Hypertriglyceridaemia in Type 2 Diabetes: Risk and Management

Guest Article by Martin MacDonald

Mac-Nutrition get a weekly update from Medscape: Diabetes and Endocrinology News. Generally I just skim the headings but occasionally a title like "Managing Hypertriglyceridaemia in Type 2 Diabetes" comes up which takes my fancy. You can sign up for a free account if you wish but I generally wouldn't advise bothering… If you want to read this very short article I am referring to here, click here.

Hypertriglyceridaemia is having high levels of triglycerides (fats) in your blood. It is not the same as eating a lot of fat as I will explain. This will be a very short blog that may or may not cause any discussion but it's good to get it off my chest!

So, in the article I'm getting the usual message… drug therapy is better than food. Omega 3 fish oils are a last resort after multiple drugs (fibrates and statins) are given… but then I read this:

Patients with triglyceride levels >11.30 mmol/lL should immediately start a very low-fat diet, in which fat accounts for ≤15% of calories.[24]

Obviously I was a little surprised as only the sentence before they had talked about the benefits of

Avoiding tobacco and high-carbohydrate foods, and eating a diet low in saturated fat and sugar

Now obviously they are going to point to saturated fat… because that's always the bad guy right? But then to go on and demonize ALL fat?? What happens when you eat a VERY low fat diet? In the long term people eat more carbohydrate… what does that do? Here are a few blogs Mac-Nutrition has written on this exact topic:

Here is a blog written specifically on the topic of saturated fat and triglyceride levels by the way… guess what? When controlling for carbohydrate intake, saturated fat improved blood TG and cholesterol (VLDL) levels!!

Low carbohydrate beats even moderate carbohydrate in lowering blood TG levels

One of our clients, who after a very short time of reducing carbohydrates and alcohol, and increasing his saturated fat intake markedly more than halved his TG levels!

The infamous UK Dietary Guidelines study that got so much attention. Switching from a standard diet to a diet in line with the Eatwell (haha) Plate caused a significant increase in blood TG concentrations after 1 week!

Increasing carbohydrate intake even in male and female runners increases TG levels!

Finally, I looked up the [24] study that was quoted… It's this one: Oh and Lanier (2007). Management of hypertriglyceridaemia. Am Fam Physician 75:1365–71.

Fortunately I could get the full paper… you'll never guess what… there is no reference, no data, no reason why patients should be put on this 'very low-fat diet' which is so low in fat that even the Institute of Medicine in America, which is a fan of reduced fat diets, thinks it is too low in fat! Anyway, not a lot of point to this blog other than to document this general rubbish. The only really interesting thing that came out of reading the article was that

Consuming fish oil containing 2–4 g EPA and DHA daily can lower triglycerides by 30–50%

This equates to around 7-8 of the MyProtein omega 3 fish oils (300mg EPA+DHA/capsule) or 4 of their new Omega Balance.