I’ve previously discussed how you can send your HDL cholesterol on a standard cholesterol/lipid panel through the roof, signaling great changes in health and longevity. Let’s now discuss another often neglected value from the same panel, triglycerides. In my HDL post, I related how, in my own personal experience, I raised my HDL from 27 mg/dl to 94 mg/dl, while reducing my triglycerides from 350 mg/dl to 47 mg/dl. Plenty more people have done likewise following the Wheat Belly lifestyle.
This single triglyceride value holds a ton of useful information. It is surprising that, given the conventional practice to focus only on total cholesterol (generally useless) or the calculated–not measured–LDL cholesterol value that is wildly inaccurate, the world of useful health information captured by the triglyceride value is typically ignored. So let’s talk about what you can learn from this value.
Among the keys to understanding triglycerides are several basic facts:
- Triglyceride blood levels go up from fat consumption (since fats are triglycerides by definition), but carbohydrates are converted by the liver (de novo lipogenesis) to triglycerides. Carbohydrates make a much larger contribution to fasting and after-meal triglycerides than fats in the majority of people.
- Triglycerides are stored in human fat cells, but are very active. Fat therefore serves as an active repository, constantly releasing triglycerides back into the bloodstream. This is part of the reason why overweight people have high triglyceride levels.
- Most triglycerides in the bloodstream are contained within particles called very low-density lipoproteins, or VLDL. Triglyceride-packed VLDL particles interact with other lipoprotein particles, especially LDL particles and HDL particles, contributing triglycerides to them. Triglyceride-enriched LDL and HDL particles go through changes that make them much smaller in size and change their behavior. Small LDL particles, in particular, are uncommonly persistent in the bloodstream (5-7 days, rather than the 24 hours of large LDL particles), are very adherent to artery tissue, and more inflammatory. Triglyceride-enriched HDL loses much of its protective capacity and is cleared from the bloodstream more quickly, resulting in a drop in total HDL cholesterol values.
- Triglycerides from carbs and body fat, in turn, block insulin, raising blood sugar, and cause artery constriction/hypertension. This is why type 2 diabetics typically also have high triglycerides and hypertension, as well as high blood sugars.
- Triglycerides manufactured by the liver do not all leave as VLDL particles, as some stay in the liver (for unclear reasons), causing low-grade liver damage reflected in common liver tests, such as AST and ALT; this is called fatty liver.
If you cut the fat in your diet while increasing grains and carbohydrates, the net effect will be a rise in triglycerides, sometimes substantial, from increased de novo lipogenesis. The increase in carbohydrate intake also grows visceral fat that, in turn, releases more triglycerides, sending them even higher. HDL levels drop, LDL particle number increases, especially of the small LDL variety, and linger longer. Over time, blood sugar goes up, blood pressure goes up, fatty liver begins to show—a very, very familiar scenario.
At what blood triglyceride level do these effects begin to kick in? 60 mg/dl (though this can vary from individual to individual). At a triglyceride level of 150 mg/dl, for instance, the level generally felt to be safe quoted in national guidelines, there is typically a substantial drop in HDL and its protective function, oodles of small LDL particles, and insulin and blood pressure effects–150 mg/dl is not ideal. It is also clear from clinical studies that cardiovascular risk of heart attack begins to rise even with triglyceride levels in the 80-90 mg/dl range.
So how can you drop triglycerides substantially, even achieving values of 40 or 50 mg/dl, as is common around here. Easy:
- Eat no wheat or other grains
- Manage carbohydrates–I advocate consuming no more than 15 grams net carbs per meal
- Supplement omega-3 fatty acids, EPA and DHA, from fish oil only–never krill, not flaxseed or chia. The dose is 3600 mg EPA + DHA (total) per day, divided into two doses.
- Manage bowel flora–Feeding and cultivating bowel flora with prebiotic fibers/resistant starches drop triglycerides even further.
Do the above and visceral fat begins to shrink, also. In other words, follow the Wheat Belly lifestyle and triglycerides–as well as so many other health phenomena–all fall into place. I’ve used this formula many times in both face-to-face patients, as well, and watched triglycerides plummet. I virtually never had to use any drugs to achieve triglyceride values of 60 mg/dl or less.
And don’t forget that, in the midst of active weight loss and for several weeks afterwards, triglycerides can be higher than desirable, dropping after weight loss has subsided.