Patients often ask “What are triglycerides and how can they harm our health?”
In this article, I’m going to answer these questions. I’ll clarify a few things about triglycerides and explain the best ways to reduce blood triglyceride levels, with an emphasis on nutrition and lifestyle changes.
What are triglycerides made of (the chemistry)?
It’s important to first understand the chemical structure of this lipid (fat).
Three fatty acid molecules and a molecule of glycerol form triglycerides.
Triglycerides deliver the most amount of energy derived by fat to our body.
Burning of one gram of fat produces about 9 kcal/g of energy which is almost double the energy produced by burning one gram of carbohydrates (4 kcal/g).
What is the normal range for triglycerides?
Most guidelines recommend keeping the blood triglyceride level below 150 mg/dl.
Blood triglyceride level needs to be checked in a fasting state because eating food could affect the level almost immediately.
It’s suggested to fast for 8 hours prior to the blood work–you can drink plain water but no food.
Causes of high triglycerides
The triglyceride level can increase because of any of the following:
Increase in carbohydrate intake
Increase in fatty food intake
Weight gain
Hypothyroidism
Liver cirrhosis
Uncontrolled diabetes
Alcohol intake
Physical inactivity
Impaired metabolism
Medications
Genetic diseases
How to lower triglycerides
In my opinion, the most important information in managing and treating elevated blood triglyceride levels is to identify the cause of this elevation.
We know that increased carbohydrate intake can raise triglyceride levels. Therefore, the most important management in this case would be to limit the carbohydrate intake including: bread, rice, potatoes, noodles and sweets.
Alcohol can raise the blood triglyceride level.
In general, alcohol intake should be limited to two glasses per day for men and one glass for women. Anything more than that could elevate the blood triglyceride level.
Weight loss
Losing 5 to 10% of a person’s body weight could result in a reduction of the blood triglyceride level by almost 20%.
Therefore, in overweight and obese patients, weight loss can be helpful.
Any weight loss program should be based on healthy lifestyle changes under supervision of your doctor.
There are many ways you could lose weight. However, not all of them are healthy and can be maintained for a long time.
Diet and nutrition
Limiting the intake of saturated and trans fats will also help with reducing the blood triglyceride levels.
Restricting fatty food intake will often limit the carbohydrate intake as well.
For example, reducing the consumption of cakes, cookies, frosties, popcorn, chips and pastries could also reduce blood lipid levels.
It’s recommended to replace saturated fats with monounsaturated and polyunsaturated fats found in canola oil and olive oil.
Fiber
Eating fiber, vegetables and fruits could help in managing this condition.
Most experts recommend eating approximately 25 grams of fiber daily. Fiber can bind to fat and prevent the absorption of these molecules.
Physical activity
Physical inactivity is a common problem in our society. Most people have limited physical activity. They spend most of their time glued to their computers and TVs.
This is especially true for younger people who have grown up with games and are affected by these changes the most.
Physical inactivity can result in impaired metabolism, weight gain and elevated blood sugar and triglyceride levels.
2008 Physical activity guidelines for Americans recommend 150 minutes per week of moderate intensity exercise. Examples for moderate-intensity exercises are,
Brisk walking
Dancing
Gardening
House work
The most efficient way to lower blood triglycerides
We’ve discussed different ways to reduce blood triglyceride levels.
I now want to give you an important tip that can significantly help you in improving this condition.
An effective and simple way to help with this condition is to reduce the consumption of added sugars through mostly processed foods.
You should avoid adding sugar to your tea and coffee.
You should also stop drinking soda and eating cookies and candies.
Fruit juice- I’m not a fan
It might sound strange to you, but I’m totally against drinking juices.
You might be wondering why? Let me explain why juices are bad for you.
Your favorite fruit juice may be called “natural” and labeled “with no added sugar”. However, this juice still contains a large amount of fructose, which is a natural sugar.
That’s why you shouldn’t think that fruit juice is totally benign and completely beneficial to your health.
Although it’s better than eating cake, but I would still limit the consumption of juices.
You should also be cautious about eating fruit yogurt, jellies and drinking sweet milk
Medications that could increase blood triglyceride levels
1) Hydrochlorothiazide
This is a blood pressure lowering medication that belongs to the family of diuretics (water pills). Hydrochlorothiazide can increase blood triglycerides and blood sugar levels. This medication might also increase the uric acid level in the blood.
2) Beta blockers
These medications can lower blood pressure and heart rate.
Routinely, the patients who suffer a heart attack or an episode of tachycardia (fast heart rate) receive metoprolol or atenolol.
This class of medication could also increase triglycerides, in addition to blood sugar levels.
3) Steroids
These drugs reduce inflammation, for instance in patients with moderate-to-severe asthma, rheumatoid arthritis and patients with obstructive lung disease (COPD).
Steroids similar to hydrochlorothiazide and beta blockers can also increase blood triglycerides, in addition to blood sugar levels.
4) Anti-psychotics
Older anti-psychotics are notorious for causing weight gain and elevating the blood triglycerides level. The most commonly known anti-psychotics are:
Risperidone.
Olanzapine.
Quetiapine.
Ziprasidone.
Aripiprazole.
5) Retinoid acid
This medication treats severe acne and it’s a metabolite of retinol (vitamin A).
6) Estrogen
Most contraceptives contain estrogen. In women, this hormone regulates reproductive and sexual development. Estrogen can treat hot flashes in post-menopausal women as well.
7) HIV medications
The FDA has approved several protease inhibitors for treatment of the HIV infection.
This class of medications can increase the blood triglyceride levels and result in hyperlipidemia. The list of protease Inhibitors is as follow,
atazanavir (Reyataz)
darunavir (Prezista)
fosamprenavir (Lexiva)
indinavir (Crixivan)
lopinavir/ritonavir (Kaletra)
nelfinavir (Viracept)
ritonavir (Norvir)
saquinavir (Invirase)
tipranavir (Aptivus)
tazanavir/cobicistat (Evotaz)
darunavir/cobicistat (Prezcobix)
Medications and supplements that could decrease blood triglycerides
Sometimes dietary changes and increased exercise can’t decrease blood triglyceride levels and drug therapy might be necessary. This is because very high blood triglyceride levels could cause pancreatitis requiring hospitalization.
Fish oil can decrease blood triglyceride levels and manage mild forms of this condition.
Omega-3 fatty acids
Fish oil contains Omega-3, DHA and EPA. Omega-3 fatty acids are essential to the body and it means that your body can’t produce this product.
The most common way to obtain a sufficient amount of omega-3 is by eating fish.
Other sources of Omega-3:
Salmon
Tuna
Halibut
Algaea
Krill oil
Nut oil
Another essential oil is omega-6. There is some data that suggests that omega-6 could increase inflammation. In contrast, omega-3 shown to reduce inflammation.
Several studies have suggested that taking three to four grams of Omega-3 fatty acids daily could reduce blood triglyceride levels by about 30%.
Getting a sufficient amount of Omega-3 through food is preferred over taking supplements.
You should consume fish with a high amount of omega-3 fatty acids, as mentioned above, at least three times per week.
Insulin resistance and elevated triglyceride level
Most of the patients with insulin resistance or “lazy metabolism”, have elevated blood triglyceride levels as well.
This elevation is one of the major components of metabolic syndrome that increases the risk for heart attack and stroke.
Patients with at least three of the following abnormalities have metabolic syndrome.
Elevated blood pressure
Low good cholesterol (HDL) level
Elevated blood triglyceride level
Elevated blood sugar level
Increased abdomen circumference
Individuals with Metabolic Syndrome have two times greater risk of suffering a heart attack or stroke and a five time greater risk of developing type 2 diabetes.
The number of individuals diagnosed with insulin resistance is continuing to grow as indicated by the worldwide obesity epidemic.
In this article, I’ve tried to answer the questions: “what are triglycerides?, how they could harm you and how to lower their blood levels.
I was just able to scratch the surface and our discussion is going to continue.
Last but not least…
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Keep reading and learning
H. Leon Daneschvar, MD
