In summary
* A review article was published at the end of April 2026. It examined the evidence for rises in LDL-Cholesterol (LDL-C) among normal weight people who go on a ketogenic diet and the implications for atherosclerotic cardiovascular disease (ASCVD) risk.
* We have reviewed this previously with reference to the “Lean Mass Hyper Responder” (LMHR) research. The LMHR work was referenced in the review article.
* The review article was in four parts: What’s the evidence for keto-diet included LDL-C elevations in people with normal BMI? What are the mechanisms for this happening? What’s the ASCVD risk? and How can keto-diet induced elevations be reversed?
* I examined the review article using the authors’ four part framework with some surprising findings – not least how little evidence there is in this field and the fact that the observation is not exclusive to normal weight or lean people.
* In previous reviews of the LMHR work I have expressed concerns that the research continues to raise questions (arguably more than it answers). This week’s research strengthened that view.
Introduction
I have some key word alerts set up with PubMed and a few specific journals to spot newly published papers that might be of interest. On April 28th, 2026, the journal of the American Heart Association published a paper by Zachary DiMattia and Kristina Petersen called “Ketogenic Diets and Low‐Density Lipoprotein Cholesterol in Adults With Normal Weight: An Emerging Clinical Challenge” (Ref 1). The paper was a review article, which is a low level of evidence if you remember the first part of our “How to read a paper” series (Ref 2). However, review articles can be valuable, as they often collate research on one topic. That’s what this paper did.
Zoe
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