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
What the evidence shows
Ketogenic diets raise LDL cholesterol and particle burden in many people, with a meta-regression of 53 randomised trials finding LDL up about 8 mg/dL, though at low certainty. The response is highly variable and modified by baseline BMI, with leaner people rising most, so this is a reliable average with a wide and clinically important spread.
The evidence (15)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Feng S, Liu R, Thompson C, Colwell B, Chung S, Barry A, Wang H 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 HS, Lee J 2021 · Int J Environ Res Public Health | meta-analysis | mixed | low | Meta-analysis in athletes found ketogenic diets increased total cholesterol. |
| Chang C, Liu Y, Rohani P, Khodadadi N, Prabahar K, Sohouli MH 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 J, Wei C, Gong F, Pang Z, Zhao H 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, Bürkle M, Thiem A, von Baehr V, Sauren J, Keferstein G 2025 · Frontiers in nutrition | 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. |
| Burén J, Ericsson M, Damasceno NRT, Sjödin A 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 F, Baharlooie M, Bagheri R, Rosenkranz SK, Santos HO 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, Diaz-Arias L, Vizthum D, Henry-Barron BJ, Schlechter H, Kossoff EH, Cervenka MC 2022 · Nutritional neuroscience | 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 NG, Soto-Mota A, Kaplan B, Ludwig DS, Budoff M, Kontush A, Feldman D 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 T, Guo M, Zhang P, Sun G, Chen B 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, Flores-Jurado Y, Norwitz NG, Feldman D, Pereira MA, Danaei G, Ludwig DS 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 E, Smeets ETHC, Schrauwen P, Mensink RP 2020 · Nutrients | meta-analysis | mixed | moderate | Meta-analysis found the most severe carbohydrate restriction raised LDL/ApoB while milder restriction did not. |
| 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 | The paper measured LDL-cholesterol, not ApoB or LDL particle number, and says so: 'Finally, we do not, in this preliminary analysis, report on the LDL particle profiles of the KETO/LMHR subjects as compared to the MiHeart cohort.' Its one ApoB sentence is an inference, not a measurement — 'exceptionally high LDL-C, as seen in LMHR, is necessarily coincident with an overall high LDL-P and ApoB level' — and particle data are deferred. What it does report is LDL-C 272 ± 91 mg/dL in 80 adults on a ketogenic diet vs 123 ± 38 in 80 matched controls: a cholesterol result, not a particle count. |
| Zhang N, Liu N, Zhao G, Yan J, Zhang P, Li X, Zhou J 2025 · Journal of translational medicine | 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 M, Moon S, Lee YS, Kim MG 2023 · Nutr Rev | meta-analysis | supports | moderate | Meta-analysis of three RCTs in normal-weight adults: 'A KD significantly increased TC by 1.47 mmol/L (95%CI, 0.72-2.22 mmol/L), LDL-C by 1.08 mmol/L (95%CI, 0.37-1.79 mmol/L), and apoB by 0.35 g/L (95%CI, 0.06-0.65 g/L).' The apoB rise is the on-object finding; 3-study pool, abstract-grade. |
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