Lifelong Health by Dr. David Lipschitz

A recent analysis of the National Health and Nutrition Examination Survey, which monitors the health of thousands of Americans across the nation, showed that the percentage of Americans with an elevation of LDL cholesterol has declined significantly over the past 25 years.

In 1980, 48 percent of Americans had an elevated LDL above 100. By 2006, the percentage declined to 40 percent.

While this news alone is certainly gratifying, it comes with some other very disturbing trends in American health: As LDL levels appear to be declining, the levels of triglycerides increased fivefold. An elevated triglyceride level is a major risk factor for coronary artery disease and heart attacks. If decreasing LDL cholesterol is simply being replaced with increasing triglycerides, the state of America's health is no better.

Triglycerides are the chemical form in which most fat exists in the body. Although the public and physicians are acutely aware of the risks of having an elevated cholesterol level, little attention is focused on identifying elevated triglyceride levels and approaches to treatment.

Today, approximately one third of all adults have an elevated triglyceride level. Normally, the triglyceride level should be below 150. But elevated levels of triglycerides result in an exponential increase in risk of heart attack. If your triglyceride level rises above 200, the risk of heart attack doubles, tripling if the value is above 400.

Poor diet has a major effect on triglyceride levels in the body. Elevated levels of triglycerides are typically present if carbohydrates constitute more than 60 percent of dietary calories, following the consumption of non-diet sodas, or eating large quantities of candy or dessert. Obese individuals almost always experience elevated levels of triglycerides. This is also true for individuals with uncontrolled diabetes, juvenile diabetes, as well as Type 2 diabetes. For obese adults with Type 2 diabetes, the combined effect of being overweight and diabetic can lead to very high triglyceride levels — and thus high risk of coronary events. Alcohol and a large number of medications (including hydrochlorothiazide, hormone replacement therapy with estrogen, steroids and viral therapy for AIDS) can also raise triglyceride levels.

While elevated triglycerides are usually the result of an unhealthy lifestyle, occasionally a genetic abnormality leads to a massive elevation of triglycerides.

These patients often have a history of abdominal pain, have had numerous attacks of acute pancreatitis, and have an unusual skin condition called eruptive Xanthoma, in which the body is covered by small pale bumps called papules. This condition is very rare, affecting about one in 10,000 persons.

An elevated triglyceride is much more common in whites than blacks, and in men than in women; it also increases with age.

In general, most physicians recommend measuring cholesterol levels after fasting eight to 10 hours. However, only the nonfasting triglyceride level is a sensitive predictor of an increased risk of a heart attack or coronary artery disease. For this reason, there is merit to having a screening blood test for cholesterol and triglycerides a few hours after a meal.

If an elevated triglyceride level is identified, the initial step should be to screen for and treat diabetes and attempt to lower triglyceride levels by avoiding alcohol and implementing healthy lifestyle habits, including diet and exercise. If the aim is weight loss, total caloric intake should be reduced and, most importantly, intake of sugars and starch must be restricted. Consuming 10 or more grams of Omega-3 fatty acids, either from a capsule, fish oil or diet, can lower triglyceride levels by as much as 40 percent.

If these approaches fail, your physician may consider the use of certain medications. The most commonly prescribed is gemfibrozol (Lopid), which is available in generic form, and niacin (vitamin B3), which is available in health food stores. Niacin can cause severe flushing and liver damage. The dose should be gradually increased until 1.5-2 grams are taken in divided doses daily.

This information on triglycerides and heart disease emphasizes the critically important role of lifestyle in promoting a long and disease-free life. Be as active as possible, eat well and live right. This is the fail-safe way to reduce risk of major illness.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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