I received my medical check up report. My triglycerides level is/was around 570. 2 years ago, it was around 590. 3 years ago it was 480 ish. The upper limit for what is considered normal is 150.
Total cholesterol (TC) was slightly above the normal range.
HDL (‘healthy’ fats) was slightly below normal.
LDL (‘bad’ fats) was normal.
Only my triglycerides level was way beyond normal.
The rest of the items in the report (BMI, sugar levels, urine, etc) are all normal.
I don’t drink and smoke at all. I rarely buy sweet drinks (maybe once every two months). I do, just like most Asians out there, consume rice almost every day.
And to be honest, I just went through a very unhealthy, extreme diet. I just lost ~10 kgs in one month (it was in June, and the medical check up was done in the first week of July). I did water fasting (took a break every 6 days) and walked ~15k steps every day.
I’m looking for English speaking doctors/dietitians in Taipei who can guide me through this or even prescribe me with vitamins/medicine that can help.
That’s pretty high! Do you know what causes it? Anything to do with your username…?
Definitely sounds like something worth keeping an eye on anyway. Maybe you could look into psyllium husk as a fiber supplement, though given the current level I guess you’d want to do other stuff too. It’s available in Taiwan, but I’ve only found the unflavored and unsweetened kind (which is pretty awful).
I just checked my spreadsheet out of interest and mine has been pretty consistently around 120–130 mg/dL over the last several years, with cholesterol at around 180–195 mg/dL. Not sure why, because my diet isn’t great.
You don’t need a dietitian. They will simply take your money and make you sicker. It is highly unlikely that you need medicines or vitamins.
The reason your cholesterol panel looks like this can be (over)simplified as follows: your body has insufficient capacity either in bodyfat or skeletal muscle to store excess dietary carbohydrates, so they end up circulating temporarily as triglycerides (it’s a curious feature of human biology that you can buffer a significant amount of fat in your bloodstream, for quite some time). The fact that your cholesterol is ‘normal’ suggests that there’s nothing pathological going on here (yet!); it’s just a natural outcome of your diet and individual genetics.
Just to be clear, since it’s often misunderstood: LDL, HDL etc are not ‘fats’ as such. They are micromachines which transport fats (triglycerides) through your water-based blood. They have a large cholesterol component, which is extracted as they circulate and used as a substrate for various processes. The fats they contain are burned for energy.
I strongly suggest getting rid of the rice from your diet - as you get older, your body will become less and less able to deal with this daily dose of rice, which has a glycemic index similar to sugar. Rice is neither necessary nor healthy for modern humans (who are mostly sedentary, not sweating in the fields). Fill the missing space on your plate with … anything else you like really. Vegetables, meat, eggs, dairy, dofu. I suggest vegetables as a default. Taiwanese food typically contains sufficient fat to meet your daily energy needs (in the absence of carbohydrates) but in any case ensure that you do have at least have some fatty pork, eggs, or something similar on your plate at each meal. Vegetable oils are not ideal but there’s no need to get obsessive about avoiding them.
If you can add a bit more detail about your typical eating habits (which don’t sound too bad) I could be a bit more specific. The upshot is that all you need to do is eat normal, human-appropriate food, keep up with the exercise, and you’ll be fine. Or at least more fine than people who don’t do those things. A dietitian will almost certainly put you on another ‘extreme’ diet, which will mess with both your head and your bodily health.
I think we have a similar impression of nutritionists and I wouldn’t recommend a family medicine doctor either (my experience of them in Taiwan… hasn’t been very positive, let’s say), but I think it might at least be worth getting checked by an endocrinologist or something to make sure there’s nothing else underlying those values (it looks like hypertriglyceridemia can be caused by various things) and order future tests covered by NHI. From what OP wrote, it sounds like they’ve been getting these results as part of annual medical checks for work or something, presumably without much follow-up.
Weeeelll … maybe. But I suggest the following aphorisms apply:
When the only tool you have is a hammer, everything looks like a nail
If you hear hoofbeats, think horses, not zebras.
The most likely explanation for the OPs presentation (which apparently includes, or included, being a bit overweight) is diet. In 95%+ of people in a similar situation, the proximate cause of the problem (or at least 95%+ of the problem) is diet. And since one’s diet can be changed in the way I’m suggesting without any downsides, it would be worth trying it, running the tests again in 6 or 12 months’ time (not sooner than that) and see if the numbers look better. If it doesn’t - well, fine, drill down into other possible causes.
An endocrinologist - if the OP sees one now - may well decide that there’s some “hormonal” problem that needs to be “corrected” with drugs. My favourite real-world example of this is doctors prescribing insulin for T2D, which is the medical equivalent of throwing a bucket of water on a chip-pan fire: it sounds like it ought to work if you don’t know what’s going on, and the fact that any doctor would have this pisspoor understanding of the condition is beyond shocking. Far too many doctors see a nail and want to hammer it down, instead of asking themselves if, e.g., the hormones might look unusual because the body is responding correctly to an unusual set of circumstances.
Consider being diagnosed specifically with “hypertriglyceridemia”. What exactly does that even mean? I’m pleased to note that Google tells me reducing carbohydrates is the default action to take (as opposed to reducing dietary fat), so that’s something. But how exactly could your circulating triglycerides be “too high”? If you have very modest musculature; if you have the type of body that cannot get grossly obese; and if you’re eating a lot of carbohydrates - well, your triglycerides will be whatever they need to be to make 1+1=2. There is no drug, no procedure, that can make it otherwise. And in any case a high triglyceride measurement, in and of itself, is not a problem; if you eat a fatty meal your blood plasma will be temporarily cloudy from the fat being buffered in your bloodstream, but your body is designed to operate that way. It’s not going to hurt you. Heart disease is assocated with high triglycerides because the thing that usually causes high triglycerides (bad diet) causes heart disease, via a whole constellation of different processes. It’s not the ‘triglycerides’ that hurt you, and therefore the use of ‘hypertriglyceridemia’ as a pathological state is inappropriate.
I assume it was a fasting measurement (as cholesterol tests usually are) and OP hadn’t eaten beforehand as instructed.
In this case, I think a value four times higher than what the majority of other people have counts as “too high” and should be a cause for concern.
I’m sure you know what “hypertriglyceridemia” means. I didn’t mean to trigger you with the “-emia” suffix, and I only meant it as another term for “high triglycerides”.
I just think it might be useful to discuss this with a real doctor, if it’s something they’ve only found out about as part of medical checkups. OP is under no obligation to take any drugs they don’t want to take.
Yes, of course, but my point was that if his triglycerides are “too high” (that is, outside the range shown on the doctor’s reference card) the first assumption should be that this is a normal biological response to pathological external conditions. Pathology should only be considered when normal good health has been eliminated as a possibility. If he goes to a doctor now (without addressing his diet) the doctor will simply throw pills at the problem, because that’s their first recourse in most circumstances.
Fats which were ultimately derived from carbohydrates in your bloodstream get there via processes that are far more complex than the one that transports fats out of your intestine and down the hepatic portal vein, which obviously only happens while you have fatty food in transit. In a fasting state, a good fraction of circulating triglycerides (regardless of the absolute quantity) have been liberated from fat cells, which are there to store and release energy. The processes that accomplish the second-by-second power-split between various different fuels (dominated by glucose and fatty acids) are mindbending and I don’t pretend to be an expert on the minutiae; but what is most likely going on here is that the OPs body is attempting to shift that balance more towards burning fat than glucose, which IMO is a good thing, not a bad thing - the presence of circulating fats causes a temporary increase in cellular insulin resistance, thus favouring the use of fat as an energy source. Unfortunately, because he’s getting that continual top-up of glucose (from the daily rice) this strategy cannot possibly dispose of the backlog.
It would be worth getting a CGM, I reckon. Your blood sugar response gives you far more information about your state of health than a cholesterol panel.
Hey Finley and Andrew, thank you for both of your responses.
My worst habits would be not exercising and irregular sleeping hours. Except for the month when I water fast, I typically don’t exercise at all. And I sleep very late; I sleep around 4/5/6 AM, to wake up around 9 AM, work, and then go home, and then take a nap, wake up before midnight, play some games/watch movies, and sleep again at 4/5/6 AM.
As for my eating habits, on weekdays I usually eat once a day, only dinner. I can’t be arsed to wake up earlier to eat breakfast since I was in college so I’m not used to eating something in the morning. During lunch break, I would rather sleep at my desk. I eat a lot for dinner, maybe 2-3x the regular portion to make up for the rest of the day.
I only eat chicken meat (no pork, beef, seafood, etc). I don’t avoid vegetables, but then again I don’t go out of my way to eat vegetables/greens. If it’s on my plate then I’ll eat it. If it’s not then I won’t be missing it. I eat a lot of spicy and pan-fried/deep-fried stuff (hence my username!) + white rice.
I would’ve thought my TG levels would be much better since I did water fasting right for almost a month before the checkup. I thought ~1 month of mostly consuming water would be enough for my body to rinse out the excess oil/fat in my blood/replace the oily blood with newer, healthier blood.
Not sure about getting a CGM, my blood sugar levels have been consistently within the normal range in the my last 3 reports.
And yes, these three tests were annual/or biannual company medical checkups. No follow-ups and we were told to not eat anything 8 hours before the checkup.
I think my dad also had the same condition, but I’m not sure; he told me that years ago when he did a medical checkup, his TG levels were also really high. So this might be hereditary, I guess? My Taiwanese colleague who I showed my report to told me get it checked by the 家醫科 (family medicine) or 新陳代謝科 (metabolism? department). Please, if you know any good doctor, let me know. Thank you.
OK, that’s definitely a bad habit, and since you know it’s a bad habit it’s probably worth making a serious effort to do something about it.
Exercise provides all kinds of benefits, and may well help with your sleep cycle. One of the best things anybody can do for their general health is to simply show up at the gym a few times a week. If you can commit to that single change instead of playing computer games, you might find you’re sleeping better.
TBH this doesn’t sound too terrible. I’ve certainly seen a lot worse. Again, it should be possible to make trivial changes and reap large rewards: just dump the white rice and make at least some effort to expand your dietary horizons a bit: different meats, different prep styles, different anything really.
Your one-meal-a-day eating pattern might offer at least a partial explanation for elevated triglycerides. Basically, you’re “fat adapted” - your body is quite good at using stored fat for energy, relying much less on glucose.
It doesn’t work like that. Fasting gives your body very little option except to start burning through bodyfat. Two fat molecules yield six fatty-acid molecules and one glucose molecule, so obviously in a fasted state your body is going to tilt all your metabolic processes towards being fat-fuelled. However, I agree that you would not normally see elevated triglycerides in this state, so that does seem a bit odd.
Don’t think of fat as ‘dirty’ or ‘bad’. Your body wouldn’t use fat as its primary long-term energy store if fat was bad for you. And honestly, try to kick the habit of doing these binge diets. AFAIK they’re not going to do you any lasting harm, but they’re completely unnecessary and could potentially trigger an eating disorder, or at least a very bad relationship with food.
Those “blood sugar level” tests are mostly meaningless - they do not contain any information about your response to a glucose challenge, which is what you really need to know to pick up signs of metabolic disease early enough to prevent harm. By the time a patient’s HbA1c or fasting-glucose has become abnormal, they’ve already been diabetic for years.
Certainly a possibility. But then again, it’s also possible that you inherited your eating/sleeping habits from your dad
Taiwanese people love going to doctors and taking medicine, but the uncomfortable fact here is that a doctor can’t fix your food, sleep patterns, or lack of exercise for you, however good he is. The question is: what outcome do you want? Do you want the doctor to prescribe you pills until your test results look “normal” (which I suspect is technically possible) but will make you feel like death warmed up and will do nothing to improve your health or longevity? Or do you want to actually live longer, look better, and feel healthy? If the latter, I’m afraid there are no shortcuts. I’d make a terrible doctor because I tell people the truth instead of what they want to hear, but I’ve done this enough times to know my advice is better than the average dietitian’s, and people who follow it are glad that they did.
Just a general question, reading between the lines here: are you OK? Do you feel depressed or unhappy? Do you feel your life has direction and purpose? I don’t want to get all “tell me about your father” on you, but some of what you describe here suggests that your funny eating and sleeping habits might be a result of some other issue.
I mostly agree with what’s been said above.
If you are having trouble modifying your diet, a dietician could be helpful, but I don’t know how to find a good one. As Finley mentioned, cutting back on the carbs can be important, along with increasing vegetables. Limit alcohol, exercise regularly. Omega-3 supplements could help and don’t have significant downsides that I know of, but I’m not an MD.
Regarding blood glucose level, “normal” can be deceiving. Mine was normal but trending upwards for a long period, and it is harder to battle it back down again than it is to keep it down in the first place. If it is increasing over the years or nearing the lower bound of normal, that should be a warning. I also like to know my HbA1c level in addition to fasting blood glucose; the former is a more stable maker of blood glucose levels over the past couple months, while the latter is more subject to fluctuations.
Your primary care doc should be able to tell of yiu need a specialist referral. That said, if the high Tg levels persist while on a good diet and exercise routine, I would tend to want to find if there are underlying causes that might be addressed
I am not sure if these are the most recent guidelines.
Yes, that’s a reasonable position, and pretty much what I was trying to say earlier. Do the diet and exercise first, then think about doctors if it’s not making any difference. However, the page you linked to predictably involves statins; in other words, the mainstream treatment is to prevent your body from synthesizing cholesterol (plus a whole bunch of other stuff) in the amounts that it believes are necessary, in order to prevent it transporting fat in your bloodstream. It’s hard to see why this would achieve anything useful, and in practice statins have not been shown to do more good than harm except in a very narrow range of conditions (and even then, the benefit is marginal).
High tg, in and of itself, has no symptoms and no sequelae. It is not a disease process and - alone - is not associated with one. High tg can be a symptom of metabolic syndrome, which is associated with a disease process, but it’s not obvious that that’s the case here, since the other signs and symptoms are not present. A doctor with three minutes to talk to the patient may well treat the (single) symptom rather than actually bothering to check what the problem is.
As I said earlier: when the only tool you have is a hammer, everything looks like a nail.
In this TG range, 500-1000 and normal LDL-C etc, statins don’t seem to be advised. Depends on individual risk.
"Adults aged ≥20 years with triglycerides 500 to 999 mg/dL: The initial step in guideline-based management of patients with severe hypertriglyceridemia (triglycerides ≥500 to 999 mg/dL) is to provide lifestyle counseling. In those with fasting or nonfasting hypertriglyceridemia, such counseling is especially important due to the established atherogenicity of triglyceride-rich remnant lipoproteins and the benefits of lifestyle interventions in reduction of these particles… Although all patients being treated for lipid disorders should have secondary causes excluded, the presence of hypertriglyceridemia should trigger a re-examination for secondary causes, particularly for diabetes mellitus and excessive alcohol intake… Triglyceride-raising medical therapy is also a commonly encountered secondary factor in clinical practice… As per the 2021 American Diabetes Association Standards of Medical Care in Diabetes, glycemic control may also beneficially modify plasma lipid levels, particularly in patients with very high triglycerides and poor glycemic control…
LDL-C risk-based therapies and triglyceride risk-based therapy: In adults 1) aged 20 to 39 years without ASCVD or diabetes mellitus and triglycerides 500 to 999 mg/dL; or 2) aged 40 to 75 years with 10-year ASCVD risk <5% and triglycerides 500 to 999 mg/dL, there is limited evidence of the ASCVD risk reduction benefit of statin therapy, LDL-C risk-based nonstatin therapies, or triglyceride risk-based nonstatin therapies…"
That looks sensible (surprisingly). Apparently things have moved on a bit.
I should probably just be clear about my intent here. I’m not suggesting the OP should avoid doctors entirely (if it comes to that), merely to be discerning about treatment, and to have some explicit treatment goals (as opposed to “let’s try this and see what happens”). A recommendation for a “good doctor” may often be based on the number of pills that they hand out, rather than (say) whether they listen and think.
Yes, It’s hard to find a good health care professional, and you often don’t find out the quality until later than would be hoped. You have to be your own advocate and not just take the doc’s/dietician’s/etc’s word.
No one asked for an update but here’s one from me:
I decided to go to a doctor in TMUH, he prescribed me with a month worth of medicine called Fenolip (once a day). A month later I took another blood test, and damn my TG level dropped from almost 600 to 120. Totally didn’t expect that at all. I thought I would need several months to lower it to that level.
The most significant difference I feel is I sleep better now (and fall asleep easier) and I don’t feel nauseated as often as I used to. I don’t know if that’s a direct result of a lower TG level though.
I didn’t mean to trigger you with the “-emia” suffix, and I only meant it as another term for “high triglycerides”.
Adults aged ≥20 years with triglycerides 500 to 999 mg/dL: The initial step in guideline-based management of patients with severe hypertriglyceridemia (triglycerides ≥500 to 999 mg/dL) is to provide lifestyle counseling. In those with fasting or nonfasting hypertriglyceridemia, such counseling is especially important due to the established atherogenicity of triglyceride-rich remnant lipoproteins and the benefits of lifestyle interventions in reduction of these particles… Although all patients being treated for lipid disorders should have secondary causes excluded, the presence of hypertriglyceridemia should trigger a re-examination for secondary causes, particularly for diabetes mellitus and excessive alcohol intake… Triglyceride-raising medical therapy is also a commonly encountered secondary factor in clinical practice… As per the 2021 American Diabetes Association Standards of Medical Care in Diabetes, glycemic control may also beneficially modify plasma lipid levels, particularly in patients with very high triglycerides and poor glycemic control…