A Promising New Treatment For High Triglycerides
- By Gregory Curfman, MD, Assistant Professor of Medicine, Former Editor-in-Chief, Harvard Health Publishing
When you think about fat circulating in the bloodstream, you might immediately think of cholesterol. But theres another type of fat you shouldnt ignore: triglycerides. As with cholesterol, high triglycerides can also increase the risk of having a heart attack. Existing drugs for lowering triglycerides arent that good at reducing heart attack risk. Thats why a report on a new way to lower triglycerides, New England Journal of Medicine, is generating some excitement among cardiologists.
How Are Triglycerides Different From Cholesterol
Triglycerides and cholesterol are both fatty substances called lipids. But triglycerides are fats cholesterol is not. Cholesterol is a waxy, odorless substance made by the liver. It is used to build cell walls, helps the nervous system and plays an important role in digestion and hormone production.
Medications May Be Needed For High Triglyceride Levels
Sometimes, healthy eating and regular exercise cant lower high triglyceride levels. This may be the case, for example, if you have familial hypertriglyceridemia or if you already have heart disease. Your doctor may prescribe medication such as fibrates or nicotinic acids. Drugs to help lower high blood cholesterol may also be prescribed, if necessary.Suggestions for managing high triglyceride levels with medication include:
- Always take prescription medications exactly as instructed.
- See your doctor if you are having side effects from the medication. Known medication side effects may include indigestion, diarrhoea, fever or muscle problems.
- Dont assume that medications will somehow overcome the hazards of an unhealthy lifestyle. A healthy diet, regular exercise and maintaining an appropriate weight for your height are the most important management strategies for high triglycerides.
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Table 1drugs That May Cause Dyslipidemias
| Sodium-glucose co-transporter 2 inhibitors | â3-8% |
| â | ââ7% |
| ABBREVIATIONS: LDL, low-density lipoprotein HDL, high-density lipoprotein. *Raloxifene has not been shown to increase Triglyceride levels, while reported increases of up to 30% have been reported with use of tamoxifen**Data remains conflicting and some evidence shows a decrease, no effect, or increase***Varies based on individual drug |
Some Less Common Conditions
Kidney problems
We have two kidneys, and they’re responsible for cleaning our blood by filtering out waste products which are then removed from the body as urine.
Chronic Kidney Disease . This is the name for a gradual decline in kidney function. People with CKD often have abnormal blood fats raised LDL cholesterol and triglycerides, and lower HDL cholesterol. Heart and blood vessel diseases are common in people with CKD so statins and other cholesterol-lowering treatments are recommended if you have CKD.
Nephrotic syndrome. This happens when our kidneys become leaky. It results in protein leaking into the urine. People with nephrotic syndrome often have raised levels of cholesterol and triglycerides too.
Liver conditions
The liver is a very important organ. It is where cholesterol and triglycerides are processed, made or broken down. Bile, a breakdown product of cholesterol, is made in the liver, stored in the gall bladder and released into the gut when we eat a meal. Its role is to help break down fat from food into small drops which can then be easily digested.
Sometimes the production of bile or its release into the gut can become blocked, for example, if gall stones develop from crystallised cholesterol. Symptoms include pain, especially after a fatty meal. The medical name for this is cholestasis, where bile is unable to flow from the liver, and it can cause blood cholesterol levels in the blood to rise.
Gout
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Hypothyroidism Or Subclinical Low Thyroid
Hypothyroidism means that you have an underactive thyroid that is unable to produce enough thyroid hormone. In functional medicine, we dont tend to wait until your numbers are bad enough to diagnose hypothyroidism.
If your numbers are in the low range of whats considered normal, you have subclinical low thyroid that increases your risk of hypothyroidism and may already cause symptoms and health issues. This is when we ideally like to address the issue and prevent further problems.
Hypothyroidism and subclinical low thyroid levels can increase your risk of high triglycerides. A 2011 study published in The Open Cardiovascular Medical Journal has found that your lipid profile, including triglyceride levels and the triglycerides/cholesterol ratio, can be impacted by your thyroid function . A 2018 study published in Frontiers in Endocrinology has also found a link between thyroid issues and lipid metabolism .
Diets High In Calories Carbs And Fats
Triglyceride levels increase with a positive energy-intake balance . In other words, when you eat more than your body needs, the surplus is transformed into fat, including triglycerides. Its easier to overeat when your diet is high in calories and contains lots of carbs and saturated fats .
Low-fat, high-carbohydrate diets are among the most common causes of high triglycerides. But wait we said that high-fat diets are bad, so doesnt that mean a low-fat diet should be beneficial? Not quite .
Saturated, unhealthy fats are bad. But your body needs healthy fats such as those found in olive oil and fish oil to keep your triglyceride levels normal and to maintain your overall health. If you dont get enough dietary fats, your body will revert to transforming the sugars you consume into fats .
This goes against the popular but unfounded belief that your body wont store fat as long as you dont eat fats. In truth, high-carbohydrate diets can be much worse than high-fat diets for your triglyceride levels. Many scientists advocate that high-carb, low-fat diets likely also contributed to the obesity epidemic in America over the past few decades .
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Saturated And Trans Fats
Saturated fats can raise triglyceride levels. They can be found in fried foods, red meat, chicken skin, egg yolks, high-fat dairy, butter, lard, shortening, margarine, and fast food. Alternatives include:
- Lean proteins such as skinless white chicken meat and fish
- Low-fat dairy
- Olive oil, canola oil, and peanut oil
Trans fats are hydrogenated fats that can be found in some packaged and fried foods. Trans fats have been banned, with exceptions, from the food supply in the U.S.
Lowering Triglycerides Without Medication
Unless your triglycerides are extremely high, lifestyle changes are the best place to start. These simple steps can significantly lower triglyceride levels.
- Beware of bad fats. Cutting back on saturated fat and trans fats can lower triglycerides.
- Go for good carbs. Easily digested carbohydrates give triglycerides a definite boost. Eating whole grains and cutting back on soda can help control triglycerides.
- Check your alcohol use. In some people, alcohol dramatically boosts triglycerides. The only way to know if this is true for you is to avoid alcohol for a few weeks and have your triglycerides tested again.
- Go fish. Omega-3 fats in salmon, tuna, sardines, and other fatty fish can lower triglycerides. Having fish twice a week is fine.
- Aim for a healthy weight. If you are overweight, losing just 5% to 10% of your weight can help drive down triglycerides.
- Get moving. Exercise lowers triglycerides and boosts heart-healthy HDL cholesterol.
- Stop smoking. It isnt good for triglyceride levels or for anything else.
About the Author
Gregory Curfman, MD, Assistant Professor of Medicine, Former Editor-in-Chief, Harvard Health Publishing
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Causes And Symptoms Of High Triglycerides
The most common cause of high triglycerides is uncontrolled diabetes. Being overweight or obese, eating a lot of carbohydrates or sugar, consuming high amounts of alcohol, having hypothyroidism, kidney disease, certain inherited lipid disorders, and being on estrogen therapy for menopause symptom management can raise your triglyceride levels, too. High triglycerides can also be a symptom of a metabolic disorder, which increases your risk of heart disease, diabetes, and stroke.
Generally, high triglycerides dont present any symptoms, but if they are caused by a genetic disorder, you may develop fatty deposits beneath the skin.
Medicines That Increase Triglycerides
High levels of triglyceride, a type of fat which supplies energy to the body, in the bloodstream can increase the risk of heart disease and stroke, Medline Plus warns.
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While the tendency to develop high triglyceride levels can be inherited, triglyceride levels can also rise due to medical conditions such as diabetes, obesity and liver disease. Certain types of medications also can raise triglyceride levels over the normal limit of 150 milligrams per deciliter .
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Treatment Options For High Triglycerides
Having high triglycerides can raise serious health concerns, so its important to boost HDL cholesterol and lower triglyceride levels. Here are some tips in order to lower triglycerides.
- Lose weight.
- Cut out sugar the American Heart Association recommends only five percent of your daily calories come from added sugar.
- Increase your fiber intake.
- Limit fructose fructose is a type of sugar that can contribute to high triglyceride levels.
- Eat a moderately low-fat diet a moderately low-fat diet has been shown to be more effective at lowering triglyceride levels, compared to a strict low-fat diet. The AHA recommends that 25 to 35 percent of your daily calories should come from fat.
- Be mindful of the fat you eat there are good fats and bad fats. Avoid saturated and trans fats, and consume more monounsaturated or polyunsaturated fat typically found in olive oil, for example.
- Increase your fish intake try salmon and sardines.
- Take triglyceride-lowering drugs if necessary and recommended by your doctor.
- Quit smoking.
- Control diabetes if you have it.
By following these tips and working close with your doctor, you can have much success in lowering your triglyceride levels and protecting your heart.
High Triglycerides: Getting Help
When it comes to cholesterol and triglycerides, perhaps the most important thing is to get regular screenings.
See your doctor and get checked out. If your triglycerides are high, you and your doctor can decide on a treatment plan — and you can make a few simple but effective changes to your lifestyle.
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Causes Of High Triglycerides + Normal Levels
Biljana Novkovic, PhDJonathan Ritter, PharmD, PhD Puya Yazdi, MDBiljana Novkovic, PhD
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What Exactly Are Triglycerides
Triglycerides are lipids or fats. They are, in part, what helps you sustain energy throughout the day. Your body makes triglycerides from unused calories, stores them, and releases them from fat cells into the blood when they are needed. They may also freely circulate in the bloodstream when introduced.
| Triglycerides Level Chart |
|---|
| > 1000 mg/dL |
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Inflammation Infection And Autoimmunity
In some cases, high triglycerides may be caused by inflammation and infection.
People with infections and chronic inflammatory and autoimmune diseases such as rheumatoid arthritis, lupus, and psoriasis often have high triglycerides and low HDL. These disease-triggered changes initially serve to dampen inflammation or fight infection, but they increase the risk of heart disease in the long run .
For example, untreated gum disease increases blood triglycerides. People with chronic gum inflammation are continually exposed to bacteria, which disrupt immune and lipid balance in the body .
What Are The Causes And Symptoms Of High Triglycerides
Causes include obesity, eating too much unhealthy food, genetics, certain illnesses including poorly controlled diabetes, kidney disease, and underactive thyroid . Some drugs, such as steroids and birth control pills, and drinking a lot of alcohol can also cause it.
Most people have no symptoms. Very high levels can cause small fat deposits under the skin and a painful inflammation of the pancreas called pancreatitis.
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How Do Triglycerides Circulate In The Blood
Pure cholesterol cannot mix with or dissolve in the blood. Instead, the liver packages cholesterol with triglycerides and proteins called lipoproteins. The lipoproteins move this fatty mixture to areas throughout the body.
Types of these lipoproteins include very low-density lipoproteins , high-density lipoproteins and low-density lipoproteins .
The Problem With High Triglycerides
High triglycerides are also called hypertriglyceridemia. According to the Centers for Disease Controls and Prevention , about 25 percent of adults in the US have high triglycerides over 150 milligrams per deciliter .
High triglyceride levels are often linked to liver and pancreas issues. A 2012 study published in the Indian Journal of Endocrine Metabolism has found that high triglycerides may trigger acute pancreatitis . A 2014 research published in Biomedical Reports has found that high triglycerides may increase the risk of non-alcoholic fatty liver disease .
High triglycerides along with poor cholesterol may also affect your kidneys. A 2016 study published in the Journal of Clinical Medicine has found that elevated triglycerides and low HDL cholesterol may cause kidney issues .
High triglycerides may also increase the risk of heart disease. A 2018 study published in Nutrients has found that high triglycerides may increase the risk of cardiovascular disease . However, other research, including a 2011 review published in Atherosclerosis, Thrombosis, and Vascular Biology has found that the relationship between triglycerides and cardiovascular issues is not clear . The link may be more complex and we may have to consider other factors as well.
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Diagnosis Of High Triglycerides
A blood test can reveal whether or not you have high triglycerides. You may need to have two blood tests for accurate results. Dont eat anything for at least 12 hours before each blood test because food particularly fatty food can temporarily boost triglyceride levels in the blood and skew your test results.Triglycerides are measured in mmol/L. The range includes:
- Very high over 6 mmol/L
- High between2 and 6 mmol/L
- Borderline high between 1.7 and 2 mmol/L
- Normal below 1.7 mmol/L
The doctor may also test your cholesterol levels. In many cases, high triglycerides and high cholesterol go hand in hand. This condition is sometimes known as combined hyperlipidemia.
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When To Contact A Doctor
While high triglyceride levels may not usually cause symptoms, anyone who is uncertain or concerned about their triglyceride levels should consult a doctor.
Additionally, any adult who has not had a lipid profile test in the last 46 years should speak with a doctor about their cardiovascular risk factors and possible need for a test. Catching elevated levels of health markers, such as triglycerides or cholesterol, at an early stage may help a person make changes earlier to address the underlying issue.
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- Arnett, D. K., et al. . 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines.
How Is A Lipid Disorder Diagnosed
To check your cholesterol levels, your doctor will order a blood test called a lipid profile, or lipid panel. This test measures your total cholesterol and triglycerides. Before this test, your doctor will likely ask you to avoid eating and drinking liquids other than water for at least 8 to 12 hours.
The lipid profile measures cholesterol in milligrams of cholesterol per deciliter . Your total cholesterol level should be no higher than 200 mg/dL. Learn how to understand your cholesterol results.
A combination of medications and lifestyle changes is a common treatment plan to correct high cholesterol and triglycerides. Your doctor may also suggest certain supplements.
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Supplements And Medications To Lower Triglycerides
Some diabetes medications, Actos , for example, will also lower triglycerides, says Shurmur. However, this drug may cause or worsen congestive heart failure, warns the FDA.