Optimizing Your Triglycerides
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Optimizing Your Triglycerides

Many authorities now advise more aggressive treatment of high triglycerides. Here is a rundown on these blood fats and why optimizing them is important for your health.

What Are Triglycerides?

Triglycerides are the major fats in foods. They have a backbone consisting of a glycerol molecule to which three fatty acid molecules are attached. All glycerol molecules are the same, but the fatty acids may vary greatly. The types of fatty acids that are attached to the triglyceride determine whether it is a saturated, trans, monounsaturated, or polyunsaturated fat.

When you eat any type of fat, it passes through your stomach and is digested and absorbed in your small intestines. From there it is sent to your liver for processing and shipping throughout your body. Your body can also make triglycerides from excess carbohydrates.

The liver packages fat into very-low-density lipoproteins (VLDLs), which are molecules made of protein and fat, but are mainly composed of triglycerides.

Next, VLDLs travel through your bloodstream to unload fat, depositing most of the triglycerides in fat cells for storage. Once unloaded, the VLDLs become low-density lipoproteins (LDLs)—mainly made of "bad" cholesterol, which in excess can cause arterial plaque.

Another type of blood fat called high-density lipoprotein (HDL, or "good" cholesterol) takes your body's unwanted cholesterol back to the liver where it is excreted or used to make more VLDLs.

Importance for Health

Having too much triglyceride in your blood—usually attached to a VLDL molecule—can adversely affect your health in several ways. Extremely high triglyceride levels can trigger an attack of pancreatitis. Pancreatitis is the inflammation of the pancreas, an abdominal organ that secretes digestive enzymes.

Research has also identified high triglycerides as an important risk factor for cardiovascular diseases such as heart attack, stroke, or hardening of the arteries. Though the data are not as well established as for high cholesterol, it's a huge issue since coronary heart disease causes over 450,000 deaths each year and is the single leading cause of death in the US.

Desirable Range

Based on growing evidence linking high blood triglycerides to heart disease, in 2001 the National Cholesterol Education Program (NCEP) lowered the acceptable limit in its guidelines. NCEP says all adults aged 20 or older should have a fasting blood fat profile at least once every five years. (This is a simple blood test).

Once you've gotten your results, you can compare your triglyceride score with what experts have to say about these values:

Triglyceride Level
(milligrams/deciliter [mg/d])
Classification
less than 150Normal
150-199Borderline high
200-499High
500 and greaterVery high

Risk Factors for High Triglycerides

If your triglyceride level is not normal, you and your doctor may want to search for a treatable cause. Factors that can increase your risk of high triglycerides include:

  • Sex—Men are more susceptible than women. After menopause, a woman's risk increases.
  • Age—The risk of high triglycerides increases with age.
  • Genetic disorders, including a family history of high triglycerides or diabetes
  • Lifestyle factors such as:
    • Physical inactivity
    • Overweight or obesity
    • High carbohydrate intake (over 60% of total calories)
    • Excess alcohol intake
    • Smoking
  • Medical disorders such as:
  • Certain drugs such as:
    • Cortisone drugs
    • Estrogens
    • Retinoids
    • Beta-blockers and diuretics

Lifestyle Therapy

Treatment for abnormal triglyceride levels usually involves lifestyle changes. The American Heart Association recommends a diet that is low in saturated fat. However, it's important not to overly restrict total fat (25%-35% of total calories is about right), because a very low-fat, high-carbohydrate diet can actually raise your triglycerides.

Most saturated fat should be replaced with healthful monounsaturated and polyunsaturated fats. Increasing one’s intake of omega-3 fatty acids is especially important. Omega-3 fatty acids are polyunsaturated fats found in fatty fish (such as salmon, mackerel, herring, sardines, trout, and tuna) and certain plant sources, including flax seeds, canola oil, and walnut oil.

Research shows that taking fish oil capsules can help lower triglyceride levels, as well as reducing other cardiovascular risk factors. This is welcome news since eating the recommended two or more servings of fatty fish per week isn’t always possible, especially given the concerns surrounding mercury.

The American Heart Association recommends that individuals with high triglyceride levels consume 2-4 grams of omega-3 fatty acids in the form of fish oil capsules daily. It’s important to note that fish oil capsules should be viewed as medication and only taken under the care of a physician.

Weight loss—often as little as 5-10 pounds—also helps lower your triglyceride levels, as can limiting alcohol intake, quitting smoking, and getting regular, moderate exercise. If you are already at risk for heart disease, talk with your doctor before starting an exercise program.

Drug Therapy

When lifestyle measures fail to control triglyceride levels, your doctor may recommend lowering your triglycerides with the help of medication. Drug treatment may also be advised if you have diabetes or another chronic disease associated with coronary artery disease. In addition to fish oil capsules, medications such as nicotinic acid, resins, fibric acid, or statins can be used to help optimize your triglycerides.

RESOURCES

American Heart Association
http://www.americanheart.org

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/

CANADIAN RESOURCES

Healthy Canadians
http://www.healthycanadians.gc.ca

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca

References:

American Dietetic Association. Disorders of lipid metabolism evidence-based nutrition practice guideline. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/summary/summary.aspx?view_id=1doc_id=9533. Accessed February 26, 2008.

Arteriosclerosis, thrombosis, and vascular biology. American Heart Association website. Available at: http://atvb.ahajournals.org/content/vol25/issue2/. Accessed February 26, 2008.

Capell WH, Eckel RH. Treatment of hypertriglyceridemia. Curr Diab Rep. 2006;6:230-240.

Cholesterol treatment guidelines update. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20020301/871.html. Accessed February 26, 2008.

Clinical application of ATP III guidelines. Lipid Management. Fall 2001.

Essential fatty acids. Linus Pauling Institute website. Available at: http://lpi.oregonstate.edu/infocenter/othernuts/omega3fa/. Accessed February 26, 2008.

Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.

Fish and omega-3 fatty acids. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4632. Accessed February 26, 2008.

Hypertriglyceridemia. EBSCO Dynamed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed February 26, 2008.

Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: National Academies Press; 2002. National Academies Press website. Available at: http://www.nap.edu/openbook.php?isbn=0309085373. Accessed February 26, 2008.

Lauer MS, Fontanarosa PB. Updated guidelines for cholesterol management (editorial). JAMA. 2001;285:2508-2509.

Oh RC, Lanier JB. Management of hypertriglyceridemia. Am Fam Physician. 2007;75:1365-1371.



Last reviewed June 2008 by Dianne Scheinberg MS, RD, LDN

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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