Dietary Steps to Controlling Triglycerides
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
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.
CCRF would like to thank London Health Science Centre Cardiac Fitness Institute for their contribution to the website.
The articles, on the Cardiac Health Foundation of Canada website, are presented with the understanding that the Foundation is providing information only and not rendering medical advise. Please check with your family physician, specialist or health care professional before implementing any of the ideas expressed in these articles.
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