I've been coaching for years now, and this scenario happens like clockwork:

Someone goes carnivore. They feel amazing. Energy is up, mental clarity is sharp, inflammation is down. They get blood work done. Their doctor sees elevated LDL cholesterol and panics. "You're going to have a heart attack. Stop this diet immediately. Here's a statin prescription."

The person freaks out, quits carnivore, and goes back to feeling mediocre.

Here's the truth: most doctors are interpreting carnivore blood work through a conventional lens that doesn't apply. Elevated LDL on carnivore doesn't mean the same thing as elevated LDL on a Standard American Diet.

Let me show you what to actually look at.

Why Total Cholesterol Doesn't Matter

Your doctor sees: Total cholesterol 280 mg/dL.

Your doctor thinks: Heart attack risk.

The reality: Total cholesterol is a meaningless number.

Total cholesterol is just the sum of LDL + HDL + (triglycerides ÷ 5). It doesn't tell you anything about particle size, oxidation, or actual cardiovascular risk.

You can have total cholesterol of 280 with:

  • High HDL (protective)
  • Low triglycerides (protective)
  • Large, fluffy LDL particles (benign)

Or you can have total cholesterol of 180 with:

  • Low HDL (risk factor)
  • High triglycerides (risk factor)
  • Small, dense LDL particles (atherogenic)

Which person has higher cardiovascular risk? The second one. But conventional medicine focuses on total cholesterol and LDL, ignoring the context.

LDL Cholesterol: Particle Size Matters More Than Number

Your doctor sees: LDL 200 mg/dL.

Your doctor thinks: Cardiovascular disease risk.

The reality: LDL particle size and oxidation matter more than LDL number.

There are two types of LDL particles:

Pattern A (large, fluffy): These particles are too large to penetrate arterial walls easily. They're protective or neutral. They're common on high-fat, low-carb diets like carnivore.

Pattern B (small, dense): These particles easily penetrate arterial walls and oxidize, contributing to plaque formation. They're common on high-carb, high-inflammation diets.

Standard cholesterol tests don't measure particle size. They just give you total LDL. That's why elevated LDL on carnivore (mostly Pattern A) doesn't carry the same risk as elevated LDL on a Standard American Diet (mostly Pattern B).

If your doctor is concerned about LDL, ask for an NMR LipoProfile or Cardio IQ test. These measure particle size and number, giving you actual risk assessment.

The Triglyceride-to-HDL Ratio: The Most Important Marker

From my experience coaching, this is the single best predictor of cardiovascular health on carnivore: the triglyceride-to-HDL ratio.

How to calculate it:

Triglycerides ÷ HDL = ratio

What it means:

  • Below 2: Excellent metabolic health, low cardiovascular risk
  • 2-4: Moderate risk
  • Above 4: High risk, insulin resistance likely

On carnivore, most people's triglycerides drop significantly (often below 70 mg/dL) while HDL rises (often above 60 mg/dL). This gives a ratio well below 2, indicating excellent metabolic health.

Example:

  • Triglycerides: 65 mg/dL
  • HDL: 70 mg/dL
  • Ratio: 65 ÷ 70 = 0.93 (excellent)

Even if your LDL is 200, if your triglyceride-to-HDL ratio is below 2, your cardiovascular risk is low. That's what matters most.

HDL: Higher Is Better

Your doctor sees: HDL 75 mg/dL.

Your doctor thinks: That's good.

The reality: They're right. HDL is protective.

HDL (high-density lipoprotein) is often called "good cholesterol" because it transports cholesterol away from arteries back to the liver for processing. Higher HDL is associated with lower cardiovascular risk.

On carnivore, HDL typically rises because saturated fat increases HDL production. If your HDL is above 60 mg/dL, that's protective — even if your LDL is elevated.

If your HDL is below 40 mg/dL (men) or 50 mg/dL (women), that's a concern. It suggests insulin resistance or metabolic dysfunction. But on carnivore, low HDL usually improves within 3-6 months.

Triglycerides: Lower Is Better

Your doctor sees: Triglycerides 55 mg/dL.

Your doctor thinks: That's very low. Is that okay?

The reality: Low triglycerides on carnivore are a sign of excellent metabolic health.

Triglycerides reflect how much fat is circulating in your bloodstream after meals. High triglycerides (above 150 mg/dL) indicate insulin resistance and poor fat metabolism. Low triglycerides (below 70 mg/dL) indicate efficient fat-burning and low inflammation.

On carnivore, triglycerides often drop to 50-70 mg/dL or lower. This is not a problem. It's a sign your body is burning fat efficiently and not storing excess as triglycerides.

If your triglycerides are still elevated (above 100 mg/dL) after 12 weeks on carnivore, consider:

  • Are you still eating processed foods or seed oils? (Hidden inflammation)
  • Are you overeating protein and converting it to glucose? (Reduce protein slightly)
  • Are you insulin resistant? (Give it more time, ensure adequate fat intake)

Inflammation Markers: What Actually Predicts Heart Disease

Cholesterol gets all the attention, but inflammation is the real driver of cardiovascular disease.

Here's what to ask for on your blood work:

hs-CRP (high-sensitivity C-reactive protein):

  • Below 1 mg/L: Low inflammation, low cardiovascular risk
  • 1-3 mg/L: Moderate inflammation
  • Above 3 mg/L: High inflammation, investigate causes

On carnivore, hs-CRP typically drops significantly within 8-12 weeks. If yours is still elevated, consider autoimmune issues, chronic infections, or stress.

Homocysteine:

  • Below 10 μmol/L: Optimal
  • 10-15 μmol/L: Moderate risk
  • Above 15 μmol/L: High risk, cardiovascular concern

Homocysteine is an amino acid byproduct. Elevated levels indicate poor methylation and increased cardiovascular risk. On carnivore, homocysteine usually stays low due to adequate B vitamins (especially B12, folate, B6) from meat.

If homocysteine is elevated, consider adding liver or organ meats for methylation support.

Fasting insulin:

  • Below 5 μIU/mL: Excellent insulin sensitivity
  • 5-10 μIU/mL: Moderate insulin sensitivity
  • Above 10 μIU/mL: Insulin resistance

This is one of the best markers for metabolic health. On carnivore, fasting insulin typically drops below 5 within 12 weeks. If it doesn't, assess protein intake (too much protein can spike insulin) and ensure you're not snacking between meals.

Thyroid Function: Don't Ignore It

Some people experience thyroid changes on carnivore, particularly a drop in Free T3 (active thyroid hormone). This is often metabolic adaptation (lower T3 = more efficient metabolism), not thyroid dysfunction.

But if you're experiencing symptoms (fatigue, cold intolerance, hair loss, weight gain), check:

  • TSH (should be 0.5-2.5 μIU/mL)
  • Free T3 (should be in upper half of reference range)
  • Free T4 (should be mid-range)
  • Reverse T3 (elevated reverse T3 indicates stress or inflammation blocking T3 conversion)

If Free T3 is low and you have symptoms, consider increasing carbs slightly (add honey or fruit) or adjusting meal timing to support thyroid function.

When to Get Blood Work on Carnivore

Baseline (before starting): Get a full lipid panel, fasting insulin, hs-CRP, thyroid panel, and vitamin D. This establishes your starting point.

3 months in: Repeat lipid panel, fasting insulin, hs-CRP. Most metabolic changes are visible by this point.

6-12 months in: Full panel again to assess long-term trends. If everything looks good, annual testing is sufficient.

How to Talk to Your Doctor

Most doctors aren't familiar with carnivore. They'll see elevated LDL and panic. Here's how to navigate that conversation:

What to say:

  • "I understand LDL is elevated. Can we look at particle size? I'd like an NMR LipoProfile to assess actual risk."
  • "My triglyceride-to-HDL ratio is [calculate yours]. That's a strong predictor of cardiovascular health."
  • "My inflammation markers (hs-CRP, homocysteine) are low. That suggests low cardiovascular risk despite elevated LDL."
  • "Can we monitor trends over time rather than reacting to one data point?"

What not to say:

  • "Cholesterol doesn't matter." (It does, but context matters more.)
  • "My carnivore influencer said ignore LDL." (Cite actual research instead.)
  • "Standard medicine is wrong about everything." (Adversarial tone shuts down conversation.)

If your doctor refuses to order advanced lipid testing or dismisses your concerns, consider finding a functional medicine practitioner or cardiologist familiar with low-carb/carnivore diets.

The Bottom Line

Your cholesterol went up on carnivore. That's normal. It doesn't mean you're heading for a heart attack.

What matters most: triglyceride-to-HDL ratio, inflammation markers (hs-CRP, homocysteine), fasting insulin, and LDL particle size (if you can get it tested).

If those markers are good — triglycerides low, HDL high, inflammation low, insulin low — your cardiovascular risk is low, regardless of LDL number.

Don't let a single elevated LDL number scare you off carnivore when everything else is improving. Context matters. Get the right tests, interpret them correctly, and trust your body's response.