Last month we talked about high cholesterol and how it contributes to the development of coronary artery disease.  I specifically discussed high density lipoprotein or HDL.   HDL functions to move cholesterol molecules out of the plaque forming cells and to the liver for disposal.  It is thus known as “good” cholesterol.  But there are several HDL subtypes and they are not equally beneficial.  Subtype HDL2b is protective against heart disease while subtype HDL3 is not protective.  Cardiac risk assessment should include total HDL levels as well as HDL subtype levels.

In addition, triglyceride levels should be evaluated.  Evaluation of triglyceride levels should not take a back seat to cholesterol measurements.  Elevated triglycerides in and of themselves are a risk factor for developing coronary artery disease.  Several epidemiological studies have shown this association.  Other studies have shown elevated triglyceride levels frequently occur with low levels of HDL.  An observational study evaluating lipid panels in patients with suspected heart disease found a high ratio of triglycerides to HDL was the strongest predictor of heart disease.   

Individuals with abnormal levels of triglycerides are at risk not only for vascular disease such as heart attacks and strokes, but also cognitive impairment (high levels of triglycerides appear to be neurotoxic), abdominal obesity and difficulty losing weight.  In an animal study conducted at St Louis University School of Medicine, it was shown that high triglycerides blocked leptin from passing into the brain.  Leptin is a hormone secreted by fat cells; when it passes into the brain it signals us to stop eating.  If our brains don’t receive this signal we keep eating even when we are full leading to a higher risk of weight gain.

So what are triglycerides?  Triglycerides are molecules which transport fat from the digestive system to other cells.  The liver produces triglycerides when dietary fats are unavailable.  However, most triglycerides result from dietary intake of sugar, high calorie foods and saturated fats from meat, dairy products and processed foods.  The more calories we eat (and don’t burn off with physical activity), the more triglycerides we produce.  This extra energy is stored as fat and levels become higher in the blood stream.  When levels are very high, a fatty liver and/or pancreatitis—inflammation of the pancreas can develop. 

Those at particular risk for elevated triglycerides are diabetics, obese and sedentary individuals, alcoholics, individuals with hypertension and those with a family history.  Individuals in these risk groups should have their triglyceride levels measured at least once a year and treated aggressively if elevated. 

Various medications can also increase levels of triglycerides.  Most commonly, beta blockers and diuretics used to treat high blood pressure, estrogen therapy in women, tamoxifen and birth control pills.  Exogenous estrogen is thought to increase triglyceride levels by increasing insulin resistance and decreasing the clearance of these fats by the liver.  Birth control pills can decrease insulin sensitivity by 40% in association with increased fatty acids, cholesterol and triglyceride levels.  Other medications which affect triglyceride levels are prednisone, Accutane and protease inhibitors used to treat HIV.

Simple life style changes are highly effective for lowering triglyceride levels.  Changes such as weight loss, exercise and increased fiber intake all contribute to decreasing triglyceride levels.   A diet with limited intake of simple sugars such as cakes, candy, cookies, chips and other processed foods is necessary to decrease triglycerides.  A diet low in saturated fat is also effective.  Saturated fat is found in animal products such as meat and dairy.  And of course avoiding all trans-fat in your diet is a must.

Not all fats are detrimental to your health.  Omega-3 fat found in fatty fish such as salmon, tuna, and sardines can successfully lower triglyceride levels.  Omega-3 intake may also prevent cardiac arrhythmias, improve visual acuity in preterm infants and has been used to improve cognitive and mental health.  Adding fatty fish to your diet at least twice a week and/or supplementing with fish oil significantly improves triglyceride levels. 

Optimal nutrition is paramount for lowering triglyceride levels. Sufficient levels of chromium, calcium, B vitamins and anti-oxidants are necessary to sustain a healthy liver and digestive system.  These organs are key players in fat metabolism and should not be compromised. 

The first step in lowering triglyceride levels is knowing if they are high.  Have your levels measured and understand the significance of your numbers.  The next step is working towards lowering your levels.  Most cases of elevated triglycerides can be decreased without the use of medications.  In fact, statins such as Lipitor are much less effective at lowering triglycerides than natural therapies such as weight loss, fish oil and other life style changes I have mentioned.  If you understand your treatment options and make the right health choices you can lower your triglycerides and decrease your risk for cardiac disease. 

Dr. Briones is a board certified internist with an integrative holistic practice in Temecula.  She offers advanced cardiac risk assessment screening along with other physiological studies to assess overall health.  She can be reached at (951) 514-9395 or at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .