Transcription
So, you've just got your blood test back and you've been told that your triglyceride level is high. And the very first thought a lot of people have is, right, well, I need to cut back on the amount of fat I'm eating. You know, triglycerides are fat in the blood. So, the fat that I eat must be causing it. Well, that's not really the case. The biology here is a lot more interesting than that. And if you go straight to cutting fat, you might miss the actual cause entirely.
So, here's what we're going to cover in this video today. The first thing we're going to cover is what triglycerides actually are. Then, I'm going to talk about this big myth around fat, this big lie we've all been told for years and years. Then, we're going to go through five specific drivers, five reasons your triglycerides might be high. And some of these will actually surprise you. After that, we're going to talk about what this actually means for your long-term health and how much risk we're actually talking about. And then we're going to talk about what you can actually do about it, what moves the needle, and then these specific habits that you can really introduce to your daily life.
So, what are triglycerides? Well, triglycerides are basically just fat floating around in your blood. That's it. Your body uses them as fuel 24/7. They're basically just stored energy that gets released when you actually need it. It's completely necessary and, you know, a completely normal part of physiology. Now, the problem isn't having them. The problem is having too many of them sitting in your blood persistently over time because that tells you something is going wrong with how your body is managing energy.
Now, think of it like a delivery system. Your body is constantly moving energy around your body and triglycerides are the packets that energy travels in. Now, when everything's working properly, those packets get picked up and used. When things go wrong, they start to pile up in the blood and start causing damage to the walls of your blood vessels very quietly over years and decades. And the reason this matters is that your blood is flowing through every single organ in your body, including your heart, your brain, your kidneys, your liver. So when something is persistently wrong with what's in it, the effects eventually show up literally everywhere.
And here's where that big myth around fat starts to fall apart. So people assume, I ate fat. There's fat in my blood. So those two things must be connected. And yes, right after a meal, right after you eat something, fat from that food does briefly circulate in the blood. That is completely normal. But fasting triglycerides, the one on your blood test, those mainly reflect what your liver is producing. And your liver makes triglycerides primarily out of excess sugar and carbohydrates, not dietary fats. It takes the sugar that you eat. It converts it into fat and then it releases it into the bloodstream. So the olive oil that you had with your dinner last night probably isn't the problem. The issue, and this is really important, the issue for most people is the liver working overtime on too much sugar and too many refined carbohydrates.
So, let's go through these five main drivers, then. These are the five reasons your triglycerides might be high. And understanding which ones apply to you really is the key to actually fixing it. So, the biggest driver for most people is sugar, particularly added sugar and refined carbohydrates. Things like sugary drinks or sweets or any sort of dessert or white bread or pastries, white pasta, you know, these eaten regularly in large quantities can actually cause a high triglyceride level. The thing is, the type of sugar found in fruit juice and fizzy drinks and table sugar is particularly efficient at being converted into fat by the liver. So, a large glass of orange juice or a can of Coke or Sprite and it isn't just sugar that you're burning off. A significant proportion of it actually gets turned into fat in the blood. And there is solid research showing that cutting sugar, cutting carbohydrates, lowers your triglycerides by quite a large amount. And liquid sugar in particular seems to have a disproportionately large effect.
Now, the second driver is something called insulin resistance. Now, if you've watched any of my videos, you will know that I talk about this pretty much all the time. So insulin is a hormone that your body releases when you eat. Its job is to manage your blood sugar and tell your fat cells to hold on to their fat rather than releasing it. Now when insulin stops working properly, which happens gradually with weight gain or inactivity or poor diet, your fat cells start leaking fat into the bloodstream constantly. The liver then gets overwhelmed. It produces more fat in the blood and the whole system really struggles to clear it. Now this is why people who carry a lot of weight around their middle so often have raised triglycerides.
Now driver number three is alcohol and inactivity. Actually two points here. So alcohol is one that people consistently underestimate. What it does is it pushes the liver towards making more fat and then releasing more of it into the blood. And in some people this effect is actually quite dramatic. Even at what most people would consider sort of mild to moderate drinking. And then we've got inactivity. So your muscles when they're working actively help to clear fat from the blood. When you're sedentary, which to be honest, most people seem to be these days. You know, we commute to work, we have desk jobs, we have automated delivery systems, all of this sort of stuff. When you're sedentary, that clearance slows right down. And then sitting underneath all of this is excess weight around your middle, visceral fat which surrounds your organs which drives the whole cycle forward.
Now driver number four is all about your thyroid gland and medication. So there are some medical causes that we need to be aware of here. One of them is an underactive thyroid. So your thyroid is a small gland in your neck that just literally controls your metabolism. You know, how fast your body burns energy, how hot or cold you feel, things like that. Now, when your thyroid gland isn't producing enough hormone, your body literally struggles to clear fat from the blood properly. It is a very common and frequently missed cause of raised triglycerides and it's a really simple blood test to rule this out. Another one here is medication. So, some very commonly prescribed drugs can raise your triglycerides as a side effect. And this is something that doesn't get told to patients anywhere near enough in my opinion at least. Anyway, so we've got beta blockers which are used for things like blood pressure and heart conditions. So these are drugs like atenolol and metoprolol and bisoprolol and propranolol. These can raise your triglycerides. Not commonly but it is a side effect. The other class is thiazide diuretics. Another type of blood pressure medication. Things like bendroflumethiazide in the UK and hydrochlorothiazide in the US. And then we've got a class of drugs called steroids. So things like prednisolone that we use for inflammation and autoimmune conditions. We've also got some antipsychotic medications and also something called isotretinoin used for severe acne. Now if you're on any of these medications and your triglycerides are high and your doctor hasn't really connected the dots yet, then this is really a conversation worth having as soon as possible.
And then finally, we've got genetics as our fifth driver. And this is one that I want to talk about from experience actually. You know, this is really easy to read about in a textbook or in a research article, but it's quite hard to fully understand and visualize until you actually see it. Now, I remember the first time I took blood from a patient with a condition called familial hypertriglyceridemia, which is basically an inherited condition where the body can't clear fat from the blood properly. Now, when I drew his blood into the vacutainer or into the tube, you expect to see dark red blood from the vein that you always see. But instead, the blood actually looked like butter, like somebody had mixed butter into the blood. It was pale. It was really thick. It was the most unusual thing I'd ever seen in a blood bottle. And this is because his triglycerides were so high that the fat was literally visible in the sample. And that image has stayed with me ever since. Now, most people with genetic tendencies towards high triglycerides won't be anywhere near that extreme. That was a really extreme case. But some people, you know, are just simply born with a tendency to run higher levels regardless of what they eat or how much they exercise. Lifestyle changes, which is really what this video is about. You know, these help, but they won't fully solve the problem on their own. Now, if you're eating a lot better and you're exercising more and your lifestyle has massively improved and your levels are still high, then that's worth raising with your doctor rather than just blaming yourself because there is a chance that you could have one of these genetic conditions.
Okay, so we've talked about what drives your triglycerides up. What I want to do now is talk about why you should even care. Why does any of this even matter? But first, what I want you to do is try and think about your great-grandparents or great-great-grandparents, you know, four or five or six generations ago, what their day would have looked like. Well, for most people back then, they would have been getting up early and moving constantly throughout the day. There would have been no sitting at a desk for 8 hours, no driving to work or driving to the shops, no escalators or lifts or any of that sort of stuff. Physical work was just part of life. They had to do it to survive. And what they were eating was just whatever was grown locally. You know, whatever was available like veg and meat and eggs and fish. There was no supermarket full of ultra-processed foods or, you know, fruit juices or fizzy drinks or anything like that. None of that existed back then. All there was was whole foods. Refined sugar was expensive and incredibly rare. And if we could go back and measure their triglycerides, which obviously we can't, they almost certainly would have been low. Not because of genetics, not because they were trying to keep them low, just because the conditions that drive triglycerides up simply weren't around at that time. The food wasn't there. The inactivity wasn't there. The excess that we have these days wasn't there.
And now fast forward to today and almost everything has flipped. We sit for most of the day. We move very little and sugar is basically in everything now. And triglycerides have followed that trend. So when I say high triglycerides are a modern lifestyle problem, I mean that very literally. This is a condition that would have been genuinely rare for most of human history. That is the same for things like insulin resistance and high blood pressure and other chronic conditions that just weren't around 100 years ago.
Now, high triglycerides on their own are not going to kill you tomorrow. For most people, you've got a lot of time to fix this. What they do is actually quietly increase your risk of serious conditions over years and decades. And that's actually what makes them worth paying attention to now while you can do something about it. The clearest risk obviously is cardiovascular disease, heart attacks and strokes, things like that. A big study published in The Lancet looking at over 300,000 people found that people with high triglycerides had a significantly increased risk of heart attack. And importantly, that relationship held up even after accounting for other risk factors. So, it's not just that people with high triglycerides tend to have other problems. The triglycerides themselves appear to be part of the story.
Elevated triglycerides are also very closely linked to something called metabolic syndrome, which is a cluster of conditions that I talk about quite often, including high blood sugar, high blood pressure, excess weight around the middle and an abnormal cholesterol as well. Having metabolic syndrome roughly doubles your risk of heart attack and increases your risk of type 2 diabetes by about five times, five times the risk. And triglycerides are one of the five markers used to diagnose it. And then we've got a condition called pancreatitis, inflammation of the pancreas just here, which at very high triglyceride levels becomes a real risk. It can be life-threatening. It is very, very serious and incredibly painful. We see it quite often in the emergency department. And it's actually the condition that my patient had, the one I talked about earlier, whose blood literally looked like lard or butter.
And here's what I find really motivating about all of this. Everything we've talked about so far. A study published in JAMA Cardiology showed that simply addressing the lifestyle factors that drive triglycerides up, so your diet, your activity, your weight, this produces really meaningful reductions in your cardiovascular risk. Unless you've got a genetic condition which your doctor can diagnose with a simple blood test, you don't need a drug or an expensive supplement, just a few consistent habits done over months and years really does reduce your risk of disease and death. And that's what I want to focus on for the rest of this video.
So, the first question that people have is, does the fat that you eat actually matter? The honest answer is sometimes, but probably less than you actually think. And it really depends on what kind of fat you're eating. If you're eating a lot of heavily processed fried food, and if you're eating in a really big calorie surplus, then yes, it becomes relevant at that point. But natural fats like olive oil or nuts or avocado or oily fish, these actually tend to improve your triglycerides when they replace the sugar and refined carbs that a lot of people eat. The research on the Mediterranean diet is pretty consistent on this. Swapping sugary snacks and white bread for things that include olive oil and nuts and seeds and fish that we just talked about moves things in the right direction. The problem with this old low-fat advice, which a lot of people still follow, is that when you take fat out of food, it usually gets replaced with sugar and refined carbs to make it taste good. And for triglycerides specifically, that swap makes things a lot worse, not better.
Cutting out liquid sugar is probably the best thing that most people can do. Things like fizzy drinks or fruit juice or really sugary smoothies or sweet coffees, things with lots of syrups and cream, that sort of thing. What happens is that these deliver a large amount of sugar to the liver very quickly. And removing these can make a really noticeable difference within weeks. Losing weight around your middle as well, if you have excess weight to lose, can be a really powerful driver here. This is mentioned in the research all the time. Another really powerful thing obviously is exercise. Particularly regular low aerobic exercise like walking after meals or a gentle cycle or walking up and down the stairs a few times a day. What this does is it helps your muscles to clear fat from the blood more efficiently and improves how well your body manages your blood sugar. This is one of the most direct things you can do. Another thing is building your meals around protein and vegetables and fiber rather than refined carbs because what this does is reduces how much sugar hits your liver across the entire day. As we know because we've talked about it lots in this video, sugar is really important for your triglyceride level. If you drink alcohol, then cutting back, even just moderately, is absolutely worth it because the effect on your triglycerides is often larger than most people expect. Another one is oily fish. So things like salmon or sardines or mackerel, try and get at least two portions a weekend if you can. The omega-3 fats in these sorts of foods have really, really good evidence behind them for lowering your triglycerides and your cholesterol. And for people with really high levels, probably because of a genetic condition, there are medications that are absolutely worth it. But this is a conversation you have to have with your GP. If you've got your blood test results back, it's so important that you get a doctor to go through them with you and explain each one of them. The key point here is don't look at your triglyceride level in isolation. It tells you much more when you look at it alongside your good cholesterol, your HDL, your waist measurements, your blood sugar level, your liver function as well. The ratio of your triglycerides to your HDL level in particular is really worth discussing with your GP. It's a really useful marker for how well your body is managing blood sugar and insulin overall.
So, the takeaway for this video is this. If your triglycerides are high, then asking how much fat am I eating is probably the wrong first question. Better questions are: How much sugar am I eating? How much refined carbs am I eating? How much am I exercising? Am I carrying excess weight around my middle? How much alcohol am I drinking? Has my thyroid been checked? And am I on any medication that could be causing any of this? And these are conversations to have with your doctor because for most people, high triglycerides are not a fat problem. They are a modern lifestyle problem. And there are loads and loads of videos across this channel that will absolutely help you with that.