Dietary Steps to Controlling Triglycerides

Perspectives in Cardiology April 2001
By Cardiac Fitness Institute – London Health Science Centre - Ontario)

While lowering blood cholesterol levels has been proven to lower the risk of coronary artery disease [CAD], the same relationship has not been established for elevated blood triglycerides. The link between CAD and triglycerides is complicated further by the relationship between high-density lipoprotein [HDL] cholesterol and triglycerides. Elevated triglycerides have a lowering effect on HDL cholesterol which, by itself, is known to increase the risk of CAD. Because of these relationships, triglycerides and cholesterol may be affected by similar risk factors for CAD, including increased body weight and decreased physical activity. In addition, increased alcohol intake and excessive intake of refined carbohydrates and sugar also appear to contribute to higher triglyceride levels.

Triglycerides are available from dietary sources, which are essentially the fats we eat. During digestion and the absorption process, these fats are packaged as chyclomicrons and travel throughout the body. They are generally used by the muscle cells for energy or stored in adipose tissue for future energy requirements. Many genetic and metabolic problems can develop in this process, leading to extremely elevated levels. Control of these problems can assist in improving triglyceride levels.
Many heart patients may have a mixed hyperlipidemia, where both low-density lipoprotein [LDL] and triglycerides are elevated. In his situation, modification of the type and amounts of fat in the food program will benefit the patient. Drug therapy may also be indicated, with the drug of choice being one that controls not only LDL cholesterol, but also the triglyceride level. Some of the statins [ mean reduction of 10 to 30 % depending on the initial triglyceride level ] and fibrates [ mean reduction of 20 to 55 % ] offer this dual advantage. Nicotinic acid may also be used with an expected 20 to 40 % reduction, however, it is not commonly employed due to its side effect of severe flushing.

Nonpharmacologic interventions include dietary restrictions of 25 to 30 % in the total fat and <7 % saturated fat. Adding aerobic exercise to this routine can produce a triglyceride lowering of 20 to 24 %. In addition to this, additional lifestyle modifications such as weight control and restriction of alcohol can enhance these figures. The American Heart Association is also in favor of restricting the intake of sugar and refined carbohydrates. The use of fish, and in some situations, fish oils, also appear to have a beneficial triglyceride lowering effect and reduces coronary heart disease events. Successful studies reported in Harris and Smith's comprehensive review of the topic used 3 to 4 grams of omega-3 fatty acid from marine sources to produce triglyceride lowering in the area of 25 to 30 %. To achieve this by eating fish, the patient would have to consume approximately 400 grams of salmon or 130 grams of sardines daily. Taking a fish oil supplement isn't much better. High potency [80 to 95 % fish oil ] capsules weighing 1 gram each were used in the studies. However, these products may not be readily available. A local health food store had 100 % salmon oil capsules of 1 gram containing only 30 % omega-3 fatty acid. To achieve this amount of omega-3, the patient would have to take 12 fish oil capsules a day.

Currently, there are no definitive guidelines for evaluating the risk for CAD posed by elevated triglycerides. It is important to note that severely elevated triglycerides > 10 mmol/l leads to an increased risk of pancreatitis and should be treated aggressively. Current acceptable triglyceride levels for patients remain at <2 mmol/l and it is their association with other coronary heart disease factors that is a source of concern. Dietary modification seems to be a well-tolerated first step in controlling modestly elevated triglyceride levels.

Five steps to Controlling Triglycerides :
1. Maintain a healthy body weight.
2. Take note of the fat you consume.
3. Reduce your intake of simple sugars.
4. Eat fish more often.
5. Drink alcohol only in moderation, if at all.

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