High Blood Triglycerides: Sources, Types and Multiple Causes
The purpose of this website is to present, to all who want the knowledge, a safe and dependable method through which individuals can lower their elevated blood triglyceride levels. You can achieve astonishing results - if you put your mind to it. By having the whole page printed, you can read it in a nice easy chair, away from that glaring monitor.
As found in the bloodstream, triglycerides are fats being transported from intestines to body cells. They may originate from two sources:
the food you eat, mainly sugar, animal products and saturated fat (sweets, red meat, dairy) processed in the intestines, and/or
being manufactured within the body by the liver itself -- especially during times, when dietary fats are not available.
Dietary fats (from food) are absorbed through the gut – the intestines where they are assembled (synthesized) into special “lipid packets” called chylomicrons, a microscopic, minute fat particles formed during fat digestion and assimilation that directly enter the lymphatic system.
Intestinal triglycerides, or chylomicrons, containing approximately 85 percent triglycerides, are then delivered through the bloodstream to the liver, where they are processed (the normal half-life of chylomicrons is about 10 minutes).
(The half-life of a substance refers to the time required to eliminate or metabolize half of the total quantity of the substance from the body following its digestion.)
Hepatic Triglycerides: Very Low Density Lipoproteins
Any disturbance in lipid synthesis causing an excess of intestinal chylomicrons and/or and excess of triglyceride-rich VLDLs produced in the liver, or any disturbance in their breakdown will cause elevations in blood triglyceride levels.
One of the main jobs of the liver is to make sure that all the tissues of the body receive the triglycerides they need to function at optimal levels.
Whenever possible (i.e., for about 8 hours after a meal), the liver takes up dietary triglycerides from the chylomicrons produced in the intestines or - especially when dietary fats are not available - synthesizes them.
However, fats are not soluble in water. Because the liquid part of blood is made up with water, the liver packages triglycerides, along with special proteins, into tiny water-soluble packages-spheres, or carrier molecules, called very low density lipoproteins, or VLDL. In this form, they are released into the circulation and delivered to the cells of the body.
In fact, VLDL is one of three hepatic - synthesized by the liver - major "lipid packets,” which include:
high density lipoprotein (HDL-"good" cholesterol) and
low density lipoprotein (LDL-"bad" cholesterol).
Each one of these "packets" contains then triglyceride and cholesterol, but in varying amounts unique to each packet.
As their name suggests, very low density lipoproteins (VLDLs) are much lighter than low density lipoproteins (LDL), containing mainly cholesterol, and high density lipoproteins (HDL), containing mostly the excess cholesterol removed from tissues and carried back to the liver.
This is because of their makeup - VLDL particles contain less protein and more fat (mainly triglycerides) than both LDL and HDL cholesterol. In fact, fatty triglycerides account for approximately 50 percent of the dry weight of a VLDL molecule, compared to only 5 to 10 percent for LDL and HDL.
It contains so much triglyceride, in fact, that you can get an idea of what the VLDL concentration is by dividing the triglyceride value by 5.
At present, there is no direct way of measuring VLDL, so the direct measurement of triglyceride is considered the next best thing, and the calculation is done if needed.
However, the more VLDL is produced by the liver, the higher triglycerides, and the more fat in the bloodstream.
A high level of triglyceride-rich VLDL ("normal" is 1-30, optimal is below 20) also goes hand in hand with a low level of protective HDL-"good" cholesterol.
Furthermore, as VLDL travels through the bloodstream – its normal half-life is about 9 hours - cells remove its triglycerides, which are replaced with cholesterol.
This is bad news. According to many medical experts, triglycerides themselves can be harmful to the cardiovascular system leading to a heart attack or stroke. Also, excess fat makes the blood more sluggish and reduces its ability to carry oxygen to cells.
Multiple Causes and Associated Conditions
The most common cause of an elevated triglyceride level is a non-fasting specimen.
There are many, common and uncommon causes of high blood triglycerides, including dietary indiscretion, metabolic disease, drugs, or rare genetic mutation of an enzyme in the lipid metabolism pathway (type I hyperlipoproteinemia).
However, the commonest cause of an elevated triglyceride level is -- inadequate patient fasting, since a recent meal will cause fat in the form of triglycerides to be transported from the gut to the rest of the body.
Once a non-fasting specimen has been eliminated as a possible cause of increased triglycerides, the other causes should be considered, such as:
metabolic syndrome X, also called the insulin resistance syndrome or pre-diabetic syndrome; although not a cause of high triglycerides, metabolic syndrome is closely associated with this condition, along with low HDL-"good" cholesterol
obesity or overweight; generally when people lose weight, both triglycerides and HDL-"good" cholesterol improve
type 2 diabetes and/or when the body cannot handle blood sugar (glucose); poorly controlled diabetes can increase triglycerides significantly, especially when blood glucose is out of control
prolonged stress - during stress, fat is not being metabolized as rapidly and efficiently; a new study has found the evidence that psychological stress causes triglycerides to stay in the bloodstream longer contributing to heart disease (Psychophysiology, 2002: 39; 80-85)
prolonged depression - depression works on your body in different ways than stress, but the results are the same; in a 1994 study, Dr. Glueck and colleagues demonstrated that high blood triglycerides, together with high total cholesterol and low HDL-"good" cholesterol, were the sole causative factors in mild to serious depression he detected in patients referred for treatment of severe familial hypertriglyceridemia
too long fasting (way over 14 hours); it causes major changes in energy metabolism, especially with implications for blood triglycerides
regular ingestion of refined carbohydrates such as starches, grains, sweets, and other sugar-containing foods; generally, a diet in which more than 60% of the energy intake is from carbohydrates
heavy caffeine use, on average 560 mg of caffeine per day; however, the amount of caffeine in coffee or tea is variable: one 5 oz. cup of coffee contains approximately 40-170 mg caffeine (average 80 mg), one 12. oz. can of Cola contains 30-60 mg caffeine (average: 45 mg), one 8 oz. cup of black tea (one tea bag) contains 25-110 mg caffeine (average: 40 mg)
smoking cigarettes (overall, as smoking is one of the biggest contributors to excessive blood fats, smokers have significantly higher serum concentrations of triglycerides compared with nonsmokers; smoking does damage indirectly by reducing HDL-"good" cholesterol, which helps take triglycerides from the blood back into the liver for excretion.)
alcohol (alcohol abuse - heavy drinking or alcoholism)
lack of exercise (sedentary lifestyle, lack of physical activity)
chronic liver disease, such as cirrhosis, most often associated with alcohol abuse
nephrotic syndrome, a condition indicating kidney damage, characterized by high levels of protein in the urine, lack of protein in the blood that lead to hyperlipidemia with elevated cholestorols, triglycerides and other lipids, and edema
pancreatitis - inflammation or infection of the pancreas, which in turn may be caused by high levels of triglycerides
cyclosporine (Neoral) - a potent immunosuppressant, prescription medication used to prevent rejection problems in kidney, liver, heart and bone marrow transplants (currently, a bone marrow transplant is the only cure for chronic myelogenous leukemia (CML); however, the procedure is successful less than 2/3 of the time). Following bone marrow transplants, cyclosporine increases both triglyceride and LDL-"bad" cholesterol levels in blood
dialysis or kidney transplantation; 50 to 80 percent of kidney transplant patients have some degree of high cholesterol and/or triglycerides which may persist for years after transplant
interferon (IFN) therapy - there are several reports that interferon can cause alterations in lipid metabolism in about 10 to 15 percent of patients resulting in mild elevations in triglycerides and increases in cholesterol; usually, the changes return to normal when treatment is stopped
atherosclerosis, the underlying cause of heart disease
hyperlipoproteinemia (hyperlipidemia), characterized by abnormally high levels of lipids (cholesterol, triglycerides, or both) carried by lipoproteins in the blood
vertigo which may be a symptom of numerous problems with metabolism, including high blood triglycerides (Lehrer JF, Poole DC, Seaman M, et al. Identification and treatment of metabolic abnormalities in patients with vertigo. Arch. Intern. Med. 1986;146:1497–500)
underactive thyroid (hypothyroidism) - a condition caused by the effects of too little thyroid hormone in tissues of the body
cystic fibrosis, a fatal inherited disorder affecting mainly the lungs and the digestive system (high blood triglyceride levels in people with cystic fibrosis may be related to a chronic low-grade inflammation or to a dietary macronutrient imbalance with an excess absorption of simple carbohydrate compared to fat)
Kawasaki Disease (KD) - a febrile systemic vasculitis in children; an inflammation of the blood vessels accompanied by high fever of unclear cause and overrepresented in Asian populations, especially Japanese, and among Americans of Japanese descent; in the early phase of KD, lipid profile alterations include increased levels of triglycerides and decreased levels of high-density lipoprotein (HDL), and cholesterol; if untreated, KD can be complicated by coronary and peripheral arterial aneurysms (CAA)
lupus, an autoimmune disorder, chronic inflammatory disease affecting especially the skin, joints, blood, and kidneys
gout, one of the most common forms of arthritis (joint inflammation), usually affecting the feet and ankles, especially the ball of the big toe
Cushing's syndrome, sometimes called "hypercortisolism" - a relatively rare hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol, commonly characterized by upper body obesity
polycystic ovary syndrome (PCOS) - an endocrine (hormonal) disorder; although high triglycerides are very often associated with PCOS, they are not seen in every woman (no two women experiencing PCOS have exactly the same symptoms)
estrogens, for example as "the pill" or as hormone replacement therapy (HRT), such as Premarin (for menopause or hysterectomy); progesterone, however, also tends to increase blood triglycerides and decrease HDL-"good" cholesterol
corticosteroids (kor-ti-koe-STER-oyds) - strong cortisone-like, antyinflammatory drugs, such as Hydrocortisone, Prednisolone, and Prednisone; abnormal deposits of fat on bones and in the bone marrow reduce the blood circulation leading to osteonecrosis, also called avascular necrosis, typical in AIDS patients
cholestyramins (koe-less-TEAR-a-meens) - drugs for lowering cholesterol, such as Questran or Prevalite
beta-blockers - a short name for beta-adrenergic blocking agents or beta-blocking agents (most of the generic names for beta blockers end with "olol"); used in the treatment of high blood pressure (hypertension), cardiac arrhytmias, angina (chest pain) and in patients with coronary artery disease to help prevent additional heart attacks. Some beta-blockers, without intrinsic sympathomimetic activity (ISA), tend to raise serum triglycerides and to decrease HDL-"good" cholesterol. The common adverse effects of beta-blocker are cold hands, fatigue; the less common, but serious adverse effects include the provocation of asthma, heart failure or conduction block. Beta-blockers are effective in only about 20 percent of patients over 60 years old in whom the thiazides (diuretics) are the drugs of choice
diuretics - such as thiazides (bendrofluazide), medicines usually given for high blood pressure or heart failure, often in combination with other antihypertensive agents, including beta-blockers; also known as water pills, diuretics increase blood triglycerides
Tamoxifen (Nolvadex), the number one recommended drug treatment for women recovering from breast cancer; however, with potential lethal side-effects; besides elevated blood triglycerides, tamoxifen has been associated with induced menopausal symtpoms, eye damage, blood clots, asthma, liver, uterine (endometrial), and gastrointestinal cancers
miconazole (intravenous) - an antifungal agent administered by intravenous infusion in the treatment of severe systemic fungal infections such as candidiasis
spironolactone - a drug for cirrhotic ascites (hepatic cirrhosis with ascites)
Accutane (a trade name of Isotretinoin) - a powerful drug used in the treatment of acne with several significant side effects, including increased blood fats - sometimes to risky levels
Quinapril (Accupril), an antihypertensive (blood pressure lowering agent) known as an ACE inhibitor with numerous side effects, including high triglyceride levels
Mirtazapine (Remeron), a newer antidepressant (it can cause increased blood levels of triglycerides to 500 mg/dL, or 5.6 mmol/L)
cancer – "The lipid profile in cancer patients is characterized by low low-density lipoprotein-cholesterol, low high-density lipoprotein-cholesterol and relatively high serum triglycerides." (Journal of Clinical Laboratory Research 2000; 30(3): 141-145)
early-onset of schizophrenia - dyslipidemia may be related to the more severe forms of schizophrenia or to a more prolonged exposure to antipsychotics; also a poor diet due to cognitive disorders may play a role, increasing the risk for the cardiovascular complications of higher serum triglyceride levels (Am J Psychiatry 161:176, January 2004)
HIV+, especially protease inhibitors (PIs), such as Ritonavir, associated with fat redistribution, increased risk for atherosclerosis, diabetes and bone damage (osteonecrosis) due to lipid abnormalities (hypertriglyceridemia or hypercholesterolemia)
periodontal disease - a Japanese study indicates a relationship between elevated serum triglyceride level (> 149 mg/dl, or 1.7 mmol/L) and periodontal status (Community Dent Health 2004 Mar;21(1):32-6).
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