Is a Low Carb High Fat Diet Heart Healthy?

We hear the words Heart Healthy a lot, especially when it comes to our nutrition.


By now, you’re likely used to seeing cereals with the “heart healthy” moniker. Is it really heart healthy? We all too frequently refer to foods as “heart healthy”, or we say that our doctor gave our hearts a “healthy” checkup.  


It all sounds nice. But what does it mean? How do we define heart health?


How does LDL Cholesterol affect Heart Health?


Unfortunately, most of our current definitions center around LDL cholesterol concentration.  While LDL cholesterol plays a role in heart health, it by no means defines heart health in totality.


In fact, in many cases it is the least important factor.


Our healthcare system has simplified things too much, so as a result we focus on one bad guy, one demon to fight. In reality heart disease is caused, and made more likely to occur, by a constellation of contributing issues.


Elevated blood sugar, elevated insulin levels, inflammation, high blood pressure, poor nutrition, and yes, lipids all contribute to heart health.  It does us all an injustice to over simplify it to one single cause.


What food is heart healthy?


Our superficial definition of cardiac risk is how industrial seed oils containing polyunsaturated fatty acids (PUFAs) became known as “heart healthy.”


Studies show that they can lower LDL. But they can also increase inflammation and have no clinical benefit and even increase risk of dying. According to our simplified definitions, that doesn’t stop them from being defined as “heart healthy.”


 That’s right! Something that increases our risk of dying is still termed “heart healthy.”  How’s that for a backwards medical system?!


Same for blood sugar. If you have a diagnosis of Type 2 Diabetes (DM2) that is a risk for cardiovascular disease. If you don’t have the diagnosis, you are fine. That ignores the disease of insulin resistance that can predate diabetes for decades and increases the risk of heart disease and possibly even cancer and dementia.


Cereal can also be called “heart healthy” as they may minimally lower LDL. But is that a good thing if they contain grains that also worsen your insulin resistance and metabolic syndrome? I say definitely not.


Time has come to stop this basic, simplified evaluation and start looking at the whole picture.


How Low Carb High Fat Diets Improve Heart Health


Low carb high fat diets have been vilified as they can increase LDL. But the fact of the matter is that it does so only in a minority of people. The truth is that they can improve everything else!


These diets reduce blood pressure, reduce inflammation, improve HDL and triglycerides, and reverse diabetes and metabolic syndrome! Shouldn’t that be the definition of “heart healthy” we seek? Instead of focusing on one isolated marker, shouldn’t we define heart health by looking at the whole patient?


Only by opening our eyes and seeing the whole picture of heart healthy lifestyles can we truly make an impact on our cardiovascular risk and achieve the health we deserve.


Join me in demanding more. Demand better.


Thanks for reading,

Bret Scher, MD FACC

17 thoughts on “Is a Low Carb High Fat Diet Heart Healthy?”

  1. Can the low-carb, high fat diet prevent and reverse heart disease? Can a low carb ketogenic diet eliminate or reduce angina? The reason for these most pertinent questions is that Dr Caldwell Esselstyn, Dr. Joej Furhman and the Pritikin Program all claim that a low fat (5-15% fat) will eliminate angina and prevent and reverse heart disease. I have not heard any low carb or keto proponent echo those thoughts. Can someone with severe or moderate heart disease or angina safely eat a ketogenic or low carb diet and see an improvement in those conditions?





    1. Thanks for your comment Candace. There haven’t been any studies done investigating if a LCHF or keto diet can reverse heart disease. But that being said, the vegan studies that have looked into this were comprehensive lifestyle management programs, not just dietary interventions. In addition the measurements they used to claim “reversal” were crude measurements with a wide confidence range, so the data is fairly questionable for its actual significance. The best we can do is find a lifestyle that is sustainable and improves the majority of our cardiovascular risk markers. For some that will be a LCHF diet, but it may not be for all.

      1. I survived a massive heart attack in 2011, was given a stent and placed on a typical battery of blood thinner, beta-blocker, ACE inhibitors, statins and aspirin. I was also prediäbetic. The first three years I lost 30 lbs and plateaued. At that point, my GP, not my cardiologist, suggested that I go vegan in the hopes that I might be able to reverse my cardiovascular disease. My cardiologist was counseling me at the same time on how I could keep cheese in my diet.

        I did decide to follow the regimen taught by Dr Esselstyn, managed to find a new cardiologist who incorporates diet as part of his treatment plans and have lost an additional 45 lbs (so far) and have shed the statin, the blood thinner, the ACE inhibitor and am down to 6.25 mg qd of metoprolol (3% of max nominal dosage) with the prospect of going off that last drug as well. My BP now is 115/65 mm Hg, my total cholesterol is 135 mg/dL and my resting pulse is 60-65 BPM.

        One of the things that persuaded me to follow Esselstyn’s regimen was the PET scans and angiograms he published in his book “Prevent & Reverse Heart Disease” of blocked arteries reöpening after eating a minimally processed *whole-food, plant based*, low-fat vegan diet (i.e., *intact* whole grains and potatoes instead of grain flours and mashed potatoes.)

        Question: Is there any similar radiographic evidence that’s been published for patients who’ve followed a keto-diet?

        I was fortunate that I had the drive to teach myself via the Internets how to cook and eat this way (I’m a 60 year old Southerner who was raised on ribs, fried chicken, fried fish & seafood, steaks, etc) and I learned that it takes as much as 3 months plus to have one’s taste buds adapt to a diet that doesn’t add salt, oil or sugar. It was initially a tough row to hoe since it requires major change in what you eat, but I figured radically changing what I eat was much less “radical” than what I saw my mother go through when her cardiologist sawed open her sternum to replace her aortic valve. With appropriate support, it is possible to make the life-style changes necessary reverse heart disease through a reformed diet. I have never felt better I see no reason why living another 40 years is unreälistic for me.

        1. Thank you for your question. This is an interesting topic that deserves a detailed analysis and explanation. We don’t feel the blog is an appropriate forum for this. If you would like a more individualized approach and answer, please feel free to sign up for a one-on-one medical consultation.

  2. I have been doing the Esselstyn eating plan for my heart health for 18 months. I lost 30 lbs and for a year, I did fine and my cholesterol numbers were great. Over this last holiday period, I regressed and have gained some weight back. I miss the protein the most. My wife and step-daughter have had great success with the Keto plan and I’m thinking about joining them on the journey. They’ve lost weight and I’ve seen an overall improvement in attitude and other areas. But I am concerned about my heart health as I’ve had 4 stents. Would this be a healthy choice for me at this stage? I am 68 yrs old, play golf 4-5 times a week and am fairly active.

    1. Hi Richard. Great question. In general I believe a well formulated low carb high fat diet is beneficial for heart health. The key, however, is formulating it correctly for you and following your makers to make you are progressing accordingly. I find that many people have a hard time sticking with an ultra-low fat program, and usually feel poorly on it. Many of the clients in my 6-month program come from this background and are amazed and how great they feel on a low carb high fat diet. But it isn’t one-size-fits-all, so make sure you are working with someone who understands heart disease and understands the intricacies of nutritional therapy.

    2. Hi, Mr Richard,

      Congrats on your accomplishments! It sounds like you managed to collect your stents without going through a heart attack like I did.

      Eating the way Dr Esselstyn suggests does require a significant change in how you eat, but it can be done. I’ve been eating this way for five years now. I’m a “good ol’ boy” raised in the South and was a hell of a grillman and friends and family used to always come to my home for my Thanksgiving spreads. It’s really hard to change over if you’re living with people who are eating the things that you still love and are trying to move away from. It’s the salt, the oil, and the sugar (SOS) that is drawing you back. But, if you can stick to the new way of eating, you can transform your tastebuds to love the new salt, oil and sugar levels… I never thought I’d reach the point where a mess of ribs would turn my stomach, but I have.

      If I can be of help to you, I’d be willing to do so if we could find a way to connect. For the past year and a half, I’ve once a month prepared a soup-to-nuts, SOS-free buffet with three entrées, two or three prepared salads, a green salad, and a soup or two. Even confirmed omnivores who thought they had have meat at every meal enjoyed what I served and would come back for seconds and even thirds. There are a lot of recipes from North Africa, Greece, the Middle East, South America that taste great.

      Regardless, I hope only good things for you

    1. Hi Ravi. In my experience, I am not sure LCHF has a direct effect on SVT. However, it can be very effective at weight loss and promoting overall health, which in the end may benefit SVT.

  3. My father just had a mild heart attack followed by an angiogram and angioplasty. He now has 8 stents. He is on several other medications, one for cholesterol. He has gained a significant amount of weight from prednisone for inflammation. I’ve been doing keto myself for 6 months with great results. I want him to try it. Is this advisable?

    1. Hi Stacy. I am sorry to hear about your father and I hope he is recovering well. I apologize but I cannot give individual medical advice online. I do use different versions of low carb nutrition with patients with heart disease and prior stents, but the key is following them very closely to make sure all their markers are progressing, and working to find the right version of low carb. I hope your father’s doctor will be open to different options to help him. Best of luck. Bret

  4. I think a lot of people fail to recognize that most studies of low fat diets are compared to diets that are high in processed foods and sugar as well as unhealthy fats like seed oils.

    Of course people get better when they leave those foods out of their diets.

    The problem is it is hard to get funding for LCHF ( healthy fat ) diets, and compare them to the more vegetarian style diets.

  5. I am 53 and died of a heart event last July. After all the testing, my arteries are clear but I have cardiomyopathy and a low LV ejection rate. I take Bisoprolol 2.5mg. Obviously I am not after a medical consult in this forum but would be curious to know whether it is safe to go LCHF with my type of situation. All I every see is advice around CVD, cholesterol (mines normal), blood glucose (mines normal) etc. I did try LCHF once before my heart event but found I was very shaky with zero energy and seriously missed the carbs. Thanks for your thoughts.

    1. Hi Tina,
      So sorry to hear about your experience. Unfortunately, Dr. Scher is unable to give medical advice on his blog. This is an interesting topic that deserves a detailed analysis and explanation. If you would like a detailed evaluation and answer to your questions, you could always consider an individualized consult. In fact, we highly recommend it.

  6. Hi,
    So my husband and I have been eating keto since the end of July. We changed due to my husband’s high blood pressure and not feeling well. We both have been feeling great eating like this. A few weeks ago a stress test, which lead to an angiogram revealed that my husband needed a quadruple bypass surgery. It has now been almost three weeks since the surgery. At the hospital here in Sweden he was not offered any dietary advice (not even the typical eat low fat and low sodium). I’m still eating keto and I wonder if my husband can start eating keto/LCHF again?

    1. Hi Jo,

      I’m glad that Keto has been working for you and your husband and that you’ve been feeling great! Sorry to hear about your husband’s surgery and hope that he’s been having a speedy recovery.

      As for your question around dietary advice, unfortunately, Dr. Scher is unable to give medical advice on his blog. If you would like a more detailed evaluation and answer to your questions, you could always consider an individualized consult.

      We hope that is helpful and that your husband starts feeling better soon.

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