What happens to triglyceride levels on a ketogenic diet?

By Dr. Stephen Phinney and the Virta Team

Triglycerides are among one of the most predictable changes when one adapts to and maintains a well-formulated ketogenic diet. For people starting out with elevated triglycerides, they almost always show a sharp and sustained reduction. On average, people with metabolic syndrome will see their serum triglycerides reduced by half when on a ketogenic diet (Volek, 2009).

Yes, there are people who may not respond this way, but the exceptions tend to be people whose serum triglycerides were already within the normal range. Increases in triglycerides during a well formulated ketogenic diet may occur, but this is rare. In those cases, it may be due to carbohydrate consumption that is greater than one’s tolerance or due to alcohol consumption in the day or two prior to the blood test.

Citations

Volek JS, Phinney SD, Forsythe CE, Quann EE, Wood RJ, Puglisi MJ, Kraemer WJ, Bibus DM, Fernandez ML, Feinman RD. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids. 2009; 44:297-309. doi: 10.1007/s11745-008-3274-2.

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20 Comments

  1. Avatar

    My friend who had been on keto for 3 weeks went from 45-70 triglyceride levels between her 2 medicals and her total cholesterol had increased . She didn’t do the test fasted as nobody informed her of it, would this make a difference?

    Reply

    1. Virta Health

      Fasting is typically required for triglyceride levels.

      Reply

    2. Avatar

      Absolutely that would impact the test. You always fast for a lipid panel bloodtest

      Reply

  2. Avatar

    Yes, fasting does make a difference. In addition, cholesterol may elevate briefly at the beginning of a ketogenic diet, until the body becomes keto-adapted and begins burning fat as its primary source of fuel (can take up to, and for some longer, 6 weeks). Being in ketosis and being keto-adapted are 2 separate processes.

    Reply

  3. Avatar

    hi
    my TRIGLYCERIDES was 2.96mmol/L after 3 weeks of Keto become 17.66mmol/L
    is this normal ?

    Reply

    1. Virta Health

      Hi, We are unable to provide specific medical advice via this forum. We would encourage you to reach out to work with your healthcare provider to address your concerns.

      Reply

    2. Avatar

      Mine also did this. My dr had me do labs in office unannounced unfasted. Results were terrible.
      Now I’m on a triglyceride lowering drug. I believe in keto, I obviously did something wrong.

      Reply

    3. Avatar

      My Triglycerides doubled and sometimes is almost tripled. Can not seem to find to much info on this. My TC is in the upper normal range. The bits and pieces of info I can find and my own thoughts. When on keto our body uses stored Triglycerides in fat for energy as well as ketones. The fat stores Triglycerides so if my body is full of Triglycerides and using it as needed for energy and will read high. No different when a healthy person has lots of sugar and carbs their blood sugar will rise for a short time. At least that is my thoughts. I am in no way a doctor I asked my cardiologist this question he could not answer, it was over his head.

      Reply

  4. Avatar

    Hello. I’ve been basic keto for a few years. Super clean keto.
    My cholesterol has gone up and up since starting.
    My hdl is very low 0.9 and my trigs are way up high 6.6
    Should I be alarmed ?
    Any advice please I need help

    Reply

    1. Virta Health

      We are unable to provide medical advice in this forum, so we would recommend that you speak with your physician.

      Reply

  5. Avatar

    Been on Keto for a couple month my triglycerides went from 300 ish to 469, while my A1C went from 8.3 to 5.4, my ketones always stay between 1.0-3.0, I don’t drink, and I maintain a diet well under 50 carbs most the time closer to 25 carbs a day.
    my labs all looked great, except hdl was low, ldl “not valid” due to high triglycerides.

    Reply

  6. Avatar

    This is something I’m concerned about also. Starting out with 50 or less carbs, and only eating healthy fats. I’m not going to consume butter or high-fat meats. I feel a little bit better about this diet with taking this approach having high triglycerides. The high fats are okay but I’m making mine healthy fats

    Reply

    1. Avatar

      Even healthy fats, like Avacado, nuts, peanutbutter are loaded with Saturated fats. I just got my blood test results after doing keto for 2 months and Triclycerides are high.

      Reply

  7. Avatar

    My triglycerides went up and LDL skyrocketed! My doc hasn’t seen those results yet, as I ordered from online labs. I’ve been strict keto for 4 months, always in ketosis. If your burning fat, even in a 12 hour fastted state for the blood draw, would you have more triglycerides in your blood anyway? Mine went from 100 6 months ago to 123. Ldl 250, hdl 46, (what I remember) so tot cholesterol 319.

    Reply

    1. Virta Health

      Hi Judy! We are unable to provide specific medical advice via this forum. However, triglycerides are typically in the desirable range if under 150 mg/dL. If you are still losing weight, there can be a transient increase in lipids as fat moves out of the cells and into the bloodstream. It may be best to reassess around 3-6 months after weight loss has stopped in order to get a more accurate picture of what is happening.

      Reply

  8. Avatar

    Thank you !!! This describes my exact theory you said it very well. I was a 433 pound man 6’2” lost 122 pounds my TC is good but my Triglycerides are all over the place, I am on a super clean Keto diet for the last 8 months. I was on insulin type 2 diabetes, been off insulin from Keto day 1 totally insulin free 8 months. A1C is now 5.3 and still improving every month.

    Reply

  9. Avatar

    I am thoroughly confused. I had super-high triglycerides last lipid panel test: > 600. Doctor told me to limit carbs, alcohol, and sugars. I have, and googled low carb diets which seem to be equated with ketogenic diets. I read that keto diets actually raise triglycerides (at the beginning? all along? sometimes????) If I’m high triglycerides, why would I emulate a keto diet, then? I’m staying away from the fat-side of the diet, since I’m ovo-lacto-pescatarian. Omega-3 is the high stuff for me. I can’t figure this out: what to do.

    Reply

    1. Virta Health

      Triglycerides are significantly impacted by carbohydrate and alcohol intake, which is why your physician recommended limiting them. We see a significant decrease in Triglycerides in our study patients on a high fat, low carbohydrate diet but there are some people who will show elevated triglycerides while they are losing weight. Once weight loss subsides, triglycerides typically go down to normal.

      Reply

    2. Avatar

      I just got my labs back today and my triclycerides are high too. I looked up what causes that and it said saturated fat. UGH. All that I eat on Keto is saturated fat. Meats, Coconut oil, Peanut butter, butter etc. Everything!! Now, I am nervous about eating saturated fats.

      Reply

      1. Virta Health

        Hi Mary! If you want to learn more about saturated fat and why it isn’t bad for you, check out https://blog.virtahealth.com/the-sad-saga-of-saturated-fat/

        For more info on what to expect when it comes to cholesterol levels, you might find this post particularly helpful: https://blog.virtahealth.com/blood-lipid-changes-with-ketogenic-diet/

        Reply

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