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:
- 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).
- You may 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.
- 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.
- 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.
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 a day, with 1/2 tbs of heavy cream). Otherwise only drink water. BTW I’m 68 yrs old.
Your HDL will almost certainly come up if you bring your trigs down, which I’d definitely consider important, IMO. Consider the four steps above, particularly 3 and 4 to help get there.
Thanks Dave. Have cut coffee from today! Carbs currently around 30 gms a day, so will try and cut that. Don’t have a lot of excess fats, beyond the olive oil on salad and butter on a few veg. Don’t do fat bombs, bulletproof coffee, shakes etc. But Dr was pressing me to go back on meds, which I definitely don’t want to do…so determined to do SOMETHING to improve it!
Great to hear, Liz. Please consider sharing the data back, however it goes. 🙂
What do you theorize is the mechanism behind this, Dave? Trigs down = HDL up?
Is there any chance that zero calorie sweeteners such as aspartame in Crystal Lite would have any affect on Trigs/HDL? I use Crystal Lite when backpacking to flavor salted water once or twice a day and sometimes use it at home because it’s hard to drink enough plain water.
Hi John – I’ve not seen anything regarding this specifically from what people have shared (and haven’t noticed anything in my own bloodwork after quitting diet soda) but if I were curious about this regarding myself, I would likely just try switching to plain water for a week or two and see. Assuming I’d already gone through the other items on the list in the post and ruled them out.
Seven years ago, my TG was over 350. I switched from sugar to Splenda, Munk fruit, and erythritol and my TG dropped below 90 in 6 months. How can coffee have any effect TG levels? It does not. Coffee is good! 5% of people are posting advice with no knowledge and no credentials with fabricated data.
Hi Jae – no one is saying here that coffee is the only thing that can impact triglyceride levels! There are many – frankly much more likely – causes, of course. Metabolic syndrome being a notable one. If no metabolic syndrome then (as noted in the above post) other factors like not being properly fasted prior to testing, or a few other things may play in as well from what we’ve seen. I would suspect these well before suspecting coffee as a culprit.
Rocco is sharing his experience with the phenomenon outlined here. To note, this is a niche problem – it appears to be fairly uncommon, only impacting a subset of a subset of people – most people, from what we’ve seen, can drink coffee in the days leading up to testing without it having any noticeable impact. In the people who do, typically coffee as a factor is only suspected after other factors (metabolic syndrome, not fasting long enough/too long, not being water-only fasted, etc) have been ruled out. The people who are experiencing this (like the author of the post) can confirm it is coffee – specifically coffee, even black coffee, even decaf coffee – influences their triglyceride level and can alter their level simply by drinking or not drinking coffee in the days leading up to the blood test.
But again, just because some people are reporting the above phenomenon sometimes doesn’t mean it’s the only reason for higher triglyceride levels, nor is it anywhere near the most common that we see here or out “in the wild”.
I have read quite a bit on how saturated fats and fattier cuts of meat actually help to increase your HDL… along with moderate exercise.
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.
Yes — if you quit coffee and retest, please come back to us and post the data. Would love to see how it turns out. 🙂
Absolutely I will. Thank you Dave
Ok, Dave. Quit the coffee over 2 months ago. Still 99% carnivore. Occasionally a hand full of raspberries. Mostly water with some unsweetened tea. Everything headed in the right direction .
1st test. Tri’s were. 696. 10 days later and they dropped to 292 without coffee. Yesterday my test came back at 228. This is my lowest ever. But still not satisfied. Gonna really hit the gym hard. Guess the tea will have to go also. What about the Heavy whip cream on the berries ?
Just so no one gets confused. I changed my title from Rock to Rocco. Same person
That’s some powerful data. Dropping off the coffee really had a huge impact!
And yes, you might want to consider dropping off the liquid/refined forms of fat (per #4 from the above advice)
Thanks again. Gonna do the water only challenge for 90 days. Drop Everything but meat and water. Need to drop 10 more pounds/ lower my body fat to 15% or better. Maybe not need, but my goal. Other than that, I am healthy, happy and haven’t felt this good in a long time. You are the man ! Will report back in another 90 days…
How long does it take to get results? I dont want to do carnivore for 90 days. I want to get Tri’s down with a SUSTAINABLE solution and carnivore is not sustainable. What about donating blood plasma? I heard or read that somewhere. I only drink one cup of coffee a day but it’s a large cup but it’s also half decaf so it’s like one small cup a day in the morning with a odd second cup one or two day a week.
Ive been LFHC two or three months but eat asparagus 4 – 5 days a week.
and don’t change anything else; I’m sure you will see coffee had nothing to do with it
is it the coffee only? or is it because of creamers etc. in the coffee?
coffee had nothing to do with it
What else can I eat for breakfast other than oatmeal lowering my cholesterol and triglycerides are bad
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.
Hi Linda — my guess by your comment is you aren’t on a low carb high fat diet, is that right? If you’re on a mixed diet of both carbs and fat, then seeing high triglycerides is something I’d consider worth tackling. You might want to consider a diet that helps to lower them (whether low carb or not).
Mine went from 285 in 6 months to 149. The next 6 months went to385
Hi Luanne — this article is definitely for you! Your TG should have remained lower and gotten lower still. Consider these steps to better figure out what is going on.
Any thoughts on the mechanism for coffee to increase TG? Is it also tea (and therefore likely the caffeine)? Cheers.
Correct! I suspect it is caffeine and indeed we see this in many studies with regard to lipolysis. But I zero in on coffee in particular as even heavy diet soda drinkers haven’t been showing the kinds of TG rises coffee drinkers have. So this may just come down the sheer quantity of caffeine per cup.
No problem with trigs here but one thing I have done is switch to decaffeinated coffee. This might help people to not give up on coffee but get the lower trigs.
Thanks for the tip, Sven
Didn’t the coffee experiments show caf and decaf equally affected tgs?
Yes but that comment was written two years ago – a year before that experiment was done. 🙂
I came across a few papers that say caffeine increases triglycerides and reduces insulin sensitivity.
Caffeine can decrease insulin sensitivity in humans. https://www.ncbi.nlm.nih.gov/pubmed/11815511
Caffeine-induced impairment of insulin action but not insulin signaling in human skeletal muscle is reduced by exercise. https://www.ncbi.nlm.nih.gov/pubmed/11872654
It seems that what is happening is that caffeine increases adrenaline, which increases lipolysis, which increases free fatty acids. Insulin sensitivity has to decrease to allow the lipolysis to happen.
Of course, the real question is; Is that good, bad, or indifferent. I think it explains my moderate TG (~130) while on LCHF
So then are you saying to cut out caffeine and increase exercise to help lower trig? Would this include dark chocolate? Serious question.
@Becky, Exercise lowers trigs temporarily. I just had the lowest trigs in 5 years but it was two days after a vigorous hike that made my butt sore (and is still sore lol). Cutting caffeine works for some people. I just switched to decaf. Chocolate *usually* has no affect on trigs but raises HDL and tends to lower LDL (a good thing). I just bought some dark chocolate 20 minutes ago. I would not cut dark chocolate except as a test if you want to. Are you home testing trigs as I am? I bought a CardioCheck Analyzer with just trigs and HDL strips. I’m not sure chocolate has a significant *measurable* effect.
Speaking of exercise lowing trigs… https://cholesterolcode.com/impact-of-endurance-running-on-cholesterol/
It’s interesting, I’d have assumed it to be caffeine all this time as well. But we seem to see it with coffee in particular and much less so with caffeine. Recently, there was an experiment with someone who confirmed his sensitivity and tried decaf with these results. https://cholesterolcode.com/guest-post-impact-of-coffee-on-triglycerides/
Did I hear anywhere (I hear/watch you a lot) you saying that you think decaf would also be problematic? That’s the route I’m thinking of taking. I drink coffee for pleasure, not even for the famous energy boost.
Yes, this is mentioned in this guest post. They also had a reaction to decaf and filtered coffee. We’ve not seen anyone react to other caffeinated beverages like tea or energy drinks or so on, so it does seem to suggest it may not be the caffeine in itself.
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.
Rob — tea may be an issue in large quantities. In fact, we have a case who may be experiencing very high TGs because he really can’t let go of tea. But we won’t know until we can get him to test without it.
Eggs should be fine — that’s a very *unrefined* source of fat. Butter can be a problem if you are downing it in large quantities.
Thanks Dave. I am talking about 2 cups of tea with about 30 gms of butter. Would that be considered large quantities ? I need to have tea once a day and have been drinking for a long time. If I need to be out of tea and butter for one week and test, i can do it. Can a week without tea be good measurement ?
Sure, you may want to consider a week without tea and the added butter.
The bergamot oil in Earl Grey tea is now said to reduce bad cholesterol, even better have your Earl Grey made from red bush (rooibos) tea which is naturally caffeine free.
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 big fan Cronometer Gold user & track intake quite accurately. I could tighten up there somewhat.
I’ve never tried bullet coffee nor fat bombs ever. Fats I use in moderation are olive oil, butter, de-flavoured coconut oil, pure cream.
Trigs (Nov 2017) 3.17 (280) drifted down from 4.01 (354) May 2016.
HDL (Nov 2017) acceptable – only just – at 1.3(50) and has tended to hover at close to 1.2 for years.
LDL (Nov 2017) 5.8 (223)
Other tests indicate small dense particles.
A real picture of dyslipidemia not so?! I’ve kept records since 2007. A period on statins did not help the situation much and I stopped them in 2012.
A sedentary lifestyle (home-based accountant),a high BMI and my age do not help.
I have recently broadly adopted Raymund Edward’s OKL keto with higher protein and it seems to help with *stubborn* weight loss. The results of my latest efforts to right my situation will tell all in the blood tests to be done….. thanks for ‘listening’ Dave.
Hi Eileen- Yes, I’d hope you’d continue tackling those trigs! Again, you’d want them to be below 1.69 mmol/L at a minimum, but preferably below 1.13.
Thanks Dave, I’ll report back.
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 have the high TGs (158) after 4.5 days of fasting confirmed by another test, but I did not know enough back then (2015) to test before the 4.5 days.
My trigs are wildly variable: 113, 120, 158 (4.5 days fasting), 65, 157 (4.5 days fasting), 147, 58, 54.
Date TC LDL HDL TGs TG/HDL
10/31/16 195 112 54 147 2.72
11/14/16 163 96 55 58 1.05
I was shocked my TGs were so high (147) on 10/31, so I got another test taken two weeks later (after vacation, no less), and got a substantially lower number (58). I have no idea what changed between these. It could have been carbs, as insulin was also high on 10/31 (33.0) and lower on 11/14 (but still high, 23.8). I’m similar to Jimmy Moore, though, as my insulin tends to be high unless I fast a lot (I’m also much stricter keto now, eating near carnivore levels).
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 from around that point the more markers like triglycerides may be confounded.
I’m not sure what happened between 10/31 and 11/14 either, but it could have been you weren’t properly fasted, or had coffee on the morning of the test, or higher carb in the days prior, or anything similar to that. It’s why it can be a good idea to log what you’re eating (even if just by taking pictures) for about a week prior to getting bloodwork done so you can go back and troubleshoot if needed 🙂
Trigs can also fluctuate normally about 20-30% between tests, as well.
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 test. I really need a lab at my office, so I can get test like this done w/o driving anywhere. 😉 (Though the test two weeks later was water-only fasting with insulin of 23.8.)
I have to say about the food that I just can’t do blogging about it or calorie counting. I’ve did that for years on low fat, and I hate it now. I’m down about 50 pounds not doing it, so if I don’t have to do it, I won’t. If I need to, I will, but I hope I never need it.
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.
While you are still relatively new into the diet, I would’ve expected your TGs to definitely be under 1.7 mmol/L at this point (preferably under 1.13). You may want to consider the steps above to help reduce this marker.
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 10*12/L reference range 4.50 – 5.50
Haematocrit 0.393 reference range 0.40 – 0.50
Should I be concerned?
Hi Simon — can’t say I have a lot of experience on the RBC and Hcrit just yet. Ping Ted Naiman or Ben Bikman as I think that might be more in their wheelhouse.
Thanks for the response Dave, I’m aiming to get my triglycerides lower & was just wondering about my LDL figure. I believe the theory goes that low triglycerides (generally) indicate that you have the large (non damaging) particles of LDL in abundance over the small (damaging) LDL particles – I know there’s a genetic element too. Obviously, an NMR would tell me for sure – I’m working on that.
Do you think my Triglycerides in the context of my results are worrisome and worthy of considering removing my Bulletproof coffee from my diet? Im a real food advocate other than that!
Sorry for sidelining you with the red blood cell & haematocrit figures.
Your Trigs of 1.1mmol/L (97 mg/dL) aren’t of big concern for me. But for me personally, if cutting out BPC would bring it down further, I probably would. As with most food choices of enjoyment, it could be a trade off.
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.
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).
What Siobhan says! But seriously, we usually talk about this when someone is low carb and their trigs seem very oddly high. So if your trigs are already low, you might not have an issue.
When you refer to coffee in your article above, do you mean zero-carb coffee, ie black coffee without sugar and cream etc. Thanks.
Too early to say. I’ve anecdotally gotten both black and non-black versions reported as problematic, but again, the sample size is super small. So we can’t say for sure yet.
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
I’d try going 10 days without and testing on the 11th day. Try to keep all food, exercise, etc as the same as possible. 🙂
And of course, please share back the data!
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 me sick. Stopped them 2 yrs ago when I changed my diet. I DO drink a very large amount of coffee and tea a day, so, reading the blog, I wonder is that a player here? I’m a 30 year Registered Nurse so please don’t feel you have to put things in ‘plain English’ lol. Any thoughts or help appreciated, thanks for the great information.
I will concede I’m not psyched about your numbers. HDL is very low and TG very high. Of course, what usually drops the TG will typically raise the HDL. So you may want to consider the steps in this article.
Thanks Dave. As of today I’m cutting back on the coffee to 1 cup in the morning, and am planning on cutting it out altogether in short order. I’ve drank so much, for so long it’ll take a hot minute to detox and fight off the withdrawal. Also fear I have some “carb leaks” (great term, I’m borrowing that one btw) in my dietary routine. Looking for homemade Keto salad dressing recipes, and had been using “fat bombs” pretty often. I’m rethinking my entire diet routine, and will definitely be detailing my food choices & macros from here on. Also will try to increase exercise to help my body do what it should. Stupid desk job for the past several years isn’t helping. I’m sure I’ll have other questions, will continue to look at your videos and read the articles. Thanks, I feel your information is spot on!!
It’s annoying, but I can assure you much of everything we do successfully is simply a matter of building habits. You’ve recognized what you want to change, not it’s just the hard work of sticking to it. 😉
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
4 weeks later:
total Cholesterol 4.2
I’m now really doing the low carb thing, but do 2 cups of filter coffee with cream a day.
Concerned at the reduction in HDL and increase in triglycerides between the tests.
The doctor is concerned at my liver ALT(SGPT) measure of 88 U/l, which I don’t have an earlier reading for comparison. I assume this could be a statin side-effect.
I too would prefer your TG were lower and HDL higher — however — I don’t have a lot of experience reading labs nor knowing much about secondary prevention patients, particularly so soon after the surgery. It could be your body is in a reparative event which would itself explain the numbers more as well. Again, very speculative.
I have been frustrated with the doctors, as I find their communication approach very old-fashioned and it feels too much like I’m in school and they are the teachers that know best. If I don’t ask questions, I don’t get any information.
Do you know of any papers or other bloggers looking at low carb in people recovering?
Off the top of my head, You might want to check with Bret Scher, Ted Naiman, and/or David Diamond.
I had already come across Ted, but thanks for the additional leads. I did forget to mention that I’ve lost 4 KG (from 87 down to 83 KG) in weight between the blood tests. I have read that weight loss can increase triglycerides during weight loss?
Yes — I know from my own personal data that this can impact lipid numbers quite a bit. Consider giving it a little more time until you are weight stable.
I’m sorry to hear about your struggle, Steven. Pretty soon I’ll be putting more time into secondary prevention research and have a stronger opinion on it. But for now — as I always try to do — I point out that I don’t know what I don’t know.
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
That’s incredible !
Wow! What a huge improvement!
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?
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.
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….
Per Siobhan’s comment — hard to say on the “we should” pontificating. The extra TG may be benign, it may be terrible. We just don’t have enough evidence yet.
But sure, if I were a coffee drinker and wanted to ensure the best blood lab, I would likely quit coffee at least 10 days before the test.
Have you tested decaf coffee yet to find out if it also affects TG results?
That was tested here – although it hasn’t been replicated by someone else yet (currently in progress) he did see a rise from decaf coffee as well.
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 : )
but when you say “coffee” do you mean caffeine? what about decaf? Thank you.
We don’t fully know yet, I have seen mechanistic arguments for both. In this guest post, decaf was tested which still resulted in increased triglycerides.
But, some replication on this would be helpful, for sure, to verify the result.
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 keto but I delayed it until I was 9 days ZC. I fully understand I'm seeing a snapshot of my system in transition. That was not my intention but that's how it played out.
BUN is 42, uric acid is 9.2, eGFR 47, creatine 1.6. I tend toward the top of the scale on all of those measures historically but nothing like those numbers. Usually within range or a point off.
TC 359, HDL 77, TG 179.
I was exactly 12 hours fasted, not dehydrated.
I'm less concerned about the lipids than the kidneys.
I also feel like shit. Exhausted, foggy, insomnia, the two week diarrhea that is common to ZC.
One 16 once cup of coffee a day upon waking.
Any thoughts? I'm trying to decide if I need to stop what I'm doing, wait through a transition, see a doctor, or what.
My first suspect is electrolytes given everything you just mentioned. I should again mention that I tend to be way up on the scale myself and often have to have lots and lots of salt (at least north of 6g, usually around 10g). Everyone is different, but I do find when I’m low on it I get very puny, have poor sleep, foggy headache, an overall feeling of malaise, etc.
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 carbs per day depending on my activity type and level) I expected that my trigs should have stayed steady or dropped, but they have either been about where they were before or somewhat higher (my latest reading was around 120.) I do drink coffee but I drank coffee before when my trigs were lower. I could cut my carbs more however my athletics suffer and I feel a bit lethargic when I do, so I try to follow more of a Robb Wolf/Ben Greenfield/Paul Jaminet/Mark Sisson model of macros. I know that Dr. Davis has said that he saw many patients whose trigs were higher when they were losing body fat, however I’m fairly lean and stable with my weight. I do have something from time to time that would qualify as a fat bomb so I will try cutting back on that although I will have to put some thought into what to replace those calories with. I used to (in my high-carb days) eat a lot of oatmeal so I have been working that back into my carb budget.
I’m curious if you’ve seen this pattern and have any thoughts. It seems that there is a lot of emerging experience for people who can tolerate ultra-low carb but not as much for those of us who seem to do better on moderately low carb.
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 percent fat is at approximately 12%. I feel that I am in the best shape of my life and overall feel great.
Last week, I visited my doctor for a routine check up and we discussed my weight loss journey and the KETO diet. My doctor said I looked healthy and recommended for me to take a blood test.
I received my blood test results and I was slightly concerned with my overall Cholesterol and LDL. Prior to my blood draw I was fasting for 10 hours, consuming no food. I did have a black cup of coffee and apple cider vinegar in the morning.
Cholesterol 295 mg/dL
Triglyceride 56 mg/dL
HDL 76 mg/dL
Low density lipoprotein calculated 208 mg/dL
If you have some time would you be able to give your opinion on my results?
Yes, your story and profile fits to a Lean Mass Hyper-responder. You should watch my presentation here: http://cholesterolcode.com/ketocon-2018-initial-lmhr-presentation-rough-cut/ — It will help to make a lot more of this make sense.
And consider joining our new Facebook group for LMHRs: https://www.facebook.com/groups/leanmasshyperresponder
Hi dave, I am not on face book, is there another way to join the group? I have already commented for the high responders ( according to your parameters , I am one).
Hi Diane – unfortunately the group is a facebook group, so if you don’t have a profile there’s no way to join…
You could always make a profile – if so inclined – in order to join the group, that would likely be the most straightforward way to get access.
Thank you for your response Dave. I’ll check out the link.
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 “mainstream” media/medical/nutritional/Pharma industrial complex don’t want to help us with the TRUTH….
It’s early for me to say with any reasonable expertise as I haven’t read many of the studies yet. But of course, the easiest way to find out is to simply cut out all these drinks for 10-14 days and retest. Try your best to keep all other variables the same.
I’ve already cut down to 1 cup of coffee a day-down from about 8-10, and 1 drink of weak tea in the evening-down from 3-4 of regular strength. Soon I plan to cut those out as well. Caffeine withdrawal is a bitch!! Should be able to retest in a month, have a PCP appointment end of August, plan on getting the tests then. I’ll post the results. Thanks for your honesty sir.
That’s great, Anthony. And feel free to share back the new data, however it goes.
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 your thoughts
For one, I don’t think an increase of 113 from 80 is a head-turner. I’d generally prefer it were below 100, but it’s hard to say for sure what the level of “noise” is given TG is the noisiest of markers.
Second, yes — I think BOTH you longer fasting period of 21-22 hours and your recent weight loss can contribute to the higher TG (as I’ve shown with my own data).
Dave how are you. My boyfriend had
He did what’s saids in this page 14h fast, . Gave up coffee heavy cream… And now 13 days later…
He stills in the high risk, I don’t know what to do and we don’t have low carb doctors in my country.
What do you recommend?
I’m really sacred.
Going out of keto? Please help! Thanks.
Sorry for too many questions, but he can’t eat even a 5ml olive oil to dressing his salad? I mean totally zero butter cream and oil? Thanks!
That is pretty interesting as far as results go. If I were in the same position I’d make sure I was tracking my food – every single thing I was eating including sauces and condiments and such – just to get a good idea of what I was eating, and carb/fat content, etc.
It may be helpful to do this for say, a week, and then take that information to a forum – I prefer the ketogenic forums – to get some feedback and see if it could be something in the diet causing the issue. Perhaps that would help? I would definitely want to try and pinpoint what’s going on.
You know what? The weirdest thing is that I track everything on my fitness pal. For this 9 months I have been login everything for each of us… Im going to cut the olive oil and butter and see how it goes. Because my test went perfect but his… Idk. Thank you for the answer!
For those who have found coffee to be a problem raising Trigs and have cut it out, what kind of improvement have you seen?
Do you mean improvement in trigs? One example was someone whose trigs dropped by 400 points just by cutting coffee for two weeks…
Most people I’ve seen go from 2-300 to <120 mg/dL if it was the coffee causing the issue.
I had my blood drawn again this morning, it’s been over 3 weeks since I’ve had a drop of coffee. Hoping to see some improvement in the trigs. Have you ever encountered people for whom coffee has affected other lipid measures?
Mostly it tends to impact triglycerides, LDL, VLDL, and remnant cholesterol. Hopefully your test sheds some light on the issue!
ON COFFEE Blood Drawn 20-July-2018
–==== CholesterolCode.com/Report v0.9.2 ====–
…9 months on Keto (less than 20g carbs) ::: 12 hours water fasted…
Total Cholesterol: 662 mg/dL 17.12 mmol/L
LDL Cholesterol: 572 mg/dL 14.78 mmol/L
HDL Cholesterol: 51 mg/dL 1.33 mmol/L
Triglycerides: 202 mg/dL 2.28 mmol/L
Remnant Cholesterol: 39 mg/dL 1.01 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.76 >>> Medium-High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.234 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 571 | Iranian LDL-C: 578
Total/HDL Ratio: 12.98
TG/HDL Ratio in mg/dL: 3.96 | in mmol/L: 1.71
NO COFFE FOR 24Days Blood Drawn 17-Aug-2018
-==== CholesterolCode.com/Report v0.9.2 ====–
…10 months on Keto (less than 20g carbs) ::: 13 hours water fasted…
Total Cholesterol: 571 mg/dL 14.77 mmol/L
LDL Cholesterol: 493 mg/dL 12.76 mmol/L
HDL Cholesterol: 56 mg/dL 1.44 mmol/L
Triglycerides: 114 mg/dL 1.29 mmol/L
Remnant Cholesterol: 22 mg/dL 0.57 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.39 >>> Medium Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.048 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 492 | Iranian LDL-C: 451
Total/HDL Ratio: 10.2
TG/HDL Ratio in mg/dL: 2.04 | in mmol/L: 0.9Join the discussion
I’ve also procured a requisition to get my thyroid tested. Still can’t figure out why my Trigs are so high, over the last couple of weeks I’ve also tried to incorporate more sources of mono unsaturates (fish, olive oil, avocados etc). Any suggestions Siobhan?
Siobhan, started working with a Naturopathic Doctor. BINGO his is licensed to take blood samples and were going to mail them to texas to get a full NMR with fasting insulin apoa apob LP(a) etc etc! $150 CDN but it’s worth it in my eyes. Bad news is that I requested a thyroid blood req as I had a couple of symptoms… one being sky high LDL, just got a call today that they’ve scheduled me for a thyroid ultra sound. So more to come on that. Good news is that I will have standard lipid panel from when I was NSNG, a standard Lipid panel from when I was fully keto and one when I was Keto and off coffee, the next NMR will be Off coffee, Keto but avoiding sat fat as much as possible and focusing on the mono’s. Hoping to chase this all down and get to a peaceful mind soon! Thanks for all your hard work Siobhan and Dave and can’t wait to see your latest 12.5 day protocol data 🙂
Glad to see you’ve found someone who is willing to help you get some more info! I’m sure I’ll do a write up when all the data comes in from the protocol, so stay tuned! 🙂
Blood draw from the 20th Dec 2018. Considering back in July I had a total cholesterol of 17.12mmol I’d say I’m still moving in the right direction. Ditched the one meal a day and haven’t a drop of coffee since this summer, have tried to focus on getting more omega 3s (Sardines, literally every day). One thing this time that has changed was my exercise routine in the week leading up to the blood draw was negligible compared to usual I also had some freezing for a dental repair the week of this draw.
LDL is down, HDL is up, Trigs are down, AIP down and Remnant Chol is down. Off to see a cardiologist next and keeping my fingers crossed that I can obtain a CAC score. I’m reassured by my numbers getting better and being closer to a hyper responder. Hope you can comment on my new numbers Siobhan.
Join the discussion…–==== CholesterolCode.com/Report v0.9.3 ====–
…2 years on LCHF (20g to 120g carbs) ::: 13 hours water fasted…
Total Cholesterol: 312 mg/dL 8.08 mmol/L
LDL Cholesterol: 241 mg/dL 6.22 mmol/L
HDL Cholesterol: 59 mg/dL 1.52 mmol/L
Triglycerides: 67 mg/dL 0.76 mmol/L
Remnant Cholesterol: 12 mg/dL 0.31 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.2 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.301 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 240 | Iranian LDL-C: 206
Total/HDL Ratio: 5.29
TG/HDL Ratio in mg/dL: 1.14 | in mmol/L: 0.5
I was thinking the VLDL and remnant cholesterol were the same thing.
Remnant cholesterol is cholesterol contained not only in VLDL, but also IDL, and chylomicrons as well.
Just check my trigs with my cardio check, a little worried.
What way of eating are you following ?
Carnivore now 4 months.
That is definitely something I’d want to look into more. Were you water fasted 12-14 hours for it? No coffee, etc?
Could there be some kind of resistance going on from eating too much fat over a period of time that is similar to the insulin resistance from eating too many carbs? Perhaps eating more fat is beneficial up to a point, but later causes a need for more fat and then finally causes a very bad result similar to insulin insensitivity. Does coffee increase bile flow? If we cannot get enough energy from glucose or ketones than perhaps we become anorexic or anorexic-like. I believe anorexics have high cholesterol. Do they have high triglycerides too? Maybe it’s best after a long period of eating a high fat low card diet to increase healthy carbs to offset the fat consuming famine-like periods.
I have exactly the same situation. I know it is two years later but did you figure out why tryglecerides went up on Keto. I am so scared. Never had this happen before.
No, I have not figured out why my triglycerides went up on a keto diet. However, I am now trying to be very careful about my weight which at the time dropped down to 86 pounds. I am about 5’1″. I was on a keto diet only because I was trying to decrease my glucose levels which were headed into a prediabetic range. The keto diet really helped to lower the glucose but I got to a point where I really couldn’t go on with the weight loss even though I was eating plenty of food.
I am now eating only “real” food. I am still staying low carb but not keto. I have not had another cholesterol screening since, so I don’t know what my triglycerides are like now. I do check my glucose at home and my readings are now very good. I really don’t need a keto diet anymore. My next cholesterol test is scheduled for 2022.
Thank you for this information! I am concerned my husband who has been keto for 8 months and his Tri’s have increased however the doctor said in the last test that he did not need to fast so his numbers went from (fasting 250mg/dL to nonfasting 479mg/dL) Either way still too high! I am worried I don’t want him on a Statin but maybe he needs to be. I am afraid I am causing him harm by not having him on it. I will have him stop coffee and see. He is keeping his carbs below 20g per day
Hi Karen — indeed, I certainly think being on keto and having a non-fasted cholesterol test is problematic as you are *literally* moving the triglycerides from the fatty meal you just had to your blood stream via chylomicrons. I actually demonstrated this in a video myself: https://www.youtube.com/watch?v=ZQHztlN1Yls
Certainly I consider high fasting triglycerides a likely concern (hence this article), but it’s hard to determine for sure without the “fasting” measurement in the first place.
Just to clarify, it’s only coffee not other caffeinated items. Correct?
Too early to say, we just don’t have enough data yet. Coffee is particularly high in caffeine, so it’s hard to disentangle how much is column A vs column B as it were.
wonder if it is to do with proteins. They contain leucine an mTOR activator like glutimine. My diet is very low carb, low protein , tons of fat. Thus very little glucose being produced. Try a 100% fat oil diet see what it does.
Rephrasing my question: If I was to drink decaffeinated coffee, would this also confound my numbers? I do love the taste of coffee (probably the ritual too). 🙂
Thing is I have been drinking in excess of 6 cups of coffee a day for 30 years at least – Trigs like 33-75
Not meaning to cross post, but I just did my blood draw and TG came to 476, Dr. is prescribing Statins. When you say coffee sensitivity, is that coffee specifically or caffeine? A1C is down from 7.6 to 6.2 in 3 months. Just trying to fight of the statins.
We’re not really able to tell yet. All the cases we’ve seen thus far have been coffee specifically, but that could just be because it’s a frequently consumed caffeinated beverage. It is possible any high intake of caffeine could do the same, we’ve just not seen it yet.
I have been on the Carnivore Diet for about 5 months and just had my annual physical with blood work. Cholesterol (Fasting) – 278, Triglycerides – 199, LDL – 197.2, Glucose (Fasting) – 108, Creatinine 1.3, considered to be high. Also Anion Gap – 7.7 is considered to be low. All other numbers in all tests were within normal range. Blood Pressure was 110/70 mmHg and pulse was 56 bpm. In general I feel really good and have since shortly after going on the Carnivore Diet.
I did the Cholesterol Drop Protocol (“Feldman Protocol”) Three and a Half Days, One Blood Test. My last meal was a large meal of beef brisket finishing up around 7 pm and had the blood test about 9:30 am the next morning.
I would be curious to see what you think about my results.
CHOLESTEROL (FASTING) 278
TC/H (CHOL/HDL RATIO) 6.8
GLUCOSE (FASTING) 108
ANION GAP 7.7
TOTAL PROTEIN 7.2
A/G RATIO 1.7
ALK PHOS 49
As noted in the article, my first question would be… do you drink coffee? And if not, do any of the other possibilities apply? Those trigs are something I’d want to look further into to see what’s causing them, if I were in your shoes.
Also, is the test you did the protocol on the same one you did for your annual? You may want to redo without the protocol, sometimes just intentionally overloading fat calories past satiety (as you do for the protocol) can mess with markers (obviously the whole point of it) including triglycerides in some cases, so it may just be a one-off.
I do drink coffee and I do on weekends mostly have a few drinks usually vodka with soda water and lime. Coffee and alcohol both can cause issues with lipid counts. I typically on weekends use heavy whipping cream in coffee but during the week I drink black coffee.
Likely the quickest way to sort it out is just to cut out all of those for two weeks or so and get a retest done to see if it fixes itself – no coffee, no alcohol, no liquid fats (heavy cream). Then if it does, you can do add them back in one at a time to pinpoint which (if any) is causing the undesirable results.
74 years old on LCHF for 6 years +/-,Triglycerides are 57…I do drink coffee, usually two cups in early AM. What I do notice is that since starting coffee after a ten year layoff is that BP is consistently much higher.(The reason I stopped coffee was an increase in BP) Was 100-110/60-68 with no coffee. Last one I did was 130/80 and it’s varied between 120/70 to the previously mentioned reading. Pulse not significantly affected. The higher BP is noted even before having coffee for the day.
While your trigs certainly aren’t high by any means, caffeine sensitivity can express itself in different ways (if that is the component in coffee that causes high triglycerides in some people). Perhaps that’s what it is? To isolate you could likely switch to decaf and see if the higher BP resolves.
This thread and site hold such a wealth of info! I thought I’d share a unique situation as an outlier. I had high dose radiation therapy as a.child for Leukemia. As a result, I have metabolic syndrome and over time I have figured out through a series of n=1 experiments that I have severe adipocyte insulin resistance. On Lchf, my cholesterol numbers were Ldl-p 1050 with small dense particles 800; triglycerides 600. On low fat, the cholesterol numbers change to. Ldl-p 1450, small dense 600 and triglyceride 185 (lowest ever). Hdl has gone up as triglycerides have come down. I don’t want to give up on high fat though because I believe there is a profile that will work. My next test will be zero fruit and grain, high greens, low Sat fat, high mono fat, zero oils, fasting and exercise… Staying fat adapted staying with fish oil and niacin. I have never been overweight.. Approx 10 percent bf. Do I try to lower triglycerides and raise hdl at the expense of raising ldl-p?
Any thoughts on whether working out in a fasted state (~11 hr fast) 90 minutes prior to blood being drawn might cause a spike in triglyceride measurement? I’ve adhered (to varying degrees) to low carb regimens, but after a period falling off the wagon I adopted a pretty strict keto approach <20g carb/day about 5 weeks prior. This particular test tryglicerides where up over 400 whereas typically I had been under 100 with "good" nutrition. This has me mystified and honestly, a little concerned, which is why I'm trying to figure out what's gone wrong.
I don’t think I’ve ever seen triglycerides go up that high from exercise before, could it be one of the other options like isolated fat intake (e.g. MCT, melted fats), or coffee/caffeine? That is certainly something worth looking into further. Is your HDL likewise higher or did it go down as triglycerides went up?
My HDL was 39 versus 41 a couple years ago, so it’s down but not dramatically. I did drink some coffee about three hours prior to the blood draw, and it wasn’t dripped through a paper filter (something I learned after the fact was significant). I’d done the same thing prior to past blood work (though with a paper filter). It could be liquid fats, I tend to use one or more of olive oil, avocado oil, C8 MCT, on things like salads, and do use heavy cream on occasion, but I don’t remember consuming any in excess the night before the blood work. I would say the cause could be about anything, or a little of everything. Thanks.
Yeah, that’s within normal fluctuation for HDL in my experience. It sounds like it could be a bit of everything, so perhaps try controlling for known confounders across the board (the things you mentioned) and re-test and then if it one of those you can narrow it down from there 🙂
I started Keto about a month ago and have been having issues with high heart rate and am supplementing electrolytes. I am a skinny guy 5’11’ 142 lbs and went down to 135lbs within a month. I recently had a blood test and my TG have skyrocketed. I used to be on an almost vegan diet so my ratios were very clean. Here are my numbers:
Results – Almost vegan – Keto (1month)
Total Cholesterol – 135 – 157
LDL – 74 – 66
HDL – 45 – 50
Triglycerides – 79 – 203
I eat very clean, no grains, a lot of salad, avocado, olive oil, almond butter, salmon, chicken, cauliflower, broccoli, okra, bitter gourd, chia seeds, some blueberries.
Is this just a part of transitioning and becoming fat adapted?
Prior to keto my cholesterol was normal. Trigs, HDL, LDL etc. Now my trigs are 195 and my hdl is down, ldl is up. Doctor says borderline and will retest in 6 months but mentioned statins. How can I get my trigs back down?
Jessica, you may want to join Dave’s LMHR Facebook page. I think he checks that more often. This morning he replied to me on FB and said to follow the steps listed above – cut out coffee, lower net carbs to less than 20 grams, and remove fats from oils etc. Get fats from food.
Thanks. I am already decaf and only one a day.
Hi Jessica — have you worked through all the steps in the above article?
Hi, I have not yet. I am going to definitely retest and try these things. I think what makes my case difficult is I also have hypothyroidism / Hashi’s and paraxoysmal afib so they always want me to be low sodium and low fat.
Ahhhh… yes, that is a pickle.
How recently did you start keto? Sometimes testing too early can net some odd results.
Also, were you properly water fasted 12-14 hours for the labwork?
If you’re more than, say, four or so months in I would start out with logging all your food. This can help catch carb leaks – e.g. unexpected carbs from condiments, or spice packets, or things like that – that can add up and end up netting a high fat higher carb diet, which can contribute to high triglycerides. If you don’t see anything there, try the other options listed here and see if it’s one of those.
Hi Siobhan, I started Keto late Oct 2017 so this was baiut 6 months into keto. I did however have this test done while not fasting. My current docotr said fasting doesn’t make much of a difference anymore. I thought that was odd but went ahead and went down the lab anyay. She wants to repeat in Jan which I will insist on fasting and that would be 14 months into keto at that point.
I would definitely agree a re-test is in order, 12-14 hours water fasted…. Although the guidelines have changed recently to not require fasting, I highly recommend avoiding going into a test non-fasted for a few reasons.
Because you’re doing keto which is – by definition – a high fat diet, if you’re eating a meal it’s generally going to be a high fat meal. That fat has to get transported after its been digested, and to do that it has to go through the bloodstream. So if you get bloodwork done in the middle of that process (e.g. nonfasting) you’ll likely have higher triglycerides, and possibly lower HDL as well.
Dave has actually tested this and confirmed his triglycerides are massively higher than normal if he does the lipid test non-fasted.
In fact, here’s a video on that exact topic!
You’re welcome 🙂
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When you mention coffee, I wonder if you mean more specifically caffeine. I have two or three decaf espressos a day.
So far we’ve only seen coffee specifically, but this could just be because it’s the most commonly consumed caffeinated drink. It could very well be the caffeine, or it could be something in coffee specifically. For now we just err on the side of what we’ve seen from people so far.
This article is predicated on the assumption that having high triglycerides is problematic. It seems to me that the entire knowledge base on blood lipids is unclear. We have a whole industry trying to lower our LDL, with skeptics objecting that this goal is unjustified. Why the worry over trigs now?
Hi Dave, thank you so much for your work, it’s really enlightening. I’m type 1 diabetic and have been strictly keto for six months now. I had no idea until recently that I should be getting a full lipid profile, so I don’t know my pre-keto numbers, but total cholesterol has been under 5 mmol/l all my life (I’m 39). I asked for a full lipid profile this time, and I’m seeing my diabetes consultant tomorrow. HbA1c historically was always mid- to low-60s, best ever (pre-keto) was 57 mmol/mol (7.4%) – now down to 51 mmol/mol, which is great. But the cholesterol results have sent me into a panic:
total cholesterol 21.5 mmol/l (831 mg/dl)
HDL 3.1 mmol/l (120 mg/dl)
LDL 16.8 mmol/l (650 mg/dl)
triglycerides 3.5 mmol/l (310 mg/dl)
I fasted for 15 hours before the test, but I did have some coffee a couple of hours beforehand. I’m wondering which is worse: high HbA1c or high TGs?! Any input gratefully received!
I also forgot to mention that I’ve always been very lean. And by chance, I’ve uncovered some pre-keto numbers this morning:
HDL 1.2 mmol/l & LDL 2.3 mmol/l on 07/Apr/2006;
HDL 1.5 mmol/l on 26/May/2015;
LDL 2.4 mmol/l on 20/Jan/2017.
From this, I would guess my profile has always been fairly steady. But no TG numbers, alas.
Hi Colin, I would definitely want to re-test *without* the coffee on the morning of the test, as stated in the article. We’ve actually seen quite a few of these cases by now, and I’ve generally see it be the case that if HDL *and* triglycerides are high in a low carber it is sometimes something like a caffeine/coffee sensitivity.
With any troubleshooting, I always find it helpful to start logging all of your food, if you aren’t already. That way if the above doesn’t clear it up you can quickly troubleshoot your food intake and see if there is anything there (like carb leaks in sauces, condiments, etc) that could be contributing as well.
If possible, cut out the coffee and liquid fats (if you consume them) for about two weeks and get a re-test with no coffee on the morning of the test either and see where it gets you. If it’s not that, then it would be time to review food logs, and check over the other possibilities on the list in the article. The profile you’ve described is one I’ve seen a few times now, but luckily with a bit of troubleshooting most of the people find out what was causing the odd result and can correct it.
Thanks, Siobhan. Really helpful. I’m fairly confident I don’t have any ‘leaks’, but will watch out for them anyway, and will go caffeine-free for a fortnight, as you suggest. [sobs quietly]
Well, it doesn’t hurt to double check for leaks, people can sometimes be blindsighted by the tiniest things, like spice packs, and things like that. I’ve heard of that happening before in quite a few different people and correcting that made all the difference.
Good luck with the no caffeine, though! And do let us know if the trouble shooting helps you figure out what’s going on 🙂
Are these steps to be done all the time or just prior to testing? Thank you in advance for answering!
These are general steps to take in case you have high trigs on a low carb diet – if you single out what caused the high trigs it kind of depends.
Some of them are wise to do every single time before a test (Fasting properly, no coffee on the morning of the test), some of them I’d find it wise to continue all the time (carb leaks), and some it is more of a gray area (coffee, or liquid fats).
For the last group, we don’t necessarily know that in this case the high triglycerides is necessarily indicative of something undesirable going on, but personally I’ve not come across a good long-term reason to have high trigs, so if I personally experienced it I’d just continue with the fix going forward. But, it’s up to the individual, really.
Wow Cracy results after 2 months Carnivore:
I am STUNNED by my blood results! (And not in a good way)
8/27/2018 ( 2 months CV) Note: was at 45gr carbs/day last year until Sept when I got into ice cream in Italy. Finally ditched sugar 6/1/2018, so I wasn’t a good low carber for 9 months.
Glucose 77 (they consider low)
8/6/2017 (6 months after starting HCLF – 45 gr carbs/day)
3/15/2016 (trying to be vegan)
According to this, carnivore is doing terrible for me. Ideal trig/hdl ratio is 1.00. I am going the wrong way. I love this diet. I am never hungry, never craving food. I am going to run out to drug store and buy a cholesterol test. I cannot believe my triglycerides would be that high!! Don’t see how protein could do that! I was not feeling well that day – my SIBO was giving me fits. But why was my HDL so low?? That is considered normal, but it should be going up on Carnivore. Any thoughts?
I had my blood test last week, been on lchf for 14 months now and have come off All meds Inc statins. Hba1c now 42 (classed as excellent control here in the UK) however I showed high triglycerides at 3 instead of the required 1.5 max. I did have a black coffee beforehand as I hadn’t yet read this forum, but I was thinking…if triglycerides are for transporting fat as energy, doesn’t having them high at certain points just mean that I have fuel ready for burning as it should be and so if I was to go for some excercise and test again maybe they would be used up and therefore lower? Any thoughts
Hi, do you do any of the things listed in the article?
Were you 12-14 hours water fasted for the blood test? Do you consume liquid fats? Do you drink coffee?
Hi Dave. Love what you’re doing!
Recently got my blood results with a surprising TG count of 150. 6mos ago it was 98 to go along with an HDL-c of 90. HDL this time was 58.
Been lchf for about 7 weeks prior to the test. This was an at-home (everlywell) test, btw. My hs-CRP, however, was .39 and so am pleased with that.
I suppose my main question is how independently are these markers to be viewed? Does the CRP score mostly mitigate the slight concern for the TG count?
Not in my opinion, no. For example, you could have high insulin levels (hyperinsulinemia) with a low CRP, and this example could very likely result in high TG as well. I like CRP, but it’s not the only marker to pay attention to.
thanks so much! i understand if you’re too busy to field a specific follow-up, but just in case:
(11/8/17): total – 286, ldl – 186, hdl – 90, tg – 98
(1/30/18): total – 336, ldl – 257, hdl – 56, tg – 116
(9/12/18): total – 377, ldl – 275, hdl – 58, tg – 150, hba1c – 5.3
I’ve always maintained consistent exercise. Drinking has been problematic, however, that’s been in check the past few months and consequently caffeine intake has gone up. As I’ve only been real consistent with lchf (this time around) for the past 2 months, I suppose I shouldn’t be too concerned, and will test again around Jan. Though the trend of my trigs bothers me.
I’ve got a keto mojo at home so I’ll check my glucose fasting and after meals (1 and 2hrs) to see how that shakes out. I don’t have insurance so I’ll do another everlywell test in a few months. It’s possible my tg’s have been increasing due to some significant sugar & junkfood binges I was doing prior to eating consistently well starting 7/20 I guess. If you have any thoughts or feedback, greatly appreciated. ~eric
when you say oil, should we reduce olive oil on our salad?
Yes — if you’re reducing liquid and processed oil. Consider bringing them as low as you can and retest.
Do You think 2 tablespoon of olive oil per day is too much?