Why it's crucial to keep triglycerides at 60 mg/dl or less

There's one truly helpful value on a standard cholesterol panel: triglycerides. Ironically, it's also the value most likely to be ignored or mismanaged because the doctor wastes your time by focusing on the useless total and LDL cholesterol values, having been brainwashed by the flawed science and pharmaceutical marketing. 

Here is WHY triglycerides are so important, HOW you can reduce your value to the very important level of 60 mg/dl or less without resorting to the use of any pharmaceuticals, only natural and dietary strategies. 

Chapters

• 0:00 Why Triglycerides Matter Most
• 1:52 Dismantling LDL And Diet Myths
• 3:40 Normal Ranges Versus Real Health
• 5:34 How The Liver Makes Triglycerides
• 8:18 VLDL, Small LDL, And Artery Damage
• 12:05 Targets And Downstream Benefits
• 14:15 Diet To Turn Off Lipogenesis
• 16:20 Omega‑3s: EPA And DHA Strategy

Transcript

William Davis, MD: 0:00

Let's talk about why I believe it's so important to keep your blood triglyceride level to 60 milligrams per deciliter or less. This is among the most important and powerful markers for your health that you can get. Ironically, it's the most useful number in a conventional cholesterol panel. Remember, there's a total cholesterol, an LDL cholesterol, HDL cholesterol, and a triglyceride level. Well, this is what I tell people. Take a big black magic marker and cross out total and LDL cholesterol, because they're silly, they're ridiculous. Those numbers should have been discarded decades ago in light of the new science that tells us those measures don't really tell us any, almost nothing at all. Yet they are the focus of a trillion dollars worth of statin cholesterol drugs, for instance. It led to the dietary advice to cut saturated fat and cholesterol. All of this is nonsense. You do not have to do that to reduce or even eliminate risk for cardiovascular disease. So the real tragedy of all that nonsense on diet and statins and LDL cholesterol is that it took everyone's attention off the real causes of heart disease, which are identifiable and easily and readily corrected. But there's no pot of gold in doing so. There's no fancy drugs, no procedure. You know this. My colleagues, including cardiologists, are not, let's be clear on this, they are not experts on health. They are rank amateurs in health. They're experts in pharmaceuticals and revenue-generating activities like procedures. And health just happens to be this kind of sideline they almost dismiss. So they've gotten it wrong so many times. And among the mistakes they made was the advice to reduce saturated fat and cholesterol, which does not reduce cardiovascular risk. But anyway, back to the primary issue here, and that is the value of following triglycerides. Now, if you look on your lipid panel, your cholesterol panel, you'll see that the normal or reference range is 150 milligrams per deciliter or less. Is that true? No, of course not. That's like the blood glucose nonsense. If you're 126 milligrams per deciliter or less, you're not type 2 diabetic. Well, yeah, but you still have all kinds of health problems like kidney disease, an increased risk for cardiovascular disease, a long list, when your blood glucose, say, is 123. Okay? So that cutoff of 126 just means above that, they officially classify you as a type 2 diabetic. But having a blood glucose of, let's say, 120, 123 is still terrible. Same thing here. At a triglyceride level of 150 milligrams per deciliter, it tells you a whole long list of problems with your health. And so it's only when you get your triglycerides down to 60 milligrams per deciliter where all those problems go away. So to understand this, let's recount where triglycerides come from. So they come from your liver. Your liver is wonderfully effective in converting carbohydrates and sugars to triglycerides. Triglycerides are fats. Fats are triglycerides. If you had a bottle of olive oil, for instance, that's a bottle of a form of triglycerides. Your liver is very good at converting carbohydrates and sugars to triglycerides, converting carbohydrates to fats. So that process is called liver or hepatic de novolipogenesis, making new fats. So if I eat, say, a bagel or sandwich with bread, the amylopectin A of wheat and grains or the sucrose, the sugar, is converted by your liver to triglycerides. Now the liver wants to release those into the bloodstream, but it can't just release triglycerides because if you release fat into the bloodstream directly, it will coalesce. So think of your salad dressing. If you made salad dressing, what happens to the oil, the oil and vinegar? They separate. At the bottom is the higher density, the more dense vinegar and water. Floating to the top is the oil, because oil is less dense, but it coalesces, right? If you shake it, within a minute, it's back to separation, right? So oils coalesce. Well, if your liver released triglycerides, oils, into your bloodstream, they would coalesce and you would infarct or block the capillaries, the small blood vessels, in all your organs, and you would be dead, probably within minutes. So the liver has evolved to package those triglycerides into water-soluble particles because the blood is a water-soluble vehicle. It doesn't look like water, but it's water-soluble, right? Especially when you remove the red blood cells. You'll see it's clear plasma. So the liver packages those triglycerides into water-soluble particles. Now, these particles are called very low density lipoproteins. They're very low density because they're filled with fat, just like the oil in your salad dressing. So we call it VLDL, very low density lipoproteins, so that the triglycerides are solubilized and don't coalesce. Now, those VLDL particles are important because they are a direct cause for coronary disease. And those triglyceride-rich VLDL particles are known to interact with LDL particles, not LDL cholesterol, that stupid marker that should have been discarded, abandoned decades ago, but the actual particles themselves, the low-density lipoprotein particles, the LDL particles. So the VLDL particles interact with the LDL particles and they make the LDL particles triglyceride rich. Now that triglyceride-enriched LDL particle goes through a series of enzymatic reactions in the bloodstream that makes that particle small. Now, a small LDL particle is very different than a large LDL particle. A large LDL particle is the result of consuming fats, and the liver recognizes those large LDL particles and clears them very rapidly within 24 hours. The small LDL particle is not well recognized by the liver because the recognition protein on its surface, called apoprotein B, is partially concealed and the liver cannot see it, cannot recognize it. So the small LDL particle circulates in your bloodstream over and over and over and over again, including in the coronary arteries, giving it lots of opportunity to enter the arterial wall, which better able to enter because it's smaller, it's much more adherent to the structural proteins in your artery wall, it's much more inflammation-provoking, and when in the bloodstream is much more prone to factors like oxidation that make it much more dangerous. So the small LDL particle is perfectly crafted to cause coronary disease, heart attack, sudden cardiac death, appearance of symptoms like angina that lead to stent implantation and bypass surgery, as well as atherosclerosis and other parts of the body, like the carotid arteries. So that whole process began in the liver by consuming carbohydrates. And so when you have a triglyceride level of 60 milligrams per deciliter, it means that there's very little VLDL particle production. It means there's very little VLDL to interact with the artery wall. It means there's very little VLDL to interact with the LDL particles to generate the small LDL particles. So what you'll see when you get your triglycerides down to 60 or less, and by the way, typically on my programs, we get triglycerides of about 44 to 47 or so. That's common in most people. When you have that low a triglyceride level, you don't have small LDL. And other good things happen. It tends to be followed by reductions in blood glucose, in insulin resistance, and weight loss. So how do you get your triglycerides down to 60 milligrams per deciliter or lower? Well, think about the diet, how the liver causes via uh liver denova lepogensis. Stop consuming the amylopectin A of wheat and grains and sugars. So we eliminate wheat, grains, and sugars, and that alone, precipitous, dramatic reductions, even if your triglycerides are 400, say, that alone will drop your triglyceride levels dramatically. Let's say to maybe 100 or so. Dramatic drop. Getting omega-3 fatty acids. While omega-3 fatty acids have been debated for 20 years, ever since the epidemiologic studies came out, suggesting that populations that ate a lot of fish or seafood had reduced cardiovascular events, but that science has clarified in the last few years and it is crystal clear now, well established, that not only is omega-3 fatty acid supplementation effective in reducing cardiovascular risk, it's also effective in regressing coronary disease. If you don't know what I'm talking about, please see my other videos, my Define Health podcast, my thousands of blog posts on William DavisMD.com, where I talk about the clarifying science on omega-3-fatty acid and how it is an absolutely essential cornerstone. You can only get it, by the way, from fish oil. There's some other rare sources like algae, but fish oil is by far the preferred source. And you want both the EPA and DHA. Don't fall for the silly arguments that because the pharmaceutical form is EPA alone, that you only need because remember, EPA is very effective for reducing cardiovascular risk and regressing carneary plaque, but it's DHA that preserves cognitive health and brain health to prevent dementia. And if you took a prescription form of EPA, you need to take conventional fish oil to get to DHA. That's stupid. Just take the fish oil, right? And we aim for a dose of a minimum of 3,000 milligrams of EPA and DHA per day. Not 3,000 milligrams of fish oil, but 3,000 milligrams of EPA and DHA or more, because that's the dose that not just facilitates regression of carneuriplaques, specifically the soft rupture-prone components that cause heart attack, but it also stacks the odds in favor of reducing dementia risk. It's one of the very few things that actually is truly beneficial. If you don't understand what I'm talking about, see my conversations and all those places I mentioned to understand the difference between something that is neurotrophic, beneficial to the brain, and something that is nootropic, that is just has transient beneficial effects on cognition. Those are two very different things. Fish oil is a neurotrophic agent. It actually has been shown with good science to preserve brain health, but it's the DHA. So don't fall for the silly pharmaceutical argument that only EPA is effective. You want both for heart health, brain health, and for reduction of triglycerides. Now, even better. So omega-3 fatty acids are very effective in dropping your triglycerides. Typical drop would be 25 to 40 percent. But go even further, address insulin resistance. How do you do that? Well, the diet is a big step in that direction. The omega-3 fatty acids help, but also address vitamin D, iodine, and magnesium. These are nutrients largely lacking. These aren't just random, these are nutrients largely lacking in the modern human experience. For instance, you don't drink water from rivers and lakes, right? You have to filter it. That water in rivers and lakes has sewage and herbicide, farm runoff, and other garbage. You'd get sick. So you have to filter water. Well, water filtration removes all magnesium and modern produce, lettuce, green peppers, etc. The way it's raised on farms, there's very little magnesium, there's about as much as a 90% reduction in magnesium content in modern produce. So we have to supplement magnesium. Likewise, iodine, vitamin D, these are things largely lacking. But when you synergize, when you put all those four things together, omega-3 fatty acids, iodine, magnesium, omega-3 fatty acids, they synergize to minimize insulin resistance. And that drops your triglycerides even further. And then the last thing we do is we address the disrupted gastrointestin microbiome. So recall that half the U.S. population has allowed fecal microbes from the colon to ascend and colonize the small intestine, 24 feet of small intestine. Small intestine is very permeable. When those microbes, when those fecal microbes die, because they only live for a few hours at a time, they release their toxic compounds, especially a component of their cell wall called endotoxin. That endotoxin empties into the bloodstream. Now the gastrointestinal system, your liver, your intestines, etc., empty into a part of the venous system called the portal venous system. And that system empties directly into the liver. So your liver, when there's a disruption of the gastrointestinal microbiome, whether it's just in the colon, colonic dysbiosis, or worse, in the entire small intestine, also SIBO, small intestinal bacterial overgrowth, those situations cause that endotoxin from fecal microbes to empty into the portal venous system to the liver. And your poor liver takes a beating and it amplifies liver denoval lipogenesis that produces triglycerides, thereby VLDL and small LDL. So we're going to address colonic dysbiosis and more commonly SIBO. You see my recipe for what I call SIBO yogurt, and all that is, is we're going to cultivate beneficial microbes that nearly everybody has lost, that colonize the small intestine and colon, very unusual, and produce what are called bacteriocins, natural antibiotics, smarter than prescription antibiotics, because they're selective for the bad microbes. The E. coli, the salmonella, the campylobacter, all the fecal microbes that are in place they don't belong or they're overpopulated. So this, what I call SIBO yogurt recipe, lactobacillus roterite, lactobacillus gastri, and my most recent recipe, bacillus subtilis. Those microbes colonize the small intestine and colon, produce bacteriocins, and this has been magnificently effective in correcting SIBO when judged by measures like hydrogen gas production in the breath. That's a whole nother conversation. But because you've reduced endotoxemia in the portal venous system, you're helping turn off liver denova lipogenesis, and you're going to see a further reduction in triglycerides. But do you see how silly it is to think that reducing cholesterol reduces cardiovascular risk? Or taking a silly drug like a fibrate or a statin drug to reduce triglycerides does not even get close to addressing the actual source of these problems. So, in summary, we're going to follow a diet that turns off liver denova lipogenesis, that creates triglycerides. We're going to address nutrients, but especially omega-3 fatty acids, but as well as vitamin D, iodine, magnesium. When all this put together is put together, they synergize to minimize insulin resistance that would have been amplifying your liver denova lipogenesis. Then lastly, we're going to address colonic dysbiosis and SIBO using what I call SIBO yogurt by my recipe that reduces portal vein endotoxemia and you further get a reduction. This is how you get triglycerides to 60 milligrams per deciliter or less, and thereby turn off that very important contributor to coronary disease. Now, once again, if you want to know more about this, you want to see the scientific rationale, you want to see the science behind it, that's all in my books, Superbody, Super Gut, Wheatbelly, and others. In my blog, WilliamDavesMD.com, my YouTube, other YouTube videos, of course, there's several hundred of them. My blog post, WilliamDavesMD.com, there's several thousand blog posts. So I try to make all this because you know what? If there's a battle being fought here, it's against the forces of conventional health care that do not provide health. They do not serve you in helping you become healthy. In fact, they're doing the opposite. They use pharmaceuticals and procedures only. It's a rare MD or other practitioner who actually understands nutrition and health. And so that's the mission here. Try to help you understand that there's a rationale here. It's not something I made up last Tuesday. There's actual science, there is ration, it's just not being delivered to you.