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Jul 04

High Triglycerides on Low Carb – And What to Do About It

Triglycerides (TGs) are effectively fat-based energy. And if you’re on a low carb, high fat diet (LCHF), you are likely eating them every day, along with storing them as such in your own fat cells. The “tri” is for the three fatty acids grouped in each one to a glycerol backbone.

So a common question I get is, “Hey, if we’re powered by triglycerides on LCHF/Keto — then why do my blood tests show my triglycerides have gone down since I started?”

Simple… your usage has gone up. Way up! And that’s a good thing!

Generally speaking, you want to aim for having your triglycerides below 150 mg/dL at a minimum, and preferably below 100 mg/dL for optimum health. I consider this universal, by the way. It doesn’t matter if you’re on a LCHF/Keto, Vegan, Paleo, Mediterranean, or Bob’s Special Custom Juice and Burger Diet. If you have high triglycerides, it suggests a problem — and certainly a problem I pay attention to more than any other marker.

Steps to Take

Here is my general checklist:

  1. Confirm you water-only fasted for 12-14 hours before your cholesterol test. (No food, no coffee, just water) The more outside that window you are, the more it can increase your TGs (especially if near a fatty meal).
  2. You have a coffee sensitivity. I know, I know, I hate to be the bearer of bad news. But we’ve found a surprisingly large number of low carbers who see their triglycerides stubbornly high from what appears to be coffee alone. Note this is just a fraction of the coffee drinkers as most of them appear to be doing fine.
  3. You may have “carb leaks”. Get serious about tracking your food. Be really, truly, absolutely sure you’ve accounted for all carbs in the diet. Common unaccounted-for leaks include sauces, spices, beverages, alcohol, and many things labeled “0g Carb” that actually aren’t (rounded down in some nutrition labels) such as some brands of Heavy Whipping Cream. Sometimes you want to use a glucometer to detect what is actually higher carb than you thought. Bottom line: many who have even moderate carbs while on a LCHF diet can see their TGs spike because it’s still too much of an energy surplus.
  4. Cut out refined/liquid/concentrated forms of fat. Drop bulletproof coffee, oils, fat shakes, fat bombs, etc. Move toward as much fat from real food sources as possible.

These above steps I’ve worked with family and friends on when TG is high and it’s had a very high success rate, save two people.

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68 Comments on "High Triglycerides on Low Carb – And What to Do About It"

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Liz LePla
Guest
My TGs are 3.26 (uk.Think that’s 228.5US). I would add that they were 619 a year ago when I was on meds (cholesterol med + statin) but I weighed 198 lbs. Now, lchf for 9 mnths, weight 144lbs, and NO cholesterol meds. BUT I also have v low HDL – 0.99 (38 I think US) so have been advised to eat more olive oil, take omega 3 oil supplements (I already eat oily fish about 3 times a week). Any advice, if to get the TGs down you suggest lowering oils? I could try the coffee (just have one espresso… Read more »
Rock
Guest

Again, you were spot on Dave.
Dropped my outrageously high Triglycerides by 400 points just by going ZC ( zero coffee) on Carnivore . That was after only 10 days ! Can’t wait to see what the numbers will look like in another 3 months. Have always had high Tri’s, been 3 to 5 cups of coffee and working on the midnight shift for over 30 years. Never suspected the coffee. Great advice as usual.

Linda
Guest

What else can I eat for breakfast other than oatmeal lowering my cholesterol and triglycerides are bad

Liz LePla
Guest

It’s the carbs that raise the triglycerides…so try a carb-free breakfast. Bacon and eggs. Omelette. Full fat greek yougurt, red berries, and chopped nuts.

Luanne
Guest

Mine went from 285 in 6 months to 149. The next 6 months went to385

Adam
Guest

Any thoughts on the mechanism for coffee to increase TG? Is it also tea (and therefore likely the caffeine)? Cheers.

Rob Smith
Guest

Dave

Does tea causes same issue, especially when had with butter ? How about eggs ? I am vegetarian and have eggs. Choices for me on Keto are very limited.

Eileen Janeke
Guest
Hi, as stated on FB, this is EXACTLY my problem and has been for years. In my country, South Africa, we are always advised to water fast from 10pm previous night before blood tests. I usually go in for tests about 9am. I am going for tests soon so will make it 12 hours exactly for that. I have 100% coffee (instant) *maximum* twice a day. With 2T pure cream & maybe no sweetener or often erythritol or xylitol. These are 2 of the sweeteners recommended by the Noakes Banting regime. I just cannot drink black coffee. I am a… Read more »
BobM
Guest
What about those of use who fast often? I have found my trigs increase while fasting: Date TC LDL HDL TGs TG/HDL 2/29/16 168 103 52 65 1.25 3/04/16 188 121 36 157 4.36 2/29 was after 12 hours of fasting; 3/4 was after 4.5 days of fasting. My trigs went from 65 to 157 while not eating. Notes: Did drink 1 drink of coffee per day (may have had a tiny amount of cream in it, can’t remember). Otherwise, water only. (May have had chicken broth, too, which I no longer use but may have been using then.) I… Read more »
Siobhan Huggins
Admin
Hi Bob – Yeah it’s pretty expected for triglycerides to be high during a multiday fast. During this time you’re relying solely on your own body fat for energy, so your body may put out more triglycerides than usual just to make sure there’s enough for all the cells that need it, is my guess as to why that happens. It has been documented in formal studies, and Dave also documented this in his own data. This is why it’s best to get bloodwork done 12-14 hours fasted – no more, or less because the further away you get away… Read more »
BobM
Guest
Hi Siobhan, It might have been coffee for the 10/31/16 test. I read for one of the tests that coffee could be drunk, so I did (w/o cream). That might have been the test where I drank black coffee beforehand. Otherwise, all tests done with 12+ hours of water only fasting. Note that the 10/31/16 test had an insulin level of 33, but a hemoglobin A1C of 5.2. (I’m only down to 5.0 now…so 5.2 is relatively low.) If I did drink coffee before the 10/31/16 test, I wonder if that also affected insulin? Hmm…maybe I’ll have to do a… Read more »
Yvonne Nowakowski
Guest

I’ve only been on the low carb diet for around 5 to 6 weeks but just had the result of my HB1ac test and my triglycerides are 3.12. I’m not overweight but I’m Type 2 diabetic. My question is. How long should it take to see an improvement in levels. My next triglyceride test is in 6 months and I’m hoping to see a lower figure.

Simon
Guest
Hi Dave, this is very interesting. I drink Bulletproof coffee almost every day as per of my LCHF lifestyle – I’m moving towards a Ketogenic lifestyle now having put my type 2 Diabetes into remission. I think my recent results are reasonable: HbA1c 46 mmol/mol HDL 1.4 mmol/L LDL 3.7 mmol/L Trigs 1.1 mmol/L Would love to get an NMR test to distinguish the LDL particle size but, my UK practice has never heard of it! Do you have any observations or comments? One thing that had me thinking was that my red blood cell count was low: RBC 4.31… Read more »
Digby
Guest

I hate you KetoDave (not really), but coffee was the last thing I have always really enjoyed, and look forward to—though I never drink caffeine coffee due to sleep issues. But for the sake of my August physical and labs I’m dropping coffee.

Siobhan Huggins
Admin

Just note that not *everyone* experiences this with coffee, but note if you get back some weird results that *may* be what it is. It doesn’t happen for everyone though (I drink plenty of coffee for example, and it doesn’t appear to do anything).

MOHAMMADZAKI MOHDGHAZALI
Guest
MOHAMMADZAKI MOHDGHAZALI

Hi Dave.

When you refer to coffee in your article above, do you mean zero-carb coffee, ie black coffee without sugar and cream etc. Thanks.

Hassan+Ahmed
Guest

Hi Dave, excellent article. If i wanted to test myself on coffee how long to drop the coffee before the lab sampling ? I use to be in the range 0.9 to 1.2 in the past but lately some of the tests were about 3 and yes i have been drinking /espresso american coffee much lately whereas in the past it used to be a 1-2 teaspoon of instant coffee all cafinated

I am on low carb and sometimes keto for years

Tony Webb
Guest
Hey all, new here, but not new to LCHF/Keto, been following Dr. Jason Fung, Diet Doctor for almost 2 yrs. Lost nearly 50#, now 167# for over a year. Have Type 2 DM in remission, off all the meds. Success, right? Well, my recent labs scare me. Thought I was doing great until these came back. I’m in the US, so the lab values reflect that. HgbA1c 5.2, Total Chol 330mg/dl, HDL 28mg/dl, LDL 243mg/dl, Triglyceride 294mg/dl, CPeptide 2.13ng/ml. Reading thru the Cholesterol Code, and the Triglyceride section/blog, and realize something’s wrong. Was on Statins for years, they simply made… Read more »
Steven Dick
Guest
Had an NSTEMI event at beginning of June and had 3 stents placed in 2 arteries. I was already low carb-ish, but with quite a few “carb leaks”. Am now on a statin, which I’m not happy about, but a lot of pressure from the doctor here in Switzerland to stay on it as they are purely focused on lowering LDL. Measurements day after stents placed (all mmol/l): total Cholesterol 5.3 HDL 1.02 non-HDL 4.3 LDL 3.8 Triglycerides 1.04 4 weeks later: total Cholesterol 4.2 HDL 0.90 non-HDL 3.3 LDL 2.6 Triglycerides 1.59 I’m now really doing the low carb… Read more »
john willis
Guest

When I started keto on January2018 my trigs were 516, but they had been as high as 3590 in 2016! I didn’t really figure things out strictly till March, but it’s been strict keto/ carnivore since then and my trig test yesterday came back at 60!!!! I’d had my ac1a1c as high as 14.6 with the 3580 trigs now its 5.9

Siobhan Huggins
Admin

Wow! What a huge improvement!

Rock
Guest

That’s incredible !

Hassan+Ahmed
Guest

Just a thought, you don’t have to answer

If we said coffee increases the triglyceride which is the energy. Where does the triglyceride comes from is it from the body fat or the body is not utilizing the fat? Is this why we feel satiated after drinking coffee? Is the high triglyceride a false reading as a result of high coffee intake and that the metabolism is actually unchanged?

Siobhan Huggins
Admin

From what I’ve read thus far, it increases lipolysis – e.g. it increases the release of fat from storage. I’ve not seen anything on it interfering with use of fat for energy, so my suspicion is that it’s increasing supply (from body fat stores), not decreasing usage. But, to be fair, I’ve also not seen a study implying it *doesn’t* interfere with fat utilization either, so it’s squarely in the “not sure” camp for now.

Rock
Guest

So then if that’s the case. If we do drink coffee, then we should increase exercise to burn it off. And then quit drinking it 10 to 12 days before blood work ?
Maybe 1 or 2 cups per day, instead of 5 or 6 on the night shift….

JohnD
Guest

Yea, as I was reading the comments I had the same thought. Have a coffee right before exercise. Then again, some say you shouldn’t “need” coffee to exercise, if you do need the caffeine then maybe you’re not getting enough sleep. My “guess” would be, if you’re trying to lose excess body fat then coffee before exercise is possible a good idea. If your BF is OK and you’re getting enough sleep then it’s decaf time : )

Ron Blouch
Guest
I’ve been listening to you all over the place, Dave. Just finished the truncated Robb Wolf podcast. I’m having some trouble so I’m going to reach out here to see if you have any thoughts on what’s happening. I’m 11 days ZC after 6 months full keto. I did not feel great on keto but I persisted anyway. <20g carbs, 100-140g protein. 20/4 IF. I decided to get a baseline blood test to see how my levels change on ZC over time and I'm freaking out a bit. I wanted to do the test at the end of 6 months… Read more »
Superchunk
Guest
Dave, Many thanks for all your effort on this. This topic is something I’ve wondered a lot about as well. I used to follow a low-fat diet which translated into an astronomic level of carbs. I seemed to do fairly well on that for most of my adult life until I ran into some general health issues and switched to a moderately low-carb approach which improved many things for me. When I was high carb my trigs were always pretty good, in the 70-100 range, however since I’ve gone lower carb (I vary between about 50 and 130 grams of… Read more »
Nathan
Guest
Hi Dave. I am a 33 year old male. I have always been very active with zero health problems. In October of 2017, I weighed approximately 195 pounds with 23% body fat. I started intermittent fasting, switched to a healthy balanced diet, and worked out four to five times per week at Orange Theory Fitness. In January of 2018, I weighed in at approximately 178 pounds and felt I hit plateau. In January of 2018, I started the KETO diet, started tracking my food/calories, continued intermittent fasting, and workouts. As of today, I weigh approximately 162 pounds and my body… Read more »
Anthony Webb
Guest
Hello everyone–quick question regarding coffee/tea and their adverse effects–do we believe its the actual caffeine in the drinks that interferes with the lipolysis in the liver, or another compound common to them both? I know there are numerous compounds found in both coffee and tea, just trying to formulate a plan of attack here, as I am a HEAVY coffe/moderate tea drinker, whose Cholesterol and Triglycerides have both spiked even after approaching 2 years KETO, with 50lb weight loss, DM Type 2 reversal, and otherwise feeling fantastic. Thanks for this website and wonderful info, Dave and everyone else-heaven knows the… Read more »
Donald
Guest
Hello Dave, very quick question. My triglycerides have been 80 or under for 2 years, I keep diet tight so nothing has changed, this paticular time My HDL stayed 60 like it has been but triglycerides rose to 113. Only things I can say may have affected it was I was fasted for 21 or 22 hrs because it was a late test, and I was in middle of mini weight loss 3lbs for some reason, Ive been low carb for years and at matience, I think wt loss was caused by upped walking and increased activity past month..what is… Read more »