More Important Than Cholesterol?

Readers of this newsletter know that I have long believed that the national obsession with cholesterol is ridiculous. Cholesterol is a relatively minor risk factor for heart disease compared with much more serious things like inflammation. And the emphasis on cholesterol to the exclusion of other more important risk factors has also led us to take our eye of the ball when it comes to a risk factor we can easily do something about without taking a single medication: triglycerides.

Triglycerides are the main form in which fat is found in the body, the diet and the bloodstream. (A triglyceride is simply three (“tri”) fatty acids bound to a glycerol backbone.) High triglycerides are an independent risk factor for both heart disease and stroke. An even more important number than your cholesterol level is the ratio of triglycerides to HDL cholesterol. According to research published in Circulation, the Journal of the American Heart Association, and in the journal Clinics, this ratio is a powerful predictor of heart disease.

It’s easy to figure your ratio. Look at any standard blood test that your doctor orders for you. It will contain a number for triglycerides and it will contain a number for HDL cholesterol. If your triglycerides are, for example, 150 and your HDL cholesterol is 50, your ratio is 150:50, or 3.

The triglyceride to HDL ratio is also an excellent low-tech surrogate measure for insulin resistance. Those with high ratios (over 4 or 5) are very likely to be insulin resistant, a condition in which the muscle cells stop “listening” to insulin. Insulin resistance increases the risk for diabetes, metabolic syndrome, obesity and heart disease, and many health professionals are beginning to get on board with the idea that insulin resistance is actually the underlying cause of all of these.

Triglycerides trigger the liver to produce more cholesterol, particularly the small dense particles known as LDLb which are particularly harmful.

Elevated triglycerides can be due to being overweight, being inactive, smoking, or eating a diet very high in carbohydrates. You can bring triglyceride levels down rather easily by reducing sugar in the diet. High sugar diets- or diets high in processed carbs- raise insulin, a hormone which not only causes you to store fat but also signals the liver to produce more triglycerides.

On a low-carb eating plan, triglycerides drop like a rock. This has been seen on virtually every low-carb diet study ever done. The more sugar and carbs you eat, the higher your triglycerides go. High carb diets raise triglycerides and low-carb diets lower them. It’s that simple.

Don’t eat products that list sugar, fructose, corn syrup, sucrose, dextrose or honey as one of the first ingredients, and try eating more nuts. According to a study in the Archives of Internal Medicine, people with elevated triglycerides were able to lower them by 10% by consuming approximately 2-3 ounces of nuts a day.

Fish oil has also been shown to lower triglycerides, another reason to take this important daily supplement. (3,4,5,6)