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Triglycerides

TRIGLYCERIDES

A triglyceride consists of glycerol and three fatty acids bound to it. Triglycerides form one of the primary energy sources in the blood. Unused triglycerides are stored in adipose tissue (white fat cells), the main triglyceride storage in the body. To some extent, triglycerides are always in the blood, fueling muscles. VLDL (very low-density lipoprotein) forms the main triglyceride transportation system in the circulatory system. Thus, in addition to cholesterol, (V)LDL particles carry triglycerides (fat-soluble vitamins and antioxidants). As the volume of triglycerides increases, the capacity of the LDL particles to carry cholesterol is reduced. This causes the body to produce more LDL particles to maintain the efficiency of the transportation mechanism. Triglyceride metabolism is disrupted by insulin resistance.


Eating increases the volume of triglycerides in the blood. Triglycerides are carried from the intestine through the circulatory system to adipose tissue for storage unless used for energy during exercise. Between meals, triglycerides are released from adipose tissue into the blood, which is used for energy. A high level of triglycerides in the blood is linked to an elevated risk of cardiovascular diseases, atherosclerosis, stroke, and cardiac arrest.


Increased triglyceride levels are caused by lack of physical exercise, obesity and excess weight, smoking, excessive alcohol use, untreated diabetes and insulin resistance, kidney diseases, hypothyroidism, a diet rich in sugar and carbohydrates, and excessive energy supply from food. These lifestyle factors are particularly harmful if the individual has low HDL cholesterol levels and high triglyceride levels in the blood. The risk of coronary artery disease increases by 20% for every increase of 0.26 mmol/L in triglyceride levels. Low triglyceride levels are generally considered normal, although in some cases extremely low levels may be caused by hyperthyreosis, absorption issues, liver damage, or certain hereditary lipoprotein diseases.


Factors decreasing triglyceride levels include:

  • For individuals with excess weight, a weight loss of 5–10% has been found to decrease blood triglyceride levels by 0.45 mmol/L on average
  • Adding monounsaturated fatty acids (such as virgin olive oil) to the diet and using it to replace other fats • Consuming oily fish at least twice per week
  • Restricting the intake of carbohydrates and particularly sugars – the most significant single action is to replace sugar-rich beverages with water
  • A ketogenic diet (extremely low in carbohydrates)
  • Adding fibers to the diet may slightly reduce blood triglyceride levels
  • Consuming nuts (except for peanuts) regularly (3–7 portions per week)
  • Regular exercise (daily activity as well as high-intensity interval training (HIIT))
  • Reducing the volume and frequency of regular alcohol use

Adding the following dietary supplements and herbs to the diet:

  • Fish oil (reduces the production of triglycerides as well as promotes their removal from circulation) – however, the dosage must be based on what is known as pharmacological level, i.e. 3.4 g/day (triglycerides will decrease by 25–50 % after a month of use)
  • Alpha-lipoic acid (particularly for overweight or diabetic individuals)
  • Garlic (extract/powder; 600–900 mg/day)
  • Turmeric and curcumin (curcuminoids 1000 mg/day), particularly for individuals with diabetes or metabolic syndrome

Reference ranges and guidelines (fS-Triglycerides):

  • Reference range: 0.45–2.60 mmol/L
  • Recommended level: less than 1.70 mmol/L
  • Optimal: less than 1.00 mmol/L

A comprehensive population study (n=13953) determined that the optimal triglyceride level for young, healthy males is less than 0.75 mmol/L.


When assessing triglyceride levels, comparing them to HDL cholesterol levels is crucial. Various studies have found that a high triglyceride/HDL cholesterol ratio is linked to atherosclerosis and hardening of arteries, coronary artery disease, type 2 diabetes, cardiac mortality, and overall mortality. The higher the ratio, the higher the risk of the aforementioned phenomena and terminal events. This ratio is also more accurate than the LDL cholesterol levels in predicting the first cardiovascular event. The triglyceride/HDL cholesterol ratio is also a good indicator of insulin resistance (in European men and women) – the lower the ratio, the better the insulin resistance.


The triglycerides/HDL cholesterol ratio has also been found to predict the size of the LDL particles. More than 78 % of individuals with a ratio higher than 1:66 had predominantly small and dense LDL particles (a risk factor), whereas 81 % of individuals with a ratio lower than 1:66 had large and buoyant LDL particles.


The recommended “reference” range for the triglyceride/HDL cholesterol ratio:
A reference range has not yet been determined for the ratio. However, the following limits have been set based on several studies:

  • Optimal: less than 0.87
  • Normal: less than 1.74
  • High: 1.74–2.62
  • Very high: more than 2.62

A comprehensive Chinese population study of the triglyceride/HDL cholesterol ratio set a ratio of 1.3 for men and 1.0 for women to signify a boundary between high cardiovascular risk and typical risk. This means that in the studied population, the occurrence of cardiovascular diseases was lowest when the ratio fell below these limits. A similar study in Pakistan determined a ratio of 1.0 for a population consisting mostly of women (71.5 %).