?
The ketogenic (keto) diet is a low-carb eating plan, similar to the Atkins Diet. It involves drastically reducing carbohydrate intake and increasing fat consumption. A low-carb, high-fat (LCHF) diet is defined as a diet with more than 45% of total daily calories coming from fat and no more than 25% coming from carbohydrates. This dietary shift forces the body to enter a state of ketosis. The body begins to break down fat for energy instead of relying on carbohydrates.
When you eat less than 50 grams of carbohydrates a day, your body eventually runs out of fuel (blood sugar) that it can use quickly. This usually takes 3 to 4 days. Next, you will start breaking down protein and fat for energy, which can cause you to lose weight.
In ketosis, the liver produces ketones from fat, which then serve as an alternative fuel source for the body, especially the brain. People frequently use the ketogenic diet to lose weight, but it can help control certain medical conditions, such as epilepsy. People with type 1 diabetes are not recommended this diet, because it increases the risk of producing ketoacidosis.
Potential Cardiovascular Risks
While the keto diet may offer short-term benefits such as weight loss, concerns have been raised regarding its long-term cardiovascular effects.
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Increased LDL Cholesterol
Several studies suggest that a keto-like diet can lead to elevated levels of LDL (low-density lipoprotein). It is often referred to as "bad" cholesterol. Increased cholesterol is due to the high levels of saturated fat and low levels of fiber in the keto diet. The review summarized the current evidence on how keto diets may raise heart disease risk. Ketogenic diets appear to lower blood levels of triglycerides but raise levels of artery-clogging LDL cholesterol.
Iulia Iatan, MD, PhD, attending physician-scientist at the Healthy Heart Program Prevention Clinic, St. Paul’s Hospital in Vancouver, emphasized that their study found that regular consumption of a self-reported diet low in carbohydrates and high in fat was associated with increased levels of LDL cholesterol- or "bad" cholesterol-and a higher risk of heart disease.
Cardiovascular Events
Research indicates a potential link between LCHF diets and an increased risk of major cardiovascular events. The study also showed people on a LCHF diet had more than two times higher risk of major cardiovascular events, such as arterial blockages requiring stents, heart attacks, strokes and peripheral arterial disease.
After an average of 11.8 years of follow-up-and after adjustment for other risk factors for heart disease, such as diabetes, high blood pressure, obesity and smoking-people on an LCHF diet had more than two-times higher risk of having several major cardiovascular events, such as blockages in the arteries that needed to be opened with stenting procedures, heart attack, stroke and peripheral arterial disease.
The Role of Saturated Fats
It’s become clear that even if you consume the healthiest fats as part of the keto diet, such as fish and olive oil, you’ll still end up consuming an unhealthy level of saturated fat. “Probably the diet in which there’s a large consumption of saturated fats from animal products is likely contributing to the increase in cholesterol,” says Brunham.
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Observational Studies vs. Causation
It is important to note that many studies are observational. They show a correlation between the diets and risks for cardiac events, not causation between the two. A limitation of the study is that participants provided dietary information at only one point in time, which should be considered when interpreting the study findings, Iatan said. Because the study was observational, it can only show an association between the diet and an increased risk for major cardiac events, not a causal relationship.
Case Study: Keto Diet and Myocardial Infarction
A 38-year-old male with no history of cardiac disease presented with chest pain typical of acute coronary syndrome. He assumed very-low-carbohydrate ketogenic diet (VLC-KD) 4 weeks prior to admission but no other lifestyle change. Workup showed dynamic ST-T changes on electrocardiogram, significantly elevated troponins, ketonuria, and mild rhabdomyolysis.
Transthoracic echocardiogram revealed mild inferior wall hypokinesia and cardiac catheterization showed normal coronaries; hence, the diagnosis of type II myocardial infarction (MI) was established. This case is the first in the literature to report a strong temporal association between VLC-KD and type 2 MI.
Physiological Changes
Dietary CHO restriction in VLC-KD mediates significant and quick metabolic changes at the cellular level: glycogen stores become depleted, insulin levels drop, and free fatty acids (FFAs) are mobilized to the liver creating ketone bodies. Oxidative stress in VLC-KD caused by nutritional ketosis, antioxidant deficiencies, and increased fat consumption eventually lead to the formation of reactive oxygen species (ROS).
Heart Palpitations and the Keto Diet
If you are on the Keto diet, it’s actually “normal” for you to experience a slightly higher heart rate during the first few weeks of the diet. Now, if you continue to experience high blood pressure and heart palpitations it can be due to dehydration and lack of salt content in the body from the diet.
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Addressing Heart Palpitations
If you are experiencing heart palpitations, stay hydrated and add salt into your keto diet. If your heart palpitations happen infrequently and go away fast, they likely are not serious.
Medication Adjustments
In case you suffer from diseases such as diabetes or hypertension, it is very likely that your heartbeat increases in frequency, this is because by decreasing the consumption of glucose decreases the need to take medications to reduce diabetes, as well as hypertension improves markedly with a low carb diet; therefore the usual dose of medications that you usually consume will be very high causing heart palpitations.
Other Potential Side Effects
The most common are usually not serious: You may have constipation, a slight drop in blood sugar, or indigestion.
Mitigation Strategies
a) Drink plenty of water and increase moderate salt intake.
b) Consult the doctor.
Alternative Nutritional Plans
The keto diet can be a great tool to lose weight and improve one’s health but it’s not right for everyone. There are plenty of other great nutritional plans out there to follow that will lead you to a healthier lifestyle. As part of our nutritional counseling services, we’ll create an individualized nutrition plan for you that will help get you on the path to healthy eating. Contact us today to schedule a consultation.
“The best diet is the one that you’re going to be able to stick with,” Dr. McIntyre said. “So there are lots of studies that have looked at this. And really the bottom line is people can lose weight with any diet, and the science also supports that people will do better with an eating plan that they can sustain.
The Importance of Consulting a Physician
“That’s why it’s important to discuss diet changes with your physician,” Dr. McIntyre said. Before starting this dietary pattern, they should consult a health care provider. As with any health concerns, your specific treatment program should be discussed thoroughly with your primary care physician as well as any specialists who may need to be consulted - like a cardiologist. “If cholesterol levels are super high, consult with your doctor because there may really need to be careful attention paid to managing the risk of heart disease,” Dr. Brunham adds.