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.