I lost weight and my cholesterol . . . went up!

This is a fairly common observation around these parts: “I eliminated wheat from my diet and have limited my consumption of junk carbohydrates like corn and sugars. I lost 38 pounds over three months and I feel great. I initially lost weight rapidly, but have more recently slowed to about 1-2 pounds per week. But my doctor checked some lab values and he flipped! He said that my HDL dropped, my triglycerides went up, and my blood sugar went up 20 points! He wants me to take a statin drug and metformin for my high blood sugar. What gives?”

Easy: You are losing weight. Let me explain.

When you lose weight, you are mobilizing energy stored as fat. That fat is mobilized as fatty acids and triglycerides into the bloodstream. 10 pounds lost, for instance, means the equivalent of 35,000 calories of fat released into the bloodstream.

These fatty acids are not alone. They interact with the other elements in the bloodstream. In particular, this flood of fatty acids:

Block insulin–and thereby increase blood sugar. A non-diabetic can even become transiently diabetic during weight loss.
Increase triglycerides–A starting triglyceride level of, say, 120 mg/dl, can increase to 180 mg/dl during active weight loss. (Triglycerides contain fatty acids.)
Decreased HDL–Excess fatty acids and triglycerides modify HDL particles, causing their degradation and elimination. A starting HDL of 45 mg/dl can drop to 28 mg/dl, for example.
LDL measures go haywire–The conventional calculated LDL cholesterol, or even generally superior measures like apoprotein B or NMR LDL particle number, can go in any direction rather unpredictably: They can go up, down, or sideways. Likewise, the (miserably useless) total cholesterol value can go up, down, or sideways.
Increased blood pressure–This is likely due to the enhanced artery constriction that occurs due to increased endothelial dysfunction, i.e., dysfunction of the normal relaxation mechanisms of arteries.

The key is to recognize these phenomena as nothing more than part of weight loss and the inevitable mobilization of fatty acids into the bloodstream. Accordingly, decisions should not be made based on these values, since they are transient. Your doctor will likely try to push hypertension medication, statin drugs, fibrate drugs, diabetes drugs . . . all for a transient effect. Is there a way to not experience these changes? Sure: liposuction. To my knowledge, there is no way short of extracting fat with a trocar to avoid these changes.

As a practical matter, avoid having blood drawn until weight has plateaued for at least 4 weeks and these changes are allowed to reverse. Only then will you know what you have achieved in your wheat-free adventure.

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Comments & Feedback...

  1. Nancy

    Within a month, all of my husband’s cholesterol numbers improved. We refused statin drugs. He dropped 70 LDL points. We followed Dr. Fuhrman’s books on nutrition. By following almost the same diet my mom stopped taking all diabetes medication within 3 weeks. Both of their Doctors were amazed.

  2. jjb

    Dear Dr. Davis,
    First let me say – your book is revolutionary. It was what led me to question everything regarding diet and the SAD that is so pushed in mainstream. I am writing because I recently had my cholesterol done and despite knowing that it probably is *just fine* and temporary, it would calm my anxiety if you would comment.
    Here is the situation: I am 46 yo female with Crohn’s and migraines. I went gluten free in Aug 2012 and Paleo (still do lactose free dairy) Jan 2013. My Crohn’s which was mild, has completely subsided and my migraines nearly disappeared. I went from 167 lbs (I am 5’5″) to 145. I feel great and have started running again because I have so much energy. I rarely “cheat” and if so it is always gluten free. I recently decided to try the Fat Fast (Ketogenic) diet to see if I could lose the extra 10 (135 has been my goal…) since I have essentially stalled at 145-148 lbs. I started the fat fast 4 days ago and already lost 4 pounds (although that might be due to running 6 miles yesterday!). Ironically, I also had a physical planned for yesterday and had fasting blood work done. Breakdown was: TC 341, LDL 248, HDL 74, TG 98 Chol/HDL 4.6. My doctor called immediately and wants me to go on statins. I think not. I told her I was doing Paleo and now the Fat Fast for a few days and she does not get it (I didn’t expect her to, as I have gone thru the SAD, messed up medical school myself and have a PhD in Biochemistry, (again ironically) in Cholesterol Metabolism!) I’m embarrassed to say that my entire thesis was based on the “Lipid Hypothesis” and can be completely discarded at this point. Thankfully, it is not what you study, but learning to think while studying it that matters. Regardless – Can you tell me – what are your thoughts on this? I believe that it is entirely possible that my numbers were out of wack because I was ketogenic and fat wasting. And all that fat was probably hanging out in my blood! It makes biochemical sense. Have you seen/heard any concrete evidence of this yourself? My plan is to stop the fast (although it was pretty easy…and I was not hungry, AT ALL) as I am content losing a few lbs and that is good. And I will ask to have my blood work repeated in a few weeks/month. Any comments very much appreciated.

  3. Sharron

    I had my long awaited yearly checkup in late November and the doctor said
    What have you changed between Dec. last year and now because your cholesterol results are AMAZING!!
    You have achieved better results than I have seen with medication
    Below risk area now
    Only saw one other patient who had as good a result with diet when he went from 300 Lbs to 200 lbs.
    Triclycerides dropped by more than half. (They had actually dropped by 62 %!!)
    I am so excited! Now I know FOR SURE I am on the right path.
    Thank-you Dr. Davis for showing us the way.