TRI, TRI Again

My PCP says my Triglycerides are too high. I expected that and would have whacked him had he said anything else, given the evidence. I read about the two main drugs to treat it, Tricor and Lopid, and was not surprised when he prescribed Tricor, which I'm trying to set up through mail order.

We'll see how that drug works out for me. It does have some interactions with my other drugs, meaning I will have to take it in the AM and watch out for complications such as muscle pain.

He also was a bit concerned about my blood glucose at 106. All told, my vitals put me in the category of having Metabolic Syndrome, a precursor to all kinds of disease including heart disease and diabetes. I'll be getting a Hemoglobin A1C test next time around to check my long term blood glucose readings. Perhaps I'll cover Metabolic Syndrome later, as many of my contemporaries doubtless have this condition.

I'm continuing 4-5 days at the Gym in the early AM, alternating between heavy aerobics on the treadmill and weight lifting. I did get to run outside last week, which was lovely.

I'm taking care of myself to the best of my capabilities. How about you?

Johnny's Report Card

Well my lab results of my Lipid Profile are back. Here's what they say:

Lipid panel:
   cholesterol, total               173  mg/dl         <200    (GOOD!)
   HDL cholesterol               37  mg/dl            >39    (CLOSE!)
   cholesterol/hdl ratio           4.68                 <5.00 (GOOD!)
   LDL cholesterol, calculated   (can not be calculated when the
triglyceride exceeds 400 mg/dl).
   triglyceride                        712  mg/dl         <150>(BAD!)

So, my overall cholesterol is well within the recommended limits. My "good" HDL is close to the recommended minimum of 39, but my Triglycerides are very high.

The National Cholesterol Education Program guidelines for triglycerides are:

• Normal Less than 150 mg/dL
• Borderline-high 150 to 199 mg/dL
• High 200 to 499 mg/dL
• Very high 500 mg/dL or higher
• These are based on fasting plasma triglyceride levels (I was fasting for 12 hrs).

Current recommendations are to keep the triglycerides well below
500mg/dL, and low enough to reduce your VLDL to safe levels. Your VLDL
level is considered safe if it plus your LDL level are no higher
together than 130mg/dL. Doctors do not routinely measure VLDL, but if
you subtract your HDL cholesterol from your total cholesterol, you can
get the LDL plus VLDL sum.

So in my case, total cholesterol less HDL is (173-37) or 136. So I'm close on total VLDL+LDL, but the Tri's are way out of the safe range.

Triglyceride levels are very sensitive to diet, exercise, and health habits. It is common to have high triglycerides if you are overweight, if you are physically inactive, if you drink alcohol or smoke, or if you consume a high-fat and high-carbohydrate diet, particularly if your carbohydrates are not whole-grain foods. Triglycerides are also elevated in people with diabetes, kidney disease, thyroid disease, and certain inherited cholesterol problems. High triglycerides are one sign of the metabolic syndrome, a collection of health risks that indicate a very high risk of heart disease. It is important for you to be tested for diabetes and to have your blood pressure evaluated, because these are other features of the metabolic syndrome.

It is possible to substantially improve triglycerides by increasing your exercise and sharply cutting the amount of saturated fat and rapidly absorbed carbohydrates (processed flours or simple sugars, including milk sugar) in the diet. You should substitute whole grain foods, fruits and vegetables, skim milk and reduced-fat foods wherever possible. Medications are also available to lower triglycerides, including statins, gemfibrozil (Lopid), fenofibrate (Tricor), niacin, and omega-3 fatty acids.

In the last post I mentioned the recommendations for lowering Triglycerides.

In my case, I'm eating pretty well, getting 3-5 intense workouts each week, taking Omega-3 fish oil caplets (yuk), and tearing up the produce department. So I think I have two causes left:

1. I have a hereditary disposition to high Triglycerides
2. I need to cut back or eliminate alcohol

I have an appointment with my PCP this week. We'll see what he says about all of this.

Demon Rum - How Alcohol Affects Heart Disease

Last post we talked about Triglycerides, the Very Low Density Lipoproteins. Too much of them is bad. We mentioned that alcohol and carbohydrates increase triglycerides, while Omega-3 and Omega-6 oils and exercise reduce levels.

Alcohol's impact on Triglycerides

Alcohol are a source of excess calories which are being turned into fat - usually, triglycerides, so the fat levels in your blood go up. But that’s only part of the story. Researchers have found that apart from adding calories to the diet, alcohol also prevents the burning of fat. According to a Swiss study reported in the Journal of the American Medical Association, alcohol in the bloodstream can slow down fat metabolism more than 30 percent.

When alcohol is present in the blood, the liver prioritizes removing alcohol from the blood over other metabolic processes. The liver can detoxify about one ounce of alcohol per hour, which is about one serving of an alcoholic beverage - equivalent to 12 ounces of beer or 4 ounces of wine. In the meantime, however, any sugars present in the drink will also be further processed into triglycerides which raises their blood levels. Additionally, alcohol reduces the amount of the enzyme that breaks down triglycerides and spurs the liver to make more triglycerides. Some people have increased susceptibility to developing raised triglycerides in response to alcohol. So if you do not require insulin, or are not diabetic, and consume alcohol regularly, you may be able to lower your elevated triglycerides just by avoiding alcohol.

By taxing the liver and reducing the ability to detoxify blood, alcohol causes more harm to blood vessels. When the liver is busy processing alcohol, it is less able to process cholesterol. As a result, LDL-"bad" cholesterol levels go up. In addition, alcohol will potentiate the toxicity of cholesterol-lowering medications much more than the drugs would do alone. Actually, this is the major problem with the statins. By drinking alcohol daily, you may increase your chances of serious statin side effects, especially liver problems. Therefore, to protect your liver, you should go easy on alcohol or avoid it completely while taking a statin.

Lowering Triglycerides

Changes in lifestyle habits are the main therapy for high triglyericdes. These are the changes you need to make:
* If you're overweight, cut down on calories to reach your ideal body weight. This includes all sources of calories, from fats, proteins, carbohydrates and alcohol.
* Reduce the saturated fat, trans fat and cholesterol content of your diet.
* Reduce your intake of alcohol considerably. Even small amounts of alcohol can lead to large changes in plasma triglyceride levels.
* Eat fruits, vegetables and nonfat or low-fat dairy products most often.
* Get at least 30 minutes of moderate-intensity physical activity on five or more days each week.
* Substitute monounsaturated and polyunsaturated fats —such as those found in canola oil, olive oil or liquid margarine — for saturated fats.
* Substituting carbohydrates for fats may raise triglyceride levels and may decrease HDL ("good") cholesterol in some people.
* Substitute fish high in omega-3 fatty acids instead of meats high in saturated fat like hamburger. Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in omega-3 fatty acids.

The National Cholesterol Education Program guidelines for triglycerides are:
Normal Less than 150 mg/dL
Borderline-high 150 to 199 mg/dL
High 200 to 499 mg/dL
Very high 500 mg/dL or higher
These are based on fasting plasma triglyceride levels.

I get my blood lipid tested next week. I'll report on my cholesterol numbers once I have the results back!