At 35, Bengaluru woman had mild cholesterol: What doubled her heart attack risk then?

 

 Source: https://indianexpress.com/article/health-wellness

Excess sugar — not just cholesterol — can silently raise triglycerides or blood fats but simple lifestyle changes can reverse their levels

At 35, Priya (name changed), an IT professional from Bengaluru, thought she was reasonably healthy. Yes, she had put on a few kilos after years of working from home. Exercise had slipped down her list of priorities, and late-night food deliveries had become routine. But she wasn’t diabetic, her blood pressure was normal, and her LDL cholesterol — the number everyone talks about — was mildly elevated at 120 mg/dL, optimal being 100 mg/dL.

Then came her annual health check. Her triglycerides had shot up to 350 mg/dL, well above the ideal limit of 150 mg/dL. I wasn’t worried about her LDL cholesterol as much, but her triglycerides meant the two together could put her heart at risk. We spend so much time talking about cholesterol that people often ignore triglycerides. But in many Indians, high triglycerides are the earliest warning that metabolism is going wrong.

 

What are triglycerides? Why do we need them and how do they impact us when in excess?

Triglycerides are the most common type of fat in the body. They act as the body’s energy reserve. After you eat, your body uses the calories it needs immediately for energy. Any excess calories — particularly from sugar, refined carbohydrates and alcohol — are converted by the liver into triglycerides. These are carried through the bloodstream and stored in fat cells to be used later when the body needs energy between meals or during exercise. Without triglycerides, the body would have no efficient way to store excess energy.

Problems begin when the body constantly receives more calories than it burns. With a sedentary lifestyle and diets high in sugary drinks, sweets, desserts, refined flour and polished rice, the liver keeps converting excess glucose into triglycerides. Over time, these fats accumulate in the bloodstream because the body is producing them faster than it can use or store them safely. High triglycerides are a sign that the body’s metabolism is under strain.

This explains why someone whose diet contains relatively little fat can still develop very high triglyceride levels. It is excess sugar and excess calories that often drive the problem, not necessarily the oil on your plate.

Persistently elevated triglycerides are associated with insulin resistance, fatty liver disease, obesity and Type 2 diabetes. They also contribute to cardiovascular disease by increasing the number of cholesterol-rich particles in the blood and promoting the formation of smaller, denser LDL particles, which are more likely to penetrate artery walls and form plaques. Very high levels—typically above 500 mg/dL—increase the risk of acute pancreatitis, a potentially life-threatening inflammation of the pancreas.

Why Indians are especially vulnerable

Now triglyceride levels between 200 and 300 mg/dL are becoming increasingly common among Indians, even in relatively young adults. Our genes play a role, but only a small percentage of patients has triglycerides that are primarily genetic. For the vast majority, the causes are poor lifestyle, weight gain, physical inactivity, excessive sugar intake, refined carbohydrates and insulin resistance.

Indians also tend to develop metabolic abnormalities at lower body weights than many Western populations. Fat accumulates around the abdomen, insulin resistance develops earlier, and the liver begins producing more triglycerides long before diabetes is diagnosed.

That is why a person may appear only slightly overweight yet already be carrying a significantly increased cardiovascular risk.

The encouraging part: Triglycerides can be reversed

The reassuring news is that triglycerides are among the most responsive blood markers to lifestyle change. Unlike many inherited cholesterol disorders, elevated triglycerides often fall dramatically when the underlying metabolic imbalance is corrected.

Reducing sugar intake is usually the first step. Sweetened beverages, desserts, bakery products and refined carbohydrates need to be cut back, while meals should contain more vegetables, whole grains, pulses, lean proteins and healthy fats. Restrict calorie intake to what is allowed as per your body weight and maintain at least a 12-hour gap between your last meal of the day and the first meal the next day.

Regular exercise helps muscles use triglycerides as fuel instead of allowing them to remain in circulation. Losing even a modest amount of weight improves insulin sensitivity and reduces the liver’s production of triglycerides. In many patients, triglyceride levels begin improving within weeks. The earlier we intervene, the easier it is to reverse the process.

For Priya, that routine health check became more than a report card; it became an opportunity to change course. Instead of waiting for diabetes or heart disease to develop, she began walking daily, cut down sharply on sugary foods and processed snacks, lost weight and watched her triglyceride levels steadily decline. Even losing 5-10% of body weight can significantly reduce triglyceride levels. Lifestyle remains the first line of treatment for most people. However, if triglycerides remain high despite diet and exercise, or if levels are above 500 mg/dL, medication may be needed.