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 0.76
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
18 support 4 contradict 0 tested null 2 mixed · 24 sources, 21 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 IJ, Ibrahim N, Bredefeld C, Foo S, Lim V, Gutman D, Huggins LA, Hegele RA 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, San Onofre N, Merino-Torres JF, Soriano JM 2025 · Nutrients | observational | contradicts | low | n=105 adults overweight/obese, AKMP ketogenic-Mediterranean, 14wk, single-arm pre-post: LDL-c -11.2% (p<0.001) |
| Castellana M, Conte E, Cignarelli A, Perrini S, Giustina A, Giovanella L, Giorgino F, Trimboli P 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, Flores-Jurado Y, Norwitz NG, Feldman D, Pereira MA, Danaei G, Ludwig DS 2024 · Am J Clin Nutr | meta-analysis | supports | moderate | MA: LDL rise inversely related to BMI (large in lean, absent in obese) |
| Hassaan AI, Ebeed NM, Fatouh A, Elhariry H 2026 · Scientific reports | animal | contradicts | low | C57BL/6 mice, Moringa-supplemented ketogenic meal replacement vs non-keto comparator: LDL 25±2 mg/dL (reduced) |
| Budoff M, Manubolu VS, Kinninger A, Norwitz NG, Feldman D, Wood TR, Fialkow J, Cury R, Feldman T, Nasir K 2024 · JACC Adv | observational | supports | low | Eighty adults were enrolled because they already had 'carbohydrate restriction-induced LDL-C ≥190 mg/dL' for at least 24 months, familial hypercholesterolaemia excluded. After a mean 4.7 ± 2.8 years on diet, LDL-C was 272 ± 91 mg/dL (max 591) and total cholesterol 369 ± 95, while 'Per protocol, KETO subjects had exhibited normal LDL-C levels (122 ± 36 mg/dL) prior to adoption of KETO'. The within-person rise is large and in the claimed direction, but the cohort was selected for exactly this response, so it cannot say how often, or by how much, LDL-C rises in people who adopt the diet. |
| Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T 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 S, Su X, Feng Y, Li R, Liao M, Fan L, Liu J, Chen S, Zhang S, Cai J, Zhu S, Niu J, Ye Y, Lo K, Zeng F 2023 · Nutrients | meta-analysis | supports | moderate | Umbrella review of syntheses: search 'to identify meta-analyses ... which yielded 23 meta-analyses for quantitative analyses'; KD 'could increase the levels of low-density lipoprotein cholesterol' but 'the strength of evidence ... was generally weak'. Review — zero weight. |
| Patikorn C, Saidoung P, Pham T, Phisalprapa P, Lee YY, Varady KA, Veettil SK, Chaiyakunapruk N 2023 · BMC Medicine | meta-analysis | supports | high | Umbrella review of 17 meta-analyses of KD RCTs ('Meta-analyses of RCTs of KD were included.'); 'KD was associated with a clinically meaningful increase in LDL-C.' Units are syntheses, so it double-counts primary RCTs; review — zero weight. |
| Burén J, Ericsson M, Damasceno NRT, Sjödin A 2021 · (RCT) | RCT | supports | high | Controlled-feeding RCT n=17 normal-weight: LDL +~70 mg/dL, rose in EVERY participant |
| Dantas E, Hootman KC, Moyer J, Tomberlin M, Curran K, Ramesh B, Price H, Kim J, McPherson AC, Hurd MA, Zhu YS, Plodkowski AJ, Nagase E, Tsomides A, Cuevas BM, Martin ML, Nguyen J, Bennetti G, Rodriguez GB, Chang K, Mezzancello M, Gardner GJ, Broach V, Mueller JJ, Sonoda Y, Zivanovic O, Leitao MM, Iasonos A, Soldan K, Carthew K, Hom V, Villamater FN, Chaari RR, Gorski K, Sigouros M, Aghajanian C, Elemento O, Cantley LC, Hopkins BD, Weigelt B, Ellenson LH, Hacker K, Abu-Rustum NR, Makker V, Goncalves MD 2026 · Nature communications | 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 JM, Diefenbach D, Nadendla M, Hiebert N 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 · Molecular genetics and metabolism | 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 S, Liu R, Thompson C, Colwell B, Chung S, Barry A, Wang H 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, Morris MD, Heggie JR, Cooper-Leavitt EF, Clark CJ, Reynolds AP, Smith HA, Wendel CP, Jensen WJ, Morris TJ, Reynolds PR, Bikman BT 2026 · Journal of personalized medicine | observational | mixed | low | n=7 overweight/obese adults, keto+low-dose semaglutide, 6mo: 'LDL cholesterol responses were heterogeneous' |
| Barrea L, Verde L, Galasso M, Savastano S, Colao A, Muscogiuri G 2025 · Journal of translational medicine | observational | contradicts | moderate | 80 obese women, VLEKT ketogenic phase (<800kcal/d): 'significant reductions...total and LDL cholesterol' (p<0.001) |
| DiMattia ZS, Petersen KS 2026 · J Am Heart Assoc | observational | supports | moderate | Narrative review: 'This review synthesizes current evidence on KD‐induced LDL‐C elevations among individuals with normal body mass index'; cites trials reporting 'mean LDL‐C increases ranging from 18 to 70 mg/dL'. Estimates are others' trials, not pooled here. Review — zero weight. |
| Cooper ID, Sanchez-Pizarro C, Norwitz NG, Feldman D, Kyriakidou Y, Edwards K, Petagine L, Elliot BT, Soto-Mota A 2023 · Front Endocrinol | observational | supports | low | Non-randomized, open-label crossover in 10 lean healthy premenopausal women already eating a ketogenic diet for a mean 3.9 years: 21 days ketosis, 21 days carbohydrate reintroduction (199 g/day), 21 days ketosis. Mean LDL-C was 148.0 mg/dL (SD 61.2) in ketosis, 102.5 (29.4) on carbohydrate and 124.1 (45.8) on return, though the across-phase difference was not significant (p = 0.12); what was significant is that lower BMI predicted larger LDL-C change (β = −25.1, p = 0.001). No control group, no pre-ketogenic baseline, and 21 days did not restore the starting LDL-C. |
| Zhao J, Wei C, Gong F, Pang Z, Zhao H 2026 · (MA) | meta-analysis | supports | high | MA 53 RCTs: LDL +8.22, TC +8.06 mg/dL (TG down, HDL up) |
| Aronica L, Landry MJ, Rigdon J, Gardner CD 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, Zhou H, Tang Y 2026 · Frontiers in nutrition | 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 C, Liu Y, Rohani P, Khodadadi N, Prabahar K, Sohouli MH 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, Nguyen MA, Morrow NM, Cameron E, Trzaskalski NA, Lorenzen-Schmidt I, Morissette A, Mulvihill EE 2026 · Cardiovascular diabetology | animal | mixed | low | Mouse models (lean/obese/PCSK9-OE): KD 'mixed, sometimes detrimental' on cholesterol; PCSK9-OE males had reduced LDL on KD |
| Joo M, Moon S, Lee YS, Kim MG 2023 · Nutr Rev | 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, Kontogianni MD, Haidich AB, Bountziouka V 2026 · European journal of nutrition | 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, Li W, Chen Y, Nelson EAS, Chen X, Hui LL 2025 · Cell & bioscience | observational | mixed | low | Literature review of KD in MASLD: 'Evidence on the impact on...LDL-c was mixed' |
| Liu H, Wu W, He N, Wang X, Pan S, Zhu L, Ma S, Zhang Y, Liu Z 2026 · BMC cardiovascular disorders | 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%) |
Disagree, or know a study we missed?
We grade by evidence, not opinions. The way to weigh in is to point us to a study we haven't cited (check the evidence table above first), or to flag a problem with one we have. Every submission is reviewed; if it holds up, the grade updates and shows in Science Changes Its Mind.
Opens a short form. You'll sign in with Google so submissions are tied to a real account — we don't display your identity, and we only accept a link we can verify (PubMed, DOI, ClinicalTrials.gov).
Educational only, not medical advice. Grades and scores reflect published evidence weighted by study design and quality; see the methodology.