Q: My father has heart disease and takes statin drugs. He is very careful about what he eats, and he exercises and takes supplements. However, his triglycerides remain very high. Can you tell me what causes this problem and how to treat this condition using supplements?
A:Triglycerides are a major cause of heart disease, and one that is frequently ignored or neglected. Nearly two-thirds of all coronary heart disease cases in the US can be at least partly blamed on abnormal triglycerides.
The two general categories of elevated triglycerides are familial (or inherited) and insulin resistant. The familial variety, which is usually responsible for triglyceride levels of 400 mg/dL or greater, is relatively uncommon, and may or may not contribute to heart disease risk. The far more common variety of high triglycerides, usually in the range of 150-400 mg/dL, is often (though not always) associated with resistance to insulin, more commonly called “pre-diabetes.” This form is often a cause of heart disease.
The standard US guidelines for triglycerides and cholesterol, called the Adult Treatment Panel III, recommend that triglycerides be kept at a level of 150 mg/dL or lower. At what level, however, do triglycerides begin to add to heart disease risk? The answer is 60 mg/dL or higher. When triglycerides are present at a level of 60 or higher, several abnormal hidden particles begin to appear in the blood: very low-density lipoproteins (VLDL), intermediate-density lipoproteins (IDL), and, perhaps most important, “small” low-density lipoproteins (LDL). Small LDL alone can triple your risk for heart attack. Beneficial high-density lipoprotein (HDL) levels decrease as triglyceride levels increase. In other words, increasing triglycerides trigger a whole cascade of ill effects that cause coronary plaques to grow and that lead to heart attacks.
Measuring triglycerides is, therefore, among the most important blood tests you can take. There are several ways to lower triglycerides naturally:
Fish oil is an effective, safe way to lower triglycerides by up to 50%. It also very effectively lowers levels of the hidden particles that triglycerides create, such as VLDL and small LDL. In our coronary plaque regression program, I advise everyone to take a starting dose of 4000 mg per day of a concentrated fish oil extract. Niacin (vitamin B3) is another powerful way to lower triglycerides. Doses of 250-500 mg can be taken safely with food and plenty of water to help minimize the hot “flush” that, though harmless, can affect some users of niacin. Doses of more than 500 mg should be taken only under medical supervision.
High-fiber foods, especially products containing healthy beta-glucan such as oat bran and raw nuts like almonds and walnuts, slow sugar absorption. In effect, they lower the “glycemic index” of foods and thus can indirectly lower triglycerides.
Q: I am 43 years old and in good physical condition. While my overall cholesterol is under 200 mg/dL, my HDL tends to be very low. Any suggestions on how I can raise my HDL naturally?
A:This is a very important issue. As noted in the previous question, low HDL usually goes hand in hand with elevated triglycerides, though either can occur independently. Like elevated triglycerides, low HDL can be a powerful cause of heart disease. In fact, low HDL is by far the most common cause of heart attack in the US, even more so than high cholesterol. So why do we not hear more about raising HDL? One reason is that unlike lowering cholesterol, raising HDL does not generate huge profits for the pharmaceutical industry. Do not let this mislead you into thinking that HDL is not important.
At what level does HDL contribute to heart disease risk? The answer is any level below 60. Among the limited number of natural tools available to raise HDL are:
Niacin in daily doses of 250-500 mg commonly increases HDL by 15-20%. Higher doses should be taken only under medical supervision.
Weight loss has a powerful effect on raising HDL. For this reason, I often focus my patients’ strategies on accelerating weight loss through a carbohydrate-restricted diet (such as the South Beach Diet), regular exercise, and supplements such as calcium pyruvate. At a dose of 2500 mg twice a day, calcium pyruvate can help get your weight down quickly and safely.
Fish oil in a dose of 4000 mg per day has a modest benefit, usually raising HDL by 2-3 points.
Policosanol is a sugar-cane derivative that lowers LDL and raises HDL, though the effect tends to be very modest.
Chromium in a daily dose of 400-800 mcg “sensitizes” your body to its own insulin and can raise HDL a few points.
Additional lifestyle strategies to consider are avoiding both hydrogenated fats (which depress HDL and raise LDL) and refined starches such as flour-containing baked goods.