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Triglycerides: The Body’s Fat Depot

Most people are familiar with cholesterol and its bad effects on our health. We have been warned time and again of high cholesterol and the risk of heart attack or stroke. Several ads boast of low cholesterol, cholesterol-free or even cholesterol-lowering food products. But very few people know or understand triglycerides. So let’s put the limelight on triglycerides.

What triglycerides do Triglycerides are a form of fat in your blood, which store energy. Most triglycerides are found in fat tissue. In fact, triglycerides account for about 99 percent of fat stored in our bodies. There are 2 sources of triglycerides. They may come from fats you ingest in food since they are the main ingredients in vegetable oils and animal fats. Triglycerides can also be produced in the body from other energy sources such as carbohydrates.

Calories from a meal that are not immediately used by the body become triglycerides. These are then stored as potential sources of energy in fat cells. When energy is needed to meet the body’s demands to perform a physical activity or during fasting or starvation, certain hormones (e.g., glucagon) regulate triglyceride release from the fat storage to fuel energy needs.

Triglycerides are not all bad, provided that levels are optimal. In fact, our bodies need triglycerides for its overall functioning. Triglycerides are used as a major source of energy because they are the most concentrated form of energy. They provide twice more energy per gram than other sources of energy like proteins and carbohydrates. Triglycerides are stored mainly in fat cells but muscle cells may also store them for their own fuel needs.

Triglycerides also serve as the building blocks for cells and certain hormones because they can easily be broken down to form other fats, namely cholesterol, which are used to make cells. Thus, triglycerides play a key role in the construction process of the body.

If you regularly consume more calories than you burn, especially calories from fats and carbohydrates, you may have elevated triglyceride levels (called hypertriglyceridemia). Hypertriglyceridemia is not just caused by a diet high in fat but even one low in fat but high in carbohydrates.

Dangers with high triglycerides
Hypertriglyceridemia, just like hypercholesterolemia in the body is a serious health issue since it may ultimately lead to heart attack, stroke, and death. Studies show that high triglyceride levels raise the danger of heart disease by 2 to 3 times, particularly if associated with high LDL (bad cholesterol) and low HDL (good cholesterol) levels. Excess triglycerides and LDL accumulate and deposit in the walls of the arteries and harden it, making the arteries less elastic (atherosclerosis). The consequent narrowing of the arteries leads to hypertension. Both atherosclerosis and hypertension eventually lead to blockage of the arteries that supply the heart and brain, causing heart attack and stroke, respectively.

Elevated triglyceride levels also leads to more fat accumulation in the abdominal area (increasing waist circumference), as well as cause fatty liver disease. When triglycerides are extremely high (>1000mg/d1), there is a risk of developing life threatening inflammation of the pancreas called pancreatitis. Treatment to lower triglycerides should be started as soon as possible.

Triglyceride targets
Like cholesterol, triglycerides can be detected by plasma lipid measurements in blood samples taken after an overnight 8-12 hour fast and a 24-hour alcohol abstinence.

Triglyceride levels may dramatically be 5-10 times higher after a meal. There is increasing interest in measuring nonfasting triglycerides since these appear to be more representative of the “usual” levels of triglycerides. Most of the day, blood lipid reflects postmeal levels rather than fasting levels. However, presently, it is not yet certain how to interpret nonfasting triglyceride levels for evaluating risk of coronary artery disease.

Health organizations recommend that healthy adults older than 20 years old be screened for lipid disorders, then every 5 years thereafter to evaluate risk of coronary artery disease. However, frequency of monitoring levels may vary depending on other factors such as current health problems and the overall risk for heart disease. Your doctor can advise you on the best timing and frequency of cholesterol screening.

Adults with coronary artery disease or diabetes mellitus should have a plasma lipid screening at least once a year. Those treated for lipid problems may need more frequent testing depending on the lipid levels and type of treatment used. For children and teens, routine screening is not warranted. However, American Heart Association and American Association of Pediatrics suggest that children with risk factors as above should be tested as early as 2-years-old. The categories for triglyceride results on children and adolescents are different than in adults. Talk to your pedia about your child’s results.

Hypertriglyceridemia is usually asymptomatic. However, if the disorder is due to a genetic problem, fatty deposits may be seen under the skin called xanthomas.

The triglyceride-diabetes link
Hypertriglyceridemia and diabetes mellitus are closely intertwined. For patients with diabetes, it is especially important to regularly check triglycerides as part of the lipid panel since triglycerides increase significantly when blood sugar levels are poorly controlled. Excess glucose in the blood is converted to triglycerides. Consumption of high carbohydrates increases triglyceride levels by increasing insulin levels. Insulin then increases triglyceride synthesis and storage of fat.

Although diabetes increases plasma triglycerides, hypertriglyceridemia likewise increases risk for diabetes. Research shows that healthy men with the lowest triglyceride levels are least likely to develop diabetes. High triglyceride levels have been shown to increase insulin resistance (the body’s inability to use glucose effectively). High triglyceride level is also a major risk factor for metabolic syndrome. This is a group of disorders often occurring together which increases risk for heart disease, stroke and diabetes.

Those with metabolic syndrome are two times likely to develop heart attack and five times likely to develop diabetes.

Treatment
Initial management to lower triglyceride levels mainly involves lifestyle modifications such as diet, weight loss and increase in physical activity. These are particularly effective in lowering borderline-high levels of triglycerides back to normal. You may need to get some help to meet your goals. Consider consulting a nutritionist and a fitness instructor. A visit to your doctor is also imperative prior to starting these lifestyle interventions to ensure safety and appropriateness of the program for you.

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