My posts are intended to interest you in quantifying your current health, the nature and intensity of your exercise, your heart rate response to life and in tracking objective measures of dietary changes and stress levels. All of this is intended to help you help yourself in getting optimally healthy.
We can all note when we are tired, hungry, grumpy, anxious, elated, hopeful and the like. Additionally, I once thought that an adequate level of spiritual discipline- Yoga, Tai Chi, Rosary, Qigong, Meditation, etc- would yield a rich enough interior feedback system that something as crude as blood tests and heart rate profiles would not be necessary. I had a kind of magical thinking that if I were ‘centered’ enough my triglycerides, cortisol and testosterone, for example, would all be ‘perfect’ even as I was perfect. Pretty hilarious as I think about it.
Well after my own experiments, my thousands of tests on hundreds of patients and well done medical and physiological research by those far more famous than I will ever be, I can now say it is definitely not true that anything other than objective testing is adequate to tell whether or not you are optimally healthy.
In that light I want to show you how to track and analyze your triglycerides. Over time I will give you the same kind of direction for dozens of other tests but this is an easy one to start with. Triglycerides are in my Basic Dietary Panel.
Let’s not pretend that I can give you a few hundred word description of triglycerides in such a way that you become a competent biochemist or physiologist. The fact is you don’t need to become expert at the chemistry of triglycerides; just at how to change them. I can teach you the things in your day and behavior that change triglycerides and why you should care.
Here goes. Remember this; the liver is King. The liver rules. Make the liver happy and all will be well. Upset the liver and watch out. The liver makes triglycerides and can do so from almost anything you eat. Stress affects how the liver makes triglycerides, what you eat affects how the liver makes triglycerides and exercise affects how the liver makes triglycerides. Your genetics sets the table, loads the gun, but is not finally determinant in your triglyceride level; that is, in your fasting triglyceride level which is what I will be discussing. Fasting levels and postprandial, after eating, levels are radically different things and one of the most dramatic ways in which genetics influences triglycerides and their role in health. But let’s keep focused on fasting triglycerides.
There are several reasons why you care what your triglyceride levels are:
- The diameter of LDL particles is related to your triglyceride level; the higher your triglyceride level the smaller and more denseyour LDL particles are and the smaller, more dense LDL particles can easily pass through the walls of your arteries and cause harm. The smaller particles are also more susceptible to oxidative stress and thus can be locally harmful. Changing this, your LDL pattern, from small and dense to large and low density is almost like a light switch in decreasing your heart attack risk by over 65%. Lower triglycerides enough to switch to large low-density LDL pattern and Bingo! you’ve improved your stroke/heart attack risk by 2/3.
- Triglycerides are themselves atherogenic- i.e. directly cause hardening of the arteries.
- Triglycerides are an intermediate energy storage ‘coin of the realm’; the liver packages many kinds of dietary energy as triglycerides which are then readily stored as bodyfat. They can also be taken up and enter other energy pathways but are not uniquely necessary for these pathways and for most of us most of the time they just represent another roll above the Speedo a few minutes before appearing there.
Keep in mind that laboratories report most tests as +/- two standard deviations in a presumed to be ‘normal’ population. They report as ‘normal’ a result seen in over 95% of people. So a normal result is anything but optimal. Now some tests, and triglycerides is one of those, cholesterol is another, some tests are reported not on a normal distribution but on a politically determined range or scale. Most labs report any triglyceride level of less than 150 mg/dlas normal. Fine; this is better than the actual distribution which has an upper range nearer 200. Still, for most people most of the time 150 is way, way too high. Too high if your goal is to make large fluffy non-harmful LDL particles, to decrease the direct atherogenic effects of triglycerides and to look better in that, God forbid!, to look better in that Speedo.
Your optimal triglyceride number is related to genetics, stress, exercise and the composition of your dietary macro-nutrients. Remember the macro-nutrients are, at one level, simple: fats, sugars, proteins.
I’ve had people switch from small, dense LDL’s to large, low-density LDL’s by dropping triglycerides from 150 to 120 and I’ve also had them make the switch going from an already low 80 to and an even lower 50. Most people flip going from any triple digit to almost any double digit triglyceride level. All of these maneuvers are accompanied by bodyfat loss in almost everyone.
To put the power of behavioral change in perspective I’ve had patients with triglycerides as high as 600 drop them to below 80 in as little as 6 months and others struggle to drop them from 150 to 100 in almost any amount of time; the variable has been how serious they were about making the needed changes.
There are several trick ways to lower triglycerides; high doses of DHA/EPA- what is mistakenly called fish oil- and niacin (B3) are two. The first of theseuncouples true dietary change from the marker and the later, while dong the same, additionally causes an increase in fasting insulin; insulin not sugar/glucose.
Do it the real way; make the changes that actually make the liver happier. High doses of niacin can cause severe liver damage for example. Don’t take the cheat route; actually fix the liver and its products will be better which is surely what you really want.
Alcohol and fruit have the most dramatic effect on triglycerides; starches and simple sugars are less dramatic in their effect but can be important. Their role is better seen in insulin, fasting glucose and A1c; we will get to these in another post. Too much of almost anything can raise triglycerides but for most people who need to drop their triglycerides, alcohol, fruit and starch are the likely culprits holding triglycerides higher than is desirable.
Now be very clear I am not nor do I counsel you become a teetotaller; I am not against alcohol per se. However the notion that 2 glasses of wine a day is good for you is a commercially bought and sold conclusion that seriously done biochemistry and physiology does not support. More to our point here, the individual’s tolerance for the effects of alcohol on triglyceride levels is extremely variable. I’ve systematically shown/found some patients whose triglyceride levels went up an unacceptable amount on as little as one glass of wine a WEEK. Others seem to tolerate a half bottle of wine a DAY without important effect on their triglycerides. Mind you, I am not saying they should be drinking a half bottle a day; there are other objection to this. Are you a low tolerance or high? You need to find out.
In the same way I love fruit but very few people can make fruit a major part of their diet without raising their triglycerides too much. Almost everyone can eat 1/2-1 cup a day without harm but for many it takes very little more to be a real problem; at least so far as triglycerides are an indicator. Again, others can eat a great deal more, even of the problematic sub-tropical and tropical fruits. I say problematic in that their effect on triglycerides is more pronounced than northern and fall fruits.
Stress can raise triglycerides by the indirect effect of cortisol levels on overall hormonal levels that influence liver triglyceride manufacturing. Exercise in the right amounts can lower triglycerides or, by the same mechanism as stress, can raise them too.
The time to effect for changing triglycerides is days to weeks and not hours to days or weeks to months. Get your baseline, make a specific change and recheck your triglycerides in a month. Not wishy-washy; be specific about the interval, the kind of change(s) and how dynamic other variables have been like international travel, sleep patterns, and situational and relationship stress. If you want a good starting point get your baseline and then use my ‘Strict Step One’ diet you will find in my other blogs. Once you have cleaned out the system you can start experimenting what and how much to add back in of the things you like. Begin the process of unraveling the role of diet, stress, exercise, sleep and everything else on triglyceride levels. Be your own scientist. Properly done, understanding your body’s relationship to just this one variable will have powerful healthful effects on your well-being.
Have Fun, Smile and God Speed,
Dr. Mike
