Triglycerides, Mistreated and Misunderstood: Learn Why

What is a desirable level for triglycerides?

It depends on who you ask.

Ask those adhering to the Adult Treatment Panel (ATP-III), the “official” set of guidelines followed by most primary care physicians, and they will say “150 mg/dl.”

Ask those of us trying to achieve reversal of coronary heart disease, and we would say...“60 mg/dl or less.”

Why such a discrepancy? Which is closer to the “truth”?

The ATP-III guidelines are principally focused on cholesterol issues, particularly LDL. The guidelines provide the answer to what levels of LDL to achieve in different risk groups. If you read the full-text of the ATP-III guidelines, you will quickly recognize that triglycerides are treated almost as an afterthought, something to mention just in case LDL reduction proves insufficient (which it nearly always does, in my experience). 150 mg/dl is, therefore, a somewhat arbitrary level that is regarded as a “secondary goal” after LDL reduction is achieved.

But I believe that’s wrong.

I choose 60 mg/dl for triglycerides because that’s the level that minimizes the presence of triglyceride-containing undesirable lipoproteins like small LDL (the number one cause for heart disease in the U.S.!), VLDL, and the after-eating persistence of intermediate-density lipoprotein (IDL), a bad player in heart disease and stroke that underlie the causes of atherosclerotic plaque.

Obviously, this triglyceride target is far below that of the conventional guidelines. In my view, a level of 150 mg/dl is highly abnormal, permitting the persistence of multiple lipoprotein particles and virtually guarantees plaque growth in the coronary (heart), carotid (neck) and other arteries. In short, triglycerides of 150 are awful.

Conventional wisdom also dictates that a low-fat diet that reduced saturated fats, excess oils from olives, nuts, and meats, will reduce triglycerides. My response: absolute nonsense.

The reality is that while a low-fat diet may reduce triglycerides modestly, it often, in fact, increases triglycerides. That’s because a low-fat diet typically becomes a carbohydrate-rich diet. Any diet that increases the sugar load to your body increases triglycerides . . . enormously. But you won’t find that buried in the conventional advice, no matter how deep you dig.

Reduce carbohydrates and triglycerides drop. This simple fact was most recently observed in the DIRECT Trial comparing low-carb vs. Mediterranean diet vs. low-fat diet: triglycerides were most effectively reduced by a low-carb diet (the Atkins’ diet, in this instance): triglyceride reduction of 23.7 mg/dl on low-carb vs. 3.7 mg/dl on low-fat. Larger triglyceride reductions of 40, 50, or more mg/dl are not unusual, in my experience.

Strategies for reducing triglycerides - for real

If genuinely powerful triglyceride-reducing effects are needed, then here are several ways to get started, strategies that pack far more power than the ineffective standard advice to “reduce fats”: