Diets · Metabolic & Cardiometabolic
ketogenic diet increases ApoB / LDL particle number
In plain terms: Does the ketogenic diet raise the number of LDL/ApoB particles that carry cholesterol?
Part of: 🥗 ketogenic diet
Often yes, especially in lean people — keto raises LDL cholesterol and LDL particle burden in many, though effect size is highly individual and direct ApoB trial data remain limited.
📅 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)
How the studies fall
The evidence (15)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Feng 2025 2025 · Am J Clin Nutr | meta-analysis | supports | moderate | Meta-analysis of carbohydrate-restricted diet RCTs found mixed cardiovascular/lipid effects depending on macronutrient replacement and population, cautioning against a uniform ApoB increase. |
| Lee 2021 · Int J Environ Res Public Health | meta-analysis | mixed | low | Meta-analysis in athletes found ketogenic diets increased total cholesterol. |
| Chang 2026 · Endocr Pract | meta-analysis | mixed | moderate | Meta-regression of RCTs found the ketogenic diet raises total and LDL cholesterol, modified by baseline BMI and duration. |
| Zhao (53-RCT MA) 2026 · (MA) | meta-analysis | mixed | low | Meta-regression of 53 RCTs: KD significantly raised LDL-C (+8.2 mg/dL) and total cholesterol, with low GRADE certainty for LDL-C and no long-term outcome data. |
| Schreel L et al 2025 · study_type: observational | observational | contradicts | low | 3-month KMT (1.5:1) in 7 bipolar outpatients: mean ApoB fell 0.14 g/L (-10.5%); LDL-C rose +14 mg/dL (+9%). No control, no CI/p given. |
| Buren J, et al. 2021 · (RCT) | RCT | supports | moderate | Controlled crossover feeding trial: ketogenic LCHF diet raised LDL cholesterol in every healthy normal-weight woman and shifted LDL subfractions, indicating increased LDL particle burden. |
| Kazeminasab 2025 · Eur J Clin Nutr | meta-analysis | supports | moderate | Meta-analysis found low-carb diets raised LDL by ~20 mg/dL versus low-fat diets. |
| McDonald TJW et al 2022 · study_type: observational | observational | mixed | moderate | Modified Atkins diet, n=31 adults w/ epilepsy: at 3mo ApoB, total/small/medium LDL particles significantly increased; by 6mo only small LDL particles + ApoB remained elevated (ApoA1 rose too, ratio partly normalized). |
| Norwitz 2022 · Metabolites | mechanism | supports | low | The Lipid Energy Model confirms carbohydrate restriction increases VLDL secretion and LDL particle turnover but frames it as physiological (single advocacy network). |
| Dong 2020 · PLoS One | meta-analysis | mixed | low | Meta-analysis of low-carb diets found increases in LDL and total cholesterol alongside triglyceride reductions. |
| Soto-Mota A, et al. 2024 · Am J Clin Nutr | meta-analysis | supports | high | Meta-analysis shows low-carb diets markedly raise LDL cholesterol, especially in normal-weight adults. |
| Fechner 2020 · Nutrients | meta-analysis | mixed | moderate | Meta-analysis found the most severe carbohydrate restriction raised LDL/ApoB while milder restriction did not. |
| Budoff M, ... Norwitz NG, et al. (KETO Trial) 2024 · JACC Adv | observational | supports | low | The KETO Trial documented large LDL-C elevations in lean metabolically healthy people on carbohydrate restriction. |
| Zhang N et al 2025 · study_type: observational | observational | supports | low | 2-wk modified keto diet, n=30 obese adults: ApoB/A1 ratio increased significantly (t=5.381, P<0.001); LDL-c/HDL-c ratio also rose (P<0.001). |
| Joo (normal-weight MA) 2023 · (MA) | meta-analysis | supports | moderate | Meta-analysis found very-low-carb ketogenic diets significantly raised LDL and total cholesterol in normal-weight adults. |
Disagree, or know a study we missed?
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Educational only, not medical advice. Grades and scores reflect published evidence weighted by study design and quality; see the methodology.