Diets · Metabolic & Cardiometabolic
ketogenic diet increases LDL cholesterol
In plain terms: Does the keto diet raise bad cholesterol?
Strong support Diets 🔬 Includes disconfirming
Part of: 🥗 ketogenic diet
RefutedContestedStrong support
consensus score 0.80
Yes, often dramatically in lean people, though whether that rise carries normal heart risk is unsettled.
📅 Last reviewed: 2026-07-15 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
MechanismIn-vitroAnimalObservationalRCTMeta-analysis
How the studies fall
21 support 4 contradict 0 tested null 3 mixed · 28 sources, 24 independent groups
What the evidence shows
Ketogenic diets reliably raise LDL cholesterol and ApoB - dramatically and in essentially everyone in lean cohorts, with the rise inversely proportional to BMI. Whether this LDL elevation carries normal cardiovascular risk is genuinely unproven (measure ApoB, don't assume benign).
The evidence (28)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Goldberg 2021 · J Clin Lipidol | mechanism | supports | moderate | Clinical review: ketogenic diets raise LDL in susceptible individuals (\"not for everyone\"), warranting lipid monitoring and caution. |
| García-Gorrita C et al 2025 · study_type: observational | observational | contradicts | low | n=105 adults overweight/obese, AKMP ketogenic-Mediterranean, 14wk, single-arm pre-post: LDL-c -11.2% (p<0.001) |
| Castellana 2020 · Rev Endocr Metab Disord | meta-analysis | contradicts | moderate | Meta-analysis of VLCKD in obesity: NO significant change in LDL (total cholesterol fell); LDL increase not seen in this weight-loss context. |
| Soto-Mota A, et al. 2024 · Am J Clin Nutr | meta-analysis | supports | moderate | MA: LDL rise inversely related to BMI (large in lean, absent in obese) |
| Hassaan AI et al 2026 · study_type: animal | animal | contradicts | low | C57BL/6 mice, Moringa-supplemented ketogenic meal replacement vs non-keto comparator: LDL 25±2 mg/dL (reduced) |
| Budoff M, ... Norwitz NG, et al. (KETO Trial) 2024 · JACC Adv | observational | supports | moderate | KETO Trial: carbohydrate-restriction-induced LDL elevation accompanied measurable coronary atherosclerosis change, linking keto LDL rise to plaque. |
| Bueno 2013 · Br J Nutr | meta-analysis | supports | high | Meta-analysis of RCTs: very-low-carb ketogenic diet increased LDL-cholesterol (+0.12 mmol/L) vs low-fat despite greater weight loss. |
| Chen 2023 · Nutrients | meta-analysis | supports | moderate | Umbrella review of meta-analyses: ketogenic diet associated with increased LDL-cholesterol among its metabolic effects. |
| Patikorn 2023 · BMC Medicine | meta-analysis | supports | high | Umbrella review of meta-analyses of RCTs: ketogenic diet raised LDL-cholesterol while improving weight/glycemia, flagged as a cardiovascular caution. |
| Buren J, et al. 2021 · (RCT) | RCT | supports | high | Controlled-feeding RCT n=17 normal-weight: LDL +~70 mg/dL, rose in EVERY participant |
| Dantas E et al 2026 · study_type: RCT | RCT | supports | moderate | VLCD feasibility RCT, n=15 women (overweight, endometrial cancer), 21-28d: LDL rose 17.8±8.9%; TC rose 6±2.7% |
| Moore 2022 · Curr Dev Nutr | observational | supports | low | Carb-restricted diet caused clinically significant LDL increases across all responder categories; special \"lean-mass hyper-responder\" phenotype not supported. |
| Bozacı AE et al 2026 · study_type: observational | observational | supports | low | n=8 NKH patients on KD vs n=6 on glycine-restricted diet: 'increase in LDL cholesterol was observed...as expected' |
| Feng 2025 2025 · Am J Clin Nutr | meta-analysis | supports | high | Meta-analysis: LDL response to carb restriction depended on replacement fat; saturated-fat replacement raised LDL, unsaturated attenuated/lowered it. |
| Parker G et al 2026 · study_type: observational | observational | mixed | low | n=7 overweight/obese adults, keto+low-dose semaglutide, 6mo: 'LDL cholesterol responses were heterogeneous' |
| Barrea L et al 2025 · study_type: observational | observational | contradicts | moderate | 80 obese women, VLEKT ketogenic phase (<800kcal/d): 'significant reductions...total and LDL cholesterol' (p<0.001) |
| DiMattia ZS et al 2026 · study_type: observational | observational | supports | moderate | Narrative synthesis: short-term KD trials in normal-BMI adults show mean LDL-C increases of 18-70 mg/dL |
| Cooper ID, ... Norwitz NG, Soto-Mota A 2023 · Front Endocrinol | observational | supports | low | Lean healthy women on keto showed marked LDL rise predicted by body composition (LMHR/LEM) |
| Zhao (53-RCT MA) 2026 · (MA) | meta-analysis | supports | high | MA 53 RCTs: LDL +8.22, TC +8.06 mg/dL (TG down, HDL up) |
| Aronica 2023 · Front Nutr | observational | supports | low | DIETFITS secondary analysis: keto-like pattern caused a transient ~12% LDL rise that attenuated by 12 months alongside improved TG/HDL ratio. |
| Chen B et al 2026 · study_type: observational | observational | supports | moderate | Keto vs low-fat/balanced diet (n=650, NAFLD pts): adjusted β=+34.2 mg/dL LDL-C (p≤0.001); also ↑TC +62.9, ↑TG +36.5 |
| Chang 2026 · Endocr Pract | meta-analysis | supports | high | Meta-regression of RCTs: ketogenic diet raised LDL-cholesterol overall in adults, with magnitude modulated by baseline BMI and dietary fat type. |
| Locatelli CAA et al 2026 · study_type: animal | animal | mixed | low | Mouse models (lean/obese/PCSK9-OE): KD 'mixed, sometimes detrimental' on cholesterol; PCSK9-OE males had reduced LDL on KD |
| Joo (normal-weight MA) 2023 · (MA) | meta-analysis | supports | moderate | MA: VLCKD raised LDL & TC significantly in normal-weight adults |
| Kour H et al 2026 · Research Square | RCT | supports | moderate | 12wk RCT, 57 male endurance athletes, LCHF vs Low-GI/High-GI: 'LCHF group exhibited a significant increase in LDL' |
| Nikitara K et al 2026 · study_type: meta-analysis | meta-analysis | supports | moderate | Network MA, 47 RCTs, n=3450: KD vs low-fat-mod-carb reference, LDL +0.43 mmol/L (~16.6 mg/dL, CI 0.13-0.74) |
| Sun K et al 2025 · study_type: observational | observational | mixed | low | Literature review of KD in MASLD: 'Evidence on the impact on...LDL-c was mixed' |
| Liu H et al 2026 · study_type: meta-analysis | meta-analysis | supports | moderate | 24 studies (20 RCTs), >47,000 participants: KD vs control MD LDL-C +12.2 mg/dL (95% CI 7.5-16.9, I2=67.7%) |
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Educational only, not medical advice. Grades and scores reflect published evidence weighted by study design and quality; see the methodology.