Ketogenic diets improved glucose, weight and triglycerides in a review of 24 studies involving more than 47,000 participants, but LDL-C climbed by about 12.2 mg/dL. The July 7 analysis in BMC Cardiovascular Disorders, indexed on PubMed as PMID 42414899, sharpened the keto debate into a familiar split: the metabolic markers many readers chase moved one way, while key lipid markers moved the other.
Hanxiu Liu and colleagues searched PubMed, Embase, Web of Science, the Cochrane Library and gray literature through March 2026, then pooled randomized and observational evidence on adult ketogenic diets. The review found lower fasting glucose, lower HbA1c, lower body weight, lower BMI and lower systolic blood pressure, along with a modest rise in HDL cholesterol. Triglycerides also fell, by about 16.1 mg/dL, reinforcing why keto remains attractive to people using it for weight loss and glycemic control. The protocol was not prospectively registered.
The caution sits in the same dataset. Total cholesterol rose, and the LDL-C increase is the kind of change that matters when heart risk is part of the picture. For readers who track labs closely, that means LDL-C and total cholesterol belong on the watch list alongside fasting glucose, HbA1c and triglycerides, not after them. The review’s bottom line was individualized risk-benefit assessment, not a blanket endorsement or rejection of keto.
That framing fits with March 2026 lipid guidance from the American College of Cardiology and American Heart Association, which said about 1 in 4 U.S. adults has high LDL-C and called elevated LDL-C a major risk factor for heart attack and stroke. Their dietary guidance also emphasized vegetables, fruits, whole grains, healthy protein sources and unsaturated fats, while minimizing saturated fat, added sugars and sodium. In practical keto terms, the fat source matters as much as the carb count.
The LDL signal has shown up elsewhere too. A 2026 PubMed-indexed review said adults with normal BMI may be especially susceptible to large LDL-C increases on ketogenic diets, a warning for leaner people using keto for optimization rather than weight loss. At the same time, a 2024 GRADE-assessed meta-analysis in type 2 diabetes found very low carbohydrate ketogenic diets lowered fasting blood sugar, HbA1c, insulin resistance, triglycerides and blood pressure, with no significant LDL or total cholesterol difference. Another 2026 paper in Arterioscler Thromb Vasc Biol reported that both saturated- and unsaturated-fat-based ketogenic diets attenuated atherosclerosis despite different effects on adiposity.
The latest review leaves keto readers with a clear split to manage: the glucose and weight gains are real, and so are the lipids that can worsen. For anyone who wants the metabolic upside without leaning hard on saturated fat, a more Mediterranean-style version of keto is the cleaner frame.
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