Increased LDL-C reduction with ezetimibe in ketogenic diet-induced hypercholesterolemia.
J, G., J, W., L, B., T, K., M, C., E, S., & A, S.M. (2026). Increased LDL-C reduction with ezetimibe in ketogenic diet-induced hypercholesterolemia.. Lipids in health and disease. https://doi.org/10.1186/s12944-026-03034-w
J G, J W, L B, T K, M C, E S, et al. Increased LDL-C reduction with ezetimibe in ketogenic diet-induced hypercholesterolemia.. Lipids in health and disease. 2026; doi: 10.1186/s12944-026-03034-w
J G, J W, L B, et al. Increased LDL-C reduction with ezetimibe in ketogenic diet-induced hypercholesterolemia.[J]. Lipids in health and disease. 2026. DOI: 10.1186/s12944-026-03034-w.
@article{j2026,
author = {Gonzalez J and Wageman J and Buchanan L and Kalayjian T and Calkins M and Saner E and Soto-Mota A},
title = {Increased LDL-C reduction with ezetimibe in ketogenic diet-induced hypercholesterolemia.},
journal = {Lipids in health and disease},
year = {2026},
doi = {10.1186/s12944-026-03034-w},
note = {PMID: 42661192},
}
TY - JOUR AU - Gonzalez J AU - Wageman J AU - Buchanan L AU - Kalayjian T AU - Calkins M AU - Saner E AU - Soto-Mota A TI - Increased LDL-C reduction with ezetimibe in ketogenic diet-induced hypercholesterolemia. T2 - Lipids in health and disease PY - 2026 DO - 10.1186/s12944-026-03034-w AN - PMID:42661192 ER -
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.