LifeCare Chiropractic

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triglycerides

Fish Oil Lowers Triglycerides W/ Little or No Glycemic Effect in Diabetics – (11-02-00)

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Fish Oil Lowers Triglycerides W/ Little or No Glycemic Effect in Diabetics

Essential fatty acids have such tremendous health benefits for many chronic diseases, with no appreciable side effects. And considering that our Western diet is severely deficient in Omega-3 acids and very high in Omega-6 acids, we are not receiving these benefits from our diet. I strongly recommend all patients to maintain a daily regimen of some form of essential fatty acids.

Diabetes Care 2000;23:1407-1415 The results of a meta-analysis of 18 trials conducted over a 10-year period show that fish oil supplementation for patients with type 2 diabetes lowers triglycerides but has no statistically significant effect on glycemic control. “This study disproves the long-held belief that fish oil supplementation adversely affects glycemic control in patients with type 2 diabetes,” Dr. Victor M. Montori told Reuters Health. While the pooled data “was not able to elucidate the ideal dose of fish oil needed to achieve large reductions in triglycerides,” Dr. Montori said, it suggests that “fish oil may be safe to add to the armamentarium of triglyceride-lowering medication” for people with diabetes.

My Doctor Told Me I’m NOT Prediabetic–Is He Right?

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I have certainly made it clear that diabetes is the beast we all fight against.  But how do you tell if you’re on your way?

Just in case you don’t have a good answer to this question, it seems that many doctors get confused on this question as well.  I recently had a new patient who told me that her primary care doctor had told her she was prediabetic.   A little confused myself, I asked her some questions.  She had told her primary that she had been dealing with fatigue over the past few months, so she had blood work done.  Nothing terribly off, but her doctor, concerned about prediabetes, ordered a post-prandial glucose tolerance test (can’t remember, but I think it was the 2 hour variety).  From this, he told her she was prediabetic and needed to go on a special low glycemic index diet.  No problems with fasting glucose, triglycerides, HDL or total cholesterol.

Basically, fatigue was the only thing he was running with and looking hard to find prediabetes.  By the end of a new patient interview I can tell someone with a high degree of certainty just how fast they are running towards diabetes.  This women wasn’t it.  Incidentally, her fatigue is a pretty clear-cut case of adrenal fatigue, further confirmed by medication for anxiety.  Fatigue is not a common symptom of prediabetes.

On the flip side, I’ve had many patients over the years who had been told that they were NOT prediabetic and yet they clearly were.  Most doctors seem to only look at the sugar / glucose markers:  fasting glucose, HbA1c and maybe fasting insulin.  But long, long before insulin has a problem getting sugars out of the bloodstream there is going to be a problem with getting fats out of the blood (refer to the glucose-fatty acid cycle of Randle from 1963 if you’d like more info on this).

In other words, do not waste time looking at glucose and HbA1c in the early part of the spectrum–they’re going to be normal.  Instead, look at the triglyceride and HDL level.  THIS is probably one of the best screening tools to get a quick guess about where you are (or are not) on the diabetic spectrum.  Which brings us to this particular article.  In it, researchers looked to see what ratios between HDL and triglycerides were of concern in 2,244 healthy college students (17–24 years old) of Mexican Mestizo ancestry.  Here’s what they found:

  1. The highest 25% TG/HDL-C ratio was used to identify those with prediabetes who were at increased risk of heart disease.
  2. Heart disease risk factors were greatest in those whose TG/HDL-C ratios exceeded 3.5 (men) and 2.5 (women).

Personally, I don’t like to see the ratio get much above 2, but I’m pretty picky.  Normal triglycerides are considered below 150 mg/dl and normal HDL should be greater than 40 mg/dL (men) and 50 mg/dL (women).  As an example, a man having “normal” levels could have a ratio of 3.75–way too high.  But if your doctor does not recognize this fact, you’ll be sent away with mistaken reassurances that everything is doing ok.

As a side note, don’t confuse this ratio with the “good” to “bad” cholesterol ratio–the triglyceride to HDL ratio is far more important.

How Much Do We Know About “Good” Cholesterol?

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When it comes tocholesterol, we’ve viewed things in black and white.  Total cholesterol is bad.  LDL is bad.  HDL is good.

When drugs to lower total cholesterol and LDL cholesterol failed miserably (yes—the statins), the drug companies tried to make a drug that raised HDL cholesterol.  Ironically enough, the money for research and development likely came from the money from sales of the near-worthless statin, atorvastatin (Lipitor).

Torcetrapib, the first drug of its time made by Pfizer, indeed did raise HDL cholesterol but ended up killing patients 60% faster in phase III clinical trials so the drug was scrapped.

So what happened?

For some reason, the drug companies still don’t get it.  They don’t seem to understand that it’s not about the NUMBER, it’s about what the number represents.  Any number on your blood work, whether it’s total cholesterol, HDL, fasting glucose, HbA1c or liver enzymes, are merely the snapshot of the entire picture.  You see water leaking from 10 different locations in your house; do you plug all the individual leaks and throw down towels?  Or do you figure out what the problem is (like maybe the roof…) and fix it??

While this seems so obvious with home repair, it seems to have escaped the realm of common sense in medicine.  We find some type of lab value and latch onto it like a toddler with a new toy (or rather, a toddler with the box from the new toy…).  Then we put all of our focus into that lab value and build an entire approach to a disease based on this single lab value.

Back to the HDL issue.  HDL is not a single molecule.  Rather, as this particular study points out, it is actually made up of at least 85 different subtypes of proteins.  85.  So which ones are the best of the best and which ones are irrelevant as far as your risk of heart disease?  Many prescription drugs are designed to target a very specific pathway.  In the example above given for Torcetrapib, it is highly likely that the drug only affected a very small number of the 85+ types of HDL molecules.  Given that we don’t even understand how each of these types of HDL molecules work in concert, messing with only one could potentially lead to disaster, which is what happened.

Contrast this with lifestyle.  Lifestyle changes do not affect a single pathway.  It is likely that the right lifestyle changes geared towards lowering your risk of heart attack and moving you away from diabetes will lead to alterations in a large number of these HDL protein molecules.  Some will shift lower, some will shift higher, all moving in the direction they are supposed to go to protect you from chronic diseases.  Picture the most elaborate concert you have ever heard; each instrument orchestrating beautifully among one another to produce the perfect outcome.  THAT is what lifestyle does.

Pharmaceutical drugs, on the other hand, would be like throwing 2 or 3 toddlers with bats into the percussion section of a philharmonic orchestra.  Not pretty.

This same reason is why, despite the near universal salivation by the drug companies to create a drug that raises HDL cholesterol levels and magically lowers the risk of dying from a heart attack (while at the same time miraculously boosting profits), it will never happen.  Too many variables at play.  Stick with GMO-free soy, exercise and nuts to raise your cholesterol levels instead.

Fasting Insulin, Triglycerides Predict Insulin Sensitivity – (05-14-01)

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Fasting Insulin, Triglycerides Predict Insulin Sensitivity

This study evaluated 9 different factors that are related to insulin sensitivity and found that fasting insulin was one of the best ways to determine insulin sensitivity. This is good news because a fasting insulin is a much easier lab test than a oral glucose tolerance test. With the high prevalence of insulin resistance, I feel that fasting insulin should be a standard part of all blood workup.

Diabetes Care 2001;24:460-464 Log-transformed fasting insulin and fasting triglyceride values are the best of nine predictors of insulin sensitivity in the general population, according to a study conducted in New Zealand. Dr. Kirsten McAuley, of Otago University, in Dunedin, and associates compared the nine factors with results of euglycemic insulin clamping among 178 normoglycemic individuals deemed similar to the general population with respect to blood pressure, body mass index, and waist-to-hip ratio. According to the investigators’ report in the March issue of Diabetes Care, 42% of the sample met criteria for insulin resistance. They found that a fasting insulin of >12.2 mU/L was at least as good at predicting insulin resistance as homeostasis model assessment, insulin-to-glucose ratio, and the Bennett index. “Variables most strongly correlated with insulin sensitivity were fasting insulin, fasting triglycerides, aspartate aminotransferase.

Evaluation of the Antihyperlipidemic Properties of Dietary Supplements – (06-11-01)

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Evaluation of the Antihyperlipidemic Properties of Dietary Supplements

This article examines several natural substances and their ability to lower cholesterol and triglycerides. The authors conclude that the effects of the substances do not exceed a 25% reduction in levels and therefore only have a modest effect. Personally, I would prefer an herb with modest effect and no dangerous or even lethal side effects than a prescription with marked reduction and potentially serious side effects. I can always use the modest natural substance in conjuction with exercise and dietary modification to achieve greater responses.

Pharmacotherapy 21(4):481-487, 2001. We reviewed the published literature regarding the antihyperlipidemic effects of dietary supplements. A search of MEDLINE database, EMBASE Drugs and Pharmacology database, and the Internet was performed, and pertinent studies were identified and evaluated. References from published articles and tertiary references were used to gather additional data. Published trials indicate that red yeast rice, tocotrienols, gugulipid, garlic, and soy protein all have antihypercholesterolemic effects. These supplements, as well as -3 fatty acids, also have antihypertriglyceridemic effects. In clinical trials none of the agents led to a reduction in low-density lipoproteins greater than 25%, suggesting modest efficacy. When recommending these supplements, clinicians should keep in mind that their long-term safety is not established and patients should be monitored closely.

 

Macadamia nuts lowers plasma total and LDL Cholesterol levels – (04-23-03)

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Macadamia Nuts Lowers Plasma Total and LDL Cholesterol Levels

Sadly, I had another patient recently that I obtained old blood work on (6 months prior). This women was on Lipotor, despite the fact that her cholesterol was under 200, HDL was sky high at 80-something and triglycerides were just under 300. This does not strike me as a patient that needs meds–she needs lifestyle changes to affect Syndrome X (abdominal obesity was also present). Worsening the picture was that her liver enzymes were elevated and her PCP made no changes. Worse, the “lifestyle changes” he gave here were no breads and low fat. What an incredible disservice this patient was given. She was surprised when I told her to increase nut consumption (as well as other beneficial changes for insulin sensitivity) because her PCP told her to avoid them…

nutrition.org — Abstracts: Garg et al. 133 (4): 1060

Read entire article here

Fructose Reduces Circulating Insulin and Leptin – (06-18-04)

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Fructose Reduces Circulating Insulin and Leptin, Attenuates Postprandial Suppression of Ghrelin, and Increases Triglycerides in Women

This has been a tough one to explain. Research has shown that fructose (as in high fructose corn syrup) has little effect on insulin levels. This would, at first glance, make it seem a-ok from a dietary standpoint. But most functional medicine practioners have recommended avoiding it for a long time now.

This article starts to shed some light on the harms of this dietary factor. Basically, fructose does not effect insulin, but it does affect leptin and ghrelin in a negative way. Lower leptin levels were seen (remember that leptin speeds up metabolism and suppresses hunger) and higher ghrelin levels (ghrelin will stimulate appretite) in the participants fed high fructose diets. This could definitely lead to weight issues.

JCEM — Abstracts: Teff et al. 89 (6): 2963 –

Read entire article here

Triglycerides Induce Leptin Resistance at the Blood-Brain Barrier – (05-13-04)

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Triglycerides Induce Leptin Resistance at the Blood-Brain Barrier

Recall that leptin is a hormone produced by the adipose tissue that is designed to keep our metabolism in balance. More fat=more leptin=less appetite and faster metabolism. The reverse is then true. But, it appears that high triglycerides inhibit the ability of leptin to cross the blood brain barrier and perform its actions. Chalk up another effect of insulin resistance elevating triglyceride levels. It is rare that, whether in my office or giving a presentation, that patients know their triglyceride levels. They all know their cholesterol, and yet the relationship between cholesterol and triglycerides tells you much about why these values may be elevated.

Diabetes — Abstracts: Banks et al. 53 (5): 1253 –

Read entire article here