Microbiome drives high triglyceride levels

Over 30% of the Indian adult population suffers from Hypertriglyceridemia or high triglyceride levels in the bloodstream. This metabolic disorder is an independent risk factor & associated with onset & progression of non-alcoholic fatty liver disease, type 2 diabetes & cardiovascular disease.

The current interventions are restricted to generic nutrition recommendations & pharmaceutical approach that has helped to manage the disease associated with Hypertriglyceridemia to some extent.

While high consumption of this essential macromolecule & lipid either through animal fat or certain oils is said to elevate triglyceride levels & increase risk of metabolic & heart diseases, research & clinical evidence has found that microbiome- trillions of microbes living in our mouth & gut have an important role to play in oxidation, synthesis & biotransformation of this essential lipid.

Human body is a amazon rainforest for microbiome

Human body is a container for 40 trillion microbes living on & inside our body. The microbes living at various sites inside our body account for 99% of genes that are expressed. The two major sites having both permanent & temporary settlement of microbes are our mouth & large intestine. These microbes work on sensing mechanism & interaction between these microbes & external environment- nutrition, sleep, exercise, oral hygiene & social interaction allows these microbes to activate or express certain genes that code for specific proteins that activate, stimulate or inhibit certain biochemical functions. These functions lead to production of secondary metabolites or metabolic byproducts that  program our biology for health or disease.

The oral microbiome-Triglyceride connection

The microbes living in our mouth get the first chance to interact with the external environment & based on this biochemical communication secrete certain metabolic byproducts that could directly influence our triglyceride levels.

1.Nitric oxide production: Our oral microbes could metabolise nitrate in various green vegetables & synthesise into nitrite with the help of nitrate reductase enzyme. This nitrite is protonated with stomach acid to stimulate nitric oxide production. It has been found that nitric oxide reduces the elevated triglyceride levels.

2.Oral LPS Production: There is strong evidence that suggests deep rooted correlation between periodontal disease & high lipid & non-alcoholic fatty liver disease. Improper nutrition & wrong oral hygiene practices could trigger inflammation in the mouth & create a situation of leaky gums. This allows certain bacteria such as P Gingivalis to enter the bloodstream & translocate to the liver. This bacteria expresses virulence factors & secreted lipopolysaccharides(LPS) in the liver which causes inflammatory immune reaction & liver damage, resulting in high triglyceride accumulation.

The gut microbiome-Triglyceride connection

The microbes living in the gut based on their interaction with the food we eat, secrete certain metabolites that directly impacts our glucose & lipid metabolism & imbalanced gut microbiome promoting inflammatory activities could lead to lipid disorders & high triglyceride levels. Some of the metabolites that influence the triglyceride levels include:

1.Butyrate Production: Gut microbiome could metabolise fiber& inulin in the food we eat & synthesise into beneficial butyrate which has a healthy promoting impact on lipid metabolism & liver function. Butyrate exerts beneficial effects by activating a specific pathway- AMPK to increase lipid oxidation, thereby reducing triglyceride levels.

2.TMAO Production: Dietary choline plays a key role in regulating triglycerides levels. Certain gut microbes- proteobacteria could metabolise dietary choline found in various foods such as meat, fish, salmon, cauliflower & broccoli & synthesise into Trimethylamine(TMA) which enters the bloodstream & gets absorbed into liver where it is metabolised into Trimethylamine oxide(TMAO) with the help of an enzyme FMO3. P Gingivalis induced gingipain could increase the expression of FMO3, thereby increasing TMAO production This reduces the bioavailability of choline & leads to its deficiency, leading to decrease in export of triglyceride from the liver. TMAO also reduces the bile acid synthesis through inhibition of certain enzymes, resulting in high triglyceride levels

3.LPS Production: Improper nutrition & high sugar diet could induce production of lipopolysaccharides(LPS). In case of periodontal disease, certain oral pathogens could via oral-gut axis translocate to gut & trigger inflammation, leading to secretion of LPS. Overproduction of LPS could lead to intestinal permeability with allows this endotoxin- LPS to reach liver, causing liver dysfunction & elevated triglyceride levels

Strategies to reduce triglyceride levels 

Some of hacks which you should consider to reduce triglyceride levels :

1. Adopt right oral hygiene practices & stop using mouthwash & Fluoride rich toothpaste
2. Consume diet high in fibre, inulin & polyphenols
3. Avoid high sugar diet & processed foods
4. Keep 3 hour gap between your last meal & sleep time as late night eating could stimulate LPS Production
5. Do not neglect your oral health & visit your dentist at least once in three months.
6. Get at least 45-60 minutes of physical exercise daily.