Note: As of April 18, 2011 the American Heart Association issued a Scientific Statement Recommending that the OPTIMAL Level of triglycerides be less than 100. click here for more info.
"When triglycerides go up over 100 we start making abnormal forms of cholesterol--the small dense LDLs that are atherogenic and penetrate much more rapidly into the arteries than normal large LDLs.
When triglycerides start going up--and the changes start around 80-100--nearly everyone with triglycerides over 100 is making significant amounts of small dense atherogenic LDL--above 150 almost all LDL particles are small dense and atherogenic."
-Dr. Patrick E. McBride, Professor of Medicine and Family Medicine, University of Wisconsin, and a member of the Expert III NCEP Panel setting cholesterol guidelines-
Sometimes you hear something that makes you shake your head and think, "Why didn't I know that? Why isn't anyone explaining this?"
On the long ride home from Kiawah last week the radio reception died--I was sick of reading--and I decided to listen to the new Audio-Digest in Internal Medicine--"Lipids: the Good, Bad, Ugly", 56(15): August 2, 2009 that I had packed in my book bag.
Now go dig up your last cholesterol results. I'll wait. And if you don't have any test results--pay attention anyway--and make sure you do your best to keep those triglycerides under 80.
In A Nutshell--Here's What Dr. Patrick E. McBride is Saying About Triglycerides?
- If your triglycerides are under 80 you are making "normal large" LDLs that are not very atherogenic (think atherosclerosis; arterial plaque; hardening of the arteries)
- When triglycerides are over 150 (there are just too many particles floating around with no where to go) they briefly get inserted into the LDLs and change the LDLs into "small dense atherogenic" particles.
- Stealth LDL: That's what you call what was once a normal LDL particle that's been penetrated by free-floating triglycerides. When triglycerides are too high they are able to change the LDL into "small dense dangerous" LDL that oxidizes very easily (a bad thing) and penetrates rapidly into the arteries. Note: Triglycerides are not supposed to penetrate the LDLs!!
- Normal LDL: It's difficult for normal LDL (large & fluffy) to penetrate into the wall of an artery!
- When triglycerides are between 80-100 you start to make abnormal LDL. Some of it starts changing into the "small dense atherogenic" variety at this level. (If changes start happening over 80--it looks to me like the only safe triglyceride number is under 80!)
- When triglycerides are over 100--according to Dr. McBride--you've turned the corner & "are making at the very least, a significant amount of "small dense" LDL."
- When triglycerides are above 150, almost all of the LDL particles become "small dense atherogenic".
- Dr. McBride served on the III NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults that set the guidelines for triglycerides (and cholesterol) back in 2002. He advocated for the normal level to be under 100--and he strongly believes that the current level will go down to 100 when the next guidelines come out.
- Big clue that your triglycerides are probably too high? Abdominal obesity aka belly fat. That's the engine--the symptom--that starts the cascade toward atherosclerosis; heart disease; stroke; type II diabetes. It's a big reason for triglycerides producing nasty stealth LDL. Read "This Belly Fat is Going to be the Death of Me and Now I Understand Why."
- According to Dr. McBride, if you have abdominal obesity, the chances are greater that you are producing the abnormal dangerous "small dense" form of LDL.
- If you overconsume sugar, soda pop, saturated fats, trans fats, refined carbohydrates, and "fried apple pies"--and you are consuming more calories than you need--your body doesn't know what to do with all that junk--and you end up with lots of rich triglycerides--that are very inflammatory and very atherogenic--floating around--just looking for an LDL to penetrate and turn it into "small dense dangerous" LDL!Why You Should Care About Your Triglyceride Levels
- Triglycerides are an independent predictor of cardiovascular disease and stroke.
- They are an even greater predictor of cardiovascular disease in women, than in men.
- The dangerous duo: High triglycerides & low HDL. Add abdominal fat--and you've got a bad news trifecta!
- Even the so-called good-guy HDL turns into an evil twin in the presence of "small-dense" LDLs. So...if you think just because your HDLs are high you are in good shape and protected--think again! If your LDLs are small & dense (and that's probably because your triglycerides are too-high) you are most likely producing "small-dense" HDLs as well, which have impaired function and are less protective than normal HDLs. Oy!The Test That Will Tell You If Your LDLs are Normal or Abnormal (Small or Large)
- You can't identify people with small-dangerous-stealth LDLs from the regular lipid panel.
- Again--there is a big clue--without even taking a test. Abdominal obesity--High Triglycerides--Low HDLs=stealth LDL
- McBride thinks the best test is: The LipoProfile Nuclear Magnetic Resonance (NMR) Spectroscopy which measures both the number and size of lipoprotein particles. He says the LDL particle number is the best predictor of how much LDL we deliver to our arteries!
- I've had personal experience with this test. Pre-vegan diet--2 years ago--I took this test. Prior to the test my LDLs at the time were on the highish side (129 one time, 157 another), although my triglycerides were always under 80, and my HDLs were always between 72-96.My doctor wanted me to go on a low-dose statin, so I requested a test to see whether or not I had the large or small LDL particles. The doctor was reluctant for me to take the test because she said insurance probably wouldn't cover it. (better for them to pay for drugs for the rest of my life than test to see if I really need them)
I asked the cost, and she said it was about $125. I said I'd be willing to pay out-of-pocket for it, because why would I want to go on statins if I didn't need to. She was skeptical, but we ran the test.
Turns out, the theory of low triglycerides + high HDLs + low abdominal fat proved to be true. I passed the test with flying colors. I was mostly producing the large-fluffy LDLs, and for now at least, I don't need statins.
I've since completely changed my diet, and because that NMR LipoProfile was A-OK, my doctor doesn't see the need to run another lipid panel for awhile. Would love to know how things have changed, though.
My Lab Rat Exercising HusbandThis guy is trim. He runs, bikes, and does yoga. He competes in ultra-marathons. For some reason (genetics? diet?) his triglycerides still run over 150, so he was very interested in Dr. McBride's information. The lab rat story
We've both thought about this and looked at how he eats differently from me.
He's a huge carbohydrate consumer from 8:00 pm till bedtime. If he starts eating a box of Snyder's Pretzels, or crackers, he doesn't stop until it's finished. A bowl or two of cereal after dinner--that's common, too. And he likes an occasional beer or two at night.
Turns out--night-time eating is a triglyceride no-no. Read the whole story here.
''If the calories are exactly the same, it shouldn't make a difference, but my clinical impression is that people who eat late at night eat more,'' said Dr. Louis J. Aronne, director of the comprehensive weight control program at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. They may be eating ''an extra meal, if you will, 'the fourth meal,' as one ad put it,'' Dr. Aronne said.
''Eating a big meal just before going to bed has been found in studies to elevate triglyceride levels in the blood for a period of time,'' Dr. Aronne said.
''If you ate 500 calories during the day but walked around afterward, your muscles would be competing with your fat cells for the calories and could burn them up as energy for physical activity,'' he said. ''But if you consume it at bedtime, with no physical activity, the body has no choice but to store the calories away as fat.''
Even before Dr. McBride's triglyceride tip my husband has been seriously curbing his night-time carb-fest and lo-and-behold even his minor belly fat has just melted off. He's at his lowest weight in years and it's been no sacrifice at all. He realized that the night-time eating was just a lifelong habit that had to go. He says, "I'm just learned that it's OK to go to bed a little hungry."
In October he has a physical and he's anxious to see just how his mostly-vegan diet + the ditching of night-time carbs will affect his triglycerides and overall cholesterol.
The American Heart Association Says Cut the Sugar
Last week the AHA issued a statement recommending that Americans drastically limit their sugar intake. The average intake from 2002-2004 was about 22.2 tsp. or 355 empty calories. These are true triglyceride boosters! The statement was published online in Circulation on August 24, 2009, and will appear in print on Sept. 15, 2009. Click here for the summary. Click here for the Circulation article.
The AHA points out that excessive sugar consumption (and they include that baddy high-fructose corn syrup) is linked to "several metabolic abnormalities and adverse health conditions". And they make specific mention of the effect of diets high in sucrose, glucose, fructose--and low in fiber--on triglycerides.
"In summary, although the mechanisms are unclear, relative to other carbohydrates sources, sugar intake appears to be associated with increased triglyceride levels, a known risk factor for coronary heart disease."Here's what the AHA recommends:
"In some, but not all studies, a higher consumption of high-sugar beverages and foods is associated with evidence of increased inflammation and oxidative stress."
Women: No more than 100 calories a day of added sugar (we're talking a half a cookie here)
Men: No more than 150 calories a day of added sugar.
Back in November, 2008 I wrote an extensive post on Triglycerides and how they can be lowered. Click here to read more.
The Cleveland Clinic provides excellent info on how foods affect triglycerides. Click here for that info.
For a summary of Audio-Digest in Internal Medicine--"Lipids: the Good, Bad, Ugly", 56(15): August 2, 2009 click here.
And by the way--I'm quite pleased that I gave up sugar (well, for the most part) in January. Click here.