ArticleLipids in health and disease2026
Increased LDL-C reduction with ezetimibe in ketogenic diet-induced hypercholesterolemia.
Article in Lipids in health and disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Several case reports and a meta-analysis have documented significant increases in cholesterol levels among individuals following a ketogenic diet. However, the mechanistic drivers of this phenotype remain incompletely understood. Here, we describe a retrospective case series of 14 patients with ketogenic diet-induced hypercholesterolemia who experienced larger-than-expected LDL-C reductions after ezetimibe therapy. In a subset of participants with available genetic data, no biallelic sitosterolemia-associated variants were identified in the loci assessed. We hypothesize that chronically low insulin levels may alter hepatic cholesterol homeostasis through changes in ACAT2-mediated cholesterol esterification and in NPC1L1/ABCG5/G8-mediated cholesterol handling. The magnitude of LDL-C reduction achieved with ezetimibe in this cohort suggests that altered cholesterol absorption may contribute importantly to this phenotype. This hypothesis-generating framework offers a plausible mechanistic explanation and supports further prospective study of precision lipid management in ketogenic diet-induced hypercholesterolemia.
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