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. 


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.


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.


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.


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 tests is not ordered for suspicion of low DHEA unless Adrenal Insufficiency (AI) is suspected. There has been a recent trend supporting testing for “adrenal fatigue” though there is no evidence that “adrenal fatigue” is actually a real 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.

Anyways, searching for low levels of androgens in healthy people without specific symptoms is not recommended, and treating them with androgenic hormones just 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 is for a similar reason that my insulin is so low.

In the case of insulin, because my receptors are so sensitive, I don’t need much of it in order for it to optimally perform its functions. In contrast, someone that has insulin resistance needs a whole lot of insulin in order to maintain homeostatic blood glucose.

I’m guessing I have “hypersensitivity” to DHEA.

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.” Just like my insulin 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.

Insulin is a good example, my fasting insulin is, by some accounts, lower than the lower limit. Extreme insulin sensitivity. I just don’t need much insulin to keep healthy blood sugar and promote healthy growth.

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 hormones for 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.


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 iron so – duh – my iron stores are high. But that would be missing a key element.

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.

At the time of this writing, I haven’t gotten this test yet, but when I do, I’ll update this at the bottom of the post.

Further possibilities…

Although current science doesn’t have definitive answers as to why ferritin is elevated in the absence of an inflammatory response or a genetic condition – there are 2 scenarios I like to always keep in mind.

2 Scenarios

Scenario #1: Perhaps the test was inaccurate.

I have a degree in Chemistry and did four years of quantitative analysis research. Using graphite furnace atomic absorption spectroscopy, I measured lead contamination in fish. I can tell you, no matter how much care is taken, and how good the instrumentation is, no test is immune from error.

If something is outside the normal or expected, and you just can’t explain it – sometimes error can explain it.

Scenario #2: These higher iron storages are good and necessary for something that I just don’t know or understand.

And I think this may be the most likely scenario.

While I do everything I can to understand, to ask why, to get to the bottom of “irregular” puzzle pieces, I know my body is smarter than me.

Many people with my ferritin levels would rush to get a phlebotomy. But what if my ferritin is “high” for good reason? What if my body knows something I don’t? The last thing I want to do is try and manipulate it myself.

I believe this is what is so often done with cholesterol. We think we are smarter than the body and thus manipulate cholesterol with drugs – just to get a number that we think is good. When really that cholesterol is “high” for a reason. That reason may be perfectly appropriate and healthy or it may be that something is wrong. But masking the underlying reason and just manipulating numbers with drugs, I think is a bad strategy.

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: 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:

62 Replies to “Carnivore Diet Blood Work”

  1. Very well done. Very interesting, informative, fair-minded, and helpful. (Now four months zero carbs on your level 2.)

  2. Your testosterone is extremely high! I’d like to know what your LH and FSH levels are. I’d also like to know your T3 and fasting cortisol level.

  3. I wonder if your high ferritin is due to iron overload caused by too little calcium at meals. Calcium blocks iron absorption, but the inhibitory effect of calcium on iron absorption has been reported to be dose related, with no effect at 300 mg Ca/meal. You might try supplementing calcium or eating some dairy with each meal, in order to absorb some of the iron. For additional hacking, Chris Masterjohn has a very interesting podcast on iron absorption and how to define the cause by certain values of TIBC, ferritin and transferrin, I believe.

  4. By any chance, are you cooking a lot in cast iron pans? I’d assume so given you’re a carnivore. Studies do show an increase in ferritin by cooking in cast iron. My measurement is also a little on the high end (400) and I attribute some of it to that.

    1. I actually do not.

      I have some theories as to why some people are experiencing “elevated” ferritin in the absence of reactive inflammation and HH – these theories are under ongoing investigation 🙂

      1. Switching between low carb and Keto the past 3 years and my Ferritin has been over 600. Had the hemochromatosis test done. Came back negative. I too am interested in to what the reason may be. I monitored it for a while, but got tired of being a pin cushion…so I’ve accepted not worry about it. Also low DHEA, same scenario, I quit worrying about it.

  5. While the basic cholesterol numbers don’t mean squat you should look at LDL-P, Lp(a) and Apo B – Qwest has a CardioIQ test and directlabs is running a deal for $109 in Feb (comparable to NMR but you also get the Lp(a) and Apo B–if there is cholesterol oxidizing you will see it there. Your Liver numbers do seem elevated–ALT and Alkaline Phosphatase seem way high. Higher Alkaline Phosphatase is correlated to more aging. If you have genetic reports look rs1801282 -if you have one or more G’s you may have issues metabolizing Sat fats. You don’t want NAFLD. Since ALT is elevated and you have been keto for a while–I would seriously look at it. Keto (of any kind) should lower ALT. You don’t want your liver turned into foie gras.

  6. thx for posting this all, Kevin. My question is this: If your CRP is low and seems to prove there is little to no inflammation occurring, can you back this up with a CAC score? I ask this because i too had low CRP for the past decade (eating mostly paleo) 1.0 – 1.2, and i too had HI lipid numbers (very similar to yours) BUT i just recently found tons of calcium (plaque) on my coronary arteries (CAC of 1400!).

    1. CRP is a “blunt” tool rather than a specific identifier.

      What I mean by this is that CRP can give you a general idea of systemic inflammation, not a precise location/degree of inflammation.

      An analogy from dentistry would be something like:

      If you have cavities in a lot of teeth your “CRP” would be high. Known as generalized decay (and analogous to chronic systemic inflammation)
      If you have just one cavity the “CRP” may look just fine because all of your other teeth do not have cavities. But the rotten tooth isn’t “rotten” (inflamed) enough to raise “CRP” to the levels that systemic inflammation would.

      Your CAC would be analogous to getting a specific x-ray of the rotten tooth to actually see the pathogenesis.

      Hope this makes some sense.

    2. İ think it is something important for you calcium in coronary is no good you should check your carotid arteries

    3. Do you consume diet High i Oxalates??? Oxalate crystals can do this. Do you consume lots of plant foods and make smoothies from high oxalate greens and veggies?

  7. Why do so many people have a good response on and good blood work on diets such as the Wahls Protocol. Is it just because it removes the main ‘offenders’. Same for the Plant Paradox diet

    1. Quite possible – but I think you really need to dive in and ask another question – “what is ‘good’ blood work?”

      Does this ‘good’ blood work include insulin, hsCRP, and other values often not tested…are they assuming cholesterol is “bad” – just a couple examples of how blood work (and the lack there of and the misinterpretations) don’t tell the whole story. An important part of the story, for sure, but like I mention throughout this article, there are many pieces to the puzzle.

      1. I also was in high range with ferritin (506), and VitB12 (1570), total cholesterol 215, triglycerides 62, hdl 76, CRP below 1, TIBC was 274 (250-400 normal range). Glucose 90, a1c 5.1. I have been on carnivore for 3 months, strict low carb for year. All other bloodwork fell in normal range including cbc, hormone, metabolic panel, iron/tibc, PSA. Any ideas on why b12 is elevated would be greatly appreciated. I am a bodybuilder if that works into equation.

        1. High B12? Did you eat liver, clams and sardines right before the test?

          Generally I wouldn’t worry about high B12 as it’s water soluble, meaning you excrete it in the urine.
          It’s very rare to have high blood levels of B12 from too much in the diet.

          Ferritin is a bit elevated and would probably be worth getting a full iron panel once on the diet a bit longer (3 months is really not a lot of time in the big picture), as well as looking at your GGT. Hereditary hemochromatosis isn’t uncommon, so something else that may be worth looking in to.

  8. I had the HH test and it came back negative, TIBC 274, 33% saturation, iron 91 (40-190), had a leukemia/lymphoma panel and all was negative. Had a hepatic function panel and all was normal except high ferritin. Supposedly the high score on the B12 blood test is a symptom of blood disorder, or kidney/liver issues. I fasted 20 hours prior to test. I feel good, high energy, good workouts, sleep but concerned about b12 and ferritin numbers. Was told to just monitor, retest in 12 weeks. Only things I eat is 3 lbs. of ribeye and 4 whole eggs per day. No condiments other then salt/pepper, drink water. I had blood test results in 2015 that showed high ferritin/highB12. Now 4 years later and still have same type of results. This is the 1st time I have done the extensive bloodwork. Any ideas? Thank you!

    1. Kevin, I know this is an old thread. Is your iron level still that high (or higher)? Excess iron usually gets stored in soft tissue where it doesn’t belong. I have HH and I manage it by regular blood donations. You don’t need to go crazy. Donate 4-6 times per year and when it levels off at a more appropriate level, you can manage with fewer donations. High B-12 is not a problem. Ferritin over 250 is too high. 100 is a good number to shoot for and still very adequate for an athlete. BTW – research all the benefits you gat from regular blood donations.

      1. Hey Tom, I got the genetic test last year, I also have HH. I’ve been giving blood every 2-3 months. I am planning on doing another blood test sometime this year to see where I’m at (I’m planning on writing a full post on iron).

        1. Hi Kevin,
          Following this thread I see you found out that you have HH. Can you tell me what your Iron Sat % or Transferrin Sat % was before you started donating blood? I haven’t been too concerned about my rising Ferritin in the absense of inflammatory markers, because like you i had an undetectable hs-CRP. But my iron sat % jumped from 28 to 44. I donated blood a week ago so haven’t retested my iron markers yet. Figure I’ll redo them at 3 months at which time I’ll test for HH as well.

  9. Hi Kevin,

    I have been following a mostly HFLC diet for about 7 months, with a few cheat days here and there. I just got my bloodwork done, and my ALT was 55. I saw what you said about working out hard, but I am not super active. I don’t take a ton of Tylenol, and I rarely drink. Is there any good reason a primarily carnivore diet could cause this? Should I be concerned?

    1. It can be elevated for a number of reasons, as you probably understand from this article, I would recommend talking/working with your doctor.

    2. My Alt was high also. Range is 32 and mine was 35. Dr. wants ultrasound. I think this is unnecessary. Not sure if I should be worried or if its because of the protein.

      1. I know this is a few months later but can you tell me if your Alt is still high. I had the same results and the Dr. Wants me to go for ultrasound also but I really think it’s all the protein. I have been carnivore for a year and a half and my test have always been normal. I wish I could find more info on this. Thanks

  10. Have you considered having intracellular micronutrient testing such as from Spectracell? I think this sort of testing would be extremely interesting from the perspective of someone being a carnivore diet for 6 months+. I plan to have it done for myself and wife soon, but we are not strictly plant-free.

    1. There’s tons of things I’d love to do (like continuous glucose monitoring, blood draws on a daily basis, etc..) but sometimes feasibility, expenses, time, ect…aren’t always practical.

  11. I was diagnosed as HH about 3 years ago, and did a 4 month regimen of weekly phlebotomies. Now just over 3 years later, not having altered diet, I’m considering leaning into the carnivore diet. However, I also recently received test showing uric level of 10. From what I’ve read on “alternative approaches” and anecdotal personal testimonies, there seems to be reasonable support for approaching my health issues through carnivore. Am I crazy?

    1. I don’t think you are crazy. I also have a mutation with the HFE gene (will be writing more about this and ferritin in the near future).

    1. I will get you signed up!

      Sorry about the issues – sometimes it’s adblocker related – but I got you.

  12. Would love to know if you find anything to explain your Iron readings Kevin! I just had a similar finding.

    My history:
    12 Aug – 4+ months carnivore and I just got these results.
    Serum Iron:20 umol/L ( 10 – 30 )
    Ferritin:509 ug/L ( 30 – 500 ) H
    Transferrin:1.6 g/L ( 2.0 – 3.2 ) L
    Transferrin Saturation:50 % ( 16 – 45 ) H

    9 April – just prior to Carnivore, very heavy plant based.
    Serum Iron:17 umol/L ( 10 – 30 )
    Ferritin:514 ug/L ( 30 – 500 ) H
    Transferrin:1.6 g/L ( 2.0 – 3.2 ) L
    Transferrin Saturation:42 % ( 16 – 45 )

    5th May 2017 (just prior to going heavily into plant diet)
    Serum Iron:12 umol/L ( 10 – 30 )
    Ferritin:457 ug/L ( 30 – 500 )
    Transferrin:1.6 g/L ( 2.0 – 3.2 ) L
    Transferrin Saturation:30 % ( 16 – 45 )

    Going for the Hemochromatosis test next at the recommendation of my doctor. Possibly just need a good blood draw as I have never had one.

    1. I am going to be writing about iron/ferritin really soon.
      But as mentioned in this article it can be elevated for a myriad of reasons.
      The fact that your has been consistently elevated would tell me there is either some chronic issue or perhaps you have HH, and the genetic test is where I’d start.

      I got the genetic test (HFE analysis) and I have a mutation on the HFE gene (H63D) which I think is less common than the C282Y – but I’d just be sure your analysis includes at least these two.

  13. I happened to have a blood draw 13 days into carnivore (not deliberate, just my annual wellness check for Medicare) and the results show a directionality over what I’ve typically seen eating LCHF for the past 6 years that I and my dr (a very integrative/functional medicine-oriented dr, thank goodness) both find disturbing. Lowest HDL and highest triglycerides I have ever had — resulting in the first Tri/HDL ratio I’ve ever had that’s higher than 1. Likewise, CRP has always been in the .3-.5 range, yet now it’s a 2. Uric acid at 10! And ferritin, tho not as high as many here report, has also increased from high-normal to above range at 178.

    What gives?

    I have been dealing with psoriasis for 50 yrs, and carnivore has been my latest effort to solve it — yet it has actually flared on carnivore, as the upward movement in crp and ferritin would indicate.

    I am normal weight and got good values for fasting insulin (2.2) glucose (65) and HgA1c (5.0). So I think I can rule out metabolic syndrome.

    1. Hi Lynn, yes I’m not sure if you read the article, but I explain how getting blood work this early doesn’t tell you a whole lot, and makes it very easy to draw some false conclusions.

      1. Hi, Donald. I am sorry to say that neither carnivore nor ordinary keto had any impact on the psoriasis. Over the decades I have conscientiously tried every dietary protocol I have so far come across — including monthly 3-4-day water-only fasts — so far to no avail. My uric acid and ferritin levels did go back down to a desirable level when I stopped carnivore and went back to plain keto, so I am reasonably sure carnivore is not the right diet for me, even though I know it has been very helpful to many people. It’s off topic, I know, but I am thinking you are also searching for a non-medicinal way to control psoriasis. So I will mention that right now I am tinkering with my melatonin-cortisol circadian rhythm by taking phosphaditylserine (PS for short) at bedtime to blunt premature cortisol spike in the middle of the night and low-dose, time-release melatonin to maintain adequate melatonin until early morning hours. I am cautiously optimistic with a current improvement, particularly in the scalp psoriasis. But only time will tell whether it is just the normal, frustrating, confusing fluctuations in this condition. I AM sleeping better, though!

  14. Thank you! After my last blood work the docs wanted to start testing and prescribing stations…I said no thank you, and walked out knowing I was only 4 months into carnivore had just consumed copiuos amounts of cream and steak for the week and knew my LDL transit system would be hard at work…tests were conclusive but I have no need to worry as everything else in the labs was amazingly on spot or nicely lower than “normal” ranges. 1 month after the labs my system reached homeostasis with a bang! My journey started in 2016 at 155# 31.3% body fat ( I’m 5’4″ & 54 now) now I am at 106# and 14%body fat feeling amazing and with more energy than I’ve had in over 40 years. Honestly feel like I’m in anew body!

  15. I am 47 year old woman, heavy weight lifter 5 days a week, 112# 20% bf. I have never had elevated glucose in my life or HgAic until going keto carnivore (keto carnivore 2.5 years). I understand why but my Fasting levels are 96-106 and my AiC went from 4.4 to 5.3. Paul Saladino and Zosia Clemens will say that my protein intake is too high and fat intake too low. I typically eat 100-130g fat and 130-170g pro 10 carbs or less no dairy. My ketones are elevated .3-1.0 so my understanding is ketones can not be made if insulin is elevated so I assume insulin is low. How can I determine if my elevated BG is detrimental or do I not worry if Insulin tests low?

    1. Hi Sarah, stable blood sugar with low insulin (high degree of insulin sensitivity) – especially as a weight lifter on a low/no carb diet – this seems quite ideal. The slight elevation in BG isn’t uncommon with no/low carb diets, a means of glucose sparing (often seen in highly active / athletes and no / low carb diets)

  16. Almost 😉 let me rephrase the question? How could insuline levels be high on a zero carb carnivore diet?

  17. I have the MTHFR mutation – C677T and A1298C (compound heterozygous). I read a lot about red meat elevating homocysteine levels. Please assist. I want to go carnivore, but don’t know if I should take the chance.

  18. Hello Sarah, I had the same question as you about elevated glucose levels, and lowish ketones. Did you get a answer? Thanks Tom

  19. Regarding cholesterol (and anything else citing studies), it’s important to refer not to just one study but the entire body of studies. As you say, context is key. And as I’m sure you also know, most studies are actually flawed and many more don’t even get published and peer reviewed. By considering the body of studies, one becomes aware of what other experts have to say about that study. It’s continuous peer review involving not just yourself but also with other experts post-study.

    I have a family history of heart disease, so I’ve been particularly interested in cholesterol. There’s a great discussion, both in the article and in the comments, here: https://sciencebasedmedicine.org/the-cholesterol-controversy

    I’d be interested in your thoughts, particularly in the common errors made by “cholesterol skeptics” as identified by the author and commenters.

  20. Hello,

    I need some help…

    I’ve tried carnivore 3 times. It’s fantastic for effortless weight loss and hunger control. But I’m having a huge issue. GOUT!!

    I’m not talking a little pain. I’m talking 2 weeks on crutches, unable to shower or use the toilet without assistance, so sensitive that if the sheet touches my ankle it hurts, pain. The first 2 times i tried carnivore, it happened within a month, and, of course, i reluctantly backed off the meat and tried to do a mainly eggs and avocado (both low purine foods) keto diet.

    Eventually, my awful food addiction and lack of self control got the better of me and I went back to eating like an idiot.
    This year, I wanted to stick with it, hardcore.

    I read all these articles and saw all these videos with carnivores, claiming that fructose is the problem. The few videos i could find on people who experienced gout on carnivore, the general idea i was given, was that an initial flare-up during adaptation is possible, but after the first 2 months, you should be in the clear.

    Well, I’ve been through the adaptation. Been strict (er….98% I still drink black coffee) carnivore since February. Nothing but red meat, eggs, black coffee, salt and water since March 15th (before that, I was allowing myself cheese). Not one cheat meal, and here i am on crutches, trying reduce swelling and manage pain with rest, ice, elevation, colchicine and indomethacin.

    I don’t want to give up carnivore. It makes weight loss so effortless, but absolutely nothing is worth this level of physical pain. Not to mention not being able to do anything for myself.

    Any information you think might help would be appreciated.

      1. Hello Maztergee

        Your advice inspired me to take a food intolerance test
        I did it, eggs the green light. So did cheese, red meat, pretty much everything you can enjoy on carnivore is good with me. But, apparently, my gout disagrees. Didn’t narrow it down, but it was worth a shot.

        Thanks for the idea. 🙂

    1. Hey George, don’t know if you’ll see this but if you do I’d be really curious about where you’re at now? I started ZC in July and had a brutal two months of back to back gout. I still have the occasional flare but (thankfully) comparatively minor.

      The turning point for me was giving blood. I saw a talk by Amber O’Hearn which had a chance comment at the end that in addition to fructose, for some people high iron is a trigger. Did some research and found lots of people with gout talking about giving blood as a way of minimising attacks. Giving blood is the only really practical way of reducing iron, so I did that. And the back to back flares stopped immediately. I obviously can’t prove causation, but it was a pretty dramatic change.

      The other thing I’ve noticed is that every time since I’ve had a minor flare, I have ketones in my urine (and normally have none despite being in nutritional ketosis according to a blood test). So my theory is that I’m doing something which is causing me to produce more ketones than I can use, and since ketones take precidence over uric acid for excretion by the kidneys, I get a uric acid build up.

      1. Hi Adam,

        Thank you for your response, fellow gout sufferer. I have since gone off the carnivore diet, and am just focusing on gout. Currently, I eat one meal a day, and almost every day, I have at least 4 organic, pasture raised eggs (because eggs are the only low purine, nutrient dense animal based food I know of).

        I really do want to go back on carnivore, because it makes weight loss so effortless, and I definitely gained back some weight in July, and again in October. I think i might be able to do it without a flare-up now, as my rheumatologist put me on 300 mg a day of allopurinol, and gave me some indomethacin and prednisone (so that i have options) in case of another flare-up.

        My main concern is my own lack of self-control. I know that if i eat one meal a day, regardless of what i eat, if i follow the one plate rule (one average sized dinner plate, piled no more than 3 inches high, nothing falling off the side of the plate), i will lose weight, slowly, steadily and surely. And my gout only flares up, if i have too much alcohol without enough water (and I really only drink once a month anyway), or if i have liver or shellfish. I can have a ribeye and a potato for dinner, wake up a little lighter the next day, no gout pain.

        But if i go on keto or carnivore, one beer, or one cheat meal, is all it takes for me to have a crippling flare-up. I know the obvious solution would seem to be….don’t cheat, but i get flare-ups when i stick to the diet strictly…..although, again, with the allopurinol, this may not happen….. and to be honest, as a craft beer geek, I do not see myself going the rest of my life without the occasional (1-3 a month) IPA or imperial stout.

        I think i may try once more, and keep my fingers crossed that medications get me through any complications that may arise.

        Speaking of which, are you on any meds? If you aren’t and you get another flare-up, I would definitely recommend seeing if your doc can get you on allopurinol. It’s been a game changer for me.

        Anyway, that is interesting about giving blood. I may have to give that a shot, when/if I give carnivore another go. Do they try to force cookies/juice on you? If so, how did you get out without partaking? Did you feel ok after?

        Also, what you said about ketones competing with uric acid to be excreted makes sense. I had read somewhere that extended fasting could be really bad for a gout sufferer. That would explain why. Nothing puts you in deeper ketosis than a fast. I wonder if high fat or protein is the better way to go on carnivore for gout sufferers. I was definitely doing high fat last time (ribeyes, fatty roasts and eggs). Maybe higher protein, less fat, once a month blood donation is the way to go.

        If you have any additional info, other ideas or updates at any point, please do respond to this thread. Maybe it will help others in our situation. I hope you never suffer another flare-up again. F*** gout!

        Thanks for your input. Take care.


  21. Hi Kevin, appreciate your work greatly. I am 71 & been carnivore for 6 months now after keto for 6 months. I started keto because my HbA1c was 11.4! & weight was 103Kg. It dropped to 6.3 but now is rising again & is now 6.6. Now, weight is 77.5Kg, CRP is .5, Insulin 4, HDL nice & high etc. Just the HbA1c & ALT too high. My doctor thinks I’m cheating but I’m pretty strict. Any ideas?

    1. Hi Bob – sounds like you’ve righted the ship!

      If you and your doctor are really worried about 0.3 increase in HbA1c, then I would simply up the fat and decrease the protein a bit (i.e. focus on fattier meats).
      Much more on this here: https://www.kevinstock.io/health/high-protein-diets/
      Also, sometimes slight elevations on zero carb happen as means of glucose sparing and very well could be perfectly physiologically normal and healthy (so worth mentioning).
      Much more on this here: https://www.kevinstock.io/health/carbohydrates-and-the-carnivore-diet/

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