What happens when you keep triglycerides 60 mg/dl or less?

Of the four values provided on any standard cholesterol panel, the triglyceride value reveals the most about your health. Ironically, it is often the value most commonly ignored or dismissed, or simply treated using the wrong agents. 

Here is what you can expect if you keep triglycerides 60 mg/dl or less. 

Transcript

Who Dr. Davis Is

William Davis, MD 0:00

I'm Dr. William Davis. If you don't know who I am, I practiced cardiology for 30 years, a good deal of it in preventive cardiology in the last few years. But I also wrote a number of books, including the number one New York Times bestselling Wheatbelly series, as well as Undoctored, and more recently Super Gut and Superbody.

Why Triglycerides Matter Most

William Davis, MD 0:18

Well, let's talk about this idea. What happens to you if you get your triglyceride level to 60 milligrams per deciliter or less? So triglycerides is one of the four values provided to you on any standard cholesterol panel, in addition to total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. Now, if you've been following my conversations, you know I poke fun at total and LDL cholesterol as outdated, imprecise values, concepts that should have been discarded decades ago in light of superior information you can obtain by using other methods. But ironically, I would say triglycerides, of the four values, triglycerides is by far the most important because it's the tip of the iceberg that if it's high, and I would regard high as anything above 60 milligrams per deciliter, it signals the development of numerous distortions of metabolic health, of the sort that leads you down the path of obesity, hypertension, coronary disease, heart disease, stroke, risks for multiple cancers, risk for dementia. In other words, that one value, that triglyceride value, the one that is ironically most often ignored or at least dismissed, packs a ton of insight into your health. So let's talk for a moment.

What Triglycerides Really Measure

William Davis, MD 1:45

What are triglycerides? Well, it's a it's a blood marker, right? But they're not actually measuring triglycerides because triglycerides don't actually occur in the bloodstream in isolation because they're fats. So if you had a jar or a bottle of olive oil, let's say extra virgin olive oil, that is a bottle of triglycerides. If you had a bottle of corn oil, that's a bottle of triglycerides. Different kinds of triglycerides, but nonetheless triglycerides. So fats and oils are triglycerides. Triglycerides are fats and oils. Fats and oils, of course, differ by whether they're solid or not at room temperature. But structurally they're very similar. So triglycerides cannot occur by themselves in the bloodstream, because, like your salad dressing, oil will separate from the aqueous phase, the water and vinegar. You may shake your salad dressing and it may mix momentarily, but within seconds it goes back to separating. That's because oils coalesce. And of course, the oils go to the top because they're less dense than the water and vinegar. So oils will coalesce. And if triglycerides, oils and fats, were to occur in isolation in your bloodstream, they would coalesce and you would promptly die because they would coalesce and block off the blood flow to various organs. So the liver has evolved to not release triglycerides into the bloodstream, but to package them in particles that are soluble in the plasma, that is your blood without the red blood cells. It's more like water. It's an aqueous liquid. So liver packages triglycerides into particles. The first particle that the liver produces is called very low density lipoproteins, VLDL. Low density because they're full of fat, right? About 50% by weight of a VLDL particle are triglycerides, but solubilized by the presence of other factors like proteins and phospholipids and other things. Where do triglycerides come from? Well, there's two general sources of triglycerides. One would be your ingestion of fats and oils. So if you had olive oil in your salad dressing or you had some butter, or you ate the fat on your pork, you would digest those fats and they would enter the bloodstream as something called chylomicrons. But they are cleared very rapidly and they tend not to be a big determinant of the blood level of triglycerides. The major source of triglycerides is your liver. Your liver's conversion, it has enormous capacity for converting carbohydrates and sugars to triglycerides. So a process that converts carbs and sugars to triglyceride. That process is called liver de novolipogenesis. And all that means is the liver's capacity to convert carbs and sugars into triglycerides. Lipogenesis, making fats, making new fats, de novolipogenesis. And so whenever you eat anything that has a carbohydrate or a sugar in it, such as the amylopectin A carbohydrate unique to wheat and grains, or sucrose, fructose, glucose, fructose is especially harmful. Your liver converts those to large quantities of triglycerides. But as I mentioned earlier, you can't release those triglycerides directly into the bloodstream because they would harm you. So the liver packages them into VLDL particles. So now this process comes after the flood of chylomicrons. So you eat a mixed meal of mixed composition, fats, protein, fibers, carbohydrates. The first surge in triglycerides is really as chylomicrons. And then that lasts only a brief time, a few hours. Then long term, many hours later, there's a second surge in VLDL. That's the thing we're concerned about. Because VLDL particles themselves are a cause for coronary disease. They interact with the arterial wall and contribute to the development of atherosclerosis. And VLDL, triglyceride-rich VLDL particles, interact with LDL particles, making them, making the LDL particle triglyceride enriched. And there's a series of enzymatic, we say remodeling steps that cause that triglyceride-enriched LDL particle to become small and dense. That's the source of small, dense LDL particles that are a very aggressive cause for coronary disease, heart attacks, sudden cardiac death, and those kinds of events. When you get that triglyceride value on your cholesterol panel, it's really not triglycerides. It's meant to be an indirect way of quantifying VLDL particles, right? Because you're because the blood was drawn typically fasting. Usually you have your blood drawn right on the morning after a 12-hour fast. And so that triglyceride level is meant to represent VLDL particles. So what happens if you keep your triglyceride level 60 milligrams or below?

The Damage Above Sixty

William Davis, MD 6:48

Well, think of triglycerides as the tip of the iceberg. If triglycerides go up above 60, the higher it goes, the worse it gets. So a triglyceride level, of course, of 150 is much worse than a triglyceride level of 68, say. And of course, the the laboratory will quote a reference range, that is suggested range of 150 milligrams per death or less for triglycerides, which is ridiculous. That's like saying your blood pressure of 180 over 100 is okay. No, it's not okay. A triglyceride level of 150 or 138 or 122 is not okay because any value above 60 milligrams signifies that bad things are happening beneath the surface. So what can happen if your triglycerides go up high? Whether it's 100 or 150 or 300, even 2,000, which can happen. Well, we know that that high triglyceride, of course, as I mentioned, is accompanied by a surge in VLDL causing heart disease, a surge in small dense LDL causing heart disease. We know it's associated with measures of insulin resistance, that is your body's inability to respond to insulin, and thereby it come it's accompanied by high blood glucose, even into the prediabetic or diabetic range. It's accounted by high blood insulin, reflecting the poor responsiveness to insulin, because your pancreas overcompensates by producing huge quantities of insulin, and a higher hemoglobin A1C, that long-term measure of blood glucose. Higher triglycerides also signal higher blood pressure because there's a process called endothelial dysfunction. And all that means is there's an abnormal constrictive capacity, abnormal constrictive behavior of your arteries, and that accelerates the accumulation of atherosclerosis in your arteries as well as causing hypertension. If you were to measure inflammation measures like C reactive protein or interleukin 6, interleukin beta, 1 beta, tumor necrosis factor alpha, even a white blood cell count or a neutrophil count, all reflecting inflammation somewhere on the body, those would all be higher when triglycerides are increased. It also tells you that high triglyceride value also tells you that you have an excess of abdominal visceral fat. Recall that there's two kinds of body fat. There's subcutaneous fat just below the skin surface, which is relatively benign. It can pose a weight challenge to your joints and maybe an aesthetic issue, but it's not really a threat to your health. The fat that's really dangerous for you is fat in the abdomen and circling abdominal organs, like the liver and kidneys and pancreas, because the gastrointestinal tract drains via a specialized venous system to the liver called the portal venous system. And so when you have too much abdominal visceral fat that you may or may not see from the surface, you can still have a flat tummy and still have too much abdominal visceral fat. Well, that venous drainage of abdominal visceral fat, that fat is inflamed. And the inflammatory mediators enter or are drained in the portal venous system to the liver. And when the liver is hit with these inflammatory markers, it turns up insulin resistance and inflammation that further increase liver de novolipogenesis, production of VLDL, small LDL, right? And because triglycerides reflect that resurgent VLDL, triglycerides are going to be higher. That's a sample of the things that occur when triglycerides go up above 60 milligrams per deciliter. So if you keep your blood triglycerides at 60 milligrams per deciliter or less, all those things are either mostly or completely corrected. Blood pressure dropped, endothelial function, normal, endothelial function is restored, inflammation markers drop, abdominal

The Benefits Of Under Sixty

William Davis, MD 10:49

visceral fat is reduced. VLDL, small dense LDL particles, are reduced or eliminated. So there's tremendous power in your health, over your health, if you keep your triglycerides at a level of 60 milligrams per deciliter or less. Now, most of the people in my programs have triglyceride levels in the 40s. That's most common, 40 to 60 or so. You know, this happened to me about 40 years ago. I made the mistake of following a very low-fat vegetarian diet. I was in my 30s and I was biking. I was jogging several miles several times a week. I was playing tennis. I was very active. And yet, when I went on a low-fat vegetarian diet, my triglycerides went up to 390 milligrams per deciliter. Very high. I became a type 2 diabetic with very high blood glucose. I had high blood pressure. My small LDL particles were 1,800 nanomoles per liter. My HDL cholesterol dropped to 27, which is a high risk level. In other words, I became a metabolic disaster on what I thought at the time, 40 years ago, was a very healthy diet. Of course, it was not. More recently, I have an HDL in the 90s, normal blood pressure, small LDL zero, triglycerides 47 milligrams. In other words, but that triglyceride level you can use as the tip of the iceberg to tell you if you get it down below 60, all those things, blood glucose, inflammation, visceral fat, blood pressure, all those things follow and approach or reach ideal levels. Now,

Resources And Next Steps

William Davis, MD 12:35

I'm trying to provide synopses of these YouTube videos as a hard copy that you can download. So I'll be adding in future a link to the PDF so you can get a one-page summary of this video. And of course, if you want more engagement, see my uh many thousands of blog posts, William DavisMD.com, as well as my membership website where we talk about these kinds of things. And typically once a week we have about a two hour session via Zoom, and we talk about challenges, difficulties, questions, all those kinds of things relevant to this approach.