My son is 17 years-old. When he recently got some blood tests I decided to get his cholesterol levels checked as well.
Here are the results:
Total cholesterol: 229 mg/dl
HDL: 30 mg/dl
LDL: 102 mg/dl
He does’nt drink alcohol or smoke. His diet is very low in vegetables, but he does eat quite a lot of fruits. For the last few months he has been on vitamins A, E, B-complex and zinc prescribed by a dermatologist to deal with his acne/pimple problem. He is into weight lifting and exercises quite regularly.
My question is: Can the vitamins he is taking for acne contribute to his high level of triglycerides? If not, what could be the reason? There is no history of coronary artery disease in the family, except when I suffered from arryhthmia, which was cured when I started taking a Cal-Mag-Zinc supplement.
From the maternal side, there is history of diabetes. What are his risks are of developing pancreatitis? Do you have any advise on what kind of diet he should go on?
Your son does have a high triglyceride level, as well as an elevated total cholesterol. His HDL (good) cholesterol level is also low.
You’re concerned that he may be at risk for early heart disease or perhaps even pancreatitis (an inflammation of the pancreas in the abdomen which can cause very painful and occasionally life-threatening attacks).
First a little background. Cholesterol and triglycerides are both lipids, that is fats, which are absorbed from our diets and are also synthesized inside our bodies. They are very different types of fat however:
Cholesterol has a sterol structure, a complex ring formation similar to that of cortisone. Cholesterol is stored in various tissues, but not much in fat cells. Cholesterol is used to synthesize steroid hormones and bile acids which aid in digestion, and can also be found in our cell walls.
Triglycerides have a structure made up of a glycerol backbone to which are attached 3 fatty acids (hence triglycerides). Triglycerides are the fat that we store in fat cells and are used to store energy. Each gram of fat will yield 9 calories of energy when metabolized.
There have been vast amounts of research on the connection between cholesterol levels and atherosclerosis — the process that leads to coronary artery disease and heart attacks.
When we test for cholesterol, we commonly measure the total cholesterol — which in your son is definitely elevated for his age.
Your son’s (bad) LDL (low density lipoprotein) cholesterol is normal for an adult, but high for an active adolescent. His (good) HDL (high density lipoprotein) cholesterol is low.
High LDL cholesterol levels are most clearly involved in early atherosclerosis, but there is increasing evidence that a low HDL level can also contribute to this. According to some studies, about 50 percent of the U.S. population have an LDL level of 125 mg/dl or above — levels that can predispose us to atherosclerosis, and we see it in our high death rates from this condition. Therefore, I would say that your son is at somewhat greater risk for developing athersclerosis than most adolescents.
High triglycerides by themselves do not appear to increase atherosclerosis or heart disease, and the risk of pancreatitis is not great until the level approaches 1500mg/dl, well above your son’s level.
However, many experts would nonetheless treat a level above 500mg/dl, especially in the context of a low HDL, and especially so in someone as young as your son, since in general these problems only get worse with age.
There are quite a few inherited abnormalities of lipids, some of which produce values similar to your son’s. A detailed family history and perhaps lipid analyses of other members of the family would be necessary to identify these.
Diabetes, present in his mother’s family is commonly associated with high triglycerides and low HDL. In such cases careful control of blood sugar and weight loss can change the lipid picture. The lipid abnormalities may precede the onset of diabetes. I assume that with all the other tests, your son’s blood sugar was tested and found to be normal.
The Vitamin A he is taking for acne can also raise LDL cholesterol and lower HDL. Male sex hormones, androgens such as testosterone, DHEA or androstendione — popular drugs taken by athletes, can also bring about these changes. Since your son is a weight lifter I would be concerned that he might be taking an androgen supplement. They are widely available and often surreptitiously used by teenagers hoping to increase muscle mass.
Alcohol and a diet high in refined sugar can increase triglycerides. Your son doesn’t drink, but sugar might be a problem. Although you mentioned that your son exercises regularly, you didn’t mention anything other than weight lifting, nor did you tell us your son’s weight.
Weight lifting, though it increases muscle mass, is not an aerobic exercise, and many weight lifters in fact are quite obese. We have all seen those pictures of the Russian Olympic champion power lifters who seem to be massively fat.
The benefits of exercise on weight control, lipids, blood sugar, cardiovascular health, and general fitness all come from aerobic exercise — that is exercise that is done continuously for at least 30 minutes daily, at a level that causes one to puff and sweat. Speed walking, jogging, bike riding, cross country skiing, and many of the machines found in health clubs all provide aerobic exercise.
So my reaction to your son’s blood values would be to first make sure he is not diabetic, check that he is not taking any form of male sex hormone or androgen, stop the vitamin A, and have him reduce weight if he is at all obese.
A diet limiting saturated fats, that is low in beef, pork, whole milk and items made from milk such as butter and cheese will help reduce the LDL cholesterol and total cholesterol.
I would add Aerobic exercise because it has been shown to increase HDL levels and should be an important part of the program.
After that I would recheck the lipids periodically to see if they are improving. Since there is little immediate risk of pancreatitis or coronary artery disease, I would focus on life style strategies and not jump quickly into drug treatment.
If lifestyle changes don’t improve the situation, or he is unable to make them, I would next recommend the vitamin niacin at doses of 1500 to 3000mg per day. This dosage is often difficult to tolerate and should be increased slowly, perhaps using a long-acting form of the vitamin.
The drug gemfibrozil, (Lopid) is the next most effective anti-cholesterol medicine to reduce triglycerides and increase HDL cholesterol, but I would hate to start 17-year-old on this unless serious lifestyle changes have not helped.