Carbs and Triglycerides: Can we predict the presence of insulin resistance?

Metabolic health matters. Humans die of very predicatble diseases. Most of them are moderated in severity by improving our metabolic health. Type 2 diabetes is a serious metabolic disease with many downstream complications. The earliest forms of type 2 diabetes is insulin resistance. Insulin resistance is now prevalent in teenagers!

Glucose is typcially stored in our muscles and our liver. The muscle tissue requires insulin to take up the glucose into the cell. With insulin resistance your muscle cells do not respond to insulin well. The cells need much more insulin present to be able to store the glucose as glycogen. The muscle cells become “resistant” to the actions of insulin.

The pancreas makes insulin. Eventually the pancreas has to make so much insulin that it basically becomes exhausted and stops. This is why some people with severe type 2 diabetes need to inject insulin.

Imagine if we could predict who might develop insulin resistance and type 2 diabetes long before your pancreas stops working?!?! Imagine if we could intervene long before the progression of insulin resistance to frank type 2 diabetes and the associated chronic disease burden that comes with it? Would you modify certain food groups or change your lifestyle to gain back years of disease-free living? I imagine that most of you will answer yes to this. The issue is that we are often not told that something is wrong. Don’t assume that all doctors know this. In addition, we are not told what simple strategies we could employ to help ourselves. This post is going to change that. Knowledge is empowering. Many people will change their lifestyle if they know why they need to do it and how to accomplish it.

I have been an Orthopedic Surgeon for nearly 25 years. While I have returned many athletes to the playing field with my knife, I am often more pleased by being able to dramatically help entire families improve their health with lifestyle and dietary modification. People will often engage if they understand why they should and how to accomplish it. Over the last decade, I have chosen to optimize my own overall health and the overall health of those I treat. What often becomes evident in my interactions with you is that most of you actually do want to change your diets (within reason) and do want to exercise more. No one wants to continue their march down a path towards heart disease, stroke or neurocognitive decline and disability. Information is empowering. Knowing why we need to change and how our actions can affect that change is very powerful and often very motivating.

If we could intervene early in the process of hyperinsulinemia (too much insulin in your blood) and insulin resistance (less insulin function per unit amount in your blood) then we theoretically could stop a very predictable path towards numerous chronic diseases associated with these processes. That would allow us to intervene while your pancreas function (insulin production) is salvageable.

In turn that might spare you a life of living with a substantial chronic disease burden.

Your Triglyceride/HDL ratio and what it tells you

Well… guess what. We can often predict who is at high risk for diabetes. We do have the ability to recognize this process very early on. Some might even call this pre- pre-diabetes (type 2).

Take out your last blood tests. What were your triglycerides (Trigs) and your HDL values?

Divide your Trigs by your HDL… What is the number you get? It should be less than 3.

Example… My Trigs were 110, and my HDL is 65: that means that my TriG/HDL ratio is 1.7 or so.

What if your level is above 3? What does that mean, why is that happening and what can you do about it?

Sugar and its effect on your triglyceride levels

This is not an intuitive issue for many people. Most of you associate triglycerides with fat. That is far more logical. Therefore, let’s review a little basic physiology and show you how sugar increases your triglyceride levels. The liver is a highly complex organ. Glucose is necessary to maintain life. Your brain takes up 25+% of all the glucose in your body. So your liver will package a glucose load it sees coming from the intestines after a meal or a snack. When we eat a meal with carbohydrates the liver can:

Use glucose as energy.
Store the glucose internally as glycogen.
Convert the glucose to triglycerides, package it into a VLDL, and send it out in the bloodstream for other tissues to use.

When the VLDL particle containing the triglycerides gets into the blood, it can:

Be taken up by muscle and stored as intramuscular triglyceride.
It can be taken up by muscle, converted to glycogen and stored or used as a future energy source.
It can be taken up by fat cells and stored in your body for later use.

Intramuscular triglyceride can be used by the muscle as an energy source via a process known as oxidation. This will become important later as we discuss the role of exercise.

As you can see, glucose (sugar) and lipid metabolism are highly linked to one another. The hallmark of impaired glucose metabolism is a process we call insulin resistance. The is a very complex topic that is actually very hard to precisely define. In essence, people with insulin resistance still retain the function of their beta cells in the pancreas. Those are the cells that make insulin. The issue is that the insulin doesn’t have the same effect on many of the tissues in your body. Thus it requires more and more insulin to be present to have the same effect as someone with less insulin in their bloodstream. Eventually your beta cells in your pancreas will exhaust themselves and cease functioning. That is when people with insuin resistance or type 2 diabetes require insulin injections to keep their blood sgar under control.

If your number is above 3 then you are at very risk for developing Type 2 Diabetes, heart disease, dementia, strokes, etc. All of these diseases reflect the presence of a metabolic abnormality that has existed in your body for decades. The earliest signs of atherosclerosis are now showing up in children! So the sooner you start paying attention and fixing this issue, the sooner you will be on the path towards wellness and longer, healthier life.

What is the root cause of elevated Trigs? The answer is often carbs, in the presence of a caloric excess. In other words, excess carbs in the presence of more calories than we need increases our risk of developing insulin resistance. Our liver turns carbohydrates it receives from the intestines into Trigs. Triglycerides are then transported around our body in a VLDL.

High trigs levels can cause elevated LDL small particles which are more atherogenic than larger LDL particles. Elevated trigs can also cause a decrease in your HDL.

If carbs are the problem how do we address this?

First, for most of you, all carbohydrates aren’t bad. The carbs we need to avoid are simple carbs such as white bread, rice, potatoes, sugar, pasta, cookies, etc. Complex carbs within moderation are not going to cause a significantly elevated triglyceride level in most of us.

We need to look at how to deal with carbs in four ways.

1. What takes glucose or sugar out of your bloodstream?

By far the biggest sink is your muscles! Muscles store glucose for activity and to burn energy. So it stands to reason that the larger our muscles are the more glucose they can hold and the more glucose they will use for energy. How do we get larger muscles? We push or pull heavy things! As I showed you just last week. Even an 80-year-old will respond and grow more muscle from one bout of resistance exercise. Resistance exercise has been shown to improve how your body processes and manages glucose.

2. So we can take glucose out of our bloodstream. But we also need to put fewer carbs into our bloodstream!! The less glucose your liver has to process, the fewer triglycerides there will be flowing through your blood. That will decrease the number of Trigs in your body that your liver produces.

So we need to reduce simple carbs : bread, rice, cookies, and any added sugar. Pick one food group to eliminate this week and another group next week, and so on. Don’t start your day with a bagel. Breakfast is not your most important meal. If you are on a moderate or high carbohydrate diet then you will crave food in the morning. People on low carb diets will not have those cravings. So you can skip breakfast altogether… or you can have a few eggs and some whole-grain toast.

3. Next… we start a resistance exercise program. Again, we are trying to build our muscles to make them hungrier and we are trying to get them to remove the glucose from our bloodstream to store the energy as glycogen for food.

Next… we make our day a little harder. We walk further… we park in the spot farthest away. We take the stairs. We go out after lunch or dinner for a short walk.

4. Next… sleep 😞 Yes, sleep. Sleep improves how our body manages sugar by different mechanisms. Our brain does control our liver to a degree via the vagus nerve. The more relaxed and well slept, the better our baseline glucose levels are. The better we sleep, the lower our internal stress.

Exercise will raise your HDL levels. Decreasing trigs will raise your HDL level.

So.. the lower our trigs get, the higher the HDL and the lower of Trig/HDL ratio is. 🙂

So… your triglycerides are largely determined by the amount of carbs we eat. Not necessarily the amount of fat we eat. Yes, saturated fats raise LDL cholesterol. But, by avoiding the metabolic syndrome and insulin resistance we decrease the risk of developing a multitude of chronic diseases.

Let’s start there !!!

Are you in?

Carbs and Triglycerides: Their relationship and its ability to predict the presence of insulin resistance

Your Triglyceride/HDL ratio and what it tells you

Sugar and its effect on your triglyceride levels

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Your Triglyceride/HDL ratio and what it tells you

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Howard J Luks, MD

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