The Significance of a Low Fasting Triglyceride Test by Jeffrey Dach MD
In this 2012 newsletter by Dr. Jonathan Wright, I learned about the significance of a low triglyceride level on a routine lipid panel. When the triglyceride level is below 50 mg/dl on a fasting blood sample, this finding is highly indicative of malabsorption from gluten sensitivity. We will then do further testing with the antigliadin antibody test in blood or stool. Credit and thanks goes to the integrative medicine pioneer and legend, Jonathan Wright, MD, now retired. Here is a reprint for a small portion the Feb. 2012 newsletter:
The Root Cause of Your Autoimmune Disease – and Why Treating It Can Be Easier Than You Think by
At Tahoma Clinic, our colleague Davis Lamson N.D. pointed out to the rest of the physicians that a fasting serum triglyceride measurement below 50 milligrams per deciliter (normal in most laboratories is said to be 50 to 150 milligrams per deciliter) means gluten sensitivity and gluten-induced malabsorption until proven otherwise. (In my experience, this has been true nearly 100 percent of the time.) Lamson also points out that any individual with both undiagnosed symptoms and health problems and a fasting serum triglyceride below 75 milligrams per deciliter should always be checked for gluten-gliadin sensitivity too, as the probability is high. by Jonathan Wright, endquote
This newsletter was originally published in Nutrition & Healing newsletter; Vol. 8 Issue 12, February 2012. Used with permission. Header image courtesy of Jonathan Wright and Tahoma Clinic Facebook Page.
Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314
954-792-4663
my blog: www.jeffreydachmd.com
References:
Here are references to studies that have used the triglyceride loading test (or closely related oral fat loading tests) to diagnose malabsorption, primarily in pediatric and adult populations with conditions like chronic diarrhea, cystic fibrosis, or pancreatic insufficiency. These are drawn from peer-reviewed sources and focus on methods involving oral administration of triglycerides followed by measurement of plasma levels, breath tests, or fecal recovery to assess absorption
Jonas A, Gryboski J. Oral fat loading test: a reliable procedure for the study of fat malabsorption in children. Arch Dis Child. 1979 Oct;54(10):770-2. doi: 10.1136/adc.54.10.770. PubMed: https://pubmed.ncbi.nlm.nih.gov/507899/
Fällström SP, Nygren CO, Olegård R. Plasma triglyceride increase after oral fat load in malabsorption during early childhood. Acta Paediatr Scand. 1977 Jan;66(1):111-6. doi: 10.1111/j.1651-2227.1977.tb07816.x. PubMed: https://pubmed.ncbi.nlm.nih.gov/831377/
Shimizu T, Yamashiro Y, Yabuta K. A new oral margarine loading test in children. Acta Paediatr Jpn. 1994 Apr;36(2):183-5. doi: 10.1111/j.1442-200x.1994.tb03158.x. PubMed: https://pubmed.ncbi.nlm.nih.gov/8203264/
Moreira FL, Mota J, Trindade CE. [The fat absorption test in children]. Arq Gastroenterol. 1987 Apr-Jun;24(2):113-8. PubMed: https://pubmed.ncbi.nlm.nih.gov/3144961/
Robards MF. Changes in plasma nephelometry after oral fat loading in children with normal and abnormal small intestinal morphology. Arch Dis Child. 1975 Aug;50(8):631-6. doi: 10.1136/adc.50.8.631. PubMed: https://pubmed.ncbi.nlm.nih.gov/1200679/
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Norman A, Strandvik B, Zetterström R. Test-meal in the diagnosis of malabsorption in infancy. Tolerance tests using simultaneous oral administration of glucose, D-xylose, cream and vitamin A. Acta Paediatr Scand. 1971 Mar;60(2):165–172. doi: 10.1111/j.1651-2227.1971.tb06637.x. PMID: 5548122.
West PS, Levin GE, Griffin GE, Maxwell JD. Comparison of simple screening tests for fat malabsorption. Br Med J (Clin Res Ed). 1981 May 9;282(6275):1501–1504. doi: 10.1136/bmj.282.6275.1501. PMID: 6786533; PMCID: PMC1505440.
Bhatia SK, Bell TK, Love AH, Montgomery DA. An evaluation of a test using 14C labelled triglyceride in the diagnosis of steatorrhoea. Ir J Med Sci. 1969 Nov;8(11):545–552. doi: 10.1007/BF02955466.
Burrows PJ, Fleming JS, Garnett ES, Ackery DM, Colin-Jones DG, Bamforth J. Clinical evaluation of the 14C fat absorption test. Gut. 1974 Feb;15(2):147–150. doi: 10.1136/gut.15.2.147.
Chen IW, Azmudeh K, Connell AM, Saenger EL. 14C-tripalmitin breath test as a diagnostic aid for fat malabsorption due to pancreatic insufficiency. J Nucl Med. 1974 Dec;15(12):1125–1129.
Newcomer AD, Hofmann AF, DiMagno EP, Thomas PJ, Carlson GL. Triolein breath test: a sensitive and specific test for fat malabsorption. Gastroenterology. 1979 Jan;76(1):6–13.
Strange RC, Reid J, Holton D, Jewell NP, Percy-Robb IW. The glyceryl [14C]tripalmitate breath test: a reassessment. Clin Chim Acta. 1980 May 9;103(3):317–323. doi: 10.1016/0009-8981(80)90150-3.
Stallings VA, Mondick JT, Schall JI, Barrett JS, Wilson M, Mascarenhas MR. Diagnosing malabsorption with systemic lipid profiling: pharmacokinetics of pentadecanoic acid and triheptadecanoic acid following oral administration in healthy subjects and subjects with cystic fibrosis. Int J Clin Pharmacol Ther. 2013 Jan 29;51(4):263–273. doi: 10.5414/CP201793. PMID: 23357842; PMCID: PMC4350154.
Nishioka T, Okamoto S, Nishimura G, et al. [The fat absorption test in children]. Nihon Shonika Gakkai Zasshi. 1988;92(10):2213–2218. PMID: 3144961. (Article in Japanese).
Ling SC, Amarri S, Slater C, Hollman AS, Preston T, Weaver LT. Maldigestion and malabsorption of dietary lipid during severe childhood malnutrition. Arch Dis Child. 2002 Dec;87(6):522–525. doi: 10.1136/adc.87.6.522. PMID: 12456554.
Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314
954-792-4663
my blog: www.jeffreydachmd.com
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I received this email from CT who sent me the URL link to the reprint of the Feb 2012 Jonathan Wright newsletter discussing the significance of a low fasting triglyceride level:
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Dear Dr. Dach and Office Staff,
During our consultation with Dr Dach he mentioned an article by Dr Jonathan Wright linking gluten-gliadin sensitivity and serum triglycerides, but he was unable to locate the exact newsletter on the internet.
As this was quite fascinating I went looking for archived newsletters (which I could not find) but did find this which may be the one Dr Dach mentioned:
https://www.faim.org/the-root-cause-of-your-autoimmune-disease-and-why-treating-it-can-be-easier-than-you-think
The newsletter reads:
At Tahoma Clinic, our colleague Davis Lamson N.D. pointed out to the rest of the physicians that a fasting serum triglyceride measurement below 50 milligrams per deciliter (normal in most laboratories is said to be 50 to 150 milligrams per deciliter) means gluten sensitivity and gluten-induced malabsorption until proven otherwise. (In my experience, this has been true nearly 100 percent of the time.)
Regards,
CT