Monitoring Triglycerides is Important in HIV Disease

The Importance of Elevated Triglycerides

Insulin resistance is the cause of type II diabetes, heart disease, chronic kidney disease and most cases of high blood pressure.  These conditions are dangerous and occur much more frequently in patients with HIV Disease than in the general population.  The main reason for this is insulin resistance.

Triglyceride elevation is a symptom of insulin resistance.   If your blood triglyceride level is elevated (>150 mg/dl), then you know your body is being damaged and your risk of developing diabetes, high blood pressure, chronic kidney disease or heart attacks is increased.

A Symptom of Insulin Resistance

Think of elevated triglycerides as a symptom similar to having a fever.

If you‘re experiencing a fever, it indicates you possibly have an infection.  Treating the underlying cause of the fever (for example, a sinus infection or pneumonia) is the primary medical goal.  No one with pneumonia does well if the doctor only treats their fever.

The same holds true for triglycerides.  Their elevation is a symptom that tells you an active underlying medical condition (in this case insulin resistance) is present and needs to be addressed.

Treatment for Elevated Triglycerides

There are few prescription medications available to lower triglycerides.  Unfortunately, there effectiveness in preventing the multitude of complications associated with insulin resistance is poorly understood.  They were primarily approved to lower triglycerides from very high levels in order to avoid pancreatitis.

Scientific studies tell us that an excessive dietary intake of carbohydrate is the driving force of behind insulin resistance and a reduction in carbohydrates results in often dramatic improvement in insulin resistance and its associated disorders.

The benefit of a reduction in dietary carbohydrates (sugars and starches) has been shown is a wide variety of studies to lessen not only triglyceride levels but also improve HDL cholesterol levels,  decrease the risk of developing diabetes, high blood pressure and heart disease.

Carbohydrate Reduction and HIV Disease

Unfortunately, there are no good quality studies assessing the beneficial effect of carbohydrate reduction in patients with HIV Disease.   But I can tell you from personal experience within my Kansas City HIV practice, dietary carbohydrate reduction can often have profound health benefits among patients with HIV Disease.

Many of the benefits I’ve commonly witnessed are:

• Reduction in blood pressure and the need for blood pressure medication.
• Reduction in blood sugar and the need for diabetes medications.
• Reduction in triglycerides to normal levels without the need for medication.
• Normalization of HDL Cholesterol (healthy cholesterol)
• Reduction of the enlarged abdominal girth from lipodystrophy (fat under the abdominal muscles).
• Loss of excess body fat in general.
• Increases of fat in the face, arms and legs (a sign of normalizing metabolism)
• Remission of heartburn and bloating.
• Remission of gout (a form of arthritis).
• Improved urinary function (decreased frequency, day and nighttime).
• Improvement is a dangerous heart condition called cardiac autonomic neuropathy.

In some patients the effects have been dramatic, while in others, the improvements have been less noticeable.

It’s hard to know if the differences are due to individual genetic differences in a patient’s sensitivity to carbohydrates, the impact of different HIV medications that can worsen insulin resistance, different stages of disease, different levels of underlying immune activation or the patient’s ability or willingness to give up certain foods.

But what is true is that if it works, it can be dramatic and I believe it gives the patient  an excellent chance to prevent or forestall some of the dangerous complications of insulin resistance.

How Many Carbohydrates Should You Eat

So, if you have elevated triglycerides (or low HDL cholesterol levels) try to reduce your intake of carbohydrates to less than 125-150 grams per day.  The lower you go the more potent effect but if you can only get to 150 grams per day initially, you’ll start seeing improvements.

The vast majority of my patients with elevated triglycerides can discontinue their medications within a month or 2 after reducing the carbs to less than 100 grams per day consistently.