By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Patients usually seek medical attention regarding their cardiac risk when lab tests show their total cholesterol, triglycerides, or blood sugar levels to be high. Most people know a bit about cholesterol (enough to be often frightened by mere mention of the word) and blood sugar. However, most people are left wondering, “what are triglycerides?”.
Triglycerides are the most common type of fat found in your body. They come primarily from the carbohydrates – the calorie sources − that you eat. Triglycerides are carried in the bloodstream and distributed to tissues for energy. When you consume an excess of calories from carbohydrates, sugar, and even alcohol; your body stores those triglycerides as fat when their metabolism is insufficient. Abnormally elevated levels of triglycerides in the blood are indicative of an increased risk of inflammation, atherosclerosis, and diabetes.
Healthy Triglyceride Levels
Triglycerides have a close relationship with HDL cholesterol, a protective form of cholesterol produced by your body. HDL plays an important role in removing the oxidized LDL cholesterol particles that are involved in inflammation and arterial disease. When your doctor does a blood test, one of the important things he or she checks is the triglyceride-to-HDL ratio. A ratio takes into account the respective levels of two items in proportion to one another. The triglyceride/HDL ratio reflects how much pro-inflammatory triglyceride particles are being balanced out by protective HDL cholesterol particles. A low ratio between triglycerides and HDL is best because it indicates less risk of inflammation and cardiovascular disease. The best triglyceride/HDL ratio is 1 to 1 or 1:1 which can be “bottom-lined” and expressed simply as “1”. This essentially means you have equal parts of triglyceride and HDL – an exceptional balance.
When it comes to HDL – a higher level is better. However, HDL levels rarely go above 100mg/dL, and if they do, it usually indicates something dysfunctional. Healthy triglyceride levels are in the 50-150 range and HDL in the 50 to 75 zone. A ratio less than 2 is ideal, and less than 3 is still satisfactory.
I get a little concerned with triglyceride/HDL ratios over 3, and more concerned when the ratio is 5:1, which, unfortunately, is very common. Over the years, I’ve seen some seriously imbalanced ratios, such as a 300 triglyceride level, with an HDL of only 30 (a ratio of 10:1, or 10). As expected, this high triglyceride/HDL ratio was a reflection of serious arterial inflammation and disease. Commonly, I would see patients with metabolic syndrome and diabetes who had dangerously high ratios of 7:1 to 10:1 (or 7-10).
Triglycerides and the Metabolic Syndrome-Diabetes Connection
Also known as insulin resistance, metabolic syndrome is a condition that increases the risk of coronary artery disease, stroke, and diabetes. Some 20-25 million Americans are insulin resistant. This sneaky pre-diabetic condition does not generate overt symptoms. However, underneath the radar of detection, the cells of the body are no longer responding normally to insulin, the hormone produced by the pancreas that brings blood sugar (glucose) and triglycerides into the cells to be used for energy. When this process starts failing, the pancreas compensates by releasing more insulin. Unfortunately, the cell membranes no longer respond appropriately to those insulin surges, and the insulin becomes ineffective. Eventually, glucose and triglycerides are unable to permeate the cell membrane to enter the cells efficiently, and they start building up in the circulation. The end result is higher blood sugar and triglyceride levels in the blood, as well as the development of diabetes – which has a serious association with arterial inflammation and cardiovascular disease.
You likely have metabolic syndrome if you have the following:
- A Triglyceride level over 180mg/dL
- HDL under 40 (men) and 50 (women)
- A large waist circumference: over 35 inches in a woman and 40 in a man
- Elevated fasting blood sugar (FBS): over 100 mg/dl
- Elevated blood pressure of 130/85 or greater
In clinical practice, I often saw dangerously high triglyceride/HDL ratios in overweight women. A high triglyceride level is much more dangerous for women than it is for men. If you are a diabetic, overweight woman with high triglycerides, your risk of developing heart disease is actually 200 times greater than someone without these factors! A typical case like this might be someone following a strict low-fat diet, thinking that it will help them lose weight. As I have written before, many low-fat foods contain sweeteners and carbohydrates that ramp up the triglyceride level, as well as the body weight. The low-fat diet has turned out to be dietary folly.
What to Do About High Triglycerides
If you have high triglycerides and a poor triglyceride/HDL ratio, here’s my advice:
Switch to eating the PAMM diet. This is a style of eating that I developed based upon the unprocessed, vibrant, nutrient packed staples of traditional Mediterranean and Asian diets. The PAMM diet consists of 40-45 percent carbohydrates from fruits, vegetables, and whole grains (my favorites are gluten-free, non-genetically engineered quinoa, amaranth, and buckwheat); 20-25 percent protein from eggs, poultry, and beans; and 35 to 40 percent healthy fats from fish (such as wild salmon), nuts, avocado, and extra-virgin olive oil.
Keep your carb intake to a minimum. You need to be smart and disciplined when it comes to carbohydrates because they fuel heightened triglycerides. Stay far away from the typical refined carbohydrates that many people overeat, such as rice, pasta, potatoes, corn, carrots, peas, bread, crackers, cookies, cakes, and bagels. And as always, avoid sugar and sweets as much as possible because they fan the flames of inflammation in addition to increasing triglycerides. Remember, sugar consumption is the number one risk factor for developing heart disease – NOT cholesterol.
Cut down on alcohol.
Physical activity is a must. Keep it simple and enjoyable, but make sure it gets done. Try to walk a mile a day and as briskly as you can.
Consider three nutritional supplements that can be quite helpful:
1. Omega-3 fatty acids – are best sourced from fish or squid oil which have been proven to reduce triglycerides and raise HDL. I recommend taking 2 grams daily.
2. Bergamonte extract – is a lesser known substance derived from an orange that grows in the Calabria area of Italy; it has the same properties with the added ability to lower blood sugar.
3. Magnesium – can bring down the triglyceride level, a direct effect I’ve observed in my patients many times. This important mineral is involved in some 300 enzymatic processes in the body, including an enzyme called lipoprotein lipase. The enzyme breaks down circulating triglycerides into fatty acids for tissue use and helps form beneficial HDL cholesterol. Take about 400-600 milligrams daily in divided doses. It is best to start with a level of 100 or 200 milligrams and increase your doses over time. I like the magnesium glycinate or citrate forms of magnesium. An additional benefit of magnesium is that it can often naturally relieve constipation.
Triglycerides are big players when it comes to heart health and the inflammatory process in the body. Arm yourself with this knowledge and employ changes in lifestyle, diet, and exercise to help you get your healthy triglyceride levels (and keep them).
- Pyung CO, et al. Omega-3 fatty acid therapy dose-dependently and significantly decreased triglycerides and improved flow-mediated dilation, however, did not significantly improve insulin sensitivity in patients with hypertriglyceridemia. International Journal of Cardiology, 2014; published online at http://www.internationaljournalofcardiology.com/article/S0167-5273(14)01285-6/fulltext
- Mollace V, et al. Hypolipemic and hypoglycaemic activity of bergamot polyphenols: From animal models to human studies.Fitoterapia, 2010; published online at http://www.sciencedirect.com/science/article/pii/S0367326X10002777
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