In my last post, I discussed how, in my program for reversal of heart disease, we follow what I call the "Rule of 60": LDL 60 mg/dl, HDL 60 mg/dl, triglycerides 60 mg/dl, or 60:60:60.
We do this in order to achieve greater control over heart disease risk. Achieving these values also, interestingly, is associated with improved metabolic responses, such as those involving insulin, sugar, and inflammatory patterns. As often as possible, I also like to see people achieve these numbers using little or no medication.
A triglyceride target of 60 mg/dl is based on studies that have shown dramatic reduction of abnormal lipoprotein particles in the blood, such as small LDL particles (the number one cause of heart disease in the U.S.).
Of course, a triglyceride level of 60 mg/dl sis far below that advised by conventional guidelines. The Adult Treatment Panel-III of the National Cholesterol Education Panel suggests that a triglyceride level of 150 mg/dl is the desired target. However, in my experience, a level of 150 mg/dl is highly abnormal, associated with the presence of multiple abnormal lipoprotein particles, unhealthy metabolic responses, poor dietary habits, and virtually guarantees growth of coronary plaque that leads to heart attack. In short, triglycerides of 150 are awful.
The question I'd like to consider more closely here is:How can triglycerides of 60 mg/dl or less be achieved?
Omega-3 fatty acids from f ish oil****. Omega-3 fatty acids from fish oil are the number one most potent treatment for reducing triglycerides. Curiously, many people are very timid when it comes to supplementing fish oil. I remind people that several capsules of fish oil are no more dangerous than eating a serving of salmon.
The dose of fish oil can be adjusted by looking at the content of EPA and DHA, the omega-3 fatty acids, in each capsule of fish oil. Typically, low-potency preparations will contain 180 mg EPA, 120 mg DHA per capsule. Higher potency (though more costly) preparations contain greater quantities. For basic heart disease prevention, I advocate 1200 mg total EPA + DHA per day. However, I commonly go much higher than this to achieve further reduction in triglycerides. (Higher doses are best managed with the help of your doctor.) I do not believe that the prescription form provides any advantage over the forms you and I can buy without a prescription.
Reduction of high-glycemic index foods. Most notably wheat, cornstarch, and sugars. Everybody knows that we shouldn't eat Snickers ® bars or bags of jelly beans. But many people eat plenty of wheat-containing breads, pastas, pretzels, crackers, breakfast cereals, tacos, tortillas, etc., all in the name of increasing whole grains and fiber. In reality, they cause triglycerides to skyrocket, not uncommonly exceeding 200, 300, or 400 mg/dl. Surges in triglycerides are accompanied by a drop in HDL, creation of small LDL, increasing blood sugar and blood pressure, and increasing obesity. In fact, I advocate wheat and cornstarch elimination in many people, which results in marked reductions in triglycerides along with weight loss, increased energy, and deeper sleep.
Eliminating fructose and high-fructose corn syrup. This ubiquitous sweetener is now consumed in enormous quantities by the average American, nearly 80 lbs per year per person. You'll find it in soft drinks, ketchup, beer, breads, breakfast cereals, and many other processed foods. You'll find none in green peppers, cucumbers, and raw nuts. Fructose triggers large rises in triglycerides, as well as diabetic patterns. Don't let "fat-free" claims fool you; these are often fructose-containing foods, with fructose among the most plentiful ingredients. Sadly, honey is rich in fructose, as are fruits, so don't overdo either, even though they fall into the "healthy" category in many people's minds.
Vitamin D. I am a fanatic for correcting vitamin D deficiency in people. Having now corrected vitamin D blood levels in over 1000 patients for up to three years, I am nothing but thoroughly impressed with the range of wonderful benefits that develop, such as reduced blood sugar, increased bone density, gradual relief from arthritis, elimination of winter "blues," and many others. Among the rarely appreciated benefits of vitamin D is a reduction in triglycerides. I am uncertain why this develops, but I suspect that at least part of the effect arises from vitamin D's ability to normalize reduce blood sugar and insulin responses, both of which help reduce triglycerides.
Curious thing: Successful participants in our program, i.e., people who achieve desirable weight, reduce processed carbohydrate junk foods and saturated fat sources, and aim for the 60-60-60 targets for conventional lipids, commonly end up with triglyceride levels of 25-50 mg/dl.