Optimizing your triglycerides

What are triglycerides?

Triglycerides are the major fats in foods. They have a backbone consisting of a glycerol molecule to which three fatty acid molecules are attached. All glycerol molecules are the same, but the fatty acids may vary greatly. The types of fatty acids that are attached to the triglyceride determine whether it is a saturated, monounsaturated, or polyunsaturated fat.

When you eat any type of fat, it passes through your stomach and is digested and absorbed in your small intestines. From there it is sent to your liver for processing and shipping throughout your body. Your body can also make triglycerides from excess carbohydrate.

The liver packages fat into very-low-density lipoproteins (VLDLs), which are molecules made of protein and fat, but are mainly composed of triglycerides. Next, VLDLs travel through your bloodstream to unload fat, depositing most of the triglycerides in fat cells for storage. Once unloaded, the VLDLs become low-density lipoproteins (LDLs)—mainly made of "bad" cholesterol, which in excess can cause arterial plaque. Another type of blood fat called high-density lipoprotein (HDL, or "good" cholesterol) takes your body's unwanted cholesterol back to the liver where it is excreted or used to make more VLDLs.

Importance for health

Having too much triglyceride in your blood—usually attached to a VLDL molecule—can adversely affect your health in several ways. Extremely high triglyceride levels can trigger an attack of pancreatitis (inflammation of the pancreas, an abdominal organ that secretes digestive enzymes.)

Recent research has also identified triglycerides as an important risk factor for cardiovascular diseases such as heart attack, stroke, or hardening of the arteries. Though the data are not as well established as for high cholesterol, it's a huge issue since coronary heart disease causes 500,000 deaths each year and is the leading killer in the U.S.

Desirable range

Based on growing evidence linking high blood triglycerides to heart disease, the National Cholesterol Education Program (NCEP) recently lowered the acceptable limit in its guidelines. NCEP says all adults aged 20 or older should have a fasting blood fat profile at least once every five years (this is a simple blood text).

Once you've gotten your results, you can compare your triglyceride score with what experts have to say about these values:

Risk factors for high triglycerides

If your triglyceride level is not normal, you and your doctor may want to search for a treatable cause. Factors that can increase your risk of high triglycerides include:

• Gender – men are more susceptible than women, at least until after menopause, when a woman's risk increases
• Age – the risk of high triglycerides increases with age
• Genetic disorders, including a family history of high triglycerides or diabetes
• Lifestyle factors such as:
  • Physical inactivity
  • Overweight or obesity
  • High-carbohydrate intake (over 60% of total calories)
  • Excess alcohol intake
  • Smoking
• Medical disorders such as:
  • Kidney or thyroid disease
  • Gouty arthritis or high blood levels of uric acid
  • Diabetes
  • Metabolic syndrome, or insulin resistance syndrome, which consists of excess abdominal fat, high blood pressure, and elevated blood levels of fat and sugar
• Certain drugs such as:
  • Cortisone drugs
  • Estrogens
  • Retinoids
  • Beta-blockers and diuretics

Lifestyle therapy

Treatment for abnormal triglyceride levels usually involves lifestyle changes. The American Heart Association recommends a diet that is low in saturated fat. However, it's important not to overly restrict total fat (25-35% of total calories is about right), because a very low-fat, high-carbohydrate diet can actually raise your triglycerides. Some saturated fat should be replaced with healthful unsaturated fats, especially omega-3 fatty acids. These are monounsaturated fats found in fatty fish and flax seeds.

Weight loss—often as little as 5-10 pounds—helps lower your triglyceride levels. As can limiting alcohol intake, quitting smoking, and getting regular, moderate exercise. If you are already at risk for heart disease, talk with your doctor before starting an exercise program.

Drug therapy

When lifestyle measures fail to control triglyceride levels, treatment with drugs may be advised. The usual aim is to lower cholesterol first. Then, medications such as nicotinic acid, fibric acid, or statins can be used to help optimize your triglycerides.