Do Bad Habits Drive Up Your Triglycerides?

Everybody knows about the dangers of high cholesterol. While it is not precisely accurate that cholesterol clogs arteries and the type of cholesterol that is actually dangerous is almost never measured by doctors, the reality is that cholesterol and inflammation together are a major factor in cardiovascular disease.

Almost nobody knows about the dangers of high triglycerides. There are no billion-dollar blockbuster drugs for treating high triglycerides, no advertising campaigns warning us all of the dangers of high triglycerides, and our doctors aren't going to get kickbacks from pharmaceutical sales people for keeping our triglyceride levels low. The reason many people have heart attacks and strokes even when their cholesterol numbers are "perfect," however, usually has a lot to do with excessive levels of triglycerides.

What Are Triglycerides?

Triglycerides are the body's main way of storing unused calories. A triglyceride is a chemical combination of glycerol, which the body manufactures from carbohydrates, and fatty acids, which the body releases from fat. Triglycerides can be broken down to release glycerol so the body can make glucose to fuel the brain, or into fatty acids to fuel the muscles.

The small intestine breaks down triglycerides in food so they can be repackaged with cholesterol before they enter the bloodstream. These bundles of cholesterol, triglycerides, and a protein "balloon" containing them to make them soluble in the watery blood plasma are known as chylomicrons. 

It's accurate to think of chylomicrons as really big chunks of cholesterol and fat. Chylomicrons are so large, in fact, they don't get stuck in the linings of arteries. Some chylomicrons are used by muscles for quick energy, and others are broken down in the liver into slightly smaller chunks of mostly-cholesterol, especially very-low density lipoprotein or VLDL cholesterol.

When Are High Triglycerides a Problem?

There is a general misconception that high triglycerides do not contribute to the artery-clogging process known as atherosclerosis. Actually, they do. If you have normal cholesterol but high triglycerides, you still have a similar risk of atherosclerosis. You're just a lot less likely to do anything about it.

The way triglycerides increase the risk of heart disease has to do with the fact that chylomicrons are not completely consumed as they pass through the bloodstream. They give up more glycerol (the sugar-derived portion) than cholesterol. The cholesterol left behind in a chylomicron may be processed by the liver into small bits of cholesterol known as high-density lipoprotein or HDL cholesterol, or it may be absorbed by "foam cells" from the immune system lining the arteries. When triglycerides are absorbed into foam cells, they are just as dangerous as cholesterol.

Of course, if your immune system has not activated foam cells in the lining of your arteries, you don't get atherosclerosis. That is the reason why people who have high triglycerides or high cholesterol sometimes do not get heart disease, and people who have normal triglycerides or normal cholesterol sometimes do. 

Lifestyle Changes To Lower Triglycerides

If you have high triglycerides, however, you need to get them under control. Fortunately, that is not a hard thing to do.

First Step: Eat less or exercise more (but if you rely on exercise, you have to exercise a lot more).

The important thing to remember about triglycerides is that they are the storage form of excess calories. If you do not consume excess calories, your body will not store them. 

Since triglycerides are essentially a combination of "fat" and "sugar," cutting down on either fat or sugar as you lower your total calorie consumption will help. So will weight-loss dieting. It is not the loss of weight that lowers triglycerides, however, but rather the reduction in food consumption.

If you don't want to cut back on calories, you can always exercise more, but you will probably have to exercise a lot more. Most people who have high triglycerides need to get enough exercise to burn an additional 500 to 1,000 calories a day to make a difference, and that means exercising for hours per day, not minutes per week.

Second Step: Focus on reducing your consumption of carbohydrates.

Nobody stays on a low-calorie diet indefinitely. In fact, it's not even a good idea. Eating fewer calories on some days and catching up on others "fools" the metabolism to stay in high-gear. But when you eat extra calories, get them in the form of protein or fat, not carbohydrate.

Why? The body responds to the sugars released from extra carbohydrates with extra insulin. In turn, insulin activates an enzyme called lipoprotein lipase that "locks in" stored triglycerides in fat. Unfortunately, this enzyme also locks triglycerides in the foam cells that form atherosclerotic plaques in the linings of your arteries.

Low-fat diets usually are not a good idea if you have high triglycerides but normal or lower cholesterol levels. Lowering the fat in your diet lowers your LDL numbers, but if your LDL is not the problem, you do not need to lower it. Low-fat diets can actually make triglyceride levels worse by replacing fat calories with carb calories, triggering the release of insulin. 

Third Step: Supplement your diet with fish oil.

Fish oil is not a panacea for cardiovascular disease, but when the fundamental problem is high triglycerides, it usually helps. Fish oil contains omega-3 essential fatty acids that reduce inflammatory processes in the liver. In turn, this enables the liver to clear VLDL cholesterol out of the bloodstream, keeping it from circulating back to the foam cells that would incorporate it into plaques. Fish oil also activates a cellular receptor called peroxisome proliferator-activated receptor gamma (PPAR-gamma), which helps cells in the liver and muscles absorb more glucose from the bloodstream, reducing the amount of raw materials in circulation from which the liver could make triglycerides.

Other healthy fats do not have this particular healing property. Only fish oil lowers triglycerides. It is possible to get your omega-3's from eating fish, of course, but this requires eating about 500 grams (a little more than a pound) every day, which can provide too many calories.

Just how important is it to keep your triglycerides in check? Triglyceride levels over 1000 mg/dl often trigger a potentially life-threatening condition known as pancreatitis. Triglyceride levels over just 150 mg/dl indicate an increased risk of cardiovascular disease, especially when LDL levels are high or HDL levels are low. Even if your total cholesterol and your LDL cholesterol are fine, you may need to change your lifestyle to lower your triglycerides.