Articles, Blog

High Triglycerides (Part 1) – Medication vs. Lifestyle

October 9, 2019

Basically, it’s a hyped-up fish oil. It’s
the omega-3 oils but here’s the thing. High triglycerides is incredibly
prevalent. You see it in 25… maybe 30% of certain demographics, certain groups. And
do they really need to be taking the newest, most expensive treatment,
especially when it’s something like fish oil? Well, there’s actually something
that’s even easier, less expensive than any of that. And there seems to be again,
as usual, a major focus on medications,
prescriptions, and maybe not enough focus on lifestyle. Look at the newest, the latest, the
biggest thing in high triglyceride treatment. It’s icosapent ethyl. There
was a New England Journal article about it in January of 2019 then the
following editorials. Now it is a very impressive medication. So first of all,
what is triglycerides? And again, what are the ignored treatments? Back to
the biochemical part, you remember a triglyceride is a glycerol. You add three
fatty acids to it and the glycerol hooks the three fatty acids together. In
other words, it’s that subcutaneous fat. Most of us recognize that as
saddlebags. Now if you look on the internet, most folks will say, “Well look,
there are six ways of helping elevated triglycerides.” You may have seen some of
my videos as well. I talked about high triglyceride over HDL ratio, and that is
a very important thing. Most patients that come to me, if they haven’t had any
lab tests and they don’t have an OGTT (oral glucose tolerance test) or an insulin
survey, almost all of them will have it… a triglyceride and an HDL because you’ll
see both of those on the cholesterol panel. Again, if you look at the internet,
they’ll say okay here the causes and there’s a lot of agreement over what you
can treat and what you can’t treat. For example, as you get older, triglycerides
tend to get higher. Their gender is an issue that you can’t change either. Males
are more likely to have high triglycerides. There are other hereditary
factors and other diseases which sometimes you can’t control. You can
control the amount of sugar that you eat and that is a big deal. That is the lifestyle issue that I go over time and time again. Now there’s a lot of
agreement that you can control your obesity. I would say it’s not quite so
easy. I think there’s a lot of people, obese people, walking around that
b-bear testament to that fact I’m not gonna go down that bony hole of talking
about the success rates. Well I will just real quick I’m having most of my
patients over half coming into me now are coming in from the YouTube channel
and over half of them come to me saying, “You know what, I’ve already lost over 30 pounds.” They’re doing it by decreasing sugar, decreasing carbs (not
just sugars but all carbs), stabilizing their insulin values, and then decreasing
that eating window. So yes, you can control obesity, believe it or not. And
despite all of the obese people you see walking around, there is a much bigger
way of controlling obesity. A much better way and it’s happening more and more.
Then they get to as we mentioned in the beginning of this video,
medications like expensive medications like icosapent ethyl. Now there are some
places in the internet, you start looking around, you’ll see neglected treatments
for how high glycerides, lose weight, cut your sugar intake, go consider going keto,
consuming fiber, eating nuts, get your omega 3 fatty acids from the real thing
eating fish, exercise, limit your alcohol, and even do intermittent fasting or
Prolon fasting. Now let’s just go ask a quick question: what is hypertriglyceridemia? “Hyper” means too much; “hypo” means too little. So hyper is
too many triglycerides. That’s what we’re talking about.
“Emia” means in the blood. So again, it’s too many of these triglycerides in the
blood. Now why do you get that with insulin resistance? Why do men
get that? Why are they? Why do you get it as you’re older? Because you tend to get
inslin resistance quicker. If you’re a man, quicker as you get older. And quicker
as you get more obese. Insulin (as many people know) decreases blood sugar by
opening up the channels in our cells. So we decrease blood sugar. But what most
people don’t know is that insulin decreases fat burning or decreases the
burning of triglycerides. Hence the book and the concept, “Why We Get Fat and What To Do About It.” That book makes the statement that you
know what maybe we’re not getting fat as we get older because we’re eating more.
Maybe we’re eating more because we’re getting fat. Now what does that mean?
Well, we’re getting insulin resistance. So our insulin is cranking up and this
insulin cranks up our ability to burn that fat and decrease those saddlebags,
decrease that subcutaneous fat. As we increase that in spacial insulin level,
we decrease our ability to burn that fat. If you have more interest in that book,
its up. It’s the endocrine theory of weight gain. So this was a brief jump, a
brief video looking at a little bit different perspective on
hypertriglyceridemia, high triglycerides. We’ll cover more in a series. Thanks for
your interest. My name is Ford Brewer. I started off as
an ER doc then I became very frustrated with the fact that most
things that bring people into the ER were preventable, like heart attack and
stroke. I went to John Hopkins to get training and ended up running the
program there in prevention. There, I trained dozens of docs. And again that
was three decades ago. Since then, I’ve trained thousands of docs. And even more
importantly, supervised those docs. And even most importantly, helped
thousands of patients prevent things like heart attack and stroke.
Waiting for the disease and hoping for a cure for this kind of devastation
doesn’t work. Come to Louisville on November 8 and 9. We have a boot camp
type of environment for two days where you learn all the things that you didn’t
learn from your doc in terms of heart attacks stroke prevention. Things like
cardiovascular inflammation, how to detect it, how to measure things like
insulin resistance (the number one cause of inflammation), how to detect it, how to
measure it, how to stop it, how to manage it. You also get… you can get the labs
there for that event if you’d like and get a complete evaluation. In addition,
you get an arterial scan called the CIMT. To get the right one of those is fairly difficult. So I’m looking forward to
seeing you there. Thanks.

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  • Reply Manny Radzky October 4, 2019 at 3:08 pm

    Eat keto, will drop trigs like a rock. Did in my case. It also fixes so many other ill health. Throw in some intermittent fasting, exercise, sunshine, clean water. All work together to fabulous health

  • Reply Mary G October 4, 2019 at 4:05 pm

    Hi Doc! You don't seem like the type to be offended by a reference to Dave Feldman on the Low Carb down Under channel about one month ago. He does experiments on himself, complete with tons of blood draws. Regarding high triglycerides, I was surprised that (1) there is a subset of folks whose triglycerides whoosh up with any kind of black coffee intake; and (2) while I knew our triglycerides go down while we are asleep, I did not know that the decrease accelerates after you awake. So, for years I have had my yearly physical draw at 8:00 a.m. and got yelled at for very high triglycerides. This time, I am going to move my test to after 10:00 a.m. and not have my black coffee as specifically permitted by my doctor. It will be interesting to see whether it will make a difference more consistent with my 64 year old squeaky clean carotid artery, heart ultrasound, etc. tests. I would be interested in your usual even-handed take on this. Mary

  • Reply Daniel Christopher October 4, 2019 at 4:53 pm

    Thanks Doctor, once you eat low carb diet (keto)you will get low triglyceride

  • Reply Erik Janse October 4, 2019 at 5:04 pm

    Thanks again for the VDO Dr. Brewer, very interesting. I noticed that the level of triglycerides may fluctuate a lot, despite the fact that the someones lifestyle and eating is pretty much constant. For example: One day my fasted triglycerides was 50 and 2 months later it was 88. Is there an explanation for this fluctuation, with lifestyle and way of eating more or less unchanged over a long period of time?

  • Reply ANN BROWN October 4, 2019 at 5:05 pm

    Glad you posted this, I mentioned last night to someone that I would look this up and here you are! Thanks bunches!

  • Reply GILBERT Hernandez October 4, 2019 at 6:16 pm

    Ok then, solution eat less and eat right.

  • Reply Kelly Clover October 4, 2019 at 7:54 pm

    I have a question about ketones I wish to ask: A standard urinalysis test panel I took 2 days ago showed that ketones are being dumped in the urine which was flagged by the lab as being abnormal. I have been following a low carb increased fat diet for the last several months. I have been having trouble the past week with severe skin itching. Is this likely to be related to the dumping of ketones in the urine? Do I need to worry about this?

  • Reply 147DegreesWest October 4, 2019 at 8:14 pm

    Awesome video, Doc! Very timely for one of my loved ones who is battling elevated triglycerides. Thank you very much! I suspect that people with that Apoe 4 gene might have to cut some dairy as well as carbs. I read somewhere that people who have that gene apparently have elevated triglycerides when they eat dairy? Is that “bro science” or is that part of that gene?

  • Reply B. E. Russell October 4, 2019 at 8:58 pm

    FWIW, my aeromedical doctor believes that a person's triglyceride/HDL ratio is much more important for CV health than LDL and much more indicative of heart problems & diabetes

  • Reply farrokh farr October 4, 2019 at 9:18 pm

    like good doctor said life style life style

  • Reply Gloria Hester October 5, 2019 at 10:03 am

    Thank You for the short video , my attention span is warren out . 😎

  • Reply bing liu October 6, 2019 at 9:45 am

    Hi, doc. Can you do a video on omega 7 ?
    My husband was obese before. His BMI Was 26+. For our Asians BMI more than 25 is obese. He had borderline high blood triglyceride 2.2 mmol/L, fasting sugar was 5.7mmol/L one year ago.
    He played tennis regularly . eats much less sugar and reduces rice at lunch and dinner for 9 momnths. Takes omega- 3 1g/day, and omega -7 210 mg/day
    BW from 74 kg to 71 kg ,TG from 2.2 to 1.0 mmol/L ,FBS from 5.7 to 5.5 mmol/L.

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