Have you ever heard of blood fats? Maybe a doctor has told you that "triglycerides seem a little high." Today we are going to talk about what these triglycerides actually are, what happens when they are high, and what we should do about it. Don't worry, I will explain this very simply, in a way that you can understand.
What are triglycerides? Why are they important to us?
Simply put, triglycerides are a type of fat in our blood. They provide our bodies with energy. We get triglycerides from the foods we eat, especially from things like butter and oil. Not only that, but when we eat more calories than our bodies need, our bodies convert those extra calories into triglycerides and store them. Later, when we are low on energy, our bodies use these stored triglycerides.
So, triglycerides are an important thing that gives us energy. However, if they increase too much in the blood, it increases the risk of developing cardiovascular disease. That's why it's important for us to be aware of this condition called hypertriglyceridemia and control our triglyceride levels.
So, how much triglycerides is good?
The average adult blood triglyceride level should be less than 150 milligrams per deciliter (150 mg/dL). In fact, less than 100 mg/dL is ideal. The most important thing is to measure your triglyceride level while you are fasting. This means that you have your blood tested after you have not eaten or drunk anything (except water) for about 10-12 hours.
Hypertriglyceridemia is when your triglyceride levels are 150 mg/dL or higher.
Here's a brief overview of fasting triglyceride levels in adults:
- Healthy level: less than 150 mg/dL
- Borderline high: 150 – 199 mg/dL
- High level: 200 – 499 mg/dL
- Very high: 500 mg/dL or higher
Healthy triglyceride levels for children and young adults (ages 10-19) should be less than 90 mg/dL. If your child's triglyceride levels are high, it's best to talk to a doctor about how to lower them.
What is Severe Hypertriglyceridemia? Is it dangerous?
Severe hypertriglyceridemia is when your triglyceride levels are 500 mg/dL or higher. People with this condition are at increased risk of developing a condition called acute pancreatitis . This is an inflammation of the pancreas that requires medical treatment.
Hypertriglyceridemia is a condition that requires attention and treatment. However, in most cases, it is not a medical emergency. Your doctor can help you lower your levels. Doing so can help prevent complications that could affect your heart or pancreas.
Are hypertriglyceridemia and cholesterol the same thing?
Yes, these two are not the same. Hypertriglyceridemia and high cholesterol are two different conditions. But they are both related to the fatty substances called lipids in your blood.
Lipids are fatty substances that perform important functions in our bodies. Triglycerides and cholesterol are two types of lipids. Both travel through the blood in carrier particles called lipoproteins.
Hypertriglyceridemia is an increase in triglycerides in the blood. Hypercholesterolemia is an increase in cholesterol.
Often, people with high triglycerides also have high cholesterol levels. High triglycerides can be dangerous, especially if your "good" cholesterol, HDL (High-Density Lipoprotein), is low and your "bad" cholesterol, LDL (Low-Density Lipoprotein), is high.
Talk to your doctor about what these levels in your blood mean and how to bring them back to healthy levels.
How common is this condition?
According to surveys conducted in the United States, about one in five adults has elevated triglyceride levels (more than 150 mg/dL). However, this risk increases with age. Research has found that 42% of people over the age of 60 have this condition. This condition may be common in Sri Lanka too, due to our eating patterns and lifestyle.
What are the symptoms of hypertriglyceridemia?
Many people with hypertriglyceridemia do not show any symptoms. That's why it can be like a "silent enemy." People with severe hypertriglyceridemia can sometimes develop a condition called xanthomas. These are small lumps of fat that form under the skin. They are most often seen around the eyelids. But they can also sometimes develop in places like the knees, elbows, and palms.
Why do triglyceride levels in our body increase? What are the reasons?
There are several causes of hypertriglyceridemia. They are:
- Lifestyle factors
- Other underlying illnesses
- Some medications
- Genetic lipid disorders
Let's look at each of these in a little more detail.
Lifestyle influence
Our lifestyle has a big impact on our triglyceride levels. Because, as I mentioned before, the more calories we eat, the more our bodies convert into triglycerides. So, if you consume more sugar, fat, or alcohol than your body needs, your triglyceride levels can increase.
Lifestyle factors that contribute to high triglycerides:
- Drinking too much alcohol: You know, some of us drink a little too much during parties. That also affects us.
- Excessive intake of refined carbohydrates and sugar: Foods made from bread flour (e.g. shortbread, bakery products), sweetened beverages, cakes, biscuits, etc.
- Excessive intake of saturated fat: These are found in high-fat foods, red meat, and foods made with coconut oil.
- Lack of physical activity (sedentary lifestyle): Sitting in one place all day, working, and not exercising.
Just think, if we eat a piece of fish cooked in oil, a broth made with coconut milk, and a sweet drink in addition to the rice we eat in a day, the extra calories from all of that can be stored in the body as triglycerides.
Due to some diseases
Triglyceride levels can also increase due to various diseases. Here are some examples:
- Diabetes
- Hypothyroidism
- Insulin resistance
- Kidney disease
- Liver disease
- Lupus
- Metabolic syndrome
- Nephrotic syndrome
- Overweight or obesity
- Rheumatoid arthritis
Women have other specific risk factors:
- Menopause
- Pregnancy - especially in the third trimester.
Because of some of the medications we take
Triglyceride levels can also increase when using certain medications. Examples:
- Antipsychotic drugs - e.g. Clozapine, Olanzapine
- Some drugs used to treat HIV infection (Antiretroviral (ART) protease inhibitors)
- Some high blood pressure medications (Beta-blockers - nonselective)
- Corticosteroids
- Cyclophosphamide
- Oral estrogen
- Tamoxifen
- Thiazides - drugs that cause increased urination
Most importantly: Never stop taking a medication prescribed by a doctor without talking to him or her first. If a medication is causing your triglycerides to rise, your doctor will be able to help you. They may change the dosage or prescribe a different medication.
Genetic conditions passed down through generations
Some people may also have abnormal triglyceride and cholesterol levels due to genetic factors. Examples:
- Familial combined hyperlipidemia: Increased triglycerides, increased LDL cholesterol, and decreased HDL cholesterol.
- Familial hypertriglyceridemia (type IV familial dyslipidemia): Increased triglycerides only.
- Familial dysbetalipoproteinemia (type III hyperlipoproteinemia): Increased triglyceride and total cholesterol levels.
- Familial chylomicronemia syndrome (FCS): Elevated triglyceride levels above 1000 mg/dL.
Often, hypertriglyceridemia can be caused by one or more of these factors. For example, a person may have a genetic condition as well as a poor lifestyle. Your doctor will determine what these factors are and prescribe the best treatment.
How do you know if you have hypertriglyceridemia?
There are two main ways to find this out: a physical examination by a doctor and a blood test.
Physical Exam by a Doctor
The doctor will do a physical exam to find out about your health. He or she will also ask you about the following:
- Does anyone in the family have heart disease, high cholesterol, or high triglycerides?
- Your lifestyle (e.g. alcohol, tobacco use).
- Other illnesses you have.
- The medications you use.
With this information, your doctor can understand what is causing your high triglycerides and your risk of developing heart disease.
Blood Test
A simple blood test called a lipid panel is the only way to accurately diagnose hypertriglyceridemia. This test measures your triglyceride levels as well as your cholesterol levels.
As I mentioned before, the doctor will tell you to fast for about 10-12 hours before this blood test. That means you shouldn't eat or drink anything except water. To get accurate results, it's very important to fast exactly as the doctor tells you.
What are the best treatments for this? How can I reduce it?
There are three main treatments for hypertriglyceridemia:
- Lifestyle changes
- Medicines (drugs)
- Treating underlying causes of high triglycerides.
You may need one or more of these methods. Your doctor will determine the best treatment plan for you.
Lifestyle changes - these are the first things that matter!
Treatment often begins with lifestyle changes. These are the main things:
- Avoid alcohol: reduce it as much as possible, or stop it completely.
- Avoid refined carbohydrates and sugar: Reduce your intake of bread, sweets, and drinks as much as possible. Instead, eat whole grains, vegetables, and fruits.
- Eat more seafood, especially fish rich in omega-3 fatty acids: fish like salmon, mackerel, herring, and tuna are good choices.
- Exercise more: Do something like walking, running, swimming for at least 30 minutes a day. Be active in your daily routine.
- Control your calorie intake to lose excess weight: Try to maintain a healthy weight for your height.
- Choose healthy fats instead of saturated and trans fats: limit things like coconut oil, palm oil, butter, and margarine, and use things like olive oil, canola oil, and some nuts.
"Small changes like using less oil when cooking at home, cutting back on the amount of fatty foods we eat at the store, and drinking unsweetened tea instead of sugary tea can make a big difference."
Medications
If lifestyle changes alone don't control your triglyceride levels, your doctor may prescribe medication. Medication is especially important for people with severe hypertriglyceridemia. There are several types of medications your doctor may prescribe:
- Fibrates - e.g. Fenofibrate
- Prescription omega-3 fatty acids - e.g. Icosapent ethyl (IPE)
- Statins - Although these are primarily prescribed to lower cholesterol, they sometimes also affect triglycerides.
Controlling other diseases
If you have another medical condition (e.g. diabetes) that may be contributing to your high triglyceride levels, it is also important to control that condition well. Your doctor will provide you with the necessary advice and treatment.
Can hypertriglyceridemia be prevented?
Some causes (aging, certain diseases) are beyond our control. However, there are many things we can do in our daily lives to prevent this condition. Here are some of them:
- Eat a heart-healthy diet: Eat more vegetables, fruits, whole grains, and lean protein. Reduce oil, sugar, and salt.
- Be active: In addition to planned exercise, move your body as much as possible during your daily routine. Things like taking the stairs instead of the elevator and walking to nearby places.
- Maintain a healthy weight.
- Limit alcohol: The maximum is one standard drink per day for women and two standard drinks per day for men.
- Reduce sugar and refined carbohydrates.
Ask your doctor for further advice to help control your triglyceride levels.
What is the outlook for someone with this condition? (Outlook)
This depends on many things. For example:
- What are the causes of your hypertriglyceridemia?
- What is your triglyceride level?
- What other illnesses do you have?
Therefore, talk to your doctor to find out exactly what your condition is.
But remember, hypertriglyceridemia is a common condition, and you are not alone. Many people manage this condition well by following their doctor's advice, making lifestyle changes, and taking medication if necessary.
When should I see the doctor?
Be sure to go for your annual medical check-ups. In addition, attend any other appointments as directed by your doctor. If you have any questions or concerns, feel free to contact your doctor at any time.
What questions should you ask the doctor?
It's important to be as informed as possible about your condition, its causes, and treatments. You can ask your doctor questions like:
- What do my triglyceride levels tell me?
- Do I also have high cholesterol?
- What is causing my triglycerides to rise?
- How can I lower my triglyceride levels?
- What is my risk of developing heart disease?
- What types of exercise are suitable for me?
- Should I see a dietitian?
When do you need to go to the Emergency Treatment Unit (ETU) ?
If you have any of these symptoms , call 911 (1990 in Sri Lanka) immediately, or go to the nearest emergency room:
- Acute pancreatitis - (severe abdominal pain, vomiting, fever)
- Heart attack - (chest pain, shortness of breath, sweating)
- Stroke - (numbness or weakness in the face, arm or leg, difficulty speaking, difficulty walking)
Hypertriglyceridemia increases the risk of developing these serious complications. Therefore, it is very important to be aware of these symptoms and seek immediate medical attention if they occur.
Finally, things to remember (Take-Home Message)
Controlling hypertriglyceridemia takes some effort. But it's worth your time. You'll need to make some changes to your daily routine, and those changes may seem difficult at times. But start small. Even small changes can make a big difference in your heart health. Ask your doctor about resources and support groups to help you reach your goals. Your health is in your hands!
` hypertriglyceridemia, triglycerides, cholesterol, heart disease, diet, exercise, lifestyle
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