What is this wacky thing called "weight loss"?

I've discussed this before, but it has proven such an (encouragingly!) frequent issue that I thought it was worth discussing once again.

What happens when you lose weight?

The process of weight loss is characterized by multiple shifts in metabolic patterns that can be confusing. To the uninitiated eye, weight loss can look like a disastrous distortion in metabolism. The naive doctor on seeing your lab values, for instance, might insist you take a statin drug, a fibrate like Tricor (to reduce triglycerides or increase HDL), or simply berate you for your bad health habits--when it's actually a good thing you've accomplished.

So when you lose weight, say, 30 pounds in 3 months, what have you accomplished?

Energy stored as fat, especially from visceral fat stores, is mobilized into the bloodstream. It floods the bloodstream as fatty acids and triglycerides. These fatty acids and triglycerides don't occur in isolation, but interact with other particles and metabolic patterns. The resulting blood patterns include:

--Increased triglycerides--An increase in triglycerides, for instance, from 90 mg/dl to 200 mg/dl in the midst of weight loss is common.

--Reduced HDL--The flood of triglycerides leads to increased degradation of HDL, thus a drop. A drop in HDL from, say, 40 mg/dl to 27 mg/dl--very frightening to people--is exceptionally common.

--Increased blood sugar--The flood of fatty acids and triglycerides results in insulin resistance, leading to higher blood sugars. It is not uncommon for someone with pre-diabetes to develop diabetic-range blood sugars, or a non-diabetic to show pre-diabetic blood sugars.

--Increased small LDL particles--Though small LDL is highly variable during weight loss. When it does happen, it's probably from the interaction of VLDL (triglycerides) with LDL particles and the reaction that overloads LDL particles with triglycerides and conversion to small LDL particles.

So why don't doctors often recognize these patterns when a patient loses weight? Because they rarely see it. Most of my colleagues are accustomed to having patients come back with weight gain, getting heavier and heavier each time. Lose weight? Impossible! So they just don't recognize weight loss effects when they see it. As followers of The Heart Scan Blog know, a frequent conversation around here is "Am I too skinny?" or "How do I stop losing weight?"

The solution: Be patient. Be patient and wait about two months after a weight plateau has been achieved. That's when the numbers "settle down" and you see marked drops in triglycerides, increases in HDL, drops in blood sugar, reductions in small LDL.

As with many things, it's all about timing.

Comments (41) -

  • chuck

    9/20/2011 2:02:02 AM |

    Isn't the form of storage fat saturated fat?  maybe this is how they came up with the theory saturated fat is bad for you.  look at all those symptoms when all that sat fat is released into the blood ;)

  • Dee Miles

    9/20/2011 3:18:39 AM |

    Wow!  I'm so glad you explained this very topic because that's exactly what happened to me recently.  For the past 8 weeks I've not had any grains or sugars and I've kept my carb level about 20g per day. I've lost 15 lbs so far.  I visited my Dr. in May (prior to any weight loss, and maybe during some gain), and the lipid panel was like this: LDL 84, HDL 76, Trig 40.  When I had another blood test in early Sept, I was shocked to see the markers worse!  LDL 122, HDL 48, Trig 88.  Boy was I disappointed in those latest numbers.  Thank you for explaining how this works while losing weight.  At one point recently I was really discouraged but now I'm really glad about the timing of the tests and your post.  My next blood draw is scheduled for 3 months out from last week, at the request of my Dr.  Maybe then the numbers will have shown some improvement.
    Also, glad to hear the you will be on the low carb cruise in May.  My hubby and I are looking forward to hearing you speak and hopefully meeting you then.

  • Donald Kjellberg

    9/20/2011 5:18:03 AM |

    I experienced this very thing. After losing serious weight from the eliminating wheat, processed, and sugary foods (1 year in total) I lost 130 pounds (this is an update from a previous post per your request Dr. Williams). When I was nearly finished I went to see my doctor. He wanted to put me on statins. I explained to him how the data does not support application to me (no evidence of heart disease) and I got the mantra about standards of practice, etc, etc. I held my ground and decided I am much happier eating dairy, eggs, grass fed beef, wild caught fish, and as much raw foods (nuts, veggies, fruits) as my body desires to treat my health parameters.

    Maintaining weight, it is easy. My BMI (23 down from 40) has remained constant for a few month now. You are right, metabolic processes definitely change. I no longer have sensations of glucose fluctuations or an uncontrolled appetite. I can only imagine the improved hormone regulation and metabolic communication going on inside my body. The symptoms from obesity, all gone. Goodbye sleep apnea, hypertension, hemorrhoids, arrhythmias, gastroinestinal disruptions, smelly body, chaffing thighs, and others not mentioned.

    The positive effects are just as dramatic, but I don't want to ramble on.

    Weight loss? What is it?
    Getting your life back!

  • Dr. William Davis

    9/20/2011 12:30:01 PM |

    Excellent, excellent, excellent, Donald!

    I'm glad you got your life back and deprived Big Food and Big Pharma of revenues.

  • Dr. William Davis

    9/20/2011 12:31:07 PM |

    Yup, happens time and again. And your doctor will have no idea what this pink elephant is.

    Yes, see you on the cruise!

  • Buckaroo Banzai

    9/20/2011 1:45:43 PM |

    Would the same lipid response happen if one were replacing body fat with muscle and remain at roughly the same weight?

  • kathyj333

    9/20/2011 1:51:53 PM |

    When I lost a large amount of weight, I had a gallbladder attack. I had my cholesterol levels done during this time, and, yes, the LDL was high. Thanks for this post.

  • Jack Kronk

    9/20/2011 2:16:45 PM |

    Dr Davis,

    I began VLC back in Aug 2010 and transitioned until December. During that time, I went from a slightly pudgy and undefined 163 to a slim and muscular 148 (meaning that I likely lost more than 15 pounds of fat since I was gaining muscle at the same time.)

    My weight has remained stable but very graudally increased since December 2010 because I do heavy resistance weight training consistently and take a whey protein powder supplement. Currently I weigh in at about 155 and I have very little flab, if any.

    With respect to my lipid numbers, is my body still in some kind of transition phase?


  • Haggus

    9/20/2011 7:23:52 PM |

    I went through this back some 3 years ago and was put on a statin as a result.  While it seems out of fashion now with Dr. Davis, at least with those with blood sugar issues, I used oat bran to drive my LDL to 38 from 193mg/dl, thereby bettering Dr. Davis's 60/60/60 guidelines.

    Other effects: My trigs actually went down from 55 to 15mg/dl, my a1c increased from 4.8 to 4.9% and finally, I became anemic.

    Would I do it again if need be?  Yes, for me, life without the use of a statin trumps most everything else.  Thankfully, these days I still have better 60/60/60 numbers without the heavy use of oat bran which keeps my doctor and the blood bank happy.

  • Linda

    9/20/2011 9:20:57 PM |

    Dr. Davis................
    Another question regarding D3................
    Is there any benefit derived from taking D3 and glaucoma? Does it help relieve eye pressure in any way?

    [I am facing laser surgery, so I am really wondering if the D3 will help.]

  • Joe

    9/20/2011 9:31:43 PM |

    I don't think there's anything in the literature about D3 helping prevent glaucoma. There is some correlation between D3 and prevention of macular degeneration, but the jury is still out on it.

  • Dr. William Davis

    9/20/2011 11:05:11 PM |

    Sorry, Linda: Way out of my area of expertise.

    However, vitamin D is beneficial across so many aspects of health that it's worth doing regardless.

  • Dr. William Davis

    9/20/2011 11:25:13 PM |

    Hi, Jack--

    If your VAP doesn't reflect recent weight loss, consider:

    1) On the surface, your pattern looks like excessive carbohydrate intake for your genetic susceptibility (small LDL, low HDL, high triglycerides).
    2) Apo E2
    3) Another condition has entered the picture, such as kidney disease. Unlikely, thank goodness, but worth thinking about.

    Let me know what comes of this.

  • Dr. William Davis

    9/20/2011 11:25:38 PM |

    Yes, Buck, since the fat still needs to be mobilized into the bloodstream.

  • Ellen

    9/21/2011 2:47:16 AM |

    THANK YOU, Dr. Davis for posting this!   I've been trying to find supporting information on what happens during weight loss, because I get questions about changes in blood work from the readers of my websites.   It made sense to me that trigs would increase because of stored fat mobilization, but I searched all over pubmed and could not find a single paper to support that hypothesis.   Thanks again for confirming this!

  • Bob

    9/21/2011 3:37:37 AM |

    Dr. Davis, I posted last week about high numbers after being on a no carb, no sugar, no wheat diet for a year. You posted back that it could be weight loss and not to worry. I just heard back from two different doctors who looked at my last two VAP tests and they both suggested that I start statins as soon as possible. They are both doctors who specialize in lipids and also believe in not eating carbs sugar etc. They both want me to take a NMR test which would give them a clearer picture of what is going on. I have lost 25 lbs. over the last year. Do you think that after a year of losing weight it would still have an effect on my numbers? They are worried about apo B which I guess is why they want to see NMR. I don't mind taking the statin if I really need it but I am worried that if my apoB is high because of weight loss I am making a big mistake because once I start there will be reason to be taken off of them. I am also worried that if I don't take the statin now, if I wait another 6 months for another test, I am risking my health. I am 59 with two young children.

  • Jack Kronk

    9/21/2011 2:55:39 PM |

    ApoE2? I thought I was more in the running for ApoE4. Isn't 4 the one where it gets a bit dicey with dietary fats?

    Also, kidney disease? what makes you say that. I have had 7 kidney stones (all calcium oxalate. all "pre paleo").  I have several hypotheses about why I don't get them anymore, but my best guess is due to the increase in VitK2, since K2 sort of 'directs' where calcium goes. So I figured my kidneys were much happier with my new diet than with my SAD.

    As for excessive carbohydrate intake, yah that may be true, but I think you make an important reference about genetic susceptibility, as many people can do just fine with my carb intake as it does not produce these numbers for them.

    We have some interesting things brewing over there on PaleoHacks about what might be affecting my lipids. Travis Culp is kind of leading the charge right now and Dr K is in the mix as well.


    Thanks for your thoughts Doc.


  • Dr. William Davis

    9/21/2011 9:36:04 PM |

    Hi, Jack--

    If the 150 grams carbohydrates mentioned in the blog post was referring to your intake, then that is definitely at least part, if not all. of the underlying cause.

    Apo E2 would serve to exaggerate this effect, mostly by way of delayed clearance of postprandial lipoproteins. This could be apo E4 but it would be a very atypical pattern, since there are low HDL/high triglycerides.

    Kidney stones in and of themselves would be insufficient; it would have to involve overt kidney dysfunction.

    Anyway, please let me know what comes of this.

  • Dr. William Davis

    9/21/2011 9:40:23 PM |

    Hi, Bob--

    It's not so much the period of time required to lose the weight, but whether the blood was drawn too soon (less than 2 months) after weight plateaued. If drawn too soon, it will yield confusing or alarming numbers to the weight loss-uninitiated.

    Getting an NMR is always a good idea, since it yields the most confident value, LDL particle number.

    Have you gotten a heart scan? Remember, it's more about coronary plaque than about calculated LDL or apo B.

  • Dr. William Davis

    9/21/2011 9:42:40 PM |

    Hi, Ellen--

    Surprising, isn't it? Perhaps it's something we should do!

    Anyway, it is critical to recognize this, else people get mad and throw things and think that the diet is destructive when, in reality, it works like crazy--if you know when to draw the blood sample.

  • Bob

    9/21/2011 10:28:03 PM |

    Dr. Davis,
    I had a heart scan thanks to your blog about 4 years ago with a score of zero. At the time I was on Lipitor following low carb diet but with little sat. fat. I was mostly eating skinless chicken, salmon with mayo. Now I am on high sat. fat diet. Beef and more beef. My weight is still dropping. I started at 186 and now I am 159. I have no idea when my weight will plateau. I feel I am in a bad position as two lipid doctors feel I should be on statins now yet I believe the numbers are not accurate because of the weight loss. If I wait for weight loss to stop I may be putting myself at risk but I don't want to go on statins if not necessary.
    Tomorrow I am planning on the NMR test.

  • Gene K

    9/22/2011 2:25:42 AM |

    Since I consistently get a server error trying to post this comment to the small LDL post, I am posting it here.

    Dr Davis,

    Do you think at some point you will drop the TYP target for LDL to be 700 or less in favour of a target amount or percentage of small LDL?

    Thank you.

  • Kat

    9/22/2011 8:38:16 PM |

    I've got to show this article to my mom. My mom has struggled with her weight for a long time. Her doctor told her she would give her 6 months to try and improve her numbers through diet and exercise. If they didn't go down she would have to start taking statins which my mom did not want to do. My mom did manage to lose a considerable amount of weight (about 50 pounds) in that 6 months period. She went to see her doctor, had a lipid panel done and the doc said her lipid panel numbers were worst than before. The doctor blamed her for not eating the right stuff  and said she needed to start statins now or die. It really scared my mom and she got frustrated. She ended up taking the statins because she didn't feel she had a choice and reverted back to her old lifestyle. Maybe if she knew this information she wouldn't have been so discouraged.

  • Dr. William Davis

    9/23/2011 12:35:53 AM |

    Oh, boy, Kat. It sounds like this is precisely what happened.

    I truly find it incredible that weight loss for my colleagues is such an uncommon thing that they don't even recognize it.

  • Dr. William Davis

    9/23/2011 12:37:46 AM |

    Hi, Gene--

    Yes, I am trending in that direction. However, it remains unclear what the safe threshold is for LDL particle number or apo B when small LDL is minimized or eliminated. BIG question with no current answer.

  • Dr. William Davis

    9/23/2011 12:47:36 AM |

    Hi, Bob--

    Be careful: Even the NMR is subject to the confusing and transient changes that occur during weight loss. In fact, you can observe these effects in ALL lipoprotein testing techniques.

    I know of no way to subtract the effect of weight loss except to be patient and wait for weight to plateau.

  • Dr. William Davis

    9/23/2011 12:49:06 AM |


    I loved your comment so much I'd like to make it the focus of a blog post!

  • Tom

    9/24/2011 3:17:32 PM |

    I' ve cut out wheat from my diet and my wheat belly has disappeared. Unfortunately there is still fat around the hips/thighs. Still, I'm very pleased. Thanks!

  • Dr. William Davis

    9/25/2011 12:08:12 AM |

    Great, Tom!

    Just be patient. It tends to come with time.

  • Suze

    10/2/2011 1:31:41 PM |

    This post brought tears to my eyes. Thank you SO VERY MUCH for posting this. I have been going crazy trying to figure out what the heck is going on.
    I went to see my doc in mid-June, who put me on lovastatin (added to blood pressure meds, Ambien, and Prilosec). He had done labs and was unhappy with my cholesterol.
    I went on low carb in early June, about a week before the doc visit. I have done low carb before and knew it would drop my cholesterol, but went along for now. For 6 weeks all was fine and I lost nearly 20 pounds. Started feeling better - was able to get off Ambien and sleep better. Was able to stop the Prilosec also (my GERD disappeared). Because I was trying to get into ketosis to burn fat, I was monitoring my blood sugar. At about 6 weeks into it, I hit a stall and have had to fight like heck to keep losing any weight. But the worst part (for me) was my glucose level. Inexplicably, my fasting glucose crept up just over 100 and stayed there most days. I was horrified - I was not eating any excess sugars, in fact, trying to stay under 20-30 carbs a day. I am a nurse and I know what a fasting glucose over 100 will get me diagnosed with - diabetes. My goal is to get OFF all meds, not get labeled with diabetes and put on more of them. To top it off, my doc wanted new labs after 6 weeks on lovastatin, and I refuse to go until I figured out what the heck was going on with my glucose and fixed the problem. My doc is nice, but I highly doubt he is evolved enough to listen to this argument. He still subscribes to the high cholesterol theory of heart disease, after all.
    I Googled my head off and tried to figure it out. Lots of theories out there. I tried all kinds of supplements supposed to regulate your glucose, and experimented with timing of food and activity. Even stranger, my glucose would RISE after exercise in the morning (still fasting!), but lower if done in the afternoon. I thought maybe I wasn't eating enough carbs and my liver was kicking out glycogen during the night. The day I came home from work after a just-over-100 fasting that morning and checked my glucose and it was 90 (!) 4 hours after lunch, I wanted to go get the damn labs done, but they were closed.
    I knew blood pressure, cholesterol levels and glucose are all tied together, but it had not occurred to me that losing weight mobilized fats into the bloodstream and may be behind my glucose being a pain. Makes me wonder what the lovastatin did for the 60 days I was on it, lol. But my dilemma is that to find out, if I go with an elevated glucose, I will be hosed. :-( So I guess I'll go find a home cholesterol kit and see, and be patient on the glucose issue.
    I also found some interesting info on low stomach acid - I had been on Tums, Zantac and then Prilosec for some time, and I found my glucose issues started around the time I *stopped* taking that stuff... More food for thought.
    Anyway, thank you so much for posting this - at least I am not in a panic at the moment. I am not done yet, though - I still have about 45-50 pounds to go. I am not sure I can hold off the labs that long. I plan to keep an eye on my fasting (97 this morning) and when it's well under 100 will try to get the damn labs done.

  • Dr. William Davis

    10/2/2011 2:32:28 PM |

    That's great, Suze!

    Yes, we have to be properly armed against our doctors!

  • Kelly

    10/9/2011 1:09:15 PM |

    What defines a weight plateau? I was diagnosed with gestational diabetes while pregnant. I left the hospital 20 pounds lighter than I was pre-pregnancy thanks to a lower-carb diet. Over the next 6 months, I lost an additional 25-30 pounds. I'm not losing weight drastically any longer -- I'm now well within the "normal" range for my BMI. However I am still dropping a pound or two every month or so (still breastfeeding). When I tested my blood sugar about 4 months ago, my fasting number was 104. I'm now 11 months postpartum, so its been about 5 months of very gradual weight loss. Would this still change my numbers because I'm technically still losing weight?

  • Dr. William Davis

    10/9/2011 10:59:32 PM |

    Probably not, Kelly.

    I don't know why, but weight loss that has "decelerated" to this degree seems to not be associated with distortion of metabolic markers. It doesn't mean that continued weight loss won't yield further improvement, but that the current numbers are indeed true.

  • DanD

    10/12/2011 4:48:46 PM |

    Donald, congratulations on these tremendous improvements.  Your experience makes me think that I can do the same if I keep at it.

  • Wanda E

    10/18/2011 1:59:06 PM |

    Dr. Davis, I really appreciate all the work you put into the Wheat Belly book.  It is an eye opener.  I have a question.  My husband is diabetic (2 shots per day) also he has Mysenthia Gravis.  Do you have any information regarding Mysenthia Gravis.  Will  eliminating wheat help get rid of or lessen the effects of this disease.  My husband and I are deleting the wheat and i already feel better.  Thank you.

  • Dr. William Davis

    10/19/2011 1:28:44 AM |

    Thanks. Wanda.

    There are, unfortunately, no formal clinical observations that combine wheat/gluten elimination with markers for myasthenia gravis.

    On the most anecdotal level, I have one patient with myasthenia gravis who tells me that her symptoms are substantially improved, though not entirely relieved, with wheat elimination. This seems to be true of nearly all neurologic phenomena that do not have wheat as their original cause: at least partial improvement.

    It is certainly worth trying for this as well as a host of other reasons.

  • Jo

    10/22/2011 2:25:09 AM |

    Thank you for posting this. I think I'm going through this right now. I've lost 63 lbs since being diagnosed with DM last Nov and my A1C is down to 5.5 from over 13.3.  My weight loss has slowed to about 5 lbs per month now and I have low thyroid symptoms but all my doctor cares about is putting me on statins. I'm seeing a new doc next month to try to get more than a TSH test but I know he's going to be concerned about my lipid profile, too. I'm going to ask for either a VAP or NMR test. I don't know how bad these numbers really are but they made the last doctor flip out. I keep under 30 carbs per day, am off all wheat now, and walk at least a mile a day. Here are the most recent numbers and the change from 8 months ago:
    Total: 338 (+58)
    Trigs: 138 (-39)
    HDL: 50 (+10)
    VLDL: 35 (+4)
    LDL: 253 (+44)
    %HDL: 15 (+1)
    Chol:HDL Ratio: 7 (no change)

    I'm not sure what to do in the meantime while I wait for the next appointment, other than be patient, but I'm going to print this post out, anyway.

  • Dr. William Davis

    10/22/2011 12:42:39 PM |

    Very nice result on your weight and diabetes, Jo!

    It looks like you have a genetically-determined pattern, either familial heterozygous hypercholesterolemia and/or apo E4. Sadly, in this situation, diet efforts cannot fully disable the impaired handling of fats that arises from these genetic variants. Statins in this case may not be a bad idea. You may be the occasional exception. Statins are overused and abused, but your situation is one in which they may be appropriate.

  • Suze

    10/23/2011 3:34:55 PM |

    Well, I finally went to get the labs done, and it's a mixed result. After 4 months on low carb and nearly wheat-free:
    cholesterol - 368 to 282 (-86)
    HDL - 40 to 61 (+21 :-D)
    LDL - 287 to 185 (-102)
    ratio - 9.2 to 4.6 (cut in half!)
    VLDL - 41 to 36 (-5)
    triglycerides - 207 to 179 (-28)
    Pretty good improvement in 4 months, I think. The first two months I was on lovastatin, and the last two months, all diet/exercise. I really do not want to go back on statins.
    However, my fasting glucose was 104, despite my efforts to get it lower before getting labs. Now I will have to argue with my doc, I am sure. I got an A1c and it was 5.2, which is totally normal, so at least I am armed with something!!!

  • Suze

    10/23/2011 4:04:17 PM |

    P.S. - I have also lost almost 30 pounds!
    And - I just ordered Wheat Belly to read on my Nook. I can't wait! I think you are SO right about all of this!

  • Dr. William Davis

    10/23/2011 11:46:11 PM |

    Wow, Suze!

    Stupendous progress! Keep going.