Welcome to another e-newsletter from Three Rivers Endoscopy Center. Our physicians and nurse practitioner provide this information to help improve awareness in matters of health and nutrition. Each issue focuses on a particular topic that we feel will be of interest.

Please help spread the word! If you find this e-newsletter of interest, feel free to share it with your friends and family. Anyone can sign up for a free privacy-protected subscription at www.gihealth.com/subscribe.

Everyday we seem to hear more and more about the dangers of high blood cholesterol. Most adults have gotten the message and are being tested. Many have modified their diet and may be taking prescription medications to help keep their high cholesterol under control. However, most adults are unaware of the importance of blood triglycerides. In fact, a recent survery of over 2000 adults by the National Lipid Association revealed that most knew about the risks of high cholesterol, but very little about triglycerides. Fewer than half say they have discussed the topic with their physicians. To learn more, read on...

Pinch your waist. Do you have a roll of fat? Believe it or not, that is a good thing. Body fat is somewhat like a bank account. When times are good and food in plentiful, excess energy is deposited into body fat in the form of molecules called triglycerides. This stored-up fat is an important source of energy and also provides insulation to keep your body warm.

When times are lean, hormones in your body signal the need to make a withdrawal. A hormone-sensitive enzyme within fat cells called lipase is instructed to disassemble some of the stored triglyceride molecules into their smaller component parts, which slip into the bloodstream to help provide a constant supply of energy. It turns out that fat is a very efficient way to store energy. One pound of fat contains over 4000 calories that can be burned to fuel normal body functions - while sugars and protein only can store around 1800 calories per pound.

Too much of a good thing
Of course, this "fat bank account" was more necessary tens of thousands of years ago, when prehistoric man relied upon stored fat to survive between what could be infrequent feedings. You can have too much of a good thing, however. Now that we have such ready access to food and calories at our local grocery store, that roll of fat has become somewhat redundant. Between constant overfeeding and our ever-increasing sedentary lifestyle, many Americans have "overfunded their account" and become obese. You really shouldn't be able to pinch more than an inch of fat around your waist.

Where do triglycerides come from?
As mentioned above, triglycerides are formed from calories that you consume in a meal that are not used immediately by your body. These excess calories often come from fatty foods, such as fried foods, butter, margarine, and oils. In addition, your body can also make triglycerides from excessive calories found in sugary carbohydrates and alcohol.

Elevated triglycerides may also be a consequence of other diseases, such as untreated diabetes. People who have kidney disease, an underactive thyroid, or who are obese can get high triglyceride levels, even if they don't eat a lot of fat. This is because these conditions interfere with the way the body processes fats. And some people are born with genetic tendencies, such as "familial hypertriglyceridemia," that make triglyceride levels go very high. And as with cholesterol, older people tend to have higher triglyceride levels because they exercise less and their metabolism is often not as good as when they were younger. Commonly, hypertriglyceridemia results from a combination of factors. For example, an individual may be on a high fat diet, obese, and drink too much alcohol - all risk factors for high triglycerides. Certain medications can also cause a rise in the blood triglyceride level such as thiazides, steroids, Tamoxifen, and some beta-blockers.

Triglycerides in the blood
In addition to body fat, triglycerides can also be found floating in the bloodstream. Triglycerides together with blood cholesterol form what are called blood lipids. Lipids in the blood are important building blocks for energy and normal health. Like cholesterol, triglycerides can be measured in a blood test called a lipid profile. In medical terminology, the prefix "hyper" means high and the suffix "-emia" means in the blood. When blood cholesterol is elevated that is called hypercholesterolemia. In the same manner, a high blood triglyceride level is termed hypertriglyceridemia.

How do I know if my triglyceride level is normal or high?
You can't really tell by the way you feel if your triglyceride level is normal or high. Even if your triglyceride level is very high, you won't have any symptoms. This is why you should ask your doctor to check your triglycerides when he or she is measuring your cholesterol level or if you are at risk for heart disease. The only way to know your triglyceride level is by taking a blood test. The same lipid profile blood test that measures your cholesterol can also measure your triglyceride level at the same time.

When your doctor orders a "lipid profile" blood test to check your cholesterol, he will generally receive four results:

Total cholesterol which is divided into:

HDL level - "good" cholesterol
LDL level- "bad" cholesterol

and triglyceride level.

What is a normal triglyceride level?
The National Cholesterol Education Program (NCEP) was created in 1985 to educate professionals and the public about the benefits of lowering cholesterol levels as a way to reduce the risk for coronary heart disease. In addition to cholesterol guidelines, the NDEP also has set guidelines which define a normal triglyceride level as follows:

Why are high triglycerides bad?
Stored-up fat is an important source of energy and also helps keep your body warm. But too much fat can be a problem. Most people don't know that high triglycerides, like high cholesterol, can also put you at risk for heart disease or a stroke. More importantly however, hypertriglyceridemia is typically not an isolated abnormality. It is frequently associated with other blood fat abnormalities and the so-called "metabolic syndrome" (abdominal obesity, pre-diabetes, low levels of good cholesterol (HDL), high triglyceride, and hypertension), which are linked to coronary artery disease. Hypertriglyceridemia can also damage the pancreas. When triglyceride levels are over 500, the pancreas can become inflamed, a very serious condition called pancreatitis.

Woman have a greater risk
Few women realize that coronary heart disease (heart attack) is the single leading cause of death among American women, claiming nearly 500,000 lives each year. In addition to the usual risk factors such as smoking, high blood pressure, high cholesterol, obesity, family history of premature heart disease, diabetes and age, having high blood triglycerides also raises the risk of heart disease - especially in women. A 30 year scientific heart study done in Framingham, MA clearly showed that an elevated triglyceride level was associated with an increased risk of coronary heart disease. Women with a triglyceride level over 250 doubled their risk of heart disease - more so than men. The American Heart Association now recommends keeping blood triglycerides below 150.

How to reduce triglycerides
The first line of treatment for hypertriglyceridemia is to make some lifestyle changes:

• Watch what you eat. Eat a carbohydrate-controlled diet which is also low in saturated fats. Cut down on sugary foods. Avoid foods with a lot of fat especially fried foods. Switch to skim or 1% milk. My wife and I have switched to Giant Eagle's Deluxe Fat Free milk which tastes like 2% milk without the fat. I love it.

• Consume less red meat and eat more fish, skinless chicken, 100% whole wheat bread, fruits, and vegetables. When you shop, read the label. Don't buy foods that have "trans fat" in them, like stick margarine.

• If you have more than 2 drinks daily, cut down. Excessive alcohol consumption is like adding fuel to the fire by raising triglyceride levels even higher. Switch to wine in moderation. Beer or hard alcohol like vodka are particularly bad.

• Get more exercise: 30 minutes every day is best, but any exercise is better than not exercising at all.

• Lose weight if you weigh too much. One simple way to determine if you are overweight is by calculating your Body Mass Index, or BMI. Body mass index (BMI) is a measure of body fat based on height and weight that applies to both adult men and women.

  BMI Categories: Underweight = <18.5 Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity = BMI of 30 or greater

• Regular consumption of omega-3 fatty acids from fish and over-the-counter fish oil supplements will lower triglyceride levels significantly.

Prescription drug therapy
When patients do not reach their goals by lifestyle changes alone, long term prescription drug therapy is often necessary. For those with very high blood triglyceride levels (over 500 mg/dl), the doctor may suggest Omacor. Approved by the FDA as safe and effective, Omacor capsules provide the highest available concentrations of purified omega-3 fatty acids.

While around 2 gms of Omega-3 fatty acids per day are generally recommended, it takes about 4 gms per day to reduce high blood triglycerides. To achieve this level, one would have to take about 12 capsules of regular fish oil supplements each day, compared with only 4 pills of the Omacor formulation. Omacor requires a prescription from your doctor.

If these lifestyle changes don't help, the doctor may recommend other prescription medications - especially if the triglyceride level is higher than 500 mg/dL. Which drug depends on what the lipid profile shows. For example, for those individuals who suffer from both high triglyceride and cholesterol, a statin drug is often prescribed. Statins are able to reduce both high cholesterol and triglyceride.

Summary
Now that most adults are aware of high cholesterol, it is time to focus on the other blood fat, triglyceride. As you have read, just like high blood cholesterol, too much triglyceride in the blood can cause a premature heart attack or stroke. Considering the current obesity epidemic in this country, we can expect a significant rise in the metabolic syndrome. Thus, family doctors and internists can expect to see more patients with hypertriglyceridemia. The better educated the patient, the better the outcome will be. If you are over 40 and have not had a blood lipid panel in the last 3 years, you should make an appointment to see your doctor. Ask your doctor to be sure that blood triglyceride is checked as well.