What About Triglycerides?

Julian Whitaker, MD

You probably know your cholesterol level, and likely even your HDL and LDL cholesterol. But how about your triglycerides? A high triglyceride level is a definite health risk factor, and research over the last few years has demonstrated that it is not a risk to be taken lightly. In fact, it may be even more predictive of heart disease than elevated cholesterol.

Triglycerides Are Fat Particles

Grab a hold of your love handles and you’ve got a handful of triglycerides. Triglycerides are the primary form in which fats are stored in the body. They are also abundant in food. Ninety-five percent of the fats we eat—whether they’re unhealthy saturated fats or vital essential fatty acids—are incorporated into triglycerides.

Fat-laden triglycerides also float around in your bloodstream, carried by water-soluble lipoproteins, which shuttle them throughout the body. Triglycerides are carried primarily on two lipoproteins: chylomicrons and very low density lipoprotein (VLDL). Chylomicrons are formed in the small intestines and pick up the triglycerides that are absorbed into the bloodstream after you eat. VLDL, on the other hand, is produced by your liver and mobilizes fatty stores.

Triglycerides Raise Cholesterol…

The more VLDL your liver churns out, the higher your triglycerides, and the more fat in your blood, making it thicker and impairing circulation. An abundance of VLDL also usually means a low level of protective HDL cholesterol. Furthermore, some VLDL is converted into LDL cholesterol which, when damaged by free radicals, burrows into artery walls and causes atherosclerosis. Even worse, it tends to be a smaller, denser, and more damaging type of LDL.

Excessive levels of triglycerides damage the arteries in yet another way. After the lipoproteins make their deliveries, remnants of VLDL and chylomicrons remain in the bloodstream. Recent research suggests that these remnants are highly destructive to artery walls and play a role in atherosclerosis.

…And Predict Heart Attack Risk

For years, elevated triglycerides were ignored as a risk factor for atherosclerosis. These fats were felt to be too large to enter and build up within the arterial walls, like cholesterol does. Although as early as the 1950s, Yale University scientists showed that high triglyceride levels were more predictive of heart attack than high cholesterol, the cholesterol theory of heart disease had such a firm grip on conventional medicine that this research was largely ignored.

Today, the single-cause theory of atherosclerosis is as stale as week-old coffee, although some have yet to wake up and smell it. Heart disease is caused by a number of factors, including elevated LDL cholesterol, homocysteine, and lipoprotein(a) levels; and low antioxidants.

Let’s now add to that list a high level of triglycerides, which is a powerful predictor of heart disease. A review of 17 studies examining the link between triglyceride levels and cardiovascular disease revealed a 76 percent increased risk in women and a 31 percent increased risk in men for each 86 point increase in triglycerides. (Normal triglyceride level is 40–160 mg/dl; ideal is less than 140.)

Insulin Resistance May Be at the Heart of Hypertriglyceridemia

What causes triglycerides to rise? According to Gerald Reaven, MD, of Stanford University, in most cases it is increased levels of insulin. When insulin levels are high, as they are in insulin resistance or metabolic syndrome (formerly known as syndrome X), it causes the liver to make more VLDL, which in turn produces more triglycerides. This condition is estimated to affect one in four Americans.

Insulin resistance is a growing health concern. It is the underlying factor in type 2 diabetes, and half of all people with high blood pressure are insulin resistant. It also significantly increases the risk of heart disease—in part, because of its effects on triglycerides and the cascade of related blood lipid abnormalities.

Natural Therapies That Work

Fortunately, elevated triglycerides respond beautifully to natural therapies. A patient of mine, Kerry, had exceptionally high triglycerides for years, with levels soaring as high as 25,000 mg/dl. When he first visited the Whitaker Wellness Institute, his triglycerides were 5,300, his cholesterol was 490, and his blood sugar was 590. I prescribed a high-quality multivitamin/mineral supplement, 10,000 mg fish oil in capsules; and 1,000 mcg chromium. I also recommended he cut out sugar, bread, potatoes, and other starchy and sugary foods from his diet, and begin a walking program.

After one month, his triglycerides fell to 764, his cholesterol to 260, and his blood sugar to 189. Three months later, his cholesterol was a respectable 186 and his triglycerides 303. Kerry was ecstatic.

I feel that Kerry’s dietary changes were a major factor in his improvement. Triglyceride levels increase with the consumption of lots of sugars and refined carbohydrates. These are rapidly broken down into glucose and cause a sharp spike in insulin production. Once the body has used all the glucose it needs for energy and filled the muscles and liver with stored glucose (glycogen), the remainder is converted to triglycerides. Furthermore, all that excess insulin prompts the liver to produce more VLDL, which as you know equals more triglycerides.

Kerry’s fish oil supplements also helped. The omega-3 fatty acids in fish oil increase insulin sensitivity and dramatically lower cholesterol and triglyceride levels. Dr. William Connor and his group at the Oregon Health Sciences University Department of Medicine gave 10 patients with dangerously high cholesterol and triglycerides fish oil for four weeks. The average cholesterol level fell from 373 to 207 mg/dl (a drop of 46 percent), and the triglyceride level fell even more dramatically from 1353 to 281 mg/dl!

Here’s One the FDA Likes

One additional therapy even the FDA has approved for lowering triglycerides is, believe it or not, a B-complex vitamin. Nicotinic acid (niacin) is an excellent therapy for lowering triglycerides and cholesterol. It delays the release of the free fatty acids required to make VLDL and, in addition, lowers LDL cholesterol levels. The major side effect with high-dose niacin is the infamous “niacin flush.” Because nicotinic acid has a dilating effect on the blood vessels, some people notice a flushing or burning sensation, particularly on the face. Lowering the dose generally alleviates this side effect.

Recommendations

• Avoid foods made with sugar and white flour and instead eat vegetables, fruits, beans, and other legumes that provide a slower release of glucose and a less dramatic insulin response.
• Eat salmon or other low-mercury, cold-water fish several times a week or supplement with up to 10, 1,000 mg fish oil capsules per day, divided among meals.
• High-dose niacin therapy is best done under the supervision of a doctor. Start with 500 mg three times a day for two weeks, then build up to 1,000 mg. Make sure you take niacin with meals. With any niacin therapy, you should have your liver enzymes tested periodically. This therapy is not recommended for patients with liver disease, gout, or ulcers.
• If your triglycerides are persistently high, you should be checked for cholesterol abnormalities, high blood pressure, diabetes, and heart disease, which often accompany high levels of triglycerides. For treatment of any of these conditions at the Whitaker Wellness Institute, contact a Patient Services Representative at (866) 944-8253 or click here.

References

• Austin, MA. Epidemiology of hypertriglyceridemia and cardiovascular disease. Am J Cardiol. 1999 May 13;83(9B):13F–16F.
• Chanu, B. Hypertriglyceridemia: danger for the arteries. Presse Med. 1999 Nov 20; 28(36):2011-2017.
• Reaven, GM. Syndrome X: Overcoming the Silent Killer That Can Give You a Heart Attack. Simon & Schuster, New York, NY, 2000.
• Phillipson, B.E., Rothrock, D.W., and Connor, WE., et al. Reduction of plasma lipids, lipoproteins, and apoproteins by dietary fish oils in patients with hypertriglyceridemia, New Engl J Med. 1985; 312:1210–16.

Modified from Health & Healing with permission from Healthy Directions, LLC. Copyright 2000. Photocopying, reproduction, or quotation strictly prohibited without written permission from the publisher. To subscribe to Health & Healing, click here.