The Non-Medicated Life:
Managing Triglycerides

Editor's Note: This is the 26th in a series on optimal diet and lifestyle to help prevent and treat heart disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.

Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individual taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death.

In the first 25 installments of The Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications. This is especially true for the management of triglycerides, which are a type of blood fat that when elevated may increase the risk of heart attack, stroke, and inflammation of the pancreas.

Most people haven’t the foggiest notion of what triglycerides are and fewer still appreciate how important they are to proper health. Triglycerides, however, are not only extremely important to optimal cardiovascular health; they are also the blood fats most amenable to treatment using a non-medicated approach.

Let’s start therefore with a description of just what are triglycerides.

To put it most simply, triglycerides are the storage form of fat. To put it, perhaps, more graphically, that portion of one’s abdomen which hangs over one’s belt is composed largely of triglycerides. Three fatty acids – thus the tri – are connected to a glycerol molecule to result in nine kilocalories per gram of stored energy.

Normally triglycerides rapidly rise in the blood after a meal and then fall slowly over the subsequent 12 hours. Thus knowing the number of hours after the last meal is essential to interpreting the triglyceride level. For simplicity, blood is best drawn in the fasting state 12 hours after the last meal. This puts everyone on the same playing field and allows the physician to decide if there is an unhealthy elevation.

Fasting triglyceride levels are considered healthy if they are less than 150 milligrams per deciliter. Generally there is no lower limit which is unhealthy and there is increasing evidence that triglyceride levels above 70 milligrams per deciliter are probably not optimal.

In a number of studies triglyceride elevations are independently associated with increased cardiovascular risk.

This may be because triglyceride elevations are associated with blood fat particles which themselves cause cholesterol plaques. It may also be a result of the changes triglycerides cause in the size and number of LDL or ‘bad’ cholesterol particles and the HDL or ‘good’ cholesterol particles. Triglycerides cause the LDL particles to become smaller and actually penetrate more easily into the artery wall to from a cholesterol plaque. Triglycerides also cause the HDL particles to become smaller and they are thus more likely to be cleared from the circulation by the kidney.

Generally, the higher the HDL level, the better. HDL particles protect against the formation of cholesterol plaque because they go to existing plaque pick up LDL and bring it back to the liver in a process called reverse cholesterol transport.

Fasting triglyceride levels greater than 500 milligrams per deciliter are of immediate concern as they may cause inflammation of the pancreas. Such an inflammation, called acute pancreatitis, generally causes severe abdominal pain radiating to the back. It is a serious condition which requires hospitalization and may even be life threatening. Fasting triglycerides between 200 and 500 milligrams per deciliter increase cardiovascular risk as noted above and on the basis of national guideline recommendations may require medication.

Medications themselves may increase triglycerides. Thus avoidance of oral estrogen medication in favor of an estrogen patch or discontinuation of estrogen will generally lower triglycerides. Medication used to treat elevated triglycerides may include niacin, drugs called fibric acid derivatives, and sometimes drugs called statins. Omega-3 fish oil has also been used to treat elevated triglycerides, although the amount needed may be 4,000 to 12,000 milligrams per day, and should only be done under the guidance of a physician.

It is reassuring to know, however, that triglycerides may effectively be treated with a non-medicated approach.

• Avoiding alcohol in excess may dramatically lower triglycerides. Reductions of 30 to 50 percent or more may be realized.
• Weight loss may dramatically lower triglycerides. Even if an individual is 50 to 60 pounds or more above their ideal body weight, a weight loss of 20 to 25 pounds may decrease the triglycerides by 40 to 50 percent. Lesser amounts of weight loss may also be helpful.
• Exercise may effectively lower triglycerides, even in the absence of weight loss. A daily aerobic exercise such as brisk walking may lower triglycerides up to 25 to 30 percent. Finally, reducing carbohydrates – starches or sugars – in the diet may decrease triglycerides even when total calories are not altered.

In summary, triglycerides are an important blood fat which when lowered may decrease the risk for heart attacks, strokes and pancreatitis. Moreover, triglycerides, of all blood fats, are most amenable to treatment with a diet and lifestyle approach. Low carbohydrate consumption, avoidance of excess alcohol, weight loss, and exercise may decrease triglycerides substantially even to the point of making the use of medication unnecessary.

Center for Preventive Medicine & Cardiovascular Health

at Mid-Valley Cardiology 111 Mary's Ave. Suite 3 Kingston, NY 845-339-3663

Main Office 400 Patroon Creek Blvd. Albany, NY 518-618-1100

at Glens Falls Associates in Cardiology 747 Upper Glen St. Queensbury, NY 518-793-1083