By Dr. William Davis, MD, preventative cardiologist and best-selling author of Wheat Belly and the Wheat Belly Cookbook
Triglycerides are like the Rodney Dangerfield of cholesterol panels: They get no respect.
Of the four simple values in any standard cholesterol panel, triglycerides are the most neglected, barely mentioned by many physicians. This is a BIG mistake! Increased triglyceride levels mean an increased risk of conditions such diabetes and coronary heart disease. Higher levels of triglycerides also provide unique insights into diet and metabolism. Fortunately, high triglycerides are wonderfully easy to correct, naturally and without drugs.
Why are triglycerides so widely ignored? After all, triglyceride value is available to anybody having their “cholesterol” checked, a test as common as snow in January. Part of the reason is that increased levels of triglycerides typically don’t occur in isolation, but are accompanied by other abnormalities, such as low HDL cholesterol and high blood sugar. They easily get lost in a crowd of other issues. But it has become increasingly clear that high triglyceride levels signal potential for increased risk for heart disease, even in people with low or normal cholesterol values.1
What causes high triglyceride levels?
Triglycerides are one of the ways the body transacts energy, especially the energy stored in fat. People with generous abdominal fat tend to have higher levels of triglycerides, since fat cells release and store triglycerides which then enter the bloodstream.
Carbohydrates and sugars in the diet are also sources of blood triglycerides. The liver converts carbohydrates to triglycerides, which are then packaged in “very low-density lipoproteins”, or VLDL. This process has tremendous capacity to raise triglycerides to very high levels.2
The last contributor to blood levels of triglycerides are dietary oils and fats, though their contribution tends to be modest and only in the first few hours after a fat-containing meal.
Occasionally, people have high triglycerides due to genetic factors, such as a lipoprotein lipase deficiency. Lipoprotein lipase is an enzyme that clears triglycerides from the blood. In this situation, triglycerides can range as high as several thousand mg/dl or 15, 20, or 30 mmol/L. In this discussion, we are focusing on the much more common and more easily controlled triglyceride levels of less than 1000 mg/dl or 11.3 mmol/L.
How do high triglycerides contribute to heart disease and other conditions?
When VLDL particles in the blood come into contact with LDL and HDL particles, triglycerides are transferred to those LDL and HDL particles. These triglyceride-loaded LDL and HDL are ready targets for enzymes in the blood and liver that reconfigure them into smaller versions: small LDL and small HDL. Small LDL and HDL powerfully stimulate growth of atherosclerotic plaque in the arteries of the heart and elsewhere. Small LDL particles, in fact, have skyrocketed to occupy the top spot as cause of heart disease in North America. Excess triglycerides and VLDL lurk behind the creation of small LDL and small HDL.3
This process starts at a triglyceride level as low as 45 mg/dl or 0.5 mmol/L, becomes progressively worse with increasing levels of triglycerides, and gets really bad with triglycerides >150 mg/dl or 1.7 mmol/L. The Adult Education Treatment Panel-III of cholesterol treatment guidelines in the U.S. and Health Canada suggest 150 mg/dl or 1.7 mmol/L as the cutoff for normal - an absurd level, in my view, that virtually ensures increased risk for heart disease.
Low HDL and increased triglycerides are also patterns that characterize metabolic syndrome, or pre-diabetes, and diabetes. In our world of inactive, sedentary lifestyles and packaged, processed foods, metabolic syndrome and diabetes are rampant. That means increased triglycerides from VLDL, along with low HDL and small LDL, are also out of control. This is because the poor insulin responses of these conditions, along with the high-carbohydrate diet that created these issues, allow the liver to produce VLDL particles without restraint.4 The result: up to several-fold increased risk for heart attack.5
Triglycerides originate mostly from abdominal fat, followed by contributions from carbohydrate intake. Consuming dietary oils and fats does not contribute to excess triglycerides. While these oils and fats are made of triglycerides, they do not usually contribute to triglyceride blood levels. The triglycerides that come from fat stores and from liver conversion of carbohydrates to triglycerides outstrip our intake of triglycerides through oils and fats by a long stretch.
How to Reduce Triglycerides
Unfortunately, low-fat dietary blunders of the last 40 years still corrupt standard advice to reduce triglycerides. Low-fat diets, in fact, increase triglycerides. Typically, someone adhering to a strict low-fat dietary regimen has triglyceride levels in the 200 mg/dl (2.3 mmol/L) or higher range.6
Wheat, grains, sugars, and starchy legumes are the biggest culprits in causing high levels of triglycerides. Excess intake of alcohol can also contribute. These are the foods that cultivate excessive insulin levels, which lead to poor responsiveness to insulin, providing the fuel for increased VLDL production which appears as high triglycerides on a cholesterol panel.7
Reducing—or even better, eliminating―grains, added sugars, and starchy legumes, especially in the form of junk snacks such as chips, pretzels, and crackers; all wheat-flour containing foods like breads, pasta, pretzels, bagels, and breakfast cereals; foods made with cornstarch or cornmeal, such as tacos, tortillas, wraps, and gravies; white and brown rice; and white potatoes reduces triglycerides dramatically. In my clinic, this approach reduces triglycerides with huge success, as well as correcting related abnormal patterns such as low HDL, high blood sugar, and high blood pressure. It can also correct conditions like pre-diabetes and diabetes. The effect is nothing short of extraordinary.
Another important aspect of diet is to eliminate high-fructose corn syrup or corn syrup, since these widely used sweeteners send triglycerides through the roof.8 Always read labels (or, even better, choose foods without labels, such as green peppers, cucumbers, pork chops, and salmon!) and you will be shocked at the number of products that contain these unhealthy ingredients.
Omega-3 fatty acids EPA + DHA, from fish consumption and fish oil, are crucial in any effort to reduce triglyceride levels. And it must be EPA + DHA, not the omega-3 fatty acid, Omega-3s such as linolenic acid, found in flaxseed, chia seed, walnuts, and other sources, do not reduce triglycerides, though they are healthy for other reasons. The higher the intake of omega-3 fatty acids from fish oil, the greater the triglyceride reduction.9 The effect begins at an EPA + DHA daily intake of 1000 mg (not the dose of fish oil, but of EPA + DHA), with very substantial effects at 3000 mg EPA + DHA per day and higher. Higher doses are best taken with the assistance of your health professional.
When taken as a nutritional supplement, the best fish oil comes in the same form as it occurs in fish: the triglyceride form, i.e., all three fatty acids attached to a glycerol backbone, not the more common ethyl ester form (with each fatty acid removed), since the triglyceride form is better absorbed (especially the DHA component).10 Most capsule forms of fish oil from health food and big box stores are in the ethyl ester form, as is the prescription form of fish oil. You also want to be sure that your fish oil comes least oxidized and free of contaminants as possible, such as mercury, PCBs, and anisidine. Very few fish oils meet these strict criteria. Ascenta’s NutraSea is among the few choices that meet, even exceed, these stringent demands. It is my first choice for my patients.
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