By Dr. Cho
Examples of healthy fats in a low-carb high-fat diet, such as avocados and eggs.
Hello, everyone! Welcome to this in-depth exploration of low-carb high-fat (LCHF) diets. These diets involve reducing carbohydrate intake while boosting healthy fats—but it's not just about piling on the meat. If you've started an LCHF diet and noticed elevated cholesterol levels on a blood test, you might be feeling alarmed. Total cholesterol, LDL, triglycerides—they're all up, and perhaps someone has even advised you to quit the diet immediately. This article is for anyone following an LCHF approach or simply concerned about cholesterol. I'll break it down step by step to help you understand what's really going on.
First things first: What does a high cholesterol reading actually signify? Does it mean you're automatically a "high-cholesterol patient" who needs medication right away? Many doctors operate on a straightforward formula—if your LDL (often called "bad" cholesterol) exceeds 190, they might prescribe statins. For those with diabetes, statins could be recommended even if LDL is as low as 80. This is a common practice, but it's rooted in an outdated medical mindset that focuses on suppressing symptoms rather than addressing root causes. In the long run, this can create more health issues.
The truth is, looking at cholesterol levels in isolation is meaningless. You need to consider other markers, such as Highly Sensitive CRP, which measures inflammation in your blood vessels. (I've discussed this in detail in previous content—feel free to check it out for more insights.) No single test can definitively diagnose a disease. Think about it: An X-ray can confirm a broken bone with certainty, but most tests aren't that black-and-white. If an MRI or ultrasound reveals a lump, doctors follow up with more precise evaluations, like blood markers or even a biopsy. Biopsies are invasive procedures, akin to minor surgery, and they're not performed lightly due to risks like potentially breaking a tumor's capsule and spreading cancer cells.
Similarly, a high cholesterol result on a blood test doesn't instantly label you as having high cholesterol that requires intervention. It's like saying high blood sugar means you're diabetic, elevated blood pressure confirms hypertension, or low T3 with high TSH immediately indicates hypothyroidism. These oversimplified diagnoses ignore the body's complexity and can lead to misguided treatments. Prescribing cholesterol-lowering drugs just to bring down numbers is a flawed approach.
Unfortunately, many doctors still do this, even though it's not what they learn in medical school or at conferences. But just because it's widespread doesn't make it correct. In some cultures, heavy drinking is normalized—does that make it healthy? Of course not. The same logic applies here. Hospitals routinely prescribe statins to lower cholesterol with the promise of preventing heart attacks or strokes, but statistics reveal that this barely makes a dent in actual prevention.
Graph showing changes in LDL cholesterol levels during a ketogenic (low-carb high-fat) diet.
If you're on an LCHF diet and your cholesterol levels spike, here's my top advice: Avoid checking your cholesterol for the first six months. Those early readings aren't particularly meaningful. Cholesterol is a type of fat, and LDL and HDL are lipoproteins that transport it. When you get a blood test, hospitals typically run a Lipid Panel to assess how fats are moving through your bloodstream.
LCHF diets are designed to leverage the benefits of fats, such as reducing inflammation and enhancing overall health. But cholesterol isn't merely fat—it's a vital building block for hormones. It can be converted into vitamin D, estrogen, progesterone, testosterone, and stress hormones like cortisol. Without adequate cholesterol, your body couldn't produce these essential compounds.
People often report feeling more energized, vibrant, and even younger on LCHF diets. Why? Because hormone production ramps up significantly. Compared to a carb-heavy diet, hormone signaling can increase fourfold within just 1–2 hours after a meal. Even if you have insulin resistance, your blood sugar might appear normal on tests, but that doesn't mean everything is fine. A fasting blood sugar of 90–100 is like scoring a 65 on an exam where 100 is perfect—you're barely passing. Those numbers make me nervous, even if they seem acceptable to you.
High insulin levels, even with "normal" blood sugar, can accelerate the path to diabetes. LCHF diets improve insulin resistance simply by cutting carbs, which boosts health across the board. Increasing fat intake amplifies these benefits, particularly through hormonal changes. Improvements like better skin, sharper focus, higher energy, and reduced joint pain are all tied to these fat-driven shifts.
Diagram illustrating cholesterol conversion to steroid hormones like estrogen, testosterone, and cortisol.
If you've spent years on a carb-heavy diet, your body's ability to convert cholesterol into hormones might be a bit rusty—like a skill you haven't practiced in a long time. When you switch to LCHF and consume more fats, your body may not process them efficiently at first. This can lead to cholesterol accumulating in the blood, resulting in those high test results.
In related discussions, we've explored how burning fat can release stored toxins, sometimes causing challenging symptoms. It's a similar principle here. Acknowledge that you may have neglected your body's needs in the past, but approach it with compassion and understanding. Don't rush to conclusions like "this diet isn't for me" or "intermittent fasting doesn't suit my body" based on initial discomfort or intuition.
Illustration of vitamin D3 synthesis from cholesterol in the skin via sunlight exposure.
Cholesterol is also a precursor for vitamin D production. Many people worry about low vitamin D levels revealed in blood tests. Cultural habits like avoiding sunlight can play a role, but a lack of cholesterol—the raw material—is another key factor. Even with ample sun exposure, without sufficient cholesterol beneath your skin, your body can't synthesize vitamin D.
Insulin resistance exacerbates this issue. High insulin levels clear fats from the system too quickly, leaving little available for hormone or vitamin D production. Low-fat diets or outright fat avoidance only compound the problem. Low vitamin D increases risks for cancer, infections, and delayed recovery from illnesses. It's essential for immunity, brain function, and far more than just bone health—it's classified as a vitamin because deficiency can be life-threatening, much like other vital nutrients.
Sometimes, low vitamin D signals that your body is actively combating inflammation or recovering from an injury or infection. If you supplement with vitamin D and levels still don't rise, it's like filling a leaky bucket—the underlying inflammation isn't being addressed. (Refer to my earlier content on inflammation for deeper insights.) The solution? Ensure you're consuming enough healthy fats.
Graph demonstrating improvements in insulin sensitivity with ketogenic (low-carb) diets.
Even when fats are available for vitamin D production, your body prioritizes stress hormones like cortisol, which are crucial for maintaining blood pressure and survival. Stress, particularly mental stress, can devastate your health and is a leading cause of many medical visits. Always evaluate your stress levels.
With LCHF diets, there's no need to obsess over precise fat-to-carb ratios—you're not weighing every bite, after all. No universal ratio exists; everyone's needs differ. General guidelines are helpful, but tailor them to your body. The focus should be on gradually reducing carbs while increasing fats.
The ultimate goal is a body that doesn't depend on constant carb intake—one that remains energized and calm even when blood sugar dips. This state involves low insulin and low inflammation. Over time, you might find skipping breakfast or lunch feels natural and effortless. Some view skipping breakfast as disastrous, attributing it to their "constitution" or issues like dopamine imbalances, but it's often just unresolved insulin resistance.
Low-carb high-fat diets and practices like intermittent fasting aren't quick fixes—they're lifelong commitments. Tempting as extreme programs may be (like 20-hour fasts or water-only diets), true health comes from learning sustainable habits and applying them consistently. The journey itself is where the real value lies, and happiness emerges from that process.
Celebrate the small victories: clearer skin, waking up refreshed, fewer headaches, and sustained energy. These are signs you're on the right path. Let's commit to the joyful, vibrant life we're meant to live. If this article resonated with you, share your experiences in the comments below—I'd love to hear your story! Stay tuned for more insights.
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