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22 January 2015

Triglycerides and Diabetes - 10 Suggestions to Help Lower Them When Elevated


When I ask my patients if they understand their laboratory values, I get many queries about triglycerides. Some of the common questions are: What are they? How do they relate to my health? Are they associated with my diabetes?

If patients have elevated triglyceride levels, they always request suggestions and help to lower them. So, let’s get busy answering some of these questions!

What are Triglycerides?
Triglycerides are fats. If you attend biochemistry class, you may hear that a triglyceride is made up of three fatty acid molecules attached to a “backbone” made up of one glycerol molecule. For a brief animation of this, click here.

Triglycerides are very common in both food and the human body. When fats are broken down and absorbed in the small intestine, triglycerides are formed inside the body from the fatty acids and glycerol. For more information, click here.

Triglycerides can also be made in the body from dietary carbohydrates. (1) After a meal is ingested, if the calories are not used by the body immediately they will be made into triglycerides and stored in fat cells. We commonly think of stored triglycerides as body fat. When energy is needed between meals, triglycerides are released from the body’s fat stores and used as energy. (2) As you can see, triglycerides are needed for life, however, too much of them is not a good thing, as you will see.

Testing Triglyceride Levels

Triglycerides are evaluated as part of a lipid panel when blood work is taken. These tests are ordered by your medical team. Triglyceride levels are checked after an overnight fast. Fat from a meal can artificially raise the triglyceride levels on the test, so abstaining from food before the test is absolutely necessary. (3) Consumption of alcohol and some medications may also affect results. For a list of some of these medications, click here.

Interpretation of triglyceride laboratory results:
Normal levels are: Less than 150 mg/dL
Borderline High: 150 – 199 mg/dL
High: 200 – 499 mg/dL
Very High: 500 mg/dL or above (4) High Triglycerides are a risk factor for developing diabetes and are commonly found in people with diabetes:
If a person falls in the overweight category for their body mass index and their triglyceride levels are above 250 mg/dl (2.82 mmol/L), the American Diabetes Association (ADA) recommends testing for diabetes. The overweight category is equal to or greater than 25 kg of body weight per meter squared. (5) In addition to the risk factor for developing diabetes, approximately 35 percent of people with type 2 diabetes have triglycerides above or equal to 200 mg/dl. People with poorly controlled type 1 diabetes may also have similar problems with their triglyceride levels. Proper insulin therapy may decrease the triglyceride levels. (6)

Coronary Artery Disease Risk and Insulin Resistance Syndrome
The American Association of Clinical Endocrinologists (AACE) advises that when triglycerides are elevated, even a little, that this may be an independent risk factor for Coronary Artery Disease (CAD). They recommend that triglycerides be a component of lipid screening. When fasting triglycerides are above 150mg/dl this puts individuals at risk for insulin resistance syndrome. (7) Insulin resistance syndrome is when there is an increased production of insulin due to the possibility of a decreased number of insulin receptors on cells in the body and/or less glucose transporters in the cell. When the receptor numbers are decreased or the transporters are not working properly, more and more insulin will be made by the pancreas to compensate.

If the amount of insulin produced by the body is able to keep up with the insulin resistance then type 2 diabetes is not diagnosed. When the body can no longer produce enough insulin to overcome the resistance, diabetes is the result.

When triglycerides are above 200 mg/dl, this is a substantial risk for CAD. (7) For more information on insulin resistance syndrome, click here. http://www.fpnotebook.com/endo/DM/InslnRstncSyndrm.htm

For an animation of the problem of insulin resistance, click here.

High Triglycerides
As you can see from the AACE recommendation, high triglycerides are a serious risk for heart disease. They have also been associated with coronary atherosclerosis. (6) High triglycerides can be caused by dietary factors such as a high fat diet and/or a high intake of concentrated sweets. Consuming alcohol can also be a factor as is body fat distribution (subcutaneous abdominal adipose tissue and visceral adipose tissue), obesity and inactivity. (7, 9, 10, 11)

Medical conditions can lead to an increase in triglyceride levels including poorly controlled diabetes. (When insulin is used to bring down blood sugar levels, triglyceride levels may also decrease). Other diseases and conditions that can increase triglyceride levels include: hypothyroidism, Cushing’s syndrome, kidney and liver disease. Some people with high triglycerides have a genetic factor contributing to the condition. (7, 9, 10, 11)

When triglycerides are high, there is an increased risk of pancreatitis. It is interesting to note that in the United States triglyceride levels are rising along with obesity, insulin resistance and type 2 diabetes. In 2011, 31 percent of the population in the U.S. had a triglyceride level above 150 mg/dl. (6)


10 Ways to Help Lower Triglycerides When Elevated
Depending on your health conditions, treatment of high triglycerides may include diet therapy or a combination of diet and medication. Ask your physician what is best for you.

Discuss these points with your medical team for helping reduce triglycerides, and ask if these recommendations are for you:
If high triglycerides are caused by uncontrolled diabetes, you need to get you blood glucose under control.
Many times when cholesterol is between 150-199 mg/dl, a recommendation may be made to lose 5 percent of body weight. When 5-10 percent of body weight is lost, this may result in a 20 percent decrease in triglycerides, a decrease in low-density lipoproteins and an increase in high density lipoproteins (HDL’s). (11)
Eat 50-60 percent of daily calories as carbohydrates. (11)
Fructose should be limited to no more than 100 grams and added sugars should be no more than 10 percent of daily calories. (11) (For fructose content of many foods per 100 grams of weight, click here.
Omega-3 fatty acids found in fish oil supplementation is helpful in treating high triglycerides. Doses ranging from 4-12 grams per day may reduce triglycerides by 30-50 percent. (7)
Controlling other lipid levels and hypertension is recommended and if you smoke - stop! Studies have shown smoking has a substantially negative effect on HDL, LDL and triglyceride levels. (Smoking is also a major risk factor for a heart attack). (7)
Limit saturated fat to less than seven percent of total calories and trans-fat to less than one percent of calories.(12)
If approved by your physician, exercise for at least 150 minutes per week. Exertion should be of moderate intensity, if possible. An example is walking quickly. Exercise may help decrease triglycerides by as much as 20-30 percent. (13) AACE recommends exercising four-six times a week for at least 30 minutes (which can be broken up during the day). The exercise should burn at least 200 calories/day. In addition, muscle strengthening activities should take place at least twice per week. (7)
Even a small amount of alcohol can have a negative effect on your triglyceride levels. Limit your alcohol. (13)
Many people also require medications to help. This may be needed if lifestyle changes like diet and exercise do not have the needed effect. Medications should be prescribed based on individual needs. As you can see, triglycerides are important for our metabolism. Having high levels can be detrimental to your health. If you have a problem with high triglycerides, it is important to discuss this with your medical team.

Triglycerides and How to Lower Them

Good cholesterol, bad cholesterol, saturated fat, and unsaturated fat -- sometimes it seems like you need a program to keep track of all the fat players in the story of heart disease.

In some ways, triglycerides are the easiest to understand. Simply put, triglycerides are fat in the blood and are used to provide energy to the body. If you have extra triglycerides, they are stored in different places in case they are needed later. High triglyceride levels have been linked to a greater chance for heart disease. Just what your triglyceride levels mean and how much lowering triglycerides reduces heart disease risk is sometimes less clear.

What Are Triglycerides?

Triglycerides are important to human life and are the main form of fat in the body. When you think of fat developing and being stored in your hips or belly, you're thinking of triglycerides. Consider these things:

Triglycerides are the end product of digesting and breaking down fats in meals. Some triglycerides are made in the body from other energy sources such as carbohydrates.

Triglycerides are measured using a common test called a lipid panel. It's the same blood test that checks "good" and "bad" cholesterol levels. The American Heart Association recommends that everyone over the age of 20 should get a lipid panel to measure cholesterol and triglycerides at least every five years.

Triglyceride levels are checked after an overnight fast. Fat from a meal can artificially raise the triglyceride levels on the test.
What Are Normal and High Triglyceride Levels?

The National Cholesterol Education Program sets guidelines for triglyceride levels:

Normal triglycerides means there are less than 150 milligrams per deciliter (mg/dL).

Borderline high triglycerides = 150 to 199 mg/dL.

High triglycerides = 200 to 499 mg/dL.

Very high triglycerides = 500 mg/dL or higher.

High triglyceride levels may lead to heart disease, especially in people with low levels of "good" cholesterol and high levels of "bad" cholesterol, and in people with type 2 diabetes. Experts disagree, though, on just how bad of an effect high triglyceride levels by themselves have on the heart.

Some of the confusion stems from the fact that high triglycerides have a tendency to appear with other risk factors. We do know that a low level of good cholesterol is a risk factor for heart disease. We also know that blood tests for triglycerides can show some variability.
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