Triglycerides: What You Need To Know

If you've ever had the cholesterol levels in your blood checked, you probably had another type of blood fat measured right along with them: your triglycerides (tri-GLIS'er-ídz). New research shows that triglycerides can be a potent, but controllable, risk factor for stroke and heart disease.

Triglycerides are fatty substances made by the body from the fat in food (and sometimes from sugars). Triglycerides are carried in the blood and stored in the body as fatty tissue. Some triglycerides are also made in the liver. Triglycerides in plasma are derived from fats eaten in foods or made in the body from other energy sources like carbohydrates.

Calories ingested in a meal and not used immediately by tissues are converted to triglycerides and transported to fat cells to be stored. Hormones regulate the release of triglycerides from fat tissue, so they meet the body's needs for energy between meals. If there isn't enough fat in your diet, your body will make the carbohydrate "sugars" into triglycerides for long-term storage in the fleshy places in your body and your coronary arteries.

Excess triglycerides in plasma are called hypertriglyceridemia. Elevated triglycerides may be a consequence of other disease, such as untreated diabetes mellitus. Cardiovascular experts now know that high levels of triglycerides can trigger a heart attack or stroke -- even if your cholesterol levels are normal. Having high levels of triglycerides appears to be even riskier for women than for men.

At healthy levels, triglycerides fuel your muscles. But extra triglycerides -- the ones your muscles didn't burn because you didn't have time for a walk yesterday -- are thriftily stored as fat. Yesterday's cake may really be padding your hips today: Most triglycerides hit the bloodstream 3 to 6 hours after a meal and are burned or stored within 10 to 12 hours.

The problem is extra triglycerides can cause blood vessel walls to become clogged with fat. If that fat bursts into the bloodstream, it can set off blood clots that kill heart muscle and stop blood flow to parts of the brain. In addition, high levels of triglycerides are often part of a cluster of health problems called metabolic syndrome, or syndrome X. It includes low HDLs, high blood pressure, early or full-blown diabetes and abdominal obesity. Research suggests that nearly one in four adult women has syndrome X -- but doesn't know it!

What can make triglyceride levels soar?
Weight Gain. Extra weight is the prime cause of high levels of triglycerides. Overweight people produce too many triglycerides, and their bodies burn them and store them too slowly. Your body converts fat and some carbohydrates into triglycerides, which are a major energy source burned to power muscles. Fruits, veggies and whole grains (unrefined carbohydrates) do not jack up triglyceride levels the way white bread, pasta, cakes and cookies can. We are not certain why refined carbohydrates boost triglycerides, but they seem to hit the liver like a bullet, turning into triglycerides more quickly.

Genetics. While the vast majority of causes of high triglycerides and blood cholesterol are not genetic, some cases may be due to a genetic disorder affecting liver function. Individuals who are diagnosed with particularly high levels of either of these fats should encourage genetically related family members to undergo testing for liver dysfunction. Of those individuals with high levels of these fats, an estimated one out of 500 has a genetic basis for their condition.

Age. After about age 40, we produce less of an enzyme that helps break down triglycerides. Women are more at risk for high triglycerides after menopause, when they gain weight around the middle. At the same time, as women age, levels of heart-protective estrogens start to decline, while LDL and triglyceride levels rise.

Medications. Oral estrogen, some blood pressure medicines such as beta blockers and diuretics, some acne medicines such as Accutane, corticosteroids or anti-inflammatory drugs and bile acid sequestrants (a class of drugs used to treat high cholesterol) can all raise triglycerides.

What should your level be?
Normal is less than 150mg/dL. Borderline high is 150mg/dL, High is 200-499 and very high is anything over 500mg/dL. These are based on fasting triglyceride levels.

Changes in lifestyle habits are the main therapy for hypertriglyceridemia. These are the changes you need to make:

  • If you're overweight, cut down on calories to reach your ideal body weight. This includes all sources of calories, from fats to proteins to carbohydrates to alcohol.
  • Reduce the saturated fat and the cholesterol content of your diet.
  • Reduce your intake of alcohol considerably. Even small amounts of alcohol can lead to large changes in plasma triglyceride levels.
  • Be physically active for at least 30 minutes on most days each week.
  • People with high triglycerides may need to substitute monounsaturated and polyunsaturated fats -- such as those found in canola oil, olive oil or liquid margarine -- for saturated fats. Substituting carbohydrates for fats may raise triglyceride levels and may decrease HDL ("good") cholesterol in some people.
  • Substitute fish high in omega-3 fatty acids instead of meats that are high in saturated fat like hamburger. Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in omega-3 fatty acids.

If 2 to 3 months of diet and exercise don't significantly drop your triglycerides, talk with your doctor about these medications:

  • Statins. Commonly prescribed when both LDLs and triglycerides are elevated, statins can drop triglyceride levels as much as 32 percent.
  • Fibrates. They're often prescribed just to target high triglycerides. They include gemfibrozil (Lopid), clofibrate (Atromid-S) and fenofibrate (Tricor).
  • Prescription-only niacin. Nicotinic acid lowers triglycerides and can also increase HDLs. Because other risk factors for coronary artery disease multiply the hazard from hyperlipidemia, control high blood pressure and avoid cigarette smoking. If drugs are used to treat hypertriglyceridemia, dietary management and exercise is still important.