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Are Triglycerides as Great a Heart Risk as High Cholesterol?

April 19, 2009

Dear Friend:

Which do you think is the bigger threat to your heart health: cholesterol or triglycerides? If you answered cholesterol, you are certainly in the majority. Almost all cardiologists and other doctors will agree with you. But I—as well as numerous researchers who have been studying cardiac risk factors—beg to differ.

Here’s the story: In the past decade, some 20 studies were completed in more than a dozen countries analyzing how often people with various lipid profiles—meaning serum cholesterol (including HDL, the so-called “good” cholesterol, and LDL, the so-called “bad” cholesterol) and triglycerides—would experience heart attacks over the ensuing years. Almost every study showed that high triglyceride readings correlated very strongly with the risk of coronary events.

One 1999 study done in Malmo, Sweden, on more than 12,500 men followed for 10 years showed that of the 3,127 men whose cholesterol exceeded 245, those with triglyceride (TG) levels below 100 had 88 percent fewer coronaries than did those whose TGs were over 184.1 Another study performed at Harvard in 1997 showed that of a group of 342 subjects, the 25 percent with the combination of the highest triglycerides and low levels of HDL cholesterol had 16 times the number of heart attacks as the 25 percent with the combination of the lowest TG levels and high HDL.2 Since this represents the most striking differential in lab values leading to heart disease ever published in a major journal, one must wonder why it was given so little attention.

My explanation is that these breakthroughs run counter to popular beliefs and medical practices as well as the interests of the pharmaceutical industry, whose profits from cholesterol-lowering drugs run into the billions of dollars. Drug manufacturers and industry and political activists have a vested interest in maintaining the status quo.

Both elevated triglycerides and lowered HDL result from elevated insulin levels, a consequence, as most of you know, of eating excessive carbohydrates, which is almost inevitable on a low-fat diet. Dozens of studies have demonstrated that a low-fat regimen raises TG levels. Therefore, these numerous recent reports—which could lead to a major decline in heart disease—are given little credence because that would mean the movers and shakers in cardiology would have to change their practices dramatically.

Way back in 1966, a study from Harvard was published showing that when individuals whose TGs exceeded 500 followed a daily diet of 1,500 calories, including just 26 grams of carbohydrate, for two weeks, they experienced an average of a 75 percent drop in those levels.3 I have long known that carbohydrate restriction is the treatment of choice for high TGs. And indeed, The Atkins Center for Complementary Medicine has treated nearly 1,000 such patients who have shown a 70 percent drop in their readings.

Published reports on the Atkins Nutritional Approach™ generally show a 50 percent drop, but these studies involved people whose TGs were not unusually elevated.4,5 Also note that many studies have shown that TG levels over 100 are significantly riskier, even though the previous practice was that any level under 200 was acceptable. (In addition to carbohydrate restriction, large quantities of fish oil, are extremely effective at lowering triglycerides. L-carnitine is also very helpful.

Two final points for those of you who are now taking cholesterol-lowering drugs: When triglycerides remain over 125, these drugs are not as beneficial as our program. In addition to liver and muscle disorders from statin drugs, ask yourself whether your sex drive has diminished. If so, it may be because these drugs prevent the body from manufacturing steroids, thereby curtailing the production of all male and female hormones.

Selected References

1.Stavenow, L., Kjellström, T., "Influence of Serum Triglyceride Levels on the Risk for Myocardial Infarction in 12,510 Middle Aged Males: Interaction With Serum Cholesterol," Atherosclerosis, 147, 1999, pages 243-247.

2.Gaziano, J.M., Hennekens, C.H., O'Donnell, C.J., et al., "Fasting Triglycerides, High-Density Lipoprotein, and Risk of Myocardial Infarction," Circulation, 96(8), 1997, pages 2520-2525.

3.Reissell, P.K., Mandella, P.A., Poon-King, T.M.W., et al., "Treatment of Hypertriglyceridemia," The American Journal of Clinical Nutrition, 19, 1966, pages 84-98.

4.Yancy, W. S., Bakst, R., Bryson, W., et al., "Effects of a Very-Low-Carbohydrate Diet Program Compared With a Low-Fat, Low-Cholesterol, Reduced Calorie Diet," October 7, 2001, North American Association for the Study of Obesity Annual Meeting, Quebec City, Canada.

5.Sondike, S.B., Copperman, N.M., Jacobson, M.S., "Low Carbohydrate Dieting Increases Weight Loss but not Cardiovascular Risk in Obese Adolescents: A Randomized Controlled Trial," Journal of Adolescent Health, 26, 2000, page 91.

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