“Why did my cholesterol increase on a keto diet?”


Why did your cholesterol increase when you went on a keto diet? And why might your scale say that you’ve gained fat?

Get the answers to these 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.

Why did my cholesterol increase on keto?

I’ve been on the keto diet together with my husband for four months.

When I went for my annual check-up, I found out that my cholesterol numbers had gone up:

Total cholesterol:
2019: 180 mg/dl
2020: 224 mg/dl

High-density lipoprotein (HDL) cholesterol:
2019: 88 mg/dl
2020: 82 mg/dl

Low-density lipoprotein (LDL) cholesterol:
2019: 78 mg/dl
2020: 130 mg/dl

I am worried that this diet is detrimental to my health at this time. Could you please give me some advice?

Thank you,


Thanks for the question, Deirdre.

This is a challenging question that has to be individualized. If you are concerned about your cholesterol changes, I suggest you consult with a doctor familiar with low-carb diets and lipids. I like to remind my patients that lipids are just one part of cardiovascular risk. That is why studies such as the one by Virta health, can show a slight increase in LDL but an overall decrease in cardiovascular risk. I suggest people work with a doctor who can help put their overall cardiovascular risk into perspective rather that focus on one solitary variable.

Additionally, here are three guides that may help you understand more about the issue:

  1. Guide to cholesterol on a low-carb diet
  2. Guide to lowering LDL cholesterol on low carb
  3. Has Diet Doctor changed its view on LDL cholesterol?

Dr. Bret Scher

Why am I gaining fat on the keto diet?


I have been following the keto diet for a week and managed to lose nearly 9 pounds (or 4 kilos).

I work out four to five times a week and completely abstain from alcohol ( I drink water and coffee only). Still, today the scale showed that I’d lost one pound (0.5 kilos) of muscle in a day! And that I’d gained 0.7 pounds (or 0.3 kilos) of fat, even though I’m very strict about my intake of food.

So my questions are: how come this fat gain happened and how can I avoid it? I weigh 227 pounds (103 kilos).

I am not sure how you are measuring fat or muscle mass, but keep in mind that many measuring techniques look at fat mass and “other”, and call the other lean body mass. But water weight also falls into the “other” category. So some scales will call the loss of water weight a loss of lean body mass by mistake. So make sure you are clear about what your scale is measuring.

Also, there are day-to-day variations that take place, but what is more important for most people is the long-term results. Being patient is sometimes the most important, and hardest, thing to do.

Here is a guide that puts weight loss into perspective of health in general:

Weight, health and happiness: striking the right balance

Dr. Bret Scher

More questions and answers

Many more questions and answers:

Low-carb Q&A


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