APOE4 carriers, particularly homozygotes, may experience altered lipid metabolism on a ketogenic diet, leading to increases in LDL and triglycerides, and decreases in HDL.

“Even ApoE4 carriers tend to like you'll see their LDL go up and you'll see things like HDL go down and you'll see they start the diet and their triglycerides go up. Like I, you know, I've seen that a lot in quite a few people and I think there's some genetics that need to be unpacked there. Uh in several cases it was people that were APOE E4 carriers like they're homozygous. So I think there's something to unpack there. they just don't uh metabolize their lipid metabolism is a little bit different.”