First off I’m new to this so I hope I’m doing this forum stuff in the correct way. I’m a 54 yo male. I’m 5’11" and weigh 230 lbs and have lost 8 lbs over the past four months. I’m not as active as I should be one reason I’m recovering from inguinal hernia surgery and the other reason I’m not motivated. Anyway my concern and questions have to do with my blood work from the VA last week. My triglycerides were 838, ldl 68.5, hdl 40 and cholesterol 176. My glucose was 160, I had not fasted, and my AcC was 6.3. I’m on metformin 500mg twice a day. I know the tri’s are way off but I have a hard time understanding my cholesterol, ldl, and hdl levels. My diet has been very little carbs, but I do eat a lot of meats, fish and cheese. It seems to me I doing good on my A1C and bad on my cholesterol. I’m just really confused on what to eat and what not to. Somebody please help me to understand this better. Thanks
Fats and high cholesterol
How long have you been on a ketogenic diet? And how long have you been on Metformin? Any other medications?
If you are as new to ketosis as you are to these forums, then wait and get re-tested once you’ve been eating keto for six months. You will likely be surprised by the results. And next time, be sure to fast for 12 to 14 hours before they draw the blood, so as to get a more accurate reading. I’m surprised they even bothered, if you didn’t fast.
As for your numbers, is the triglyceride number really eight hundred thirty-eight, or is there a missing decimal point? (If the former, I wonder if not fasting had anything to do with that.) The glucose number is high and the HDL is low. Your LDL is also low, and will probably rise somewhat on keto, but your HDL should rise quite a bit and your trigs lower—a lot.
If the triglyceride number you typed was really supposed to be 83.8, then your triglyceride/HDL ratio is not badly out of whack—but you want it to be under 2.0. If the number really is 838, then get those carbs out of your life and replace the calories with lots of saturated and monounsaturated fat (in other words, butter, bacon grease, tallow, and lard are your friends, not to mention coconut, avocado, and olive oils).
Keep your protein moderate. You want to be eating enough to preserve muscle mass, but not so much as to stimulate insulin secretion or, God forbid, give you an overdose of ammonia in your blood.
Once you are eating carbohydrate under the 20 g/day limit, don’t skimp on calories. There are reasons for that, but this post is already long enough. Just eat, and include lots of fat, until you are satisfied. When your satiety signal kicks in, your appetite will drop to a more sustainable level. In the meantime, give your body all the calories it wants. You have some healing to do! 
Hi Paul,
Thank you for your responce. Yes my tri’s were in the 800’ s about 5 or so years ago they were 2000. I’ve been on metformin for 1.5 yrs on gemfibrozil for 5 yrs and the only other drug is 10mg lisinopril. Should I be concerned about my cholesterol, LDL and HDL due to the saturated fats. It seems I’m damned if I do and damned if I don’t. Thanks Paul
One good source of information about the body’s lipid system and how cholesterol works is www.cholesterolcode.com. Another good source is www.fatemperor.com. The authors of these sites are Dave Feldman and Ivor Cummins, respectively. Though they are systems engineers by trade, they are also citizen-scientists with a great deal of expertise in the area of fat metabolism.
I would say that from what I have learned, your triglyceride number should improve on a ketogenic diet, but I suppose that would depend on what is causing the high numbers. But a diet as low in carbohydrate as you can possibly manage ought to help a great deal, regardless of the cause. Dave Feldman’s site has some good information on how certain people can manipulate their triglyceride and cholesterol numbers by how they eat for a few days before the blood is drawn, if you are interested in checking that out.
My understanding is that saturated fat in the diet raises HDL (assuming carbohydrate is low, of course), and that it is the ratio of triglycerides to HDL that is the best indicator of risk for cardiovascular disease, not so much the absolute amounts. An even better assessment of your cardiac risk would be your CAC score, which measures the calcium deposits in key arteries, but it is not a cheap test, and insurance doesn’t always pay for it. You might discuss getting a CAC with your doctor, however, given how high your triglycerides are.
Be sure your doctor knows you are eating a ketogenic diet, so he can monitor your blood sugar, insulin, and blood pressure. If you start feeling lightheaded at all, it may mean that your blood pressure is decreasing ant your lisinopril therefore needs to be reduced. The same with your glucose and insulin levels and the metformin. If and when your triglyceride level declines, then your gemfibrozil will probably have to be adjusted, as well.
Cholesterol itself is essential to the healthy functioning of your body, and even high numbers don’t necessarily indicate high risk of heart disease, the way we have been told. For an assesment of the risks involved with high cholesterol and a healthy dose of reassurance, check out this video by David Diamond: