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Carnivore Diet Blood Work

Carnivore Diet Blood Work

Meal after meal for well over a year. Not one bite from a plant. Not a piece of fruit, not a serving of vegetables, not an occasional treat. Nothing but meat and some eggs. And here are the results of my Carnivore Diet Blood work.

Carnivore Diet Blood Work

When my test results arrived, they came with a warning from the facility to go see a doctor. And instead of seeing a doctor, I’ve been thinking about how to write this post – how to describe my carnivore diet blood work in the most helpful way.

This post has taken a long time to write. I started writing about lipids, attempting to describe the complex interplay of cholesterol and triglycerides in the metabolic machine, our bodies.

But as I was weaving together the intricate interplay between my lipid panel, metabolic panel, and complete blood workup in an attempt to draw a coherent picture of the complex interactions of blood, hormones and lab values in the context of my carnivore diet and lifestyle, I realized what I really needed to write here. 

If I can drive home this one thing, I’ll consider this post a success.

Carnivore Diet Blood Work: The ONE Thing

Because really this post is not about my carnivore diet blood work, nor is it about understanding all the biochemistry and physiology. Rather, it’s about understanding the framework of health in order to have a clue what your picture of health actually shows.

So instead of painting a picture of my carnivore diet lab results, I want to show you the canvas and the frame, so you can be your own artist. And at the end, I will show you some paint strokes – describing my blood work – as a means to help you paint your picture.

By the time you understand the canvas and can see the frame, you’ll understand what blood work is, if and when you should get your blood work done, and what it all means.

Carnivore Diet Blood Work: What You Need to Know

Solving the Puzzle

I want to extend our canvas analogy.

If the canvas is your picture of health, imagine the painting is cut up into innumerable puzzle pieces. If you can gather all the puzzle pieces, fit them together, you can see the picture.

Carnivore Diet Blood Work

The first challenge in solving the puzzle is gathering as many pieces as you can. Getting blood work done gives you some puzzle pieces. Pieces that you can start to connect.

Puzzle Dynamics

This is no ordinary puzzle, however. It’s very tricky. It’s dynamic.

The puzzle pieces change size and shape continuously. And not only the pieces, but the overall picture changes with it.

And all the pieces influence all the other pieces. Just imagine one tiny puzzle piece changing shape, which then slightly alters all the puzzle pieces, and the overall final picture. If you think it sounds like an impossible puzzle to solve – you’re right.

Carnivore Diet Blood Work

The only way to extract meaning is to understand it as a dynamic system.

People often make the mistake of viewing blood work as a picture of the whole puzzle. When really, your blood work gives you just a few pieces of the puzzle. And if you just put these pieces together and think these pieces show the whole picture it’s easy to draw false conclusions.

With limited perception what you think you see isn’t always what’s there. A puzzle piece (i.e. a lab value) can be an odd shape (i.e. “high” or “low”) for good reason or bad reason. That irregular shape could be just the perfect fit for that place and time. Or it could be irregularly shaped because there is a problem.

The Frame

The key to putting the pieces together, the key to actually being able to “solve” the puzzle, is to look at all the pieces in context with all the other possible pieces.

The frame that hold the canvas is context.

Context is the key.

Without context we assume your puzzle is the same as my puzzle and all our pieces should be the same.

However, your puzzle is a certain age and gender, it has certain genetics, lives in a certain area, and has a history of certain experiences, certain diets, and habits. No puzzle is the same as yours. The frame of your canvas is unique to you. The puzzle pieces that fit in your frame shouldn’t necessarily be the same shape as my puzzle pieces.

The Indecipherable Puzzle

If you just look at the puzzle pieces from your blood work you have an indecipherable puzzle.

You have this massive frame and just a few puzzle pieces. There is so much empty space in the frame that any attempt to conclude what the picture shows is a guess.

But when you add other pieces – diet, lifestyle, stress, age, gender, occupation, health and history (health, medical, diet, injuries, changes) you can start to see a more full picture. 

Now even if you gather all these pieces, you still can’t completely solve the puzzle.

The reason is that the puzzle is dynamic. It’s always changing. Puzzle pieces change shape and size with the time of day, with the season, and unless you live in a bubble these changes are difficult if not impossible to control and account for. [r]

Perhaps one of the biggest secrets to getting a good glimpse of the whole puzzle is to acknowledge the fact that the puzzle is ever-changing so at any one time you can get a snapshot, but a snapshot the next day could, and likely will, look different. 

Carnivore Diet Blood Work: When to Get Tested

Gathering Puzzle Pieces

Daily I get a message from someone who has completed 30 days on the carnivore diet, got their blood work done, and is then worried about some number on the report.

They ask me what I think.

And (after responding that I don’t/can’t give medical advice to them) I have to respond with the same “I don’t know.”

Problem #1

The first problem is all they gave me is a few pieces of a gigantic puzzle.

It’s also like handing me 5 pieces of a 5-million-piece puzzle and asking me what’s the picture on the puzzle. And even if all 5 pieces seem to fit together perfectly, I’m still just seeing a miniscule part of the whole picture.

Problem #2

The second problem is getting a test so soon after a major dietary change, is like handing me puzzle pieces that morph in size and shape before my very eyes.

I can’t tell what fits with what. Or if I could, it might fit for a second, before it doesn’t fit again.

It’s not that it’s bad to get tested this earlier, it just doesn’t tell you much. But if you continue for 6 months and get more blood work, and then another year and get more, you can start connecting some dots – start seeing a more clear picture.

When to get Blood Work

For most people, I don’t think it makes sense getting blood work after 30 days or even 90 days after a major dietary change (unless you have the time and money – then go for it).

I think it’s more valuable to first reach a homeostatic position with the diet and lifestyle. If your weight is still fluctuating, hormones are still rebalancing, just wait.

The point of the blood work is to help get meaningful puzzle pieces. And ongoing testing, whether it’s every 6, 12, 18, 24 months can help connect dots over time, again helping to draw a more complete picture.

What tests to get and how often is very individual.

As you’ll see with my results, there are some markers that I will test more frequently and others that I may test less often. My subsequent testing (both the tests and the interval) will be different than yours. But getting blood work on a recurring schedule that you and your doctor determine is a good way to keep a pulse on these parts of the puzzle, and it helps you connect dots over time.

Carnivore Diet Blood Work: Where the Confusion Arises

Obviously, the complex nature of our individual puzzles leads to a lot of confusion. But what complicates matters even further is that everyone looks at these puzzles through different frames.

Context Clues

I spent two decades studying nutritional biochemistry and physiology from the viewpoint of a bodybuilder.

When I studied, read research, and experimented it was through a lens of building muscle and losing fat.

It’s fair to say – I viewed nutrition from a different angle than say an oncologist.

Muscle vs Metastasis

Just this morning I was asked on Twitter if “carbs are needed to maximize muscle gains?”

Bodybuilding Frame

Well, to build muscle there are some very important hormones like insulin and IGF-1, without which no matter how hard you press that bar or curl that dumbbell your muscle size and strength will be severely limited.

Spiking insulin post-workout via fast acting carbohydrate is a strategy many bodybuilders use to signal to the body “time to grow.” Bodybuilders will often combine these carbs with protein. Carbs spike the insulin and the protein goes to work building and repairing. This energy signals mTOR to “turn on” which stimulates cellular growth by activating IGF-1.

All good in the context of building muscle.

Physician Frame

But through the eyes of many healthcare practitioners, insulin, IGF-1, and mTOR are all bad.

A common thread among obese and diabetic patients (and so many chronic diseases) is hyperinsulinemia – chronic high insulin levels. Insulin is bad news.

Through the eyes of an oncologist – insulin, IGF-1, and mTOR –are really bad. They fuel cancer growth.

But through the eyes of a longevity researcher the story may change.

Longevity Researcher

The researcher may conclude that turning these growth factors “on” as much as possible could increase longevity. Greater muscle mass is consistently one of the best predictors of living a long life and lowering all-cause mortality rates. (r, r)

So are these hormones good or bad? Who is right, the bodybuilder and longevity researcher or the physician and oncologist?

No one is wrong, per se. The context is different.

If you see insulin, IGF-1 and mTOR only from one vantage point you may miss the whole picture. A bodybuilder will conclude they are great for maximizing muscle growth. An oncologist will conclude they are great at fueling cancer growth.

The frame you look through matters.

Carnivore Diet Blood Work: Cholesterol Context Clues

I want to look at a couple of examples of understanding labs values and nutrition in context. 

Cholesterol

If the average doctor looks at my blood work, they may have a heart attack. And they’d likely think I’m on the verge of having a heart attack with them.

But they would be missing all the context – looking through the wrong frame or only seeing part of the picture.

Cholesterol can be “high” for good reasons and high for bad reasons. I am going to write specifically on cholesterol in the future, but for now, it’s enough to know that many factors influence cholesterol levels.

Cholesterol and Metabolism

For example, if you eat a high fat, low carbohydrate diet, the way the energy is distributed throughout the body is very different than someone who eats a carbohydrate-rich diet. (r)

If a doctor is missing this context, or perhaps doesn’t understand how this process works, they will say things like your cholesterol is high and you need to be on a statin.

Well, they will be right and wrong. Your cholesterol very well may be “high” compared to others on a the Standard American Diet (SAD), but it is high for good reason. The body is functioning exactly as it should. He’d be very wrong in suggesting cholesterol lowering medication.

Measuring What Matters

One of the most challenging obstacles in health science is measuring what matters. 

For example, drugs are often developed to reduce the risk of heart attack or stroke with a goal of long term survival. These are hard to measure without long-term clinical outcomes. So instead, pharmaceutical companies use indirect “surrogate” or “proxy” measures.

Proxies help get drugs to market as fast as possible.

Blood Sugar or Death

For example, the drug Avandia is good at controlling blood sugar. Since blood sugar is easy to measure it was used as the proxy for this diabetic medication.

The problem is that 2 out of 3 diabetics suffer heart complications. So, one of the main goals of diabetic treatment is to reduce the risk of heart problems.

But what happened with Avandia is that although it helped control blood sugar, that proxy measurement got confused by what actually matters – death. And in Avandia’s case it increases the risk of heart attack, stroke, and death. (r, r, r, r, r, r, r)

The proxy (blood sugar) didn’t correlate with the outcome (mortality).

This happens all the time.

Cholesterol Proxy

Statins are prescribed to lower cholesterol. Cholesterol is a proxy. There are drugs like Vytorin and Zetia which are great at lowering cholesterol. But they have no evidence of lowering heart disease or stroke. But lots of evidence of adverse side effects. (r)

I bring up proxy measurements because you may have a puzzle piece that looks irregular, like my cholesterol. And if this proxy (puzzle piece) isn’t seen through the correct frame it can cause you to worry. And further, it’s important to recognize that if a puzzle piece is used as a proxy to predict what the whole picture looks like – it could easily be wrong.

It’s like saying “if this one puzzle piece is a certain shape, then we predict your whole completed puzzle looks like this.” But often that puzzle piece isn’t representative of the whole puzzle.

Carnivore Diet Blood Work: What is it?

A helpful way to view your blood is to see it as a delivery system (of oxygen and nutrients) and a disposal system (of wastes products).

Certain organs are stops along this system for processing before delivery or dumping – like the liver, kidneys, spleen, and lungs.

Blood work is a snapshot in time to get an idea how this system is working.

There are thousands of tests you can get. All are puzzle pieces.

I ordered the three common panels – lipid panel, metabolic panel, and a complete blood count – as well as a few less common tests like insulin and hs-CRP.

This is not to say these are necessarily what you should get.

For example, if I had signs of metabolic syndrome, I’d get my fasted blood sugar, a glucose tolerance test, hemoglobin A1c, and fasted insulin to see how they work together for a more complete picture.

Or if I had risk factors associated with cardiovascular disease, I’d get a fractionated lipid panel, which is a more in depth look at the lipids.

Carnivore Diet Blood Work: My Results


Here are my blood test results.


Lipid Panel

The lipid panel measures two types of fats – cholesterol and triglycerides.

And the first thing that jumps out when looking at my blood work is my cholesterol. It’s “high.”

Carnivore Diet Blood Work Lipid Panel

And I am perfectly happy with it.

My HDL is quite high, my triglycerides are quite low. This is the ratio I really care about. I have very low remnant cholesterol. Based on this, my LDL is of absolutely no concern to me. (r, r) If you want to know what numbers are important, here’s my list.

As far as I’m concerned, I’m happy my brain and body are getting all the cholesterol they need. (r, r) And to me it’s further evidence that I’m a fat burner, which isn’t too much of a surprise as I’m eating almost no carbohydrates, I’m quite lean, and train daily. 

Metabolic Panel

The metabolic panel gives me a look at the processes in the body that convert or use energy.

Here I get information about minerals which can impact things like water balance, blood acidity, and muscular function (i.e. calcium, chloride, magnesium, phosphorous, potassium, and sodium).

I get information about organ function like the liver and kidneys through values like bilirubin and albumin.

Lots of puzzle pieces here.

And to the casual observer, a couple puzzle pieces look irregular in shape.

BUN and ALT

My blood urea nitrogen (BUN) as well as my alanine aminotransferase (ALT) are high. “My liver and kidneys are failing!” No, I fully expected this.

In the context of a high protein diet and daily training BUN is often elevated due to the high rate of protein metabolism and muscle turnover. (r, r) People fear metabolic acidosis but looking at my metabolic panel there just isn’t any evidence of this whatsoever.

The same goes for ALT. Elevated liver enzymes are very common in people who workout hard on a regular basis. ALT tends to remain elevated for 7+ days post workout. (r, r) And I workout every day.

I could have taken a week or two off…oh who am I kidding, I couldn’t do that.

There are a couple other values that I want to highlight.

Insulin

A fastest insulin test is one of the simplest, most affordable, most accurate tests to evaluate metabolic health. Hyperinsulinemia underlies so many of our modern chronic diseases – everything from heart disease to cancer to dementia. The biggest killers.

Blood glucose and HbA1c are valuable, but fasting insulin can detect problems before insulin resistance (pre-diabetes/diabetes) starts to set in.

My insulin was 2.3 uIU/mL.

This is very low. For perspective, anything below 2.0 is undetectable. This is the opposite of insulin resistance. I’m very insulin sensitive.

There isn’t agreement on what is ideal, but a study out of Arizona found that women with a fasting insulin around 8.0 had twice the risk of prediabetes as those with 5.0. (r) And research from the University of Washington showed “the average insulin level in the US is 8.8 mIU/ml for men and 8.4 for women.” (r) And based on our metabolic health, this is way too high. From the research I’ve done, I would say 2-5 is an ideal range.

If you are getting your blood work done, ask you doctor if you can include this test.

HS-CRP

A second test I ordered which is out of the “norm” is a high-sensitivity C-Reactive Protein test. CRP is a protein the liver makes when there is inflammation in the body. This test is used to evaluate inflammation as well as risk for heart disease. And you want it to be below 1.0.

CRP is traditionally measured down to concentrations of 3-5 mg/L, but with hs-CRP we can now detect even low-grade inflammation down to 0.2 mg/L.

My CRP was so low it was beyond detection (less than 0.2 mg/L).

This is a good sign that I don’t have any kind of chronic systemic inflammatory problem and quite low risk for cardiovascular disease. (r)

If meat was inflammatory or if it was a cause of a chronic inflammatory reaction, like from an autoimmune response, it would be detected via CRP.

It’s important to note that CRP can be elevated by many inflammatory diseases, cancers, and infections. But if it’s elevated, it’s an important puzzle piece to investigate.

Complete Blood Count (CBC)

The CBC gives me a look into the health of my blood cells – red, white, and platelets. I can see the quantity, size, and volume as a broad screening tool to detect possible infections, allergies, or diseases like anemia or leukemia.

My blood is pretty boring, all values sitting within normal range. 


Carnivore Diet Blood Work: Values of Note

I want to point out a couple values of special note in relation to the carnivore diet.

  • Homocysteine – On a carnivore diet people fear insufficient folate. Yet if I were deficient, my homocysteine would likely be high. But it’s right in the normal range. People on plant-based diets tend to have high homocysteine levels – associated with higher likelihood of cardiovascular disease and death. (r)
  • Uric acid – Many people have concerns about the high purine levels in meat and gout. Not an issue.
  • Calcium – I eat little to no dairy, and my calcium is in the high normal range.
  • Testosterone – When I announced I got my blood work, this was the one number most men asked about (it was in the high/normal range):
    • 915 ng/dL total testosterone
    • 101.8 pg/mL free testosterone
  • Estrogens – Low/normal
  • Thyroid – TSH is normal
  • Blood Sugar –
    • Glucose: 89*
    • Insulin: 2.3
    • Hb A1c: 4.9

*Although a blood glucose of 89 falls within the “normal” range, and I’m clearly not diabetic based on the other values, my blood glucose is higher than most would anticipate given this data. But this isn’t uncommon among low carb athletes. There is a theory called “Adaptive Glucose Sparing” in which the body preferentially uses fat for energy and resists the use of glucose, saving it for certain tissues like the brain and red blood cells.

Carnivore Diet Blood Work: Irregular Puzzle Pieces

When I got my blood work results I had two irregular puzzle pieces that didn’t make immediate sense to me. This gives me a good opportunity to explain my thinking process around irregular puzzle pieces.

DHEA Sulfate

The first puzzle piece that that didn’t seem to fit was my DHEA. It was a bit low. Not super low, but low, nonetheless.

This value was particularly curious because DHEA is a precursor of testosterone and my testosterone was quite high.

DHEA is produced by the adrenals and it does tend to be high in young male athletes. But like many hormones, it has numerous roles. It also tends to be high in people with insulin resistance and chronic high stress. It’s obviously influenced by a myriad of factors.

Testing DHEA

Doctors generally order DHEA test because they’re worried it’s too high (not because they think it’s low).

DHEA can be high for numerous reasons like stress. In stressful situations the adrenals release cortisol and DHEA. For example, it is often elevated in people suffering from PTSD. (r)

Generally, a doctor does not order DHEA because they suspect it might be low, unless checking for Adrenal Insufficiency (AI). There has been a recent trend of testing for “adrenal fatigue” though there is no evidence that “adrenal fatigue” is actually a thing. (r) To me it makes sense that there are milder forms of adrenal insufficiency that could explain many of the symptoms we face as a result of our high stress modern lives, but medical literature doesn’t support it.

Anyway, searching for low levels of androgens in healthy people without specific symptoms is not generally recommended, and treating them with androgenic hormones isn’t the standard of care.

DHEA Insufficiency

Symptoms of low DHEA include poor body composition (fat storage and little muscle), low libido, fatigue, depression, weakness, difficulty in getting up in the morning, and a weakened immune system.

I simply don’t have any clinical symptoms characterized by DHEA insufficiency.

The clinical expression of hormone function is a very important consideration. How you look, how you feel, how you perform are all parts of the puzzle.


So why is my DHEA low?

I have a hunch that it could be from a high level of receptor sensitivity.

In other words, I don’t need much of it in order for it to optimally perform its functions.

DHEA Hypersensitivity

Usually this is understood in the context of women who have normal DHEA lab values, but experience symptoms associated with high levels of DHEA – weight gain, hair loss, low energy, acne, irritability, infertility, deepening of voice, recent stress, PCOS.

It’s an imbalance between the amount of DHEA and the receptor sensitivity.

In a balanced scenario “low” DHEA levels would correspond to “high” receptor sensitivity.

And this is my best guess as to why my DHEA is “low.”

Hormone Receptor Sensitivity

I do think with a proper diet, exercise, sleep and general health we see efficient use of hormones (not over-production) with very sensitive receptors.

Other hormone receptors like thyroid and leptin can behave much the same way – whereby your organs don’t have to continuously pump out loads of hormone for proper function. They are efficient.

I think we should be cautious of the reactionary doctor who has an asymptomatic patient with “low” T3 and wants to put them on Synthroid. Hopefully most doctors try and see through the correct frame to make sense of the puzzle pieces.

Ferritin

The second irregular puzzle piece was my ferritin. It was quite high.

Ferritin is a measure of iron storage.

The easy explanation would go something like this: I’ve been eating a lot of red meat which is high in iron so – duh – my iron stores are high. But that would be missing a key piece.

Iron Absorption

The liver produces a hormone called hepcidin which monitors iron levels and tells intestinal cells how much to absorb.

On average we lose 1 -2 mg of iron every day – so not surprisingly – this is how much we usually absorb per day.

There are really two main causes of high ferritin levels:

  1. Absorbing more than normal (hereditary hemochromatosis).
  2. A reactionary response to inflammation such as: metabolic syndrome (obesity, diabetes), liver disease, daily alcohol, infections, cancers like Hodgkin’s lymphoma and leukemia, rheumatoid arthritis and systemic lupus erythematosus). (r, r, r)

The second one, a reactionary inflammatory response, explains high ferritin in over 90% of cases.

The problem is, the most typical explanations for high ferritin don’t seem to apply to me. I don’t have metabolic syndrome (see Metabolic Panel), I’m not chronically inflamed (see HS-CRP), I don’t drink, I don’t have any infections (see CBC), and I don’t seem to have any cancers or autoimmune diseases.

So perhaps I have hereditary hemochromatosis (HH)…

Hereditary Hemochromatosis (HH)

Hereditary hemochromatosis is a genetic change affecting the synthesis and/or activity of hepcidin. The result is an increase in intestinal absorption of iron and potential iron overload.

The incidence is about 1 in 200 so while unlikely, I definitely can’t just rule it out. (r)

Unfortunately, I don’t have prior blood work with ferritin levels. So I don’t know my personal history. But it doesn’t run in my family. The opposite does – anemia – which is an iron deficiency. In fact, it’s the most common mineral deficiency in the world.

But while my ferritin was high, it really wasn’t in the HH high range (>1000).

Vitamin C can increase iron absorption, but on a meat-only diet, and without supplementing Vitamin C, this isn’t a likely suspect. If I don’t have HH and I don’t have reactionary inflammation, it turns out we really don’t know the cause of mild elevations in ferritin. (r)

This leaves me in an interesting situation. I have an irregular puzzle piece with no immediate explanation.

What to do – How I think about “irregular” puzzle pieces

So here’s what I’ll do and how I think about this.

  • I will likely get another iron panel – this time including TIBC (total iron binding capacity). This way I can re-check ferritin as well as see if TIBC >45% (which is an indication of HH).
  • If TIBC is greater than 45% then I’d get a genetic test to rule out hereditary hemochromatosis.
  • If it is less than 45% and the ferritin is still around where it is, I’ll likely monitor over time.

As the current research recommends, observation below 1000 ng/mL is standard procedure in this case. But if ferritin elevates towards or above 1,000 ng/mL, I will likely get further testing. (r)

I tell you this to show you my train of thought when it comes to blood work.

  • What it is – A process of understanding / putting puzzle pieces together.
  • What it’s not – A reactionary response to an elevated value and immediate medication/treatment/jumping to conclusions.

Understanding vs. Justifying

There is a big difference between understanding the puzzle pieces in the big picture frame and trying to justify puzzle pieces that don’t look good.

For example, I can understand why my cholesterol, BUN, and ALT are high. And not only understand but expected this in the context of my life. It makes sense in how it fits with the other pieces of the puzzle.

But this is not to say that if I see puzzle pieces outside of normal shapes and sizes to justify them with theories.

It justifies just the opposite, to dig in, further evaluate, find some more pieces to see if it fits or if there might be a problem. 

This is exactly what I did and am doing with the ferritin and DHEA numbers. I’m digging into to possible reasons. I will monitor and test over time. I’ll keep an eye out for issues and explanations. And seek out more informed experts and opinions if called for.

Carnivore Diet Blood Work: 2024 Update

5 years later and after 7 years of carnivore eating, I got my blood work done again.

However, the context around this blood work was different than last time.

This blood work was done after 18 months of a “Carnivore Bulk” where I was eating mostly just 3 foods: beef, eggs, and raw milk.

The 2 big differences were the hypercaloric diet (thus increasing weight/body fat) and raw milk.

Important things to note about this blood work

  • Raw milk has carbohydrates, and at my peak, I was eating ~100 grams of carbs from lactose / day
  • My weight went from 153 to 185 pounds and my body fat from 12% to 19%
  • I got this blood drawn January 31st 2024, in the depth of St. Louis winter

The last important piece of context to this blood draw: The night before I was hit with a personal issue that provoked a lot of stress and a sleepless night before my 7:30 a.m. blood draw. I didn’t get my cortisol taken, but I’m pretty sure it would have been at the highest level possible. I was even having anxiety about the anxiety and how it would impact these results. Did this impact my results? Probably to some degree, but what and how much…who knows.

Now to the blood work.

Lipid Panel

My lipids in 2018 were:

  • Total Cholesterol: 313
  • LDL: 185
  • HDL: 111
  • Triglycerides: 72

I was a borderline Lean Mass Hyper-responder (LMHR).

But between the carbs (lactose from the raw milk) and the extra body fat (from the bulk), my cholesterol this time should be down according to the Lipid Energy Model, which is the theory that explains LMHRs.

Could putting on body fat and adding in one of the most cholesterol-rich foods (raw milk) actually decrease my cholesterol?!?!

It turns out the answer is “yes!”

My 2024 Lipids (vs 2018): 

  • Total Cholesterol: 205 (down 108)
  • LDL: 110 (down 75)
  • HDL: 82 (down 29)
  • Triglycerides: 72 (same)

With the raw milk and added body fat, I’m no longer a LMHR.

My LDL is just outside the “normal” range and my HDL and triglycerides are still solid.

The question now is: if you’re on a very low-carb diet, and your cholesterol goes up, is that going to cause cardiovascular disease?

Should you just add 50-100 grams of carbs/day which can dramatically decrease your LDL to mitigate this risk if you are a LMHR? Maybe.

The truth is that we don’t know.

But a recent study by Dave Feldman and colleagues sheds light on this…

They compared 5 year keto LMHRs to a matched control group.

Results: There was no relationship between LDL levels and arterial plaques. (r)

Metabolic Panel

The metabolic panel was quite similar to 2018.

I’ve addressed BUN above, but one thing to address here is blood sugar. I think the glucose was on the higher end because of the stress/sleepless night/elevated cortisol. This is an easy one to re-test (but I’m not too concerned about it).

My blood sugar over the last 90 days and insulin help fill in the picture.

Both my A1c and insulin are in a healthy range. Compared to 2018, they are higher, which is what I’d expect having put on about 35 pounds and pushing my body fat percentage to the higher end of the “healthy” range (19%).

In fact, having more “insulin resistance” at this body fat level is what you want to see. It means the body is resisting the further storage of energy.

A problem occurs when people have higher body fat and are still too sensitive to insulin whereby the body stores excess and beyond. This is what happens with excess polyunsaturated fatty acids like linoleic acid (i.e. “seed oils”) in the diet. This is a long discussion for another post, but in essence, lower body fat should result in higher insulin sensitivity and higher body fat more insulin resistance within a physiologic norm.

C-Reactive Protein

My hs-CRP is still quite low, indicating general inflammation is low.

Folate

Prior to the blood draw, several people asked that I check my folate. It looks to be all good, in the upper half of the reference range.

Over the last 18 months, I have had some beef liver (that which came with the cow I bought) and I have had eggs, usually 3/day, which are two good sources of folate.

Thyroid

My TSH was a tiny bit lower than in 2018, which is interesting as I thought it would have been slightly higher due to the milk/carbs. It’s still in the reference range and I definitely don’t have symptoms of hypothyroidism (i.e. I have tons of energy and I’ve been HOT even in the middle of winter).

Testosterone

Testosterone is nearly identical to 2018, in the upper end of the reference range.

Free testosterone is normal, but ideally would be a bit higher. Perhaps some getting bound up in SHBG (more in this in a second).

DHEA

DHEA is a bit higher than 2018, still on the low end (as discussed above).

Sex Hormone Binding Globulin (SHBG)

Unfortunately, I didn’t previously test SHBG, so I don’t have a comparison. But it’s often tested if someone is having symptoms of low testosterone.

SHBG binds up testosterone, thereby decreasing free testosterone. So, to increase free testosterone, people try and lower SHBG. But there’s some problems with this…

The first problem is that the best way to lower SHBG is to be obese. That’s obviously not our goal.

SHBG tends to go up as insulin goes down. But insulin sensitivity is generally a good thing. I don’t recommend trying to become diabetic to lower SHBG in order to try and increase free testosterone.

Next, and related, is that polyunsaturated fatty acids (PUFAs), high in vegetable oils, turn down SHBG. (r) But I wouldn’t turn to these to turn down SHBG as they are obesogenic (among other detriments).

Eating the least healthy foods and getting fat in order to increase free testosterone seems counterproductive to me.

Lastly, low SHBG is not only associated with obesity but overall mortality as well. So the goal isn’t really just lower SHBG, but for some, lowering it can mean an increase free testosterone.

My SHBG is in the higher end of the reference range, and perhaps ideally would come down a bit.

If you’re SHBG is high and free testosterone is symptomatically low, one thing that could help is some extra boron, although the effects seem to be transient.

My biggest sources of boron are milk and coffee. To get more (~1 mg/day) you’ll likely have to reach outside of the animal kingdom with foods like prunes, raisins/grapes, peaches, apples, pears, or avocados (which also provide a good magnesium punch which can help). However, fiber tends to lower testosterone and increase SHBG…

If you’re no / low carb and have high SHBG, adding in carbohydrates would likely help bring it down as carbs move your physiology more from the “fasted state” to a “fed state” which turns down SHBG.

For me, I think my biggest issue which is likely impacting some of these sex hormones is this next number…

Vitamin D3

My vitamin D is low.

Prior to getting this blood work done, I predicted by cholesterol would come down (it did), that my ferritin would come down (see next section), and that my vitamin D might be low.

Why low vitamin D?

The first obvious reason is that prior to this blood work, I’d gone months with little sun through the winter months. The second, less obvious explanation, is that I’ve put on body fat during this time too. Vitamin D is a fat-soluble vitamin. I hypothesized that less sun exposure with concomitant increasing fat reserves would result in lower vitamin D. Alas, I was right. Granted this is lower than I hoped.

At the time of this writing, I am starting my Carnivore Fat Loss phase and I’ll be doing this in the spring/summer of 2024. I predict the vitamin D levels will come up with this combination (fat loss + sun). I’ll have to re-test toward the end of summer and see.

These lower levels of vitamin D can impact sex hormones like testosterone, DHEA, and SHBG.

I know many people will say, “Just take a vitamin D supplement!” But I’m not a big vitamin D supplement advocate (another long discussion for another post). But maybe. We’ll see what the summer fat loss results bring.

If you get the Saturday 7 newsletter, I’ll be sure to keep you updated on the vitamin D status!

Iron / Ferritin

The number I was most keen to see — ferritin.

In 2018 it was high. I re-tested to verify and it was confirmed high (600-700 range).

Now…it’s in the normal range, even in the lower half of the reference range.

I anticipate this for a few reasons.

First, over the last 5 years, I’ve donated blood 13 times. That’s roughly 6L of blood.

Second, I’ve been drinking milk. Calcium is an effective way to compete with the absorption of heme-iron, thus inhibiting its absorption.

Third, I’ve continued to drink coffee and eat eggs both of which can inhibit iron absorption. (r)

Lastly, I have a theory. Prior to carnivore I had an iron poor diet. Hormones (i.e. hepcidin) did their best to maintain homeostasis with low iron intake. But with a rapid switch to an iron-rich diet, my body didn’t have time to re-calibrate, resulting in excess iron absorption and thus high iron storage (ferritin).

I’m not sure how much of a role each of these played, but I’ll likely continue to donate blood 1-2X/year and perhaps keep some milk in the diet (but I’m planning on reducing this quite a bit).

It’s great to know that my iron is under control and I can still eat pounds of red meat per day 🙂

Now I have to go get out in the sun, so I’ll see you later!

Carnivore Diet Blood Work: Conclusion

As I hope I made clear – lab values are just a few pieces of a very complex puzzle that needs to be put together in the right frame.

Since you are reading this you are probably like me, you self-educate, you’ll try putting your puzzle pieces together, and try making sense of your frame.

But please, please, please don’t take this to mean doing it alone.

Work with your doctor. This, as I hope you know, is not medical advice, rather this is advice to get medical advice, to work with your doctor and specialists and whoever you need to so that you can make the most informed decisions regarding your health.


If you’d like to learn more about what to watch out for on a meat-based / carnivore diet, I’d highly recommend watching the Meat Health Masterclass:

75 Replies to “Carnivore Diet Blood Work”

  1. I have the opposite problem. I am not strict carnivore, but a typical week will include 5-6 carnivore days (ground beef, eggs). I just got some blood work for something unrelated, and was surprised to see low hemoglobin (12.1 g/dl for a healthy 56yo male). Does anyone have familiarity or insight to this situation?

  2. I’m a 68 year old female with a hematocrit of 52 this time, 49 last time. (though it’s never been below 45 even pre-menopause). I’ve been eating Atkins/keto for 20+ years, carnivore right now, and seldom get under 100 g of protein. I assume this is no cause for concern (partly because of how they determine reference ranges, partly because I feel great) Iron levels are normal, it’s just the hematocrit that’s high.

    Since docs don’t grasp low-carb eating for the most part, I can’t ask mine. Do you see any cause for concern? Should I be donating blood regularly, as some suggest?

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