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":
Reduction of high-glycemic index foods
Most notably snacks and . . . wheat.
Everybody knows that we shouldn’t eat Snickers bars or bags of licorice.
But many people eat plenty of wheat-containing breads, pastas, pretzels, crackers, breakfast cereals, etc., all in the name of increasing whole grains and fiber. In reality, they cause triglycerides to skyrocket, dropping HDL, forming small LDL, increasing blood sugar and blood pressure, and increasing obesity. Backtrack on this advice, add back calories from healthy oils (olive, canola, flaxseed, walnut) and raw nuts, and triglycerides drop.
The omega-3 fatty acids from fish oil are a mainstay of triglyceride-reducing treatment. Omega-3 fatty acids are the number one most potent treatment for high triglycerides. Triglyceride-reducing effects begin at a combined EPA + DHA (omega-3 fatty acids) dose of 1200 mg per day.
Eliminate 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. (Imagine sixteen 5-lb bags of sugar.)
You’ll find high-fructose corn syrup in a shocking number of processed foods, including soft drinks, fruit drinks, ketchup, beer, breads, breakfast cereals, and salad dressings. You’ll find none in green peppers, cucumbers, and raw nuts. Fructose causes large increases in triglycerides, as well as diabetic patterns. Don’t let “fat-free” claims fool you: It often means that the fat has been replaced by high-fructose corn syrup.
Here are the ingredients in a popular fat-free salad dressing, for example:
Ingredients: Water, Vinegar, High Fructose Corn Syrup, Corn Syrup, Salt, Parmesan Cheese, Part-Skim Milk, Cheese Culture, Salt, Enzymes, Contains less than 2% of Garlic, Whey, Onion Juice, Autolyzed Yeast Extract, Phosphoric Acid, Worcestershire Sauce, Vinegar, Molasses, Corn Syrup, Water, Salt, Caramel Color, Dried Garlic, Sugar ,Spices, Tamarind, Natural Flavors, Hydrolyzed Soy Protein, Xanthan Gum, Potassium Sorbate and Calcium Disodium EDTA as Preservatives, Dried Garlic, Buttermilk, Spice, Dried Parsley, Caramel Color, Sodium Phosphate, Oleoresin Paprika.
This low-fat or "lite" salad dressing is, in effect, water, vinegar, and corn syrup. It will skyrocket your triglycerides.
While a couple of drinks a day raises HDL, exerts anti-inflammatory effects, and reduces blood pressure, more than this begins to raise triglycerides. Increases of hundreds of milligrams/dl can occur with several drinks per day.
Beer, in particular, raises triglycerides more than wine or other alcoholic beverages. Could it be the wheat source of beer? Or the high-fructose corn syrup? Or both? I don’t know, but beer is the least desirable form of alcohol of the choices we have.
Following these simple steps, it is unusual in my experience that you cannot achieve a triglyceride level <60 mg/dl, particularly if you also reduce weight through your carbohydrate reduction. Rarely do we need to add fibrate drugs or other prescription agents to reduce triglycerides.
Curious thing: Successful participants in our program of heart disease reversal, 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 (cholesterol values), commonly end up with triglyceride levels of 25-50 mg/dl. We have witnessed many people reverse heart disease, in fact, just by achieving a triglyceride level of 60 mg/dl or less.
William R. Davis is a Milwaukee-based American cardiologist and author. He wrote for HealthCentral as a health professional for Heart Health and High Cholesterol.