SO LONG, SUGAR!
Hiding in the shadow of bad cholesterol, triglycerides are an emerging risk factor linked to coronary heart disease.
by Phil DavisDrop the cupcake!
Sure, the package containing this cream-covered delight proclaims it is ``low fat." But further investigation reveals the truth-16 grams of sugar, two grams more than a regular cupcake. And while the "light" treat contains only 2 grams of total fat-compared to 5 grams in a regular one-such "low fat" labels often lull snack lovers into a false belief they can eat more.
Only a few years ago, excessive sugar intake would have caused concern mostly over expanding waistlines and tooth decay. Physicians knew too much sugar was one way to boost a specific kind of fat in the blood called triglycerides, but the health threat of the fatty acid molecules was considered debatable. Instead, the medical community focused on Low-Density Lipoprotein (LDL) cholesterol-also known as "bad" cholesterol-as a cause of atherosclerosis, the disease process that underlies coronary heart disease, America's No. 1 killer.
But Howard N. Hodis, M.D, USC associate professor of medicine and preventive medicine and director of the USC Atherosclerosis Research Unit, was among a small contingent of scientists who suspected that the triglycerides were a potential killer hiding in the shadow of bad cholesterol.
It appears he was right.
"We've been at the forefront on this for quite some time," Hodis explains. "In the past, it was generally believed that triglycerides really didn't have much to do with atherosclerosis, so they have been sort of a neglected issue. But in the last five years, we've developed a whole new way of looking at triglycerides as a risk factor for atherosclerosis."
An Emerging Threat
Triglycerides are fat particles that form when a person eats more food than is needed as fuel for the body. The excess fuel is converted to fat that sometimes settles in the waist or other areas on the body, but can also cling to artery walls. The buildup on artery walls is called plaque-a hard, crusty substance that can narrow arteries and lead to heart attack or stroke. High triglycerides are more common in people who are overweight, but they can be a problem for anyone.
Until the early 1990s, triglycerides were not considered a great threat.
"It's a complex, emerging field," Hodis says. "We're just now understanding cholesterol and low density lipoproteins and now we've come along with another side of the atherosclerosis story."
In 1994, Hodis and his USC research group triggered a heated debate in the medical community with the publication of a study linking triglycerides to coronary artery disease, which accounts for 200,000 deaths each year. Writing in the American Heart Association's journal Circulation, the USC scientists reported that bad cholesterol-LDLs-appeared to be masking arterial damage caused by triglyceride-rich lipoproteins called Very Low Density Lipoproteins (VLDL) and Intermediate Density Lipoproteins (IDL).
The study found that despite aggressive treatment of the bad cholesterol, patients with high triglycerides continued to suffer damage to arterial walls. Using state-of-the-art imaging techniques and specific tests, the scientists found that VLDL and IDL were the culprits.
The danger is similar to not changing the oil in a car. When neglected, both blood and oil get thick, which makes the heart or engine work harder to pump the fluid. The fluid also picks up excess debris and tends to form nasty deposits, which ultimately cause a breakdown. An engine will burn up. In humans, the end result is a heart attack or a stroke.
There is still much to learn, Hodis says. For example, some research shows that high triglycerides are stronger indicators of heart disease risk in women than men, especially women over age 50. Some future areas of study: Why some triglyceride particles lead to atherosclerosis and why others may not. "There may even be some protective particles in the mix," Hodis says.
Another mystery: "We don't really know what to make of triglyceride measurements in specific individuals," Hodis says, noting that genetics and the amount of fat in the last meal determine the level of triglycerides in the blood. "Where we are with understanding triglycerides today is where we were with cholesterol 10 years ago."
Still, the health threat is considered serious enough that the American Heart Association (AHA) has issued guidelines for acceptable blood triglyceride levels. The AHA defines "adequate" triglycerides as less than 200 milligrams per deciliter (mg/dl) in a person whose blood was tested after an overnight food and alcohol fast. The risks of poor coronary health increase steadily after that. The AHA reports that at levels around 190 mg/dl blood begins to thicken-which puts undue strain on the heart.
Hodis says levels above 500 mg/dl are a potential precursor to pancreatitis, a painful inflammation of the gland that can lead to death. Triglyceride levels above 1,000 mg/dl have been associated with pancreatitis. To be on the safe side, Hodis recommends maintaining a blood triglyceride level closer to 150 mg/dl.
That's the bad news.
Taking on Triglycerides
The good news: No miracle cure is needed to reduce triglycerides. It comes back to that old litany-a healthful lifestyle, including a good balance of dietary intake, exercise to maintain an ideal body weight, no smoking and moderation of alcohol intake. It is the same standard treatment for those individuals with high cholesterol, high blood pressure and other health concerns. For people at higher risk of heart attack or stroke, not controllable with lifestyle modifications, the imbalance can be treated with specific medications, Hodis says.
For most people, lowering triglycerides is as simple as cutting back on sweets and getting off the couch for a little aerobic exercise three days a week.
"Most of it is lifestyle," Hodis says.
But American lifestyle is the trouble. Hodis describes it as portly and sedentary. Americans love excessive sweets, alcohol and fast food, while not eating enough of the foods that keep triglycerides in check, such as fish -all of which put the heart at risk.
And the recent explosion of "fat free" foods hasn't really helped, says Ana Rego, a USC dietician. When manufacturers take out the fat, they usually slip in extra sugar to make the food taste better. Most heavily sweetened foods are high in calories-and some studies show that sugars may boost blood triglycerides higher than other carbohydrates, i.e. complex sugars, like starch.
Some examples of sugar trouble, compiled by the Center for Science in the Public Interest, a nonprofit public health watchdog organization:
o A 12-ounce can of Coca-Cola Classic, Dr. Pepper or Pepsi Cola contains 40 grams of sugar-the equivalent of 10 teaspoons of sugar. Sunkist Orange soda tops the list at 52 grams.
o According to the U.S. Department of Agriculture, persons on a 2,200-calorie a day diet should limit their daily intake of sugar to 12 teaspoons. That is one soda or a single 2-ounce Three Musketeers bar (10 teaspoons).
o Some people think they are being good by drinking fruit juice, but a cup of Ocean Spray Cranberry Juice Cocktail contains 25 grams of sugar.
"I think the biggest problem is that people take the label at face value and just run with it," says Rego. "The label may say 'low fat,' but look at the ingredients, especially the amount of sugar."
Adds Hodis: "We don't have to wait for new drugs. Through lifestyle modifications we can lower triglycerides now in the majority of individuals."
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