Metabolic syndrome is a medical condition known to be associated with type 2 diabetes mellitus (T2DM) and other health problems.^1,2 A set of five conditions define metabolic syndrome: high blood pressure, high blood glucose levels, abdominal obesity, high triglyceride levels, and low high-density-lipoprotein (HDL) cholesterol levels. This article will focus primarily on exploring the potential role the ketogenic diet, a type of diet focused on the consumption of very-low-carbohydrate and high-fat, can play in metabolic syndrome management. 

The prevalence of metabolic syndrome often corresponds with obesity,³ and each component of the metabolic syndrome, especially visceral adiposity, has been shown to be closely related to weight gain.⁴ Thus, the management of metabolic syndrome heavily focuses on lifestyle changes that promote healthy weight loss.⁴

 
A 2019 review on the effects of nutritional ketosis on metabolic syndrome management concluded that there is compelling evidence for the use of nutritional ketosis for weight and metabolic syndrome management.⁵ Although more long-term studies on very-low carbohydrate ketogenic diets (VLCKDs) are needed, current data show that the diet can result in improved weight, lipid profiles, and insulin sensitivity – important parameters of metabolic syndrome. One of the meta-analysis it reviewed concluded that VLCKDs resulted in significant weight loss, decreased triglyceride levels, and diastolic blood pressure while increasing HDL cholesterol (also known as the “good” cholesterol) compared to low-fat diets.⁹ However, low-density-lipoprotein (LDL) cholesterol (also known as the “bad” cholesterol) levels were shown to also increase.

 
A more recent meta-analysis in 2020 studying the effect of the ketogenic diet on individuals with T2DM found that the diet significantly decreased weight (mean = 8.66 kg), waist circumference (mean = 9.17 cm), and body mass index (mean = 3.13 kg/m²).⁸ The diet also significantly lowered fasting blood glucose levels by 1.29 mmol/L and hemoglobin A1c by 1.07% and improved insulin resistance. Additionally, lipid profiles were also improved, with triglycerides decreasing by an average of 0.72 mmol/L, total cholesterol by 0.33 mmol/L, and LDL cholesterol by 0.05 mmol/L, with increases in HDL cholesterol by 0.14 mmol/L.

 
Although more studies on the ketogenic diet’s effect on long-term cardiovascular health are needed, some evidence suggests that the ketogenic diet may also have blood pressure benefits.¹⁰ An expert analysis by the American College of Cardiology in 2020 noted weight loss, reductions in triglyceride levels, and improved glycemic control as key potential benefits.¹¹ However, the diet’s cardiovascular benefits may be short-term, and adherence to the diet can be challenging.^11,12