Increased inflammation on keto?


Why might you be experiencing increased inflammation on a keto diet? How do you lower cholesterol? When should you measure blood sugar? And what’s Diet Doctor’s point of view on the EHJ 2018 study finding an association between low-carb diets and all-cause mortality?

Get the answers to these and other questions in this week’s Q&A with me.

Please note that these answers do not constitute medical advice and no doctor-patient relationship is established. These answers are for general information purposes and you should discuss any changes with your healthcare provider.

Increased inflammation on keto?

We are experiencing increased inflammation (joint pain) on a keto diet. I also feel very acidic. We eat meat (not grass fed) and cheese/yogurt (some grass fed), vegetables. We are not eating keto sweets or alcohol. We have coffee in the morning.


Hi Kathleen.

Inflammation can come from multiple potential dietary intolerances. For some it is dairy, for others it can be eggs, and for many it is refined flours and grains.

The best way to find the culprit is to do an elimination diet. It can be cumbersome, but it is well worth it if you can find the culprit. If you are keto, you already did a great job cutting out the grains and flours, so that means now getting rid of all dairy and eggs and seeing if your symptoms resolve. If so, then you add one back slowly and see if they return. if they don’t resolve, then you dig deeper. Nuts? Nut flours? Veggies? Other potential causes?

Best of luck finding the culprit and continuing on your health journey,
Dr. Bret Scher

A response to the EHJ 2018 study?

I’ve searched through your pages for a reaction to the August 2018 European Heart Journal study Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality: A Population-Based Cohort Study and Pooling Prospective studies, which seems to have strong evidence against the keto and other low-carb diets, but couldn’t find any comments other than a brief note written before the study was actually published and only announced. Searches on other keto-oriented sites similarly drew a blank. This seems on the surface to be a strong study, and I’m sure your readers would appreciate an analysis.


Good question, Todd. I assume you are referring to this study.

Unfortunately, this study has a number of issues. The most glaring is that the people in the lowest quartile of carbs were still eating 40% of their calories from carbs, averaging 214 grams per day. So right away, if you wonder if this study applies to people truly eating low-carb (less than 20, 50, or even 100 grams per day) the answer is a resounding NO!

There was also a higher percentage of men, of less educated individuals, and smokers in that quartile introducing unavoidable confounding variables and healthy user bias. That is a big issue with these nutritional epidemiology studies and why we rank them as either weak or very weak evidence. Here is more about our evidence basing guidelines, and here is a link to our discussion on observational studies.

I hope that helps!

Bret Scher

How to lower cholesterol?

What do I need to do to keep it under 200? A recent blood test revealed its slightly elevated since my last result three months ago.


Hi Derek.

Please see our guide on cholesterol and low carb to get a more in-depth answer.

Hopefully that will address your concerns and help you understand the differences between total cholesterol, LDL and what the numbers mean.

All the best!
Bret Scher

When to test blood sugar?

I have been testing first thing in the morning, but now that I am fasting (16/8), does it make more sense to test just before breaking my fast?


Why not test both? Some people have a “dawn phenomenon” where the blood sugar is higher when they wake and can go down as the day progresses and they get closer to their first meal. I like to know if that is the case with my patients. Here is a link to our page explaining the dawn phenomenon.

Bret Scher

More questions and answers

Many more questions and answers:

Low-carb Q&A


More with low-carb doctors