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Jan 07

Triglyceride Carryover – A Possible Game Changer

[Note, much of this data is discussed in two videos from last week. One where I first announced the data, and another where I go over Q&A with Siobhan.]

The last week and a half has brought me some powerful new data and insights on triglycerides.

While most of what I’m about to show you is data I’ve collected directly with myself (AKA, an N=1), I think you’ll agree it is quite compelling. This is certainly one moment where my prior body of experiment data was extremely useful to compare to newly collected evidence as you’ll see below.

A Surprise Morning Spike

As many of you know, I began a “carnivore diet” experiment on December 17th. It was very restrictive in that I’d be eating only beef at first. Ten days later on the 27th I pulled out my CardioChek and did a lipid test right after I awoke. I was stunned to see:

My triglycerides (TG) were exceptionally high. I know this to be unusual because I’ve done many just-woke-up tests from experiments before. In fact, the only time I can recall having TG above 100 after having just awoken, was for three days following the second intervention of the Resistance Training Experiment — even then, that was almost 100 mg/dL lower than this number!

[Side note: If you’re new to this site, the LDL number might have surprised you too, but this was entirely expected. And if you haven’t already, consider reading this before you continue…]

Naturally, I confirmed this number for a second time a few minutes later. Then a few hours passed and I was about to have breakfast with my family. Just before, I took two more tests to confirm what I suspected — the triglycerides will have dropped. And they did… quite a bit, actually.

A longer version of this played out the next day (28th) where I woke up with even higher TG than then the day before. Only this time, I went ahead and took my lipids every hour on the hour until they were to return to below 100 mg/dL. (Shown left)

Triglyceride Carryover Effect is Observed

By this point, I couldn’t help be feel this looked too much like a postprandial (following a meal) sized marker. So I started working my way backwards toward the last time I ate.

What followed were several days where I captured both the morning lipids and those from the night before. Indeed, it appeared I was going to sleep with high TG and thus waking up with it as well.

A Carnivore Connection?

So what’s going on here?

If I’m metabolically healthy, I shouldn’t be waking up with triglycerides this high, right? Again, I wasn’t seeing anything like this before, so why now? Was there something special about the carnivore diet in particular?

Actually, the phenomenon of unexpectedly high triglycerides with some carnivores is not new. The first dramatic case I observed was with Brenda Zorn who collaborates with the 2 Keto Dudes and now works for IDM. For an experiment, she ate steaks for one month and was shocked to see her TG shoot up to 500. Gradually it dropped back down after she left the diet, but it was no less a mystery to us at the time.

Since then, there seemed to be a notably higher proportion of these reports with carnivores relative to low carbers, even if still a small subset. A fun fact to know and tell is that the carnivore diet was originally called the “Zero Carb” diet. And there in might be the biggest clue.

The Magic Twelfth Hour

While I go through more graphs and slides in the accompanying video. I want to put extra focus on one particular scatter plot for this blog post:

This is all 35 tests together on the plot and something immediately jumps out if you look closely.

Let’s divide the graph into quadrants with the vertical line at the 12 hour mark and horizontal at triglycerides …

  • In the top left area (1) we see most of the dots on the graph, all above 100 TG (above green line) and taken less than 12 hours from when I last ate (left of the red line).
  • Conversely, we see all the plots on the right side of the 12 hour line at below the 100 TG line in bottom right area (4).
  • Or to put it another way, wherever a test was taken at more than 12 hours, I always showed a TG of less than 100 mg/dl regardless of where it started at in the morning. There are no plots in the upper right area (2)

As it happens, we here at CC always recommended water-only fasting for at least 12-14 hours before a blood test. But I’ll concede I assumed 12 hours to be conservative. When someone said they had fasted 9 or 10 hours, I assumed it probably didn’t have that much impact. Now I’m starting to rethink that, particularly if this data is further reproduced by others.

Low Insulin Hypothesis

So what if this all comes down to operating at lower insulin levels?

Insulin is important for fat metabolism, although not in the way most people tend to think of it. In fact, one could argue one of insulin’s main roles is to inhibit lipolysis (the release of fatty acids from your fat cells). Thus, longer residence time of fat in the blood makes a lot more sense in this context.

Alas, to really unpack this subject will take a bit of writing and referencing with regard to technical technical things like hepatocytes, VLDL-TG, and NEFA. But I’ll save that for a later post.

Gastric Clearance Hypothesis

A couple of people hypothesized that perhaps this may just be lower overall gastric clearance from the GI tract. Perhaps my food is taking a bit longer to digest on net as I have a higher protein to fat ratio on this diet (around 35% and 64%, respectively). Thus, entry of TG into the bloodstream via Chylomicrons would take longer overall. I think this is also a very interesting possibility and may have to think on how I could test that.

Retrospective Lab Analysis

Having taken pictures of all my food for over three years is about to pay off big for this situation. I can see on my spreadsheet 18 out of the 107 blood draws where I had TG above 100 which I could match to the last time I ate from the evening before as it will be on a picture that is times stamped. Scientific OCD for the win!

Of the 18 draws, there were 11 that can be explained by my having eaten below maintenance levels. Long time readers already know this is reflected in the Inversion Pattern, which includes TG levels (see right). Generally, I need to eat at least 2,000 calories on keto or I’ll lose weight.


And another five are explained by the carbs I was taking for an existing experiment these were taken from.


This left just two blood draws that were both high enough calorie, yet also low carb.


These draws were also in the 12-14hr window, so that wouldn’t explain the increase. But of course, these increases aren’t very dramatic anyway (102 and 129).

Final Thoughts

For over three years now I’ve been very interested in how fat-based energy is distributed in the body, particularly when carried in the blood by lipoproteins. Yet, I’ve probably put a little too much focus on LDL-C and LDL-P as these markers are much more stable and predictable when compared to triglycerides for a blood test. Triglycerides are “noisy” after all.

Or… maybe they aren’t after a long enough fasting time.

Nearly every test taken at 12 hours or longer was under 100 mg/dL for triglycerides, so long as I wasn’t (1) eating low calorie, low carb (invoking the Inversion Pattern) or (2) eating moderate to high carbs (typically due to an experiment)

Thus, this data is extremely powerful for two big reasons:

  1. It shows just how easily one could be misdiagnosed with persistently high triglyceride levels, otherwise known as hypertriglyceridemia . Had I gotten a blood test at 10 hours fasted from almost any of the tests for last week, I’d have gotten that diagnosis. Just two hours later and I’d have instead gotten the optimal 100 mg/dL or less. (Think about that for a second — just a two hour window!)
  2. It provides further weight to the lipid energy model. I certainly suspect we are seeing high redistribution of TG to both adipose and non-adipose tissue alike during the rapid fall in total levels. Fasting triglycerides in the hundreds under a Standard American Diet (SAD) is rightly associated with disease because it is usually continuously at these levels, potentially due to poor metabolic health. And yet, in this case, we see mine move from the levels of hypertriglyceridemia to very ideal levels over the course of the morning every single time.

So if you’re looking for the “tl;dr” — just look at the graphic below…

Note From Siobhan

After a discussion with Dave I decided to likewise check back through the data I’ve collected and see if I had any unexplained triglyceride readings at or above 100 mg/dL. I certainly found it interesting that, even though I’d been carnivore for over a year, I had never – as far as I remembered – seen oddly high triglycerides.

This could be for a few reasons though:

  1. Up until recently, I’ve been drinking diet soda – some speculate that this could cause insulin to rise, which could possibly counteract the proposed carryover effect
  2. I try to always follow my own advice and get blood draws around 13 hours fasted, so even if it was high at the 9-10 hour mark I’d likely never know
  3. I may just not have enough data points to have had the opportunity to spot it yet.

Currently, I have 23 data points, where triglycerides were measured. Of those, there are 6 in which triglycerides are at, or above, 100 mg/dL:

  • One is from 2015 where I was on a Standard American Diet and was likely due to my high carb/western diet.
  • Two were taken while I was intentionally multi-day fasting (e.g. outside of the 12-14 hour window, reflecting the inversion pattern).
  • Two were intentionally taken while I was sick, and thus are expected to be from an immune response from the illness.
  • There is one where I wasn’t explicitly sick, with triglycerides at 102 mg/dL, however I was sneezing and felt a little “off” at the time. I retested a few days later and was in fact sick with a cold – so again, this could be explained by an immune system reaction that was currently under way.

This means that I have no unexplained high triglyceride results, perhaps owing to the fact of my consistent fasting time prior to the blood draw – although of course I’ll now have to see if I can replicate Dave’s data to confirm that.

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Gary Schneider
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Gary Schneider

I have a group of friends that follow Dr. Tim Noakes. I am the only one who is 100% carnivore….we all exercise together at least 5 days a week….we all lost a lot of weight in the beginning….but I am the only one that started to put on weight and muscle after about 11 months on carnivore and I am 65 years old..it may be just me but I believe there is definitely something quite different between between being low carb and no carb….the body seems to develop in a different way…A little side note: I am a chiropractor and my keto patients bones adjust in a completely different way than my carnivore patients….it’s subtle but different….I am starting to suspect that even a little sugar from low-carb affects the joints and tissue in the human body, although I have no way of proving it. Just a gut feeling….

Elaine
Guest
Elaine

My experience is similar: I reversed and am mostly keeping at bay 1) chronic plantar faciitis, 2) a little arthritis in my right top knuckle and 3) a little bit of knee arthritis with strict low carb and daily OMAD. The only carbs I get are almond flour from some things I bake. I too have put on a 2-3 lbs from my lightest (weight= 120 lbs). I noticed that the arthritic pain in those 3 areas comes back ever so slightly potentially due to the slight weight gain or the little increase in carbs. I try to do OMAD every day going 20 hours but am not super strict water fasting (dollop of cream or almond milk in tea and / or broth). Am trying zero carb to see if the pain goes back to zero.

Suriyan
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Suriyan

I have to point out that you should repeat your tests after being ZC for at least 3 months if not longer.

Kerry
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Kerry

Awesome. Love your work, guys. I’m in awe.

Mike Kramer
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Mike Kramer

For all my recent history, my trigs stay in the 70-76 range. These were all done when I was doing either alternate day fasting or one meal a day and came after a lot longer than a 12-hour fast.

In May 2018 I did a Feldman Protocol before getting a standard (not NMR) panel from my primary care doc. I purposely ate an evening meal the night before the test, even though I normally do not, to see if that would help lower the various cholesterol reading. The cholesterol results were lower, (though still above conventional limits of normal) but my trig went to 97.

So, I need more than 12 hours.

gretchen
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gretchen

You have a lot of data. Have you tried looking at it with neural networking software?

Josh Howard
Guest

This is incredible! Thank you for this. Can you post a link to twitter for your lipid testing device? We need more n=1 ers. Cheers – @hackingDux

chris c
Guest
chris c

Wow you always come up with such fascinating stuff!

On low fat (and probably for most of my life) my trigs were horrendous. On low carb they went from 380 to 39 and are generally around 100 or less – more variable than the HDL and LDL. I had one test non-fasting as I suspect my doctor was hoping to catch me out but to be honest I can no longer remember which test it was, the results especially the trigs never changed much between a 14 hour fast and breakfast.

She is largely quite sensible but absolutely believes that high trigs are caused by fat. I guess it will take another couple of decades before she realises carbs are the cause. I just hope she never meets you in the meantime! Do let us know what else you discover and preferably why, this is intriguing.

carlos
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carlos

Hi Chris, can you share your hdl and ldl changes also ? thanks

chris c
Guest
chris c

Sure! HDL went from 24 to 50 – 60. LDL went from 170 to over 200 on a low fat diet (the one that for the first time in my life made me gain weight), dropped to around 70 with a statin and currently (statin free low carb/keto) bounces around between 100 – 160

Part of the instability is down to hyperthyroid which dropped the LDL by exactly the same amount as a statin (who knew?) and when overtreated it jumped back up again. Thyroid doesn’t seem to correlate much with the trigs or HDL.

I knew a retired doctor who stated that back in the day when they saw high “cholesterol” they would do a TSH. Then when the low fat mania took hold the correlation was broken due to metabolic syndrome/insulin resistance becoming so widespread.

IMO I’m a responder rather than a hyperresponder and nothing I’ve done is in any way out of the ordinary, but then I’m a weird skinny (Type 2) diabetic with, I strongly suspect, a lack of Phase 1 insulin yet still a pretty decent Phase 2 which has plagued me all my life with reactive hypoglycemia, and obviously I used to have insulin resistance but no longer do. IMO the lipids and blood pressure etc. were downstream of this. The weirdness is that the dietician had to try very hard to make me gain weight, by eliminating fat and replacing it with even more carbs, so she could accuse me of “failing to comply” with the diet. Then when I actually did stop complying with the diet everything went back to near normal. I could have done this fifty years earlier if only I’d had the information.

Kevin
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Kevin

Hi guys, I just found out about the glucagon-like peptide-1 (GLP-1) and its role of rising insulin when consuming e.g. glutamin, glycin or Whey-Protein. And I found a paper on Irish Cheddar increasing GLP-1 (https://www.ncbi.nlm.nih.gov/pubmed/29884400).
And if your theory about insulin is neglecting the effect of an elevated TG in the morning by consuming carbs which causes an elevated insulin. Also products which elevated the insulin via the GLP-1 Pathway should work and therefore maybe cheese.

I attach some literature about the GLP-1 (if you haven’t already read it)

CHEERS from Germany 🙂

Kevin

Bodinham, C. L.; Smith, L.; Thomas, E. L. u. a. (2014): „Efficacy of increased resistant starch consumption in human type 2 diabetes“. In: Endocrine Connections. 3 (2), S. 75-84, DOI: 10.1530/ec-14-0036.

Gannon, Mary C, Jennifer A Nuttall, and Frank Q Nuttall. “The metabolic response to ingested glycine.” The American journal of clinical nutrition 76.6 (2002): 1302-1307.

Greenfield, J. R; Farooqi, I S.; Keogh, J. M u. a. (2008): „Oral glutamine increases circulating glucagon-like peptide 1, glucagon, and insulin concentrations in lean, obese, and type 2 diabetic subjects“. In: American Journal of Clinical Nutrition. 89 (1), S. 106-113, DOI: 10.3945/ajcn.2008.26362.

Ibarra, Alvin; Astbury, Nerys M.; Olli, Kaisa u. a. (2015): „Effects of polydextrose on different levels of energy intake. A systematic review and meta-analysis“. In: Appetite. 87 , S. 30-37, DOI: 10.1016/j.appet.2014.12.099.

Inoue, Kana; Maeda, Norikazu; Kashine, Susumu u. a. (2011): „Short-term effects of liraglutide on visceral fat adiposity, appetite, and food preference: a pilot study of obese Japanese patients with type 2 diabetes“. In: Cardiovasc Diabetol. 10 (1), S. 109, DOI: 10.1186/1475-2840-10-109.

Jakubowicz, Daniela; Froy, Oren; Ahrén, Bo u. a. (2014): „Incretin, insulinotropic and glucose-lowering effects of whey protein pre-load in type 2 diabetes: a randomised clinical trial“. In:Diabetologia. 57 (9), S. 1807-1811, DOI: 10.1007/s00125-014-3305-x.

Luque, M. (2002): „Glucagon-like peptide-1 (GLP-1) and glucose metabolism in human myocytes“. In: Journal of Endocrinology. 173 (3), S. 465-473, DOI: 10.1677/joe.0.1730465.

Mells, J. E.; Fu, P. P.; Sharma, S. u. a. (2011): „Glp-1 analog, liraglutide, ameliorates hepatic steatosis and cardiac hypertrophy in C57BL/6J mice fed a Western diet“. In: AJP: Gastrointestinal and Liver Physiology. 302 (2), S. G225-G235, DOI: 10.1152/ajpgi.00274.2011.

Seino, Susumu; Shibasaki, Tadao; Minami, Kohtaro (2011): „Dynamics of insulin secretion and the clinical implications for obesity and diabetes“. In: Journal of Clinical Investigation. 121 (6), S. 2118-2125, DOI: 10.1172/jci45680.

Zhou, J.; Martin, R. J.; Tulley, R. T. u. a. (2008): „Dietary resistant starch upregulates total GLP-1 and PYY in a sustained day-long manner through fermentation in rodents“. In: AJP: Endocrinology and Metabolism. 295 (5), S. E1160-E1166, DOI: 10.1152/ajpendo.90637.2008.

Steve Stephenson
Guest
Steve Stephenson

I’ve been a carnivore since before July 2017 (Ketofest). I’ve often wondered how, say 500000 years ago, a team of hunters could have safely stored much of their fresh kill without refrigeration or the time necessary to dry the meat. With very large predators around they would very much need to “eat and run”. Perhaps our large small intestine serves as temporary storage. I.e., the “Gastric Clearance Hypothesis” may be the answer.

Thales
Guest
Thales

Would having the flu cause a spike in Triglycerides and halving of HDL coupled with a 7 lbs weight loss too effect the results of a blood test?

Jason Skinner
Guest
Jason Skinner

Dave this is awesome information!! I have been Carnivore for just over 3 months. While my LDL has increased 2-3 fold my Triglycerides have gone up 100 points as well. The Trigs really have me perplexed but, after reading this article I’ll get another blood test around the 14 hour fasted mark to see. My initial test for Trigs was 176 and then I did another test excluding coffee and my Trigs dropped 35 points. Perhaps it was the coffee or perhaps it was my fasted window was longer on test #2. I am going to schedule another blood draw this week and make sure I’m atleast on a 14 hour fast to compare. This time I’ll be consuming coffee 😉

Thanks – Jason

Deni
Guest
Deni

Sorry, this is probably not the section to ask this question, but is it ok to exercise the 3 days prior to having your blood taken? I am just curious on what possible affect this would have. I would appreciate any info you might have on this.
thank you!

Amber Landsman
Guest

Hi Dave, Thank you for all your time and devoted effort to clarify and crack the CHOL code.
I’ve have been CV for 5 months and just had my blood work completed. I am a 43yr life long athletic female, very active (weight lifting 4-5x wk) and 21% BF (before CV – eating high protein paleo since 2012 at 24% BF). This article is helpful and Ill share with my Naturopath. My total CHOL went from 260 to 488. TG from 59 to 115 after a 12 hour fast.. LDL is 400 ad HDL 88. Previous (Fall 2018) LDL 154 and HDL 94, TG 59. A1C 5.2 to 5.3 and still waiting on CRP. All other markers are good. I think Im a hyper-responder? I could use some support/guidance from a Dr. who can accept and understand my CV WOE? I would also be interested in being part of any studies for lean hyper-responders. Do you have any suggestions of tweaks I can make to diet to bring it down but still be high protein? Then I can retest. I was thinking to incorporate more lean meats, but still no veg matter as I have had chronic facet inflammation and after 5 years am finally found a WOE/being that has reduced symptoms by 95%. PM me in email or here if you have time to share a link or resource. Im concerned and not sure who to turn to for clarity and help with such a high CHOL response. In advance thank your time.

Ernie Berlic
Guest
Ernie Berlic

Hi Guys, An observation from my Recent start to a LCHF way of life. I suspect I am FH ( Genotype test underway now – results in 20 days)

April 2019 LDL-C 10.0 Trig’s 2.90 HDL 1.0mmol A1C 7.1 ( Just Before Keto start )
July 2019 LDL-C 9.5 Trig’s 2.36 HDL 0.92mmol A1C 5.6 ( 3 months into Keto)

Is my stubborn persistence of high Trig’s and low HDL possibly affected by the lipid disfunction caused by my FH.
Is it possible that the long life of the LDL in the blood and the inability to be cleared is the cause ?

Siobhan Huggins
Admin

Hi – it is difficult to tell without an FH diagnosis/genetic testing. Regarding the HDL and trigs have you checked out this post to see if any apply? Were you 12-14 hours water only fasted? Any liquid fats? Etc