"I lost 30 lbs and my triglycerides went . . . up?"

Brad needed to lose weight.

At 6 ft tall, he began the program at 291 lbs, easily 80 lbs overweight. He wore virtually all of it in his belly.

He had laboratory numbers to match: HDL 33 mg/dl, triglycerides 225 mg/dl, LDL (calculated) 144 mg/dl, blood sugar 122 mg/dl (fasting--clearly "pre-diabetic"), c-reactive protein 3.0 mg/dl. Among his lipoprotein abnormalities: small LDL representing 80% of all LDL (no surprise).

Readers of The Heart Scan Blog know that these are the patterns of the carbohydrate-indulgent. I asked Brad to eliminate all wheat flour products, all foods made with cornstarch, and follow a diet rich in healthy oils, raw nuts, vegetables, and lean meats.

Brad returned for a discussion about follow-up basic lipids (cholesterol) values four months later--31 lbs lighter, most of it clearly lost from his abdomen. He claimed he felt more energetic and clear-headed than he had in years.

His lipid panel: HDL 34 mg/dl, LDL 122 mg/dl, triglycerides 295 mg/dl. Brad's smile dissolved. "How could that happen? You said losing weight would make my HDL go up and my triglycerides go down!"

Yes, I had said that. But I was oversimplifying.

The truth is that, when there is weight loss, especially profound weight loss like Brad experienced eliminating wheat and cornstarch products, there is mobilization of fat stores. Fat is stored energy. Energy is stored as . . . triglycerides.

So when there is substantial weight loss, there is a flood of triglycerides in the blood, and triglyceride levels in the midst of weight loss can commonly jump up, not uncommonly to the 200-300+ mg/dl range. When triglycerides go up, there is also a drop in HDL (triglycerides interact with HDL particles, modify their structure and make them more readily destroyed, thereby dropping blood levels). Occasionally, substantial weight loss like Brad experienced will drop HDL really low, as low as the 20's.

Once weight stabilizes, this effect can last up to 2 months before correcting. Only then will triglycerides drop and HDL rise. The rise in HDL occurs even more slowly, requiring several more months to plateau.

In other words, weight loss like Brad's causes triglycerides to increase and HDL to decrease, to be followed later by a drop in triglycerides and a rise in HDL.

I know of no way to block this phenomenon. And perhaps we shouldn't, since this is how fat stores are mobilized and "burned off." Fish oil does blunt the triglyceride rise (perhaps through activation of lipoprotein lipase, an enzyme responsible for clearance of triglycerides), but doesn't eliminate it.

I call these changes "transitional" changes in lipids.

Patience pays. A few more months from now, Brad's numbers will be much happier, as will Brad.

Comments (6) -

  • Jenny

    8/13/2008 2:35:00 PM |

    Thanks for posting this.  My husband has allowed himself to be carried along with my strict low-carbing for a few months now, and has lost 25 pounds +  or so so far. He had labs a couple of months ago, and his Triglycerides were up and his HDL somewhat low.  So of course his physician wants him to repeat the labs in Oct., and will want to put him on meds , I'm sure, if he still exhibits that profile.  But I will advise him to wait, to continue with what he's doing until his weight loss stabilizes, and this post will give me the concise authoritative ammo I'll need to encourage him both to continue with carb restriction and to resist medication, which he almost certainly is not a proper candidate for.  Perfect timing for us, and thanks so much! jennytoo.

  • Anonymous

    8/15/2008 1:57:00 PM |

    on another subject, but I'm curious about your thoughts on krill oil.

    Here's a post by Michael Eades on the subject:

  • Peter

    8/15/2008 7:33:00 PM |

    Hi Dr Davis,

    While fat is stored as triglycerides, it is released from adipose stores as non esterified fatty acids, and these will be predominantly palmitic acid in humans. Non esterified palmitic acid appears to be an excellent inducer of insulin resistance, and insulin resistance has been hypothesised by several authors to be a completely normal physiological adaption to fasting or seasonal carbohydrate absence. While weight loss is on going, the circulation is flooded with NEFA and "physiological" insulin resistance should predominate. If the person continues to consume "good" carbohydrate at above acute metabolic needs, the excess will get shipped out of the liver as VLDLs. Under insulin resistance lipoprotein lipase, routinely under the control of insulin, won't be doing much lipolysis and so VLDLs can hang around in the circulation... Muscle can happily accept NEFA as a prime source of energy without lipoprotein lipase having to split the lipids from VLDLs, so leave the VLDLs there to show up as fasting trigs....

    Once weight is stable the NEFA release from adipose tissue will be much better matched to metabolic needs. With the improved insulin sensitivity due to loss of visceral fat, control of both adipose hormone sensitive lipase and endothelial lipoprotein lipase activity should normalise and allow VLDLs and HDL to settle in to  more cardiologically acceptable numbers.

    Just an idea. The prediction it makes is for a reduced HbA1c due to the reduction in bulk carbohydrate (this must happen to allow lipolysis for weight loss), coupled with no drop or an increase in fasting blood glucose due to the NEFA induced insulin resistance. Very curious as to whether this happened...

    Idea is open for kicking.


  • Brian

    1/13/2010 3:35:45 PM |

    Thanks for the article.  In the midst or losing a good deal of weight I had a finger prick test here at work.  My HDL had indeed dropped into the low 20's but my Triglycerides had also dropped (maybe a good does of fish oil and cod-liver oil help those?).  Anyway my weight has pretty much stabilized at a good level and I'm looking to do a good blood test in a few weeks.  Hopefully the HDL numbers are coming up.

  • Mickey

    1/28/2010 3:47:49 AM |

    The post about Brad is from August of 2008.  So how is he doing now?  Did the triglycerides drop and HDL rise?

  • kellyme

    10/28/2011 9:27:02 AM |

    I wonder what happened to Brad now? How did it go? By the way, I wanna share this video I came across with: http://www.youtube.com/watch?v=lj-ZnG3NoZY You'll surely learn a lot of information here. Smile