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.

This entry was posted in Weight loss. Bookmark the permalink.

118 Responses to I lost weight and my cholesterol . . . went up!

  1. Michele Propes says:

    My whole family has high cholesterol and is on meds for it. I was anorexic once and went from a size 12 to a size 00 in about a month. I had gone to the Dr. And he said I had the cholesterol of an obese older male (200). Not sure how this is possible. About a year ago I weighed about 190 (under 5′ so not good) and a cholesterol of 269. I totally overhauled my lifestyle and eating habits and after losing about 20 lbs my cholesterol went down 10 pts. Not as much as I thought it should have! I then was having trouble losing anymore and someone gave me some samples of Zija and I started the diet and nutrition plan and lost 8 lbs rapidly without exercise (my RA and Fibro flared and I had to stop) and then over the next three months lost another 30 plus pounds. I was feeling so much better in all aspects of my health. I then went to do the Lila Laser lipo that they say flushes out liquid fat. I have lost 4 inches in my stomach and kept it off! Imagine my horror to go the next day to have cholesterol testing done just sure I was in normal numbers only to find out it went up to 279! I really am feeling disgusted because I tried to take Zocor but it made my muscles hurt so bad I couldn’t move for 3 days. Do you think the high cholesterol could be from the laser lipo and large weight loss and eventually it will get down so I don’t have to take meds or die young from a heart attack? I went from a size 18 to a size 9 and even though I look and feel great I’m worried for my health. Thank you, Michele

  2. Susan says:

    How long can your body be safe to have blood sugars above 250 while losing weight. I lost nothing until I weaned myself off meds then started losing like crazy. But blood sugar and BP started going up soon after. Since I have a lot of weight to lose is it ok to have those high numbers for an extended period if time? I tried explaining the fatty acids in the blood stream during weight loss to my Dr. But as expected she had no idea what I was talking about.

  3. Pingback: Biometric screening results | LCHF America

  4. Pingback: Now i have a deadline…….

  5. Pingback: Day 07 | NonOrganicHealth

  6. Claudette Gunther says:

    My trigs have more than doubled during weight loss (11 lbs) on a whole-food plant-based diet (China Study, Campbell; Preventing and Reversing Heart Disease, Esselstyn, Starch Solution, McDougall). My HgbA1C is back within normal range, my HDL is a little higher, and LDL and total cholesterol are a little lower without medicaton. I’m hoping the numbers right themselves when my weight stabilizes.

  7. Mark says:

    Well, I got my NMR back today. I’m 5’9″, 136 lbs, BMI 20, body fat% 20. 62 yr old male. I have diabetes (c-peptide score .54, indicating that pancreas is slowly giving up the ghost), and RA for which I take Enbrel. BP is 100/60. HS-crp is .3 . Last HBA1c was 5.3 (I have brought it down from 7.3). Liver enzymes all good. I have been on a low -carb Paleo diet for last 8 months or so (weighed probably 145-150 before starting it). Only form of sugar I eat is small quantities of berries and some very small quantities of 80% dark chocolate. No grains. Mostly wild fish, veggies, salads, nuts, chicken, grass-fed beef. Do use coconut butter in morning smoothies along with MCT oil, avocados,etc. Usually restrict my nuts to macadamia nuts (low omega 6), on rare occasions almonds or pecans. Take 2-4 grams of Barleans concentrated fish oil daily.
    It seems that my total cholesterol has risen as has my calculated LDL-C (was around 120 previously). HDL continues to climb since being on Paleo. First time I’ve had this test run, so not sure how my LDL-P particle number compares to where I was before.
    Haven’t talked to my family doc about this yet, but know that she thinks my particle size scores were quite good. In the past , she had been suggesting statins to me due to my LDL scores and my diabetes/RA. Not sure what she will decide now
    Your take on my scores?
    HDL-P 30.5 u/mol/L
    Small LDL-P 96 nmol/L
    LDL size – 21 nm
    Large VLDL-P <.7
    Small LDL-P 96
    Large HDL-P 10.4
    VLDL size – ** (VLDL concentration too low to allow determination of VLDL size)
    LDL size – 21.9
    HDL size – 9.5 nm
    LP-IR score 5
    LDL-P 1463
    LDL-C 139
    HDL-C 65
    TG – 48
    Total Cholesterol 214
    TG/HDL ratio – .74
    PS – I find my LP-IR score of 5 intriguing since I am a diabetic. I assume it must be this low because of how I'm controlling it by diet?

    • Dr. Davis says:

      Overall, your panel is excellent, Mark! You have minimized the number of small LDL particles (96 nmol/L is trivial).

      The only uncertainty is the LDL particle number of 1463 nmol/L, equal to an LDL cholesterol value of 146 mg/dl (drop the last digit). What NOBODY knows is what quantity of mostly or exclusively large LDL particles are allowable before they begin to contribute to plaque growth. I think–but I do not know–that a safe threshold is somewhere around 1400-1500 nmol/L. We have no data specifically addressing that question.

      Have you considered a probiotic?

      The LP-IR is a useless contrived score meant to inform the unsophisticated primary care doctor, but it has little relationship to reality. They really should publish that number.

      By the way, have you considered strength training? You seem too slender for height.

      • Mark says:

        Dr. Davis,

        Thanks so much for the reply. Good news, I think. I had heard that LDL-C can rise on low carb/high fat diets – do you think that can be a part of it? I do take a pre/probiotic, namely Prescript-Assist, which I started a month ago (2x daily). Prior to that I was taking a product from Jarrow. I also take a tablespoon of Coconut Kefir by Inner-Eco when I have those protein smoothies. I use these mostly to try to get things moving, since moving to Paleo has slowed things down. I take Magnesium Natural Calm before bed but that doesn’t seem to work any wonders either, so that remains a puzzle.

        I am too slender (although I was in this weight range in high school). My RA has caused pretty severe attenuation of my rotator cuff tendons, so I have to be pretty careful about not tearing one of those. Both upper bicep tendons have given way over the years. I do work out on a Nordic Trac for 30 minutes and usually walk 45 minutes a night at a good clip. I also use an Xiser stepper which gives my core and quads a great workout, but how to develop my upper body with my aforementioned issues remains a bit of a puzzle for me.

        Looking at those numbers, would you think it necessary that I take statins (my family doc and endocrinologist during past visits think my LDL should be at 70 and keep pushing me about it.)? It was the reason for taking this test

        Thanks again for your input!

  8. Dean says:

    Dr Davis:
    I am heartened to read that actively losing weight (mobilizing fat) can affect one’s blood lipid results. While I have been in weight losing mode, I wanted to get your opinion if other factors could also affect blood lipid test results.

    Here are some things I recall the day of and week of my test. Note: My test was on Friday morning.
    Leisurely 3 mile walk 2 hours before the 9am test
    Periodic intermittent fasting the week of the test
    Added stress (I am a single father. I had my children for an entire week through Tuesday before the test…I normally have them 3 or 4 days a week).
    General sense of fatigue towards the end of the week (I’m pinning this on a full week of work, intermittent fasting, and having my children for a week).

    In light of the above, would avoiding the above reduce the risk of wide fluctuations in cholesterol test results? Your opinion would be greatly appreciated!



  9. Dean says:

    Dr. Davis:

    I forgot to mention…I am completely wheat/gluten free (for about 1 year now, except for the occasional beer), eat natural/whole foods exclusively (with a bias towards grass fed beef), drink only water, and avoid refined sugars and carbs. Also I am four weeks in recuperating from a broken right clavicle.



    • Dr. Davis says:

      Hi, Dean–

      The intermittent fasting, in particular, can change your values transiently, usually for a few weeks afterwards. These changes include a rise in triglycerides, drop in HDL, and modest rise in blood sugar, depending on the duration of fasting and how much weight was lost.

      This all subsides and the numbers improve if they are due to fasting/weight loss.

  10. Brittnie Gunsalus says:

    Dr. Davis,

    In the past year and a half I have lost 110lbs with diet and exercise. In the past 7 weeks I have started a new fitness venture of exercise, and high/medium/low carbohydrate days (which also vary in protein count) no breads only oats, grits, white/sweet potatoes, and brown rice. Nothing processed, no fruit, no junk. I had blood work done, and an EKG. Everything came back perfect (my bp is also 105/64) except my total cholesterol was 236, and my LDL was 167. I am on this nutrtion plan as well as I do cardio 5-6 days per week, and lift weights 3 days per week. I was also just started on ortho tricyclen low 29 days ago. My Dr wants me to repeat my blood work in 6months. Should I be concerned with these values since I am on this new venture of cutting fat and the new medications? Is this high enough that I should be on medications?


  11. Kimberly says:

    I am 58, a woman, 5′ 3″ and at the time of my first blood lipid test I weight 217. In June 2013 My tests were as follows:
    LDL 172, HDL 54, Triglicerides 141. Overall 255. My risk factor was 4.7 BP 122/80.
    My Dr. advised changing my diet (which I do to increased fruits, non-fat yogurt, berries, watermelon, salads, less red meat, more fish/chicken/turkey) and I lost 18 lbs in 3 months. I’ve kinda plateaued having not lost anything in the last couple of weeks.
    I restested last week and here are the results!
    LDL up to 186, HDL, down to 53, Triglicerides up to 150. Overall 269 Risk Factor up to 5.1. BP 117/70.
    What the heck happened with my cholesterol!!!
    Now my Dr. wants me to go to an internest and possibly get on meds which I am very opposed to doing. Could my weight loss diet have caused this? Also, I take Evening Primrose oil capsules, pro biotics, fiber DX fiber chews, MSM and Choelius Forskeli. I added Vitamin D3 2000 IU during these last 3 months at the Dr’s suggestion. The only thing I think I may have done differently for my test, I may have taken the Fiber Chew and My eveniing Primrose the night before my test even though I did fast (could they have affected it?)

    • Dr. Davis says:

      Gee, Kimberly: It makes me wonder if you got lost?

      This is a blog to accompany the book, Wheat Belly. You are clearly not following this program but a high-sugar diet.

  12. Kimberly says:

    Oh and while I didn’t fast during the weight loss, there were days, that I ate very little due to being very busy or I just wasn’t hungry. Also, I did have an unusually large meal the day before my test, but still fasted that night before the test. Can that affect the test?

  13. Kimberly says:

    Oh, ha ha ha. You are right Dr. I posted on the wrong blog! My apologies!

  14. Scott says:

    Dr. Davis, im in my late 40′s. I am now 5’8″, 230 lbs. I went on a very low carb regimen about 8 weeks ago. Some days carb intake is 10 mg, some days 30 or 40 mg but not higher. Lots of protein (fish, grass fed beef, eggs, chicken, etc), good amount of saturated fat from raw cheese, grass fed butter, protein sources), good amount of mufa and puff from walnuts, almonds, avocado, etc. good amounts of non starchy vegatables, NO fruit, NO sugar. NO vegatable oil except from small amounts of extra virgin olive oil. Approx 4 grams of EPA/DHA from fish oil per day. My omega 6 to 3 ratio must be around 1/1. Lost about 12 lbs but lost probably more body fat than this as it appears I have gained muscle during this period. My Blood Pressure quickly and drastically improved and now has been steady at about 100/70. Just got lab work back and triglycerides rose from 149 to 186; HDL dropped from 36 to 31; LDL dropped from 111 to 99 (direct measurement); total cholesterol dropped from 176 to 165. I was surprised LDL and HDL and total cholesterol dropped as I expected from research that these three numbers would go up. I don’t know why they dropped. Tryglicerides went up and I expected this number to come way down with my elimination of carbs (could this really be from dumping of tryglicerides into blood from fat burning and is this also pushing down my HDL?) What are your thoughts on my numbers? I thank you in advance.

  15. Joe says:

    Dr. Davis: I started going wheat-free about 4 months ago. While I have occasionally binged (darn pizza) and for the first 1-2 months, didn’t realize the problem with gluten-free packaged foods, I am frustrated. I have gained about 15 lbs, my bad cholesterol is up as is my glucose. I have eliminated all bread products, pasta, grains, (except occasional small amounts of Quinoa and Brown rice), try to avoid wheat-containg products like spy sauce as much as possible, and cut back a lot on dairy products. Just had new bloodwork and my HDL is 66, non-hdl 154, total cholesterol is 220, total cholesterol/hdl is 3.3 (this is low risk) glucose is 91 (non-fasting).

    I started taking 3 kelp tabs/day a few weeks ago and take regular fish oil, C, B12 and D. I walk an hour 3 times a week and an hour of yoga 3 times/week. I am 61 years old, 5ft 11 inches tall and 215 lbs

    The weight and cholesterol is very frustrating. My doctor wants me to start a low dose statin. I am already on blood pressure meds.


    • Regina says:

      You don’t say how long it has been since you have “cheated”? Have you gone more than one week without wheat and packaged foods? Are you eating vegetables, meats AND fats? If you have strictly been making sure your are not eating wheat or junk (high sugar/carb, or processed food, or eating 10,000 calories) and that you are following the Doc’s recommendations, I would almost think you have a medical issue (allergy to something new in your diet??)- 15 lbs in 2mos (saying you ate good after the first two months) is a lot of weight to gain in such a short period.

  16. Stephen says:

    Hi Dr Davis,
    I have been on your recommended diet for approximately 4 months. I started Wheat Belly Diet after my father (who jogs 6 km every day) suffered a heart attack at age 66 years. He is the last person I thought would have a heart attack, (being so fit and active and all). Anyhow after an immediate triple bypass he is back on track and has recently started to jog again. (We still have no idea why this had happened to him, after all he eats fairly well and his cholesterol results are within normal range).

    Dr Davis, I want to do everything in my power to stop this from happening to him again and to take proactive measures so it wont happen to me in the future. (Hence why I commenced your diet) . However I recently had a Cholesterol blood test done and I was shocked to see that my results appear worse after the Wheat Belly Diet than before the diet. My doctor said my total cholesterol is a bit HIGH. (5.6 mmol /L) ???

    I have always been very lean so I am not sure if the weight loss theory applies to me.
    I am:
    – 38 years old (male),
    - 166 cm tall,
    - weigh 62 kilograms
    My ‘BEFORE’ and ‘AFTER’ cholesterol test results are as follows…….:


    TOTAL CHOLESTEROL: 4.4 mmol /L
    HDL CHOLESTEROL: 1.5 mmol /L
    LDL CHOLESTEROL: 2.6 mmol /L
    CHOL / HDL RATIO: 2.9


    TOTAL CHOLESTEROL: 5.6 mmol /L
    HDL CHOLESTEROL: 2.1 mmol /L
    LDL CHOLESTEROL: 3.2 mmol /L
    CHOL / HDL RATIO: 2.7

    Dr Davis, I was thrilled to see that my HDL has risen significantly, but I did not anticipate that the LDL will also rise at the same rate!

    Can you please share your thoughts on what you think may be at play?

    Much appreciated…


    • Dr. Davis says:

      I would urge you to read the “My particles are bigger than your particle” chapter in the original Wheat Belly book, Stephen.

      You will learn that:

      1) Cholesterol does not cause heart disease
      2) Cholesterol testing does not identify most of the causes of coronary disease
      3) My colleagues are interested in heart procedures and have virtually no interest in identifying the causes and putting a stop to them.

      For instance, a full assessment for coronary disease causation should start with advanced lipoprotein analysis (e.g., NMR) with lipoprotein(a); HbA1c, fasting glucose; TSH, free T4, free T3, reverse T3; 25-hydroxy vitamin D. Consider an apoprotein E genotype and sterol absorption markers.

      You can begin to appreciate why “cut your fat and take Lipitor” is absurdly oversimplified. Also, see my many, many posts on my old Heart Scan Blog.

  17. Nancy says:

    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.

  18. jjb says:

    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.

  19. Sharron says:

    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.