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 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.
  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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Liz LePla
Liz LePla
2 years ago

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.

Liz LePla
Liz LePla
2 years ago
Reply to  Dave

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!

Christian
Christian
7 months ago
Reply to  Dave

What do you theorize is the mechanism behind this, Dave? Trigs down = HDL up?

John
John
6 months ago
Reply to  Dave

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.

Siobhan Huggins
Admin
6 months ago
Reply to  John

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.

Terri
Terri
2 years ago
Reply to  Liz LePla

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.

Rock
Rock
2 years ago

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.

Rock
Rock
2 years ago
Reply to  Dave

Absolutely I will. Thank you Dave

Rocco
Rocco
2 years ago
Reply to  Rock

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 ?

Rocco
Rocco
2 years ago
Reply to  Rocco

Just so no one gets confused. I changed my title from Rock to Rocco. Same person

Rocco
Rocco
2 years ago
Reply to  Dave

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…

John
John
1 year ago
Reply to  Dave

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.

Linda
Linda
2 years ago

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

Liz LePla
Liz LePla
2 years ago
Reply to  Linda

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
Luanne
2 years ago

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

Adam
Adam
2 years ago

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

Sven
Sven
2 years ago
Reply to  Dave

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.

Bob
Bob
1 year ago
Reply to  Dave

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

Becky
Becky
1 year ago
Reply to  Bob

So then are you saying to cut out caffeine and increase exercise to help lower trig? Would this include dark chocolate? Serious question.

John
John
1 year ago
Reply to  Becky

@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.

Rudy M
Rudy M
1 year ago
Reply to  Dave

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.

Siobhan Huggins
Admin
1 year ago
Reply to  Rudy M

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.

Rob Smith
Rob Smith
2 years ago

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.

Rob Smith
Rob Smith
2 years ago
Reply to  Dave

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 ?

Eileen Janeke
2 years ago

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.

Eileen Janeke
2 years ago
Reply to  Dave

Thanks Dave, I’ll report back.

BobM
BobM
2 years ago

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.

For instance:

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).

Siobhan Huggins
Admin
2 years ago
Reply to  BobM

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.

BobM
BobM
2 years ago

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 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.

Yvonne Nowakowski
Yvonne Nowakowski
2 years ago

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
Simon
2 years ago

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?

Simon
Simon
2 years ago
Reply to  Dave

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.

Digby
Digby
2 years ago

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
2 years ago
Reply to  Digby

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
MOHAMMADZAKI MOHDGHAZALI
2 years ago

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
Hassan+Ahmed
2 years ago

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
Tony Webb
2 years ago

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.

Tony Webb
Tony Webb
2 years ago
Reply to  Dave

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!!

Steven Dick
Steven Dick
2 years ago

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 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.

Steven Dick
Steven Dick
2 years ago
Reply to  Dave

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?

Steven Dick
Steven Dick
2 years ago
Reply to  Dave

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?

john willis
john willis
2 years ago

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

Rock
Rock
2 years ago
Reply to  john willis

That’s incredible !

Siobhan Huggins
Admin
2 years ago
Reply to  john willis

Wow! What a huge improvement!

Hassan+Ahmed
Hassan+Ahmed
2 years ago

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
2 years ago
Reply to  Hassan+Ahmed

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
Rock
2 years ago

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….

Cindy
Cindy
1 year ago
Reply to  Dave

Have you tested decaf coffee yet to find out if it also affects TG results?

Siobhan Huggins
Admin
1 year ago
Reply to  Cindy

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.

JohnD
JohnD
2 years ago
Reply to  Rock

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 : )

Barb
Barb
1 year ago

but when you say “coffee” do you mean caffeine? what about decaf? Thank you.

Siobhan Huggins
Admin
1 year ago
Reply to  Barb

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.

Ron Blouch
Ron Blouch
2 years ago

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.

Superchunk
Superchunk
2 years ago

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 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.

Nathan
Nathan
2 years ago

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?

Thank you,

Nathan

Diane z
Diane z
2 years ago
Reply to  Dave

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).

Siobhan Huggins
Admin
2 years ago
Reply to  Diane z

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.

Nathan
Nathan
2 years ago
Reply to  Dave

Thank you for your response Dave. I’ll check out the link.

Anthony Webb
Anthony Webb
2 years ago

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….

Anthony Webb
Anthony Webb
2 years ago
Reply to  Dave

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.

Donald
Donald
2 years ago

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

Leti
Leti
2 years ago

Dave how are you. My boyfriend had
Tryglicerides 308!
TC: 420
LDL: 313
HDL:45
VLDL: 61
He did what’s saids in this page 14h fast, . Gave up coffee heavy cream… And now 13 days later…
Tryglicerides 302!
TC: 379
LDL: 282
HDL:37
VLDL: 59
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.

Leti
Leti
2 years ago
Reply to  Leti

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!

Siobhan Huggins
Admin
2 years ago
Reply to  Leti

Hi Leti,
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.

Leti
Leti
2 years ago

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!

Patrick
Patrick
2 years ago

For those who have found coffee to be a problem raising Trigs and have cut it out, what kind of improvement have you seen?

Siobhan Huggins
Admin
2 years ago
Reply to  Patrick

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.

Patrick
Patrick
2 years ago

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?

Siobhan Huggins
Admin
2 years ago
Reply to  Patrick

Mostly it tends to impact triglycerides, LDL, VLDL, and remnant cholesterol. Hopefully your test sheds some light on the issue!

Patrick
Patrick
2 years ago

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

–CHOLESTEROL REMNANTS–
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

–CHOLESTEROL REMNANTS–
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?

Patrick
Patrick
2 years ago

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 🙂

Siobhan Huggins
Admin
2 years ago
Reply to  Patrick

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! 🙂

Patrick
Patrick
1 year ago

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

–CHOLESTEROL REMNANTS–
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

Frank Owens
1 year ago

I was thinking the VLDL and remnant cholesterol were the same thing.

Siobhan Huggins
Admin
1 year ago
Reply to  Frank Owens

Remnant cholesterol is cholesterol contained not only in VLDL, but also IDL, and chylomicrons as well.

David
David
2 years ago

Just check my trigs with my cardio check, a little worried.
Trigs 435
LDL 289
HDL 40

Rock
Rock
2 years ago
Reply to  David

What way of eating are you following ?

Rock
Rock
2 years ago
Reply to  Rock

Carnivore now 4 months.

Siobhan Huggins
Admin
2 years ago
Reply to  David

That is definitely something I’d want to look into more. Were you water fasted 12-14 hours for it? No coffee, etc?

Colleen
Colleen
2 years ago

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.

Karen Baur
Karen Baur
2 years ago

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

Julie Fergus
Julie Fergus
2 years ago

Just to clarify, it’s only coffee not other caffeinated items. Correct?

kina
kina
2 years ago
Reply to  Dave

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.

Juls
2 years ago
Reply to  Dave

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). 🙂

kina
kina
2 years ago
Reply to  Julie Fergus

Thing is I have been drinking in excess of 6 cups of coffee a day for 30 years at least – Trigs like 33-75

Stewart Sy
Stewart Sy
2 years ago

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.

Siobhan Huggins
Admin
2 years ago
Reply to  Stewart Sy

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.

Clay Graner
Clay Graner
2 years ago

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
TRIGLYCERIDES 199
HDL 41
VLDL 39.8
LDL 197.2
TC/H (CHOL/HDL RATIO) 6.8
NHDL 237

GLUCOSE (FASTING) 108
BUN 22
CREATININE 1.3
BUN/CREAT 16.9
SODIUM 137.9
POTASSIUM 4.9
CHLORIDE 104.4
CO2 25.8
ANION GAP 7.7
CALCIUM 9.7
TOTAL PROTEIN 7.2
ALBUMIN 4.5
GLOBULIN 2.7
A/G RATIO 1.7
ALK PHOS 49
ALT 4
AST 7
T.BILI 0.7

Siobhan Huggins
Admin
2 years ago
Reply to  Clay Graner

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.

Clay Graner
Clay Graner
2 years ago

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.

Siobhan Huggins
Admin
2 years ago
Reply to  Clay Graner

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.

RS Weir
RS Weir
2 years ago

Hi Dave
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.
Any ideas?

Siobhan Huggins
Admin
2 years ago
Reply to  RS Weir

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.

Rob Monahan
Rob Monahan
2 years ago

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?

another_dave
another_dave
2 years ago

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.

Siobhan Huggins
Admin
2 years ago
Reply to  another_dave

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?

another_dave
another_dave
2 years ago

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.

Siobhan Huggins
Admin
2 years ago
Reply to  another_dave

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 🙂

Sonny Sach
Sonny Sach
2 years ago

Hey Dave,

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?

Thanks,
Sonny

Jessica E Alexander
Jessica E Alexander
2 years ago

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?

Sonny Sach
Sonny Sach
2 years ago

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.

Jessica Alexander
Jessica Alexander
2 years ago
Reply to  Sonny Sach

Thanks. I am already decaf and only one a day.

Jessica Alexander
Jessica Alexander
2 years ago
Reply to  Dave

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.

Siobhan Huggins
Admin
2 years ago

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.

Jessica Alexander
Jessica Alexander
2 years ago

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.

Siobhan Huggins
Admin
2 years ago

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!

Jessica Alexander
Jessica Alexander
2 years ago

Thank you!

Siobhan Huggins
Admin
2 years ago

You’re welcome 🙂

G Kay
G Kay
2 years ago

When you mention coffee, I wonder if you mean more specifically caffeine. I have two or three decaf espressos a day.

Siobhan Huggins
Admin
2 years ago
Reply to  G Kay

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.

G Kay
G Kay
2 years ago

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?

Colin
Colin
2 years ago

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!

Colin
Colin
2 years ago
Reply to  Colin

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.

Siobhan Huggins
Admin
2 years ago
Reply to  Colin

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.

Colin
Colin
2 years ago

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]

Siobhan Huggins
Admin
2 years ago
Reply to  Colin

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 🙂

Autumn
Autumn
2 years ago

Are these steps to be done all the time or just prior to testing? Thank you in advance for answering!

Siobhan Huggins
Admin
2 years ago
Reply to  Autumn

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.

KimL
KimL
2 years ago

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.
trig 169!
LDL 224
HDL 45
trig/HDL 3.76
Glucose 77 (they consider low)

8/6/2017 (6 months after starting HCLF – 45 gr carbs/day)

trig 82
LDL 156
HDL 59
Trig/HDL 1.39
Glucose 97

3/15/2016 (trying to be vegan)
trig 105
LDL 164
HDL 65
trig/HDL 1.62
Glucose 105

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?

David R
David R
2 years ago
Reply to  KimL

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

Siobhan Huggins
Admin
2 years ago
Reply to  KimL

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?

eric
eric
2 years ago

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?

thx!
eric

eric
eric
2 years ago
Reply to  Dave

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

Thiago Silva
Thiago Silva
2 years ago

when you say oil, should we reduce olive oil on our salad?

Thiago Silva
Thiago Silva
2 years ago
Reply to  Dave

Do You think 2 tablespoon of olive oil per day is too much?

Amy Smith
Amy Smith
2 years ago

Thanks for the info. I’ve been keto for 3 years, with the last 2 months going zero carb. I just had my yearly blood markers done and my TG are threw the roof-
296! My TG in 2017 were 68.

I have always had coffee, but would they jump so very high if I was at a 10 hr fasting window rather than 12?

I’d like to retest. Is there a certain time period I need to wait before testing again?

FYI- I’m a 49yr female. Very active and have responded very well to zero carb (lots of energy and increase in resistance training.). Thanks again.

Siobhan Huggins
Admin
2 years ago
Reply to  Amy Smith

It does seem to pop up more frequently the lower carb people go – I’m not sure if that’s just a coincidence though. I don’t think our sample pool is large enough to really know for sure.

Generally we suggest cutting coffee for 2 or so weeks for a re-test.
10 hours fasted shouldn’t cause that huge of a jump, in my experience.

What was your HDL? This often provides a hint as to the source of the issue.

Amy Smith
Amy Smith
2 years ago

Thanks for the response.

My HDL was 89.
LDL was 143
VLDL was 59

Does this give you any additional hints as to the issue?

Amy

Siobhan Huggins
Admin
2 years ago
Reply to  Amy Smith

Yes it certainly does. Generally from what I’ve seen so far people with both high triglycerides *and* high HDL tend to find that their culprit is coffee, or improper fasting.

I would definitely be curious to see your results after 2 weeks of no coffee, and 12-14 hours water fasted. 🙂

eric
eric
1 year ago

Hi Siobhan, this is so great what you’re doing here! You and Dave. Very grateful. I’m curious about Amy’s case here as I have a bit of a suspicion that coffee could be related to my recent tests as well.

On a practical level I’m not pleased to have to consider foregoing coffee for an extended period of time, let alone indefinitely. What I mean is that if our test subject (amy…sorry, ha) gets off coffee for two weeks and retests with normal Tg’s, what is the take-away? Does it infer that for a healthier life-style she should significantly reduce or eliminate her coffee intake? Or by culprit do you mean falsely influencing the test results? ~thanks!, eric (p.s. i apologize if this is already noted somewhere, I probably do need to review dave’s protocol)

Siobhan Huggins
Admin
1 year ago
Reply to  eric

Essentially… I don’t really know. The effect could be harmless in the end, with just more cycling of triglycerides from storage to VLDL and back to storage, but I’ve yet to see a case where keeping triglycerides elevated is a “good” thing.

Likely if coffee/caffeine did that to me I’d just forego it to be on the safe side, but it is up to the individual, really.

eric
eric
1 year ago

that’s my intuitive sense as well. thx! p.s. enjoyed the pic of you and amber swallowed in dave’s arms!

Siobhan Huggins
Admin
1 year ago
Reply to  eric

You’re welcome!
And I’m glad you enjoyed! It is one of my all time favorite pictures to be sure 🙂

Amy Smith
Amy Smith
1 year ago
Reply to  eric

Thanks for the question Eric. After Siobhan suggested that I forego coffee and retake the test, I went into hiding! I couldn’t bear to give up my morning ritual. I think I am ready now. Maybe.
And Siobhan, just checking…Does this mean all caffeine? Can I substitute Yerba Mate Tea?

Siobhan Huggins
Admin
1 year ago
Reply to  Amy Smith

The quickest way to confirm it’s coffee/caffeine is to forego all caffeine in case it’s not coffee in particular – yerba mate has about the same amount of caffeine as coffee, so if it comes back the same you’d still be in the spot. You could go ahead and try it anyway (if it did go down it’d certainly be interesting!) so long as you’re willing to test without if it doesn’t work, but the time saving way to do it would be just go water only for a while 😉

Amy Smith
Amy Smith
1 year ago

Hi there again:
I retested after giving up caffeine for two weeks (did have decaf coffee though each morning). Was also 14 hours fasted. Results were interesting.
Total cholesterol
September
291
November
262

TG
September
296
November
50

HDL
September
89
November
85.2

LDL/VLDL
September
143/59
November
166/10

Whatcha think Siobhan?

Siobhan Huggins
Admin
1 year ago
Reply to  Amy Smith

Oh my, that is interesting. Just to confirm, you kept up coffee consumption but switched out for decaf? And all else remained the same between the two tests?
If so, it looks like it may be specifically caffeine that may be the issue here!

fourscore
1 year ago

Long time HUGE fan and listener/watcher of Siobhan/Dave.
The coffee is one HECK of a confounder… So is weight stability.

Weight NOT stable 1 month into LCHF change (5-7lbs a week loss for 7 weeks) 7/18 and TONS of coffee before (oops) vs
Bergamot Tea / or Irish Breakfast (swapped for a week) and weight stable 7 months into LCHF.

Anyone seen it impact Remnants tho? That was my data surprise.

On LCHF (20g to 120g carbs) ::: 14 hours water fasted…
2/19 Total Cholesterol: 228 mg/dL 5.9 mmol/L 7/18 Total Cholesterol: 260 mg/dL 6.72 mmol/L

2/19 LDL Cholesterol: 168 mg/dL 4.34 mmol/L 7/18 LDL Cholesterol: 177 mg/dL 4.58 mmol/L

2/19 HDL Cholesterol: 49 mg/dL 1.27 mmol/L
7/18 HDL Cholesterol: 31 mg/dL 0.8 mmol/L

2/19 Triglycerides: 55 mg/dL 0.62 mmol/L
7/18 Triglycerides: 259 mg/dL 2.92 mmol/L

–REMNANTS–
2/19 Remnant Cholesterol: 11 mg/dL 0.28 mmol/L 7/18 Remnant Cholesterol: 52 mg/dL 1.34 mmol/L

2/19 Remnant Chol to HDL: 0.22
7/18 Remnant Chol to HDL: 1.68

Siobhan Huggins
Admin
1 year ago
Reply to  fourscore

Weight stability does definitely appear to have an impact on lipid markers, changes in diet do too – generally I’ve noticed things can be a bit wonky before the 4 month mark of a diet change. Perhaps that impacted too?
What a huge change, too! Thanks for reporting back!

As far as the remnant cholesterol, it doesn’t shock me too much – it’s likely all those trigs are being transported by VLDL and that’s what’s being seen there. Yeesh!

Samuel Ashford
Samuel Ashford
2 years ago

Dave, I have followed you for some time on the ketogenic forums and enjoy all your work. I’ve been on a carnivore diet for three months, and the last two months without any artificial sweeteners (previously addicted) or alcohol. At the one month point, my trigs were 341. Two days ago (three month point) my trigs were 330. Frustrated, I began Googling again, and found this thread. I just read your four steps above and the post from “Rock” two months ago. Can it really be as easy as coffee? And what would be the actual biological cause of coffee spiking triglycerides? That’s the only factor I haven’t eliminated. It’s just down to beef, a little pork, water, some sparkling water, coffee, decaf coffee, a little cheese, and a little butter. Nothing else. So, I’m taking the plunge now, and I’ll remove the coffee and decaf. I’m familiar with your view that lipids on a panel are a reflection of the past three days’ meals. So I’m going to give it an entire week without the coffee, and then test lipids again. Waiting with bated breath.

Rocco
Rocco
2 years ago

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 ?

Joshua
Joshua
2 years ago

Im new to this. These are my results after doing 30 days of Carnivore. How do these numbers look? My doctor was freaked out.

MY NMR Results

Component Your Value Standard Range
LDL Particle Number 1,854 nmol/L 732 – 2,035 nmol/L
Risk: Optimal 1409
LDL Small 207 nmol/L 85 – 473 nmol/L
Risk: Optimal 219
LDL Medium 323 nmol/L 122 – 498 nmol/L
Risk: Optimal 301
HDL Large 7,299 nmol/L 3,382 – 9,376 nmol/L
Risk: Optimal >6729; Moderate 6729-5353; High OR = 217.4 Angstrom
Risk: Optimal >222.9; Moderate 222.9-217.4; High >> Lowest Risk Quintile
Remnant Chol to HDL: 0.19 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.499 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 208 | Iranian LDL-C: 171
Total/HDL Ratio: 3.81
TG/HDL Ratio in mg/dL: 0.73 | in mmol/L: 0.32

Siobhan Huggins
Admin
2 years ago
Reply to  Joshua

I don’t see your HDL-C and triglycerides listed here (unless I missed them). Could you post those too?

Joshua Robinson
Joshua Robinson
2 years ago

HDL-C was 78 and Triglycerides 57

Joshua
Joshua
1 year ago

HDL-C 78 and Triglycerides 57

Siobhan Huggins
Admin
1 year ago
Reply to  Joshua

Ah, okay, that helps provide a bit more context. In that case it looks like you might be a Lean Mass Hyper-responder. You might find it helpful to watch the presentation on the page linked above. Essentially this is the profile I’d expect from someone who’s primarily running on fat, and is lean and/or active. I wouldn’t mind having that profile, to say the least 🙂

Nancy
Nancy
2 years ago

Hi,
Question, my triglycerides, hdl, ldl, and cholesterol, etc has all been excellent. I have been borderline pre-diabetic for years 97 to 99 on the scale to 100. This was taken during my yearly physical.
Yesterday at work I had a health screen. My finger poke showed that my ldl, hdl, and cholesterol were the same as last years yearly physical but my triglycerides went from 69 to 200.
I am suspecting that our keto – LCHF diet is attributing to this. So do I go low fat, low carb? How do I stay full? Does the IF not help either? Last year we were low carb only. We tried vegan for ~7 months March – September. We just started keto-LCHF 2 weeks ago.
Thoughts?

Siobhan Huggins
Admin
2 years ago
Reply to  Nancy

Were you 12-14 hours fasted for the test this time?

Nancy
Nancy
1 year ago

Yes, it was a 14 hour fast

Nancy
Nancy
1 year ago
Reply to  Nancy

I am sorry i read that wrong, no for this test the 200 level tri # i only had a ~4 hour fast. The other times it has always been a 14 hour.
The previous were blood drawss, this was a finger poke.

Jon Howard
Jon Howard
1 year ago

I’ve been on the carnivore diet for a little over 8 weeks – very strict – and my lipid panel just came back. It’s fairly shocking. Not in a good way. Here are the results:

LDL-P 2767 mol/L
LDL-C 344 mg/DL
HDL-C 68 mg/dL
Triglycerides 140 mg/dL
Cholesterol, Total 440 mg
HDL-P 42.4
Small LDL-P 1675 mol/L
LDL Size 20.7 nm

Here they were a year doing about 80/20 paleo (with the 20 being some oatmeal, rice, sprouted wheat bread, and cheese):

Cholesterol 223 mg/dL
Triglycerides 91 mg/dL
HDL 72 mg/DL
LDL 133 mg/dL
VLDL 18 mg/DL
LDL/HDL Ratio 1.8
Chol/HDL Ratio 3.1

Same lab, same Dr. btw. Very interested in your thoughts and steps I should consider. I’ve LOVED being on the diet. Mentally and physically I feel better than I did in my 20s (I’m 42).

I’m only eating eggs, beef, lamb, and pork, cooking in butter, tallow, or lard, drinking only bone broth and water. I’ll also have about 1 tbsp of feta cheese once every couple days.

Siobhan Huggins
Admin
1 year ago
Reply to  Jon Howard

The thing that stands out to me in the latest panel is the higher triglycerides paired with the high HDL. Were you 12-14 hours water-only fasted for that test?

Jon Howard
Jon Howard
1 year ago

Thanks for responding! Yes. Closer to 14 hrs. The higher TG is truly baffling to me.

Jon Howard
Jon Howard
1 year ago

I’m going to be replacing my daily 1 cup of coffee with tea prior to retaking the test. Sad face.

Siobhan Huggins
Admin
1 year ago
Reply to  Jon Howard

Sounds like a plan – do let us know whether it works or not, and remember water only for 12-14 hours before the test as well. Good luck!

Jon Howard
Jon Howard
1 year ago
Reply to  Jon Howard

Just noticed autocorrect fudged some of the units:
LDL-P and Small LDL-P should be nmol, not mol
HDL-P should be in umol/L

Camille
Camille
1 year ago

I would love a little help unpacking my recent test. It took me by surprise and led me to this website with all of this great info. Looks like my trigs might be a little too high to be considered LMHR?

Female
55 yo
5’6”, 123 lbs (was 130 lbs before starting Keto 5 weeks ago)
active (HIiT training 3-4x/week, run other days)

This was done after 4 weeks Keto (<20g carbs/day). I was eating dairy fats (cheese, cream, butter). 1 DECAF double espresso/day w/ 1/4 cup heavy cream. Eggs, chicken, fish, beef, and some low carb veggies.

9/24/2018 (NMR Lipo Profile)
13 hours water fasted.
LDL-P 1648 mmol/L
LDL-C 162 mg/dL
HDL-C 87 mg/dL
Triglycerides 101 mg/dL
Cholesterol Total 269 mg/dL
HDL-P (Total) 34.0 umol/L
Small LDL-P <90 nmol/L
LDL Size 21.9 nm

For comparison, here is my previous test from last December when I was eating a “regular” diet – whole foods about 40-30-30, C/F/P.

12/3/2017 (finger prick for health insurance screening)
13 hours water fasted
LDL-C 88 mg/dL
HDL-C 74 mg/dL
Triglycerides 172 mg/dL
Cholesterol Total 196 mg/dL

David
David
8 months ago
Reply to  Dave

I seem to be very boring and ordinary’ in this context, apart from wondering why ~85% of people gain weight when eating ad lib and regard me as a freak.

In UK, or SI, units, i.e. usually mmol/ltr, my HDL is 2.0 and at last test TGs were 0.7. So in SI units my HDL/TG ratio is 2.9. TC is 5.1.

I’ve drunk two to three mugs of fairly strong coffee per day for 40 years, occasionally a lot more. I’m aged 66 and hoping to get to 100, although I have slightly high BP and HbA1C despite a very ‘non-diabetic BMI’ of 19 and a LC, wholefood diet. Also I get through 2,000 kcal/day, sometimes 2,500 kcal/day if exercising, and my formerly fat friends on LC diets consume nearer 1,500 kcal/day = 25% less. But they weigh a bit more than me.

I can’t gain weight above my current 59 kg except if I eat large amounts extra and lift a lot of weights. The heaviest I ever got to, 63 kg, was 40 years ago on a HC diet which I gather leads to more water being retained. So, that’s similar to my weight now, I suppose.

Incidentally, I wish certain countries would use SI units. I don’t have a clue what these units of mg/dl and others like them mean without looking it up.

If you know any labs. wanting volunteers to experiment on who can gain almost no weight and stay depressingly constant even if the bathroom scales break for 6 months, ask me.

David
UK.

Thiago Silva
Thiago Silva
1 year ago

For people with type 2 diabetes who follow LC diet and after those 4 steps triglycerides continues high, what should they do? Take some medicine?

Siobhan Huggins
Admin
1 year ago
Reply to  Thiago Silva

If I were in the position I would likely do an even more in-depth investigation into what I was eating, what I was cooking with, etc. I believe Dave recounted a tale of someone who was having issues (perhaps not with triglycerides specifically, I don’t remember), who found out their problem was the beef they were buying had seasoning in it which contained some carbs or shady ingredients that ended up having an impact.

I’d also check to look at the composition of what I was eating and try messing with that – less protein, more fat, less carbs, etc.

Also for this hypothetical person, I’d also want to know how long they’ve been low carb/keto. If it’s a short time and triglycerides are trending down but are still a bit high, it may also just be a time issue.