Low triglycerides or hypotryglyceridemia are diagnosed when blood triglyceride levels are below the considered normal range, i.e. between 150 and 199 mg / dL (in the case of children and young people under the age of 18, it becomes 90-129 mg / dL).
Our energy reserves are accumulated in adipose tissue and muscle tissue in the form of triglycerides , which perform reserve functions . Hence, these energy reserves are affected when the body needs energy to carry out metabolic reactions. Triglycerides are broken down by releasing their fundamental components, fatty acids and glycerol (as glycerin is chemically defined). The splitting reaction of triglycerides releases energy, a physical quantity that is measured in calories ( kCal ) in these areas .
Are low triglycerides dangerous? Unlike hypertriglyceridemia , which can have very serious consequences, hypotryglyceridemia is not generally a clinical problem tout-court.
In addition, it can happen that the level of triglycerides in the blood is temporarily low, but if the values normalize in the short term, the deviation is not symptomatic and is not a problem.
Low triglycerides: when to worry? Instead, when the gap with respect to the values considered normal is conspicuous and not transitory, it is advisable to check for the presence of pathologies. Basically, low triglycerides can be the sign of a much more serious problem , such as an autoimmune, liver or intestinal disease.
In the latter cases, what needs to be treated is the primary cause of hypotryglyceridemia , not the alteration of triglycerides itself. In fact, the appearance of the symptoms of the underlying pathology pushes to perform in-depth checks that can lead to the diagnosis of hypotriglyceridemia and the underlying disease.
Find out what hypertriglyceridemia is, i.e. high triglycerides .
What it means to have low triglycerides
Hypotiglyceridemia is a condition represented by low triglyceride levels in the blood.
The values of triglycerides in the blood are considered within the normal limits when they are between 150 and 199 mg / dL (for children under 18 years of age 90-129 mg / dL): if less than 150 mg / dL they frame the condition of hypotryglyceridemia.
What do low triglycerides entail? Hypotiglyceridemia almost never produces serious symptoms or consequences when isolated. What is a clinical problem is the disease that caused it , when it exists. In these cases, the primary cause, which can be a genetic disease, liver, intestinal or thyroid abnormality, must be identified and treated.
In many cases, this is an isolated parameter due to temporary circumstances, such as very strenuous exercise or the use of drugs that can have a lowering effect on the concentration of lipids in the blood .
Low triglycerides: what are they due to?
Blood triglycerides can reach lower than normal concentrations due to several factors.
Some of these are benign and lifestyle dependent. For example, hypotiglyceridemia / low triglycerides can be caused by particularly intense training , or by an intensive weight loss diet or by taking lipid-lowering drugs (which reduce the blood concentration of lipids).
Instead, others correspond to potentially serious pathologies.
Possible causes of low triglycerides
Intense physical activity and low triglycerides
To understand what the effect of sport is on the concentration of triglycerides in the blood , it is first of all necessary to distinguish between physical exercise and physical activity.
exercise involves repetitive movements, specifically programmed and structured intended for the improvement of physical fitness and health. For example, physical exercises such as
- I swim
- brisk walking
- aerobic gymnastics.
Instead, physical activity includes all body movements that involve a normal expenditure of energy. For example, a regular walk or common daily household and work activities.
Therefore sport differs from one and the other in that it is subject to precise rules and is inherent in the circumstances of competition and structured competitions.
Only physical activity and sport can significantly affect triglycerides .
The low-intensity aerobic workouts for longer time intervals are more involved in the modulation of triglyceride levels .
In fact, the increase in intensity of physical performance favors not only the energy metabolism which leads to the reduction of triglycerides (but also of cholesterol) and blood pressure, but also the metabolism of fats.
Hence, it is the low-intensity aerobic workouts that accelerate the metabolism the most and lead to body weight loss more easily .
Aerobic or anaerobic exercise
As regards the mechanism of action of this type of physical exercise, more than one hypothesis has been formulated.
Intense exercise could increase energy metabolism by stimulating the adrenergic system and ultimately lead to weight loss.
Instead, the adrenergic system is the one that, under certain stress conditions, releases adrenaline and other similar molecules (collectively called catecholamines ), which increase the energy consumption by the cells of the adipose tissue.
This phenomenon leads to an increase in lipolysis , the breakdown reaction of triglycerides from their deposits, which produces fatty acids and glycerol, releasing the energy that the muscle needs to carry out physical exercise.
exercise aerobic exercise produces a decrease in triglycerides and major lipoproteins that carry them in blood, VLDL (very low density lipoproteins). Therefore, when done with high frequency, it can result in hypotryglyceridemia with no pathological implications.
Famaci and supplements
People with dyslipidemia (alterations in the lipid composition of the blood, such as hypercholesterolemia and hypertriglyceridemia) must be subjected to adequate therapy in order to prevent possible serious consequences of the cardiovascular (myocardial infarction, stroke) or pancreatic (acute pancreatitis) ).
The drugs used to reduce the concentration of fats in the blood are defined lipid-lowering , the main ones being:
- stat i ne
- nicotinic acid.
They are molecules that can, in the course of their chronic intake, cause an excessive lowering of triglycerides . A benign and temporary condition, generally not associated with relevant clinical consequences.
Even the ‘ ascorbic acid (better known under the name of vitamin C ) may contribute to excessive lowering of blood triglycerides.
As well as fibers and prebiotics , water-soluble fibers that include different types of polysaccharides (including beta-glucans, fructans and inulins) that promote the development of bacterial flora in the colon.
Hypotriglyceridemia and cystic fibrosis
The Cystic fibrosis is a disease serious genetic widespread . In fact, it has an incidence of 1 in 2,500-3,000 live births. In Italy there are about 5,000 patients affected by this disease.
It is a multi-organ disease, which affects in particular the respiratory and digestive systems.
The cause of cystic fibrosis is a mutation in the CFTR gene named after the disease (Cystic Fibrosis Transmembrane Regulator). The alteration results in the production of excessively thick mucus . For this reason, the disease is also called mucoviscidosis.
The compact mucus hinders breathing by accumulating in the bronchi, where it facilitates the stagnation of microorganisms, causing repeated respiratory infections.
It also blocks the pancreatic ducts, preventing enzymes produced by the pancreas from reaching the intestines.
Thus, the person with cystic fibrosis does not digest or absorb fatty substances, including fat-soluble vitamins ( A, D, K, E ).
The main consequence is malnutrition , which causes a slowdown in growth in children and a delay in puberty in young people.
In addition, there is a significant reduction in the concentration of triglycerides in the blood . Therefore, hypolipemia or lowering of blood fat levels must be countered by an appropriate high-calorie diet and by taking specific food supplements .
Treatment of cystic fibrosis is mainly symptomatic, even if technological innovation is beginning to make available personalized therapies able to correct the genetic defect underlying some forms of cystic fibrosis . It is possible to keep the bronchi open as much as possible with respiratory physiotherapy and various respiratory support medical therapies.
In extreme cases, when available treatments are no longer effective, lung transplantation should be performed .
Low triglycerides and thyroid
The thyroid is a small gland located at the base of the neck that secretes two hormones with a significant impact on metabolism, the set of chemical processes that occur in the body in two ways. The first is that of stimulating the tissues to produce proteins, intended for structural purposes. The second is to increase the amount of oxygen used by cells, a phenomenon that accelerates metabolism .
The hormones released by the thyroid are thyroxine ( T4 , also called tetraiodothyronine) and triiodothyronine ( T3 ). T4 is produced and rapidly converted to T3, which is effectively the active molecule.
hyperthyroidism is a condition in which the thyroid is overactive and produces an excess of hormones. It is a phenomenon that accelerates the metabolism and can generate symptoms such as:
- increased heart rate and blood pressure
- appearance of arrhythmias (especially tachycardias)
- excessive sweating
Other consequences of the accelerated rhythm to which cellular metabolic mechanisms are subjected are the reduction of triglyceride and cholesterol levels in the blood and weight loss .
The Graves’ disease is one of the most common causes of hyperthyroidism. It is an autoimmune disease in which the affected person’s immune system produces antibodies that attack thyroid cells.
A further cause of hyperthyroidism is represented by thyroiditis, inflammation of the thyroid gland , which can recognize viral infectious or autoimmune causes ( thyroiditis Hashimoto ).
Weight loss, malnutrition and low triglycerides
Can weight loss cause low triglycerides? A diet that is too drastic can occasionally lead to hypotriglyceridemia . However, it is a condition that generally has no relevant clinical consequences.
The case of malnutrition is different, which can occur in severe forms of anorexia nervosa or in some types of cancer , first of all head and neck neoplasms (which can also severely penalize the ability to eat), or in the case of neurodegenerative diseases. like Parkinson’s .
In these cases, the damage to the body can be devastating if proper therapeutic intervention is not performed, particularly at the heart level (cardiomyopathies and cardiac arrest).
People who can undergo malnutrition are patients who are not adequately fed for at least 7-10 days , especially if subjected to acute stressful conditions, such as acute criticality during a chronic disease, infectious diseases, after surgery , especially if performed under emergency conditions.
Fasting and low triglycerides
Can fasting cause low triglycerides? ipotrigliceridemia can occur even after a prolonged fast , too-rapid weight loss in obese subjects. But also after a bariatric surgery both of the gastrorestrictive type ( adjustable gastric band , vertical gastroplasty and sleeve gastrectomy ), and malabsorptive (biliopancreatic diversion) or mixed ( gastric bypass ) surgery .
Furthermore, when the refeeding of malnourished patients occurs in inappropriate conditions, the so-called Refeeding Syndrome can occur , which can paradoxically worsen the clinical picture.
In such fragile patients, atrophy of the intestinal mucosa and impaired function of the pancreas can cause severe diarrhea after the resumption of nutrition, thus leading to a further loss of nutrients.
Low triglyceridia and celiac disease
The celiac disease is a chronic inflammatory disease of genetic origin that does not allow regular nutrient absorption in the intestine. A specific genetic predisposition generates an abnormal reaction of the immune system, which, when in contact with gluten, attacks the cells of the intestinal mucosa.
In fact, gluten is the alcohol-soluble protein fraction of wheat, barley and rye; a protein complex mainly contained in foods such as bread, pasta, pizza, biscuits and crackers.
The autoimmune response invokes white blood cells (immune system cells involved in inflammation), which, in an attempt to annihilate an enemy that is not actually there, release toxic substances, damaging the intestinal villi by reducing the absorption capacity of nutritional factors. This phenomenon can lead to malnutrition .
The celiac disease (or celiac disease ) is characterized by an extremely variable clinical picture. It includes local symptoms such as:
- profuse diarrhea (associated with marked weight loss )
- extra-intestinal manifestations.
Additionally, celiac disease can also be associated with other autoimmune diseases. Therefore, the prolonged state of local inflammation can lead to an increased risk of intestinal lymphomas. The only treatment for celiac disease is a diet free of gluten ( gluten-free ) very rigid, which eliminates the symptoms and replenish intestinal tissues.
Is there a link between hypotiglyceridemia / low triglycerides and autoimmune diseases?
It seems so, even if the correlation has not been clarified to date. Many tissues in the body, first of all adipose tissue, muscle and lungs, are rich in LPL (the enzyme that breaks down triglycerides into fatty acids and glycerol, releasing energy).
It is likely that in autoimmune diseases an increased content or release of LPL by these tissues can results in low triglycerides.
Rare diseases and hypotiglyceridemia
Genetic metabolic disorders caused by mutations in the genes of apolipoproteins (the proteins that contribute to transporting triglycerides and other fats in the blood) can cause a reduction in triglyceride levels .
The less serious case is that of hypobetalipoproteinemias, a group of diseases of the lipoprotein metabolism responsible for hypotiglyceridemia / low triglycerides due to a reduction in the efficiency of fat absorption.
Hypobetalipoproteinemias are generally asymptomatic and do not require treatment, although occasionally they may be associated with food intolerance to lipids. In addition, they result in steatorrhea ( elimination of large quantities of undigested fatty substances with the feces).
Furthermore, in the most severe forms, the reduction in the absorption capacity of lipid substances can lead to a deficiency of fat-soluble vitamins and very low triglycerides levels .
abetalipoproteinemia ( ABL or syndrome Bassen-Kornzweig ) is a particular case of hypobetalipoproteinemia / low triglycerides in which these apolipoproteins are absent due to a rare genetic mutation.
Therefore, the total inability of the organism to produce very low density lipoproteins causes the syndrome to cause a significant reduction in the absorption of fat and fat-soluble vitamins and therefore of hypotriglyceridemia .
Symptoms of ABL begin in childhood. Therefore, the child with the disease does not grow adequately .
Another characteristic symptom is steatorrhea , the elimination of large quantities of undigested fatty substances with the feces. In addition, with the passage of time, important repercussions on the central nervous system can occur.
Although abetalipoproteinemia does not currently recognize a cure, high doses of vitamin E can delay or slow the progression of central nervous system lesions.
Hence, patients should also receive appropriate supplementation of dietary fat and vitamins A, D, and K.
What are the symptoms of low triglycerides
Usually, the low triglycerides does not call for clinical consideration, as it does not cause particular symptoms or significant consequences.
However, in the case of hypotryglyceridemia, very general disorders can occur, mostly referable to an altered state of intestinal balance and digestion:
- abdominal bloating
- abdominal cramps
- weight loss
muscle atrophy (manifestation that occurs mainly in growing children).
Much more noteworthy are the symptoms of the diseases that may be at the basis of the low concentrations of triglycerides.
How cystic fibrosis manifests itself: digestive and metabolic repercussions
The symptoms of cystic fibrosis are caused by the production, in the patient’s body, of a much denser mucus than the physiological one, which occludes the small ducts in the different systems.
Then, at the respiratory level, the mucus is deposited in the bronchi and causes persistent cough (initially irritating and then catarrhal), accompanied by wheezing and breathlessness ( dyspnea ). Furthermore, the respiratory system of patients is affected by recurrent infections .
Instead, in the digestive system, the closure affects the pancreatic ducts and causes the impossibility of digestion and absorption of substances of lipid origin.
Intestinal manifestations include chronic diarrhea (associated with steatorrhea ). Lack of nutrient absorption leads to poor weight and height gain, as well as a reduction in blood lipid concentration ( hypotryglyceridemia and hypocholesterolemia).
In some cases, intestinal obstruction may occur .
Symptoms of hyperthyroidism: when the metabolism speeds up
Low triglycerides and fatigue. In hyperthyroidism , the thyroid is overactive and secretes an excess of hormones T3 and T4, a phenomenon that accelerates the metabolism with consequences such as:
- weight loss despite increased appetite;
- hypotryglyceridemia and hypocholesterolemia;
- tachycardia (palpitations);
- anxiety , nervousness, insomnia and irritability;
- tremors and intense sweating ;
- intestinal disorders ;
- muscle fatigue and weakness;
- thinning of the skin and its appendages, including hair.
One of the diseases that can cause hyperthyroidism is Graves’ disease , whose characteristic symptom is exophthalmos, that is, the protrusion of the eyeball beyond the eyelid rim.
Triglycerides, celiac disease and reduction of intestinal absorption
The celiac disease is a chronic inflammatory disease of genetic origin: the contact with the gluten of people affected triggers an autoimmune reaction that determines the aggression of the intestinal villi and therefore the intestinal absorption penalty.
Manifestations of celiac disease are local (diarrhea, abdominal swelling, abdominal pain, weight loss, malabsorption) and systemic (slowed growth in children).
Intestinal malabsorption leads to hypolipidemia (reduction of the lipid concentration in the blood), in particular to hypotryglyceridemia .
Malnutrition, low triglycerides and heart problems
If one of the consequences of malnutrition is represented by hypotryglyceridemia due to poor nutritional intake, this is not the most alarming symptom.
Frail patients who are not properly fed can suffer far worse consequences , such as some serious cardiovascular conditions.
One of these is Takotsubo Syndrome , more popular with the name of Broken Heart Syndrome (or heartbreak ), which manifests itself with a sense of fatigue, chest pain and shortness of breath, mimicking a real myocardial infarction.
This condition may be accompanied by an increase in the indices of myocardial damage, the same that are altered in infarction: an increase in troponin , myoglobin and CK MB , markers of acute myocardial damage.
Takotsubo can be caused by intense emotional and physical stress.
Rare diseases and hypotiglyceridemia: symptoms
The ipobetalipoproteinemie Nobody makes group of lipoprotein metabolism diseases responsible for ipotrigliceridemia for a reduction in the efficiency of absorption of fats. They are generally asymptomatic, but can be associated with food intolerance to lipids and consequent steatorrhea ( elimination of large quantities of undigested fatty substances in the faeces).
In the most severe forms of hypobetalipoproteinemia, the reduction in the absorption capacity of lipid substances can lead to a deficiency of fat-soluble vitamins and very low triglyceride levels .
Symptoms of abetalipoproteinemia begin in childhood: the child with the disease does not grow adequately . Another characteristic symptom is steatorrhea , the elimination of large quantities of undigested fatty substances with the feces. In addition, with the passage of time, important repercussions on the central nervous system can occur.
Diagnosis: how is Low triglycerides recognized
Hypotiglyceridemia is a condition represented by low triglyceride levels in the blood.
The values of blood triglycerides are considered within normal limits when they are comprised between 150 and 199 mg / Dl. But, for children under the age of 18 these limits become 90 and 129 mg / dL .
A value between 150 and 200 mg / dL is considered borderline, between 200 and 400 mg / dL high and over 400 mg / dL very high.
Below 150 mg / dL (or 90 mg / dL) the values frame the condition of hypotryglyceridemia .
The circumstances in which we undergo a blood triglyceride test to identify a suspected hypotryglyceridemia are certainly less frequent than those in which we want to diagnose the opposite problem.
To know the blood concentration of triglycerides it is sufficient to undergo a blood test .
Since the value of triglycerides is subject to considerable fluctuations, it is necessary to arrive in the morning fasting and having eaten a normal meal the night before.
Generally, a complete picture of blood lipid concentrations is required, which includes determining the levels of total cholesterol and its fractions, HDL cholesterol (which we are used to defining as good cholesterol ) and LDL cholesterol (commonly described as bad cholesterol ) .
Low triglycerides: cure
Treatment of cystic fibrosis aims to thin the secretions and supplement the deficient nutrients.
Research has led to the development of drugs that have changed the history of the disease. The modulators of CFTR (the mutated gene at the base of the disease) allow personalized treatments able to intervene on the cause of the genetic defect present in some forms of the disease. Today the target of pharmaceutical companies engaged in this field is to develop medicines that can act on all types of mutation.
CFTR modulators (one of which is ivacaftor) allow for partial recovery of the function of the CFTR protein.
In addition, the prevention of recurrent respiratory infections is achieved through aerosols with antibiotics. But, to improve respiratory function, thinners of bronchial secretions are used .
Intestinal malabsorption prevents the patient from absorbing nutrients. Therefore it is necessary to take a supplementation of:
- vitamins (in particular the fat-soluble, A, E, K and D )
- mineral salts
- energy supplements.
But, if mucus density impairs pancreatic function, pancreatic enzymes are supplemented
Diet and hypotriglyceridemia
From the point of view of treatments, it is possible to intervene directly on the values of triglycerides , increasing them with an appropriate diet . But it is an approach that is rarely applied tout court, except in cases where the cause is intense physical exercise.
If the subject who has low triglyceride values is following an excessively restrictive diet, the doctor who takes care of it may decide to change the diet in a more permissive sense.
If the hypotryglyceridemia originates from a drug treatment, the doctor will evaluate how to manage the different situations on a case-by-case basis. If he is undergoing therapy for dyslipidemia (with statins , fibrates or nicotinic acid) , the dosage may need to be adjusted.
As for the hypotiglyceridemias caused by other pathologies, it will be essential to diagnose the underlying disease and proceed to the specific treatment.
What to eat
If the subject with hypotryglyceridemia is following an excessively restrictive diet to treat a picture of overweight, obesity or hyperlipidemia, the attending physician may decide on a modification of the diet in the sense of increasing the caloric intake from carbohydrates or lipids. .
Dietary interventions also represent a preventive tool for the onset of hypotiglyceridemia.
Diet for a malnourished patient
When hypotryglyceridemia affects a frail and malnourished patient, great attention must be paid to his diet.
In fact, the risk is that he will encounter a refeeding syndrome , which can precipitate the clinical picture. For example, in a chronic patient suffering from cancer (in particular if in the head and neck area, the neoplasms that penalize more autonomy in nutrition) or other serious diseases, the alterations in digestive function can trigger acute diarrhea after resumption of nutrition. An event that leads to a further loss of nutrients.
Therefore, the refeeding of malnourished patients must proceed in compliance with protocols that promote:
- gradual reintroduction of food
- division of meals
- balance between the nutritional components and the increase in the caloric density of the dishes (maintaining a limited volume).
For example, if the patient is suffering from dysphagia , a condition that makes swallowing difficult, it is necessary to feed him with soft, smoothies, homogenized foods.
On the other hand, if he is undergoing chemotherapy and does not eat enough due to the side effects of drugs (which can give oral mucositis ), he will need to offer fresh and non-acidic or too sweet or tasty foods, such as:
- ice creams
- creamy cheeses.
Diet for cystic fibrosis sufferers
The nutrition of the patient with cystic fibrosis must be high- calorie and high- protein .
In fact, the calories in the patient’s diet must reach 20-50% more than his daily requirement.
A goal that is difficult to achieve with just main meals and that requires frequent snacks throughout the day.
The choice must fall on foods with high caloric and / or lipid density, such as:
- fatty fish
Furthermore, it is possible to add Parmesan , cream and butter to the dishes in order to maximize the caloric intake from the fat component.
Celiac disease: what to eat
For celiac disease , the diet coincides with the treatment . Hence, it is a strictly gluten-free diet , which must be set up under the supervision of a nutritionist and continued throughout life.
The gluten-free foods on the market are identifiable thanks to the presence on the package of a crossed ear .
Therefore, naturally gluten-free foods may be present in the diet of celiacs.
It is important to observe some rules in the preparation of dishes, in order to avoid contamination by gluten:
- wash your hands thoroughly after handling foods that contain gluten
- Thoroughly clean kitchen surfaces and wash equipment and tools, removing any residues of substances at risk of contamination with gluten
- check that the cooking water or the seasoning of gluten-free foods have not been previously used to cook foods that may contain gluten
- baking foods with and without gluten in the oven at different times.
Diet for those with a lipoprotein deficiency
Hypobetalipoproteinemia e abetalipoproteinemia are treated with a low-fat diet. This reduces the absorption of fat-soluble vitamins. Therefore, it is necessary to subject patients to intensive supplementation with vitamin E and with the other fat-soluble vitamins (A, D, and K).
Other treatments for diseases that lower triglycerides
There Cystic fibrosis is a disease that requires a multidisciplinary approach: alongside drug therapy and diet, although physical therapies are needed.
For example, with the bronchial drainage it is possible to remove excess mucus from the bronchi to keep the airways open.
Instead, with the respiratory physiotherapy , a specialized technician performs a series of external maneuvers that aim to promote the mechanisms that keep the respiratory tract clean.
Surgery: when it is indicated
However, patients with severe respiratory failure who no longer respond to medical therapy must undergo lung transplantation. .
The surgery is indicated for patients with hyperthyroidism caused by Graves’ disease, in case of failure of drug therapy, the presence of a large goiter and in cases of toxic adenoma and multinodular goiter.
Surgery generally restores normal thyroid function and therefore blood lipid levels.
Lipid profile in cirrhotic patients and its relation to clinical outcome – L. Boemeke et al – Brazilian archives of digestive surgery, 2015 – NCBI