Cardiovascular Diseases and Keto
Keto Medicine
Treating cardiovascular diseases: Hypertension and atherosclerosis with a ketogenic diet
Article by the Keto doctors Dr. Brigitte Karner and Dr. Wolfgang Karner
The heart loves ketones
A person is only as old as their blood vessels.
Insulin Resistance as a Cause of Cardiovascular Diseases
Cardiovascular diseases are the leading cause of death worldwide, accounting for 40% of all disease-related deaths. Despite the now crystal-clear state of scientific evidence, many heart patients are still advised—especially after a heart attack—to eat a low-fat diet and avoid saturated fats. This advice has been completely outdated since the PURE and PREDIMED studies. It is hard to believe that cardiologists and cardiology associations continue to cling to long-outdated beliefs instead of basing their therapy on the scientific foundation of current studies.
In general, lack of exercise, high cholesterol levels, smoking, obesity, and above all visceral abdominal fat are considered causes of cardiovascular disease. However, what is rarely mentioned—and only slowly coming into focus—is that insulin resistance is the actual underlying cause of cardiovascular diseases.
High blood pressure is also closely linked to insulin resistance. Nearly all hypertensive individuals are also insulin resistant, often without knowing it.
There is still widespread fear of fats, especially saturated fats such as butter, cheese, or coconut oil, and it is still claimed that saturated fats increase so-called “bad LDL cholesterol,” which in turn is said to clog blood vessels. Unfortunately, this connection has been debunked in several studies, showing that fats do not harm the heart or blood vessels.
No Fat?
The “no-fat” craze has been proven to lead to a sharp increase in cardiovascular diseases, because “no-fat” automatically means eating more carbohydrates.
How does high blood pressure develop?
This is due to several factors:
Too much insulin increases the hormone aldosterone, produced by the adrenal glands. This causes the body to retain more sodium and therefore more water, increasing the water content in the blood — which raises blood volume and, consequently, blood pressure.
High insulin levels thicken the vessel walls. Because insulin is a growth factor, the vessel walls become thicker and blood vessels narrower. This increases pressure in the system.
Nitric oxide (NO), produced by the body, dilates blood vessels.
In insulin resistance, however, NO production decreases, so its vessel-dilating effect steadily declines and blood pressure remains elevated.
NO is our third major regulatory mechanism for hypertension — and it progressively fails as insulin resistance increases.Another important effect is insulin’s impact on the sympathetic nervous system.
Insulin activates the stress response — the more insulin-resistant a person is, the stronger this stress reaction becomes.
It is as if the body were constantly in fight-or-flight mode as long as insulin levels are high. This means chronic stress plus excessive insulin secretion combine to intensify the stress reaction further.
In summary it is primarily carbohydrates that drive blood pressure up by triggering complex biochemical reactions. These reactions arise because carbohydrates raise blood sugar, which in turn raises insulin — and elevated insulin ultimately leads to insulin resistance.
Atherosclerosis
Pathological deposits in the walls of blood vessels are referred to as atherosclerosis.
It is a slow, progressive process that primarily affects the coronary arteries, the carotid artery, and the major arteries in the legs. In the worst case, it resembles a severely calcified, narrowed pipe.
The feared complications include thickening of the vessel walls, fatty deposits, and plaque formation.
When these plaques continue to grow or rupture, they can lead to acute vessel blockages.
In the brain, this is called a stroke, and in the heart, it is called a heart attack.
There is a hypothesis that cholesterol causes atherosclerosis. However, so far there is no medical evidence to support this claim.
New scientific research increasingly suggests that the true cause of atherosclerosis is insulin resistance. This is because insulin resistance promotes an increase in harmful, dense LDL particles and oxidative stress.
Both factors trigger inflammatory reactions in the vessel walls. As protection against further oxidation, macrophages fill themselves with oxidized fats and are then referred to as foam cells. Foam cells release inflammatory substances that attract more macrophages, which in turn also become foam cells.
As more and more foam cells accumulate, the process progresses further. This leads to the formation of atherosclerotic plaques. These plaques may contain cholesterol, but in most cases cholesterol is not the actual cause.
Moreover, most doctors still measure only total cholesterol, HDL, and LDL. However, these values do not provide reliable information about cardiovascular risk.
To assess the true risk, we recommend measuring the lipoprotein profile and specific inflammation markers. Determining trans fats is also useful, as they are incorporated into cell structures like faulty building blocks and can cause damage.
Unfortunately—unlike in countries such as Denmark—trans fats are still not banned in the food industry in Germany. Trans fats are created through hydrogenation and heating of poor-quality, partially hydrogenated oils, and they hide in many processed foods such as French fries, chips, certain margarines, baked goods, and refined vegetable oils.
Of course, homocysteine should always be measured, as well as the HOMA index as a direct parameter for insulin resistance. And naturally, the omega-3/omega-6 ratio should also be assessed.
The Heart Loves Ketones!
High carbohydrate intake and the resulting insulin resistance are the true causes of increased atherosclerosis and cardiovascular disease risk.
In other words: besides exercise, reducing carbohydrate intake is the key preventive factor for keeping your heart healthy.
A ketogenic, healthy diet—plant-based with many secondary plant compounds from salads, vegetables, wild herbs, berries, and spices, low in carbohydrates, and rich in high-quality fats with plenty of omega-3 fatty acids and the right amount of protein—is exactly what benefits the heart and the cardiovascular system.
Among the secondary plant compounds, it is especially the polyphenols—such as flavonoids and oleocanthal (from olive oil)—that have been shown to provide particularly protective effects on blood vessels. They have anti-inflammatory and antioxidant effects on the vascular system. A ketogenic diet helps prevent atherosclerosis because it has an anti-inflammatory effect and favorably changes blood lipids. Furthermore, the ketogenic diet—with its healthy fatty acids—supports the heart by improving energy production, can counteract heart failure, regulates blood pressure, and may help with cardiac arrhythmias.
Our atherosclerosis patients have achieved impressive results with a ketogenic diet.
This is what our patients with cardiovascular diseases, high blood pressure, and atherosclerosis say
Live more lightly and feel stronger!
Are you suffering from atherosclerosis?
We support you in our center for holistic medicine —
on-site in Freiburg or also in the form of an online consultation.
Your Dr. Brigitte Karner & Dr. Wolfgang Karner
Keto specialists and keto physicians
Scientific literature on keto and cardiovascular diseases, high blood pressure, and atherosclerosis:
Dyńka, D. et.al. (2023): The Ketogenic Diet and Cardiovascular Diseases
The Keto Study →
Ch. Kosinski et.al. (2017): Effects of Ketogenic Diets on Cardiovascular Risk Factors: Evidence from Animal and Human Studies
The Keto Study →
Popiolek-Kalisz J. (2022): Ketogenic diet and cardiovascular risk – state of the art review
The Keto Study →
Teo, K. et.al. (2009): The Prospective Urban Rural Epidemiology (PURE) study: Examining the impact of societal influences on chronic noncommunicable diseases in low-, middle-, and high-income countries
The Keto Study →
Ros, E. (2017): The PREDIMED study
The Keto Study →
Szostak-Wegierek, D. (2013): The role of dietary fats for preventing cardiovascular disease. A review
The Keto Study →
Ciaffi, J. (2021): The Effect of Ketogenic Diet on Inflammatory Arthritis and Cardiovascular Health in Rheumatic Conditions
The Keto Study →
Haffner et.al. (1990): “Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes?”
The Keto Study →
Despres et.al. (1996): “Risk factors for ischaemic heart disease: is it time to measure insulin?”
The Keto Study →
Reaven (1991): “Insulin resistance and compensatory hyperinsulinemia: role in hypertension, dyslipidemia, and coronary heart disease”
The Keto Study →
Pyorala et.al. (1998): “Hyperinsulinemia predicts coronary heart disease risk in healthy middle-aged men: the 22-year follow-up results of the Helsinki Policemen Study”
The Keto Study →
Despres et.al. (1996): “Hyperinsulinemia as an independent risk factor for ischemic heart disease”
The Keto Study →