Triglyceride traps

31. January 2008 William Davis (17)
Triglycerides are a potent trigger for coronary plaque growth.

Triglycerides in and of themselves probably do not cause plaque growth. Instead, triglycerides contribute to the formation of abnormal lipoproteins in the blood that, in turn, trigger coronary plaque, like VLDL, intermediate-density lipoprotein (IDL), and small LDL. Excess triglycerides also modify HDL structure and cause you to lose HDL in the urine.

I see plenty of people who begin with triglycerides of 200 mg/dl, 300, 700, even over 1000 mg/dl. It doesn't take long before you learn what works, what doesn't to reduce triglycerides. This is especially true in the Track Your Plaque approach, in which our target for triglycerides is 60 mg/dl or less.

Here's a list of things to consider if you are trying to gain control of your triglycerides:

--Fish oil--A mainstay of treatment. The omega-3 fatty acids from fish oil are the number one most potent treatment for high triglycerides.

--Reduction of high-glycemic index foods--Most notably wheat. Everybody knows that we shouldn't eat Snickers bars or bags of licorice. But many people eat plenty of wheat-containing breads, pastas, pretzels, crackers, breakfast cereals, etc., all in the name of increasing whole grains and fiber. In reality, they are causing triglycerides to skyrocket, dropping HDL, forming small LDL, increaaing blood sugar and blood pressure, and increasing obesity.

--Eliminating fructose and high-fructose corn syrup--This ubiquitous sweetener is now consumed in enormous quantities by the average American, nearly 80 lbs per year per person. You'll find it in soft drinks, ketchup, beer, breads, breakfast cereals, and many other processed foods. You'll find none in green peppers, cucumbers, and raw nuts. Fructose causes large rises in triglycerides, as well as diabetic patterns. Don't let "fat-free" claims fool you. Take a look at the ingredients in Kraft Fat-Free Caesar Italian salad dressing, for instance:

Kraft Fat-Free Caesar Italian

Ingredients:
Water, Vinegar, High Fructose Corn Syrup, Corn Syrup, Salt, Parmesan Cheese, Part-Skim Milk, Cheese Culture, Salt, Enzymes, Contains less than 2% of Garlic, Whey, Onion Juice, Autolyzed Yeast Extract, Phosphoric Acid, Worcestershire Sauce, Vinegar, Molasses, Corn Syrup, Water, Salt, Caramel Color, Dried Garlic, Sugar ,Spices, Tamarind, Natural Flavors, Hydrolyzed Soy Protein, Xanthan Gum, Potassium Sorbate and Calcium Disodium EDTA as Preservatives, Dried Garlic, Buttermilk, Spice, Dried Parsley, Caramel Color, Sodium Phosphate, Oleoresin Paprika.



--Alcohol--While a couple of drinks a day raises HDL, exerts anti-inflammatory effects, and reduces blood pressure, more than this begins to raise triglycerides. Although I've come across no formal studies on this question, my gut sense is that beer, in particular, raises triglycerides more than wine or other alcoholic beverages. Could it be the wheat source of beer? Or its high-fructose corn syrup? I don't know, but beer is the least desirable form of alcohol of the choices we have.


Following these simple steps, it is unusual in my experience that you cannot achieve a triglyceride level <60 mg/dl. Rarely do we need to add fibrate drugs or other prescription agents to reduce triglycerides.



Copyright 2008 William Davis, MD
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Comments (17) -

  • Anonymous

    1/31/2008 1:23:00 AM |

    I've been following most elements of the program and my historically elevated triglycerides have come down from 308 in Nov. '07 to 213 in mid Jan. '08. Also, previous physical in Dec'06 they were 383.
    Cut back on the carbs and my daily coca-colas the last couple of weeks and am curious to see how big an effect that will have on them.

  • Cynthia1770

    1/31/2008 3:42:00 AM |

    Hi,
    My HFCS google alert picked up your blog. The problem with HFCS is that it has invaded our food supply. Courtesy of the Corn Refiners Assoc., go to
    www.corn.org/NSFC2006.pdf p29-30 list all the food and products that contain HFCS. Some surprises:
    bagels, soups, cough syrups.
    StopHFCS.com lists foods that are
    HFCS-free. They welcome additions
    and suggestions. Our home is HFCS-free. My soft drink of choice is
    Goose Island Root Beer!
    Take care,

  • Jenny

    1/31/2008 2:28:00 PM |

    Dr Davis,

    One huge question I have not seen answered is this. Drs measure FASTING tgs which are low on a lower carb diet. But a friend who had access to a cholesterol meter for a while found that after meals on a wheat free low carb diet tgs were extremely high for many hours a day.

    So should cholesterol be measured without the usual 12 hour fast? Few  of us ever fasts that long except for the test.

    Since the fasting glucose test is so poor at detecting diabetes, I wonder if the fasting cholesterol test is similarly flawed.

  • Anne

    1/31/2008 3:14:00 PM |

    Dear Dr Davis,

    My copy of 'Track Your Plaque' arrived this morning ! I had to cancel from the first company I ordered it from and found another who had a copy in stock. Thankgoodness, just in time ! I'm seeing my cardiologist on Monday for my echocardiogram and will feel more prepared to discuss referral for an EBCT scan now.

    I'm reading TYP straight away and finding it an easy read full of lots of good advice. I just read the bit about using natural progesterone cream - how interesting. I've been using that for about ten years, using it first for PMS, then for osteoporosis (which it didn't prevent but it might have been worse without it), and now I see it may be helping my heart health Smile

    I am finding that I already follow the principles of the diet except I don't eat any dairy, grains or legumes, I follow a low carb Paleo diet and have lots of vegetables, though only low carb ones as I'm diabetic too (type 2 but not typical as I'm thin and not insulin resistant)...I loved that bit on page 130 "Eat vegetables, vegetables, and more vegetables. Occasionally add more vegetables". And I do exercise and take fish oils and eat tons of fish, and vitamin D3. I still hope this will help my valve problem.

    bw's
    Anne

  • Anonymous

    1/31/2008 6:02:00 PM |

    I've been on a near-zero carb diet for 1.5 years and at my last blood screening my triglycerides were 43, HDL 53 and LDL 124. Would this indicate I have a high level of the good LDL? I eat zero wheat, sugar and HFCS.

  • Anna

    1/31/2008 6:52:00 PM |

    I've noticed something interesting at my local "natural" food store (sort of a smaller local clone of Whole Foods) ... and that is the infiltration of agave syrup, both as a product and as an ingredient in processed organic food products.  This store proudly states that it doesn't carry foods with HFCS (nor will it sell lard, but that is another rant) yet agave syrup is far worse in terms of high fructose content and all the health problems that concentrated fructose causes (high triglycerides, AGEs, uncontrolled hunger, insulin resistance, obesity, etc.  

    As I will get roller coaster blood glucose levels if I don't carefully watch my sugar and starch intake, I looked into agave syrup, because in the last year it was often recommended to me for its "low glycemic" index.  It is often labeled "safe for diabetics".

    Well, raw or not, agave syrup (nectar) is an extremely concentrated source of fructose, because the agave juice is hydrolyzed with enzymes to break apart the sugar molecules, allowing the glucose sugar molecules to be removed (I don't care if heat isn't used or if minerals remain, if that isn't "processing", what is?).  According to Wikipedia, the fructose content can be as high as 92% in some brands of agave syrup.  Compare that to 50% fructose in table sugar and 55% in HFCS.  

    No one I have talked to who uses or recommends agave syrup is aware of this (especially at the store level), yet agave syrup is halled as a superior, "healthy" sugar to use (perhaps with abandon?), especially for diabetics and anyone who is health conscious.  Enough to make your toes curl, isn't it?

    I have kept my triglycerides low (last lab 52) and that is pretty typical for me) since 2004 by reducing all sugars and starches (especially wheat) to a minimum, except for some non-starchy veggies and some very dark chocolate (70-88% cocoa solids).  I can achieve normal blood glucose levels without medication this way.  Prior to 2004 my triglycerides were well nearly 200 all the time.  With my gestational diabetes history and current impaired glucose intolerance (despite normal weight) the last thing I need is worsen things by using HF agave syrup because it is labeled a "low-glycemic" or "healthy", safer sugar.

  • Dr. Davis

    1/31/2008 7:02:00 PM |

    Thanks, Anna. I wasn't aware of that.

  • Red Sphynx

    1/31/2008 7:28:00 PM |

    Are all triglycerides the same?  Or is there a subtype analysis for them, too?

  • Dr. Davis

    1/31/2008 10:57:00 PM |

    Yes, there are, though the breakdown depends on the laboratory and analysis used.

  • Dr. Davis

    1/31/2008 10:59:00 PM |

    Jenny--

    This is among the reasons that I bash conventional cholesterol testing--among many other reasons.

    Postprandial (after-eating) patterns, however, are not well explored. One measure we use that is obtained from fasting blood but serves as a useful surrogate measure of postprandial patterns is intermediate-density lipoprotein.

  • Dr. Davis

    1/31/2008 11:01:00 PM |

    Small vs. large LDL can be genetically determined, as well as influenced by food and lifestyle. So you cannot tell just by looking at the conventional lipid panel.

  • Warren

    2/6/2008 4:39:00 AM |

    I have seen a few postings by you in which you mention that beer often contains high fructose corn syrup.  I brew as a hobby and I am unaware of any brewer that uses HFCS in beer making.  True, commercial brewers use adjuncts like rice, but most beer is made primarily from malted barley.  The typical sugar profile from malted barley is 50% maltose, 18% maltotriose, 10% glucose, 8% sucrose, and 2% fructose.  Most residual sweetness in beer comes from complex carbs like dextrins that yeast can't break down easily.

    Just thought you'd want to be accurate on this point.  Not saying that beer is a good thing, or that the types of calories in beer don't contribute to the problems you hve identified, but I think the mechanism is something other than HFCS.

  • Generic Cialis

    9/23/2010 8:54:52 PM |

    My father suffers from triglycerides and all of your advices have been taken a long time ago, this really helps to control them and keep a healthy happy life.

  • Levitra

    10/7/2010 10:07:06 PM |

    Good advice, I have heard most of this before but have never actually take them to practice, I am getting concerned about my weight lately so I better follow tis directions.

  • buy jeans

    11/2/2010 7:29:44 PM |

    Reduction of high-glycemic index foods--Most notably wheat. Everybody knows that we shouldn't eat Snickers bars or bags of licorice. But many people eat plenty of wheat-containing breads, pastas, pretzels, crackers, breakfast cereals, etc., all in the name of increasing whole grains and fiber. In reality, they are causing triglycerides to skyrocket, dropping HDL, forming small LDL, increaaing blood sugar and blood pressure, and increasing obesity.

  • Richard G Rees-Williams

    12/5/2010 12:02:11 PM |

    Well ain't this funny. I once had a random blood fat test (20th October) and as I was unaware they would do that test in my blood test. I had just eaten a lunch consisting of red meat and fruit juice (with tons of fructose) about an hour before. My serum triclyceride number was 0.4mmol/l or 35mg/dl. I guess it pays to be naturally skinny.

  • Generic Propecia

    3/4/2011 9:31:39 AM |

    Nice post, I would like to request you to one more post about that Keep it up

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