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Triglyceride Heart Risk

November 25, 2013 Written by JP       [Font too small?]

For years, I’ve been telling my clients and physician friends that the current obsession with cholesterol levels is way out of focus. In my opinion, high LDL (aka “bad”) cholesterol is more likely than not a very small contributor to the current epidemic of cardiovascular disease. On the other hand, elevated triglycerides appear to be a far better marker for lifestyle choices which probably affect heart disease and stroke risk. Fortunately, a few, simple dietary changes can lower high triglycerides and significantly improve cardiovascular wellness. Best of all, lowering hypertriglyceridemia often doesn’t require any medications or supplements.

Triglycerides are a form of fat that is contained in blood. Elevated levels of blood triglycerides (over 150 mg/dL) have been implicated in a higher risk of cardiovascular disease and all-cause mortality. In fact, a recent review of 61 studies found that the risk of death increased incrementally in relation to the amount of triglycerides present in blood samples of over 1,000,000 study participants. Simply put, the higher the level of triglycerides, the greater the incidence of cardiovascular and overall mortality.

Interestingly, conventional medicine frequently employs a distinctly natural approach to managing hypertriglyceridemia: high dosage, prescription fish oil. However, many people with high triglycerides may want to consider dietary interventions prior to (or in conjunction with) prescription or supplemental fish oil therapy. The medical literature informs that eating plenty of green leafy vegetables, nuts and oily fish can dramatically lower blood triglycerides. What’s more, if you consistently replace high glycemic carbohydrates (refined, starchy and sugary foods) with fatty fish, greens and nuts, your triglycerides levels will likely plummet. If additional support is required, losing excess weight and regular aerobic exercise can further affect triglyceride concentrations and improve your overall lipid profile. Best of all, these three nutritional strategies tend to support virtually every aspect of wellness without side effects.

My Top 3 Green Leafy Vegetable Recommendations: Kale, Spinach and Swiss Chard;

Dosage: 2 or more servings daily

My Top 3 Nut Recommendations: Almonds, Pistachios and Walnuts;

Dosage: 1 – 3 ounces daily

My Top 3 Fish Recommendations: (Wild) Black Cod, Sardines, Wild Alaskan Salmon;

Dosage: 2 – 5 servings weekly

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Effects of Blood Triglycerides on Cardiovascular and All-Cause Mortality (link)

Study 2 - Lifestyle Modifications for Treatment of Hypertriglyceridemia (link)

Study 3 – Habitual Diets Rich in Dark-Green Vegetables Are Associated with (link)

Study 4 - Effects of Total and Green Vegetable Intakes on Glycated Hemoglobin … (link)

Study 5 - Effect of Ketogenic Mediterranean Diet w/ Phytoextracts and Low (link)

Study 6 – Inclusion of Atlantic Salmon in the Chinese Diet Reduces Cardiovascular (link)

Study 7 - Inclusion of Fish or Fish Oil in Weight-Loss Diets for Young Adults ... (link)

Study 8 - Benefits of Salmon Eating on Traditional & Novel Vascular Risk Factors (link)

Study 9 - A Randomized Trial of the Effects of an Almond-Enriched, Hypocaloric (link)

Study 10 - Pistachio Nuts Reduce Triglycerides & Body Weight by Comparison to (link)

Natural Ways to Lower Triglycerides

Source: Curr Cardiol Rep. 2011 Dec;13(6):544-52. (link)

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6 Comments to “Triglyceride Heart Risk”

  1. charles grashow Says:

    “In my opinion, high LDL (aka “bad”) cholesterol is more likely than not a very small contributor to the current epidemic of cardiovascular disease.”

    Why so?

    Also-what is your opinion on LDL-P/ApoB?

  2. JP Says:

    Hi Charles,

    IMO, overemphasizing the importance of LDL cholesterol is much like counting the number of $1 bills in a wallet and, based on the value, trying to extrapolate one’s financial status. It’s a micro issue that has been inappropriately magnified.

    My best advice is not to rely on any one test to guide your cardiovascular wellness protocol. Having said that, blood pressure and sugar are important and can be easily monitored. Daily stress management and exercise almost certainly help. So too does constructive social interaction and volunteerism. Eating a Mediterranean-style diet, particularly one low in carbohydrates, has been proven to reduce various (likely) risk factors for CVD (blood pressure, blood sugar, inflammation, LDL cholesterol, triglycerides, waist circumference, etc.). So, rather than relying heavily on conventional and “up-and-coming” tests, I typically recommend adopting diet and lifestyle approaches which are associated with improved cardiovascular function and mortality.

    A few relevant links:






    Be well!


  3. charles grashow Says:


    Your thoughts on this from Dr Thomas Dayspring


    Let’s get rid of the nonsense seen all over the internet that atherosclerosis is an inflammatory disease, not a cholesterol disease. That is baloney-with the reality being that it is both. One cannot have atherosclerosis without sterols, predominantly cholesterol being in the artery wall: No cholesterol in arteries – no atherosclerosis. Plenty of folks have no systemic vascular inflammation and have atherosclerotic plaque. However clinicians have no test that measures cholesterol within the plaque – it is measured in the plasma. It is assumed, that if total or LDL-C or non-HDL-C levels are elevated the odds are good that some of that cholesterol will find its way into the arteries, and for sure there, are many studies correlating those measurements with CHD risk. Yet, we have lots of patients with very low TC and LDL-C who get horrific atherosclerosis. We now recognize that the cholesterol usually gains arterial entry as a passenger inside of an apoB-containing lipoprotein (the vast majority of which are LDLs) and the primary factor driving LDL entry into the artery is particle number (LDL-P), not particle cholesterol content (LDL-C). Because the core lipid content of each and every LDL differs (how many cholesterol molecules it traffics) it takes different numbers of LDLs to traffic a given number of cholesterol molecules: the more depleted an LDL is of cholesterol, the more particles (LDL-P) it will take to carry a given cholesterol mass (LDL-C). The usual causes of cholesterol depleted particles are that the particles are small or they are TG-rich and thus have less room to carry cholesterol molecules. Who has small LDLs or TG-rich LDL’s? – insulin resistant patients! After particle number endothelial integrity is certainly related to atherogenic particle entry: inflamed endothelia have inter-cellular gaps and express receptors that facilitate apoB-particle entry. So the worse scenario is to have both high apoB and an inflamed dysfunctional endothelium. Is it better to have no inflammation in the endothelium – of course! But make no mistake the driving force of atherogenesis is entry of apoB particles and that force is driven primarily by particle number not arterial wall inflammation: please see Ira Tabas, Kevin Jon Williams, Jan Borén. Subendothelial Lipoprotein Retention as the Initiating Process in Atherosclerosis Update and Therapeutic Implications Circulation. 2007;116:1832-44.


  4. JP Says:

    Hi Charles,

    I agree that endothelial integrity and insulin resistance both factor into CVD. Other likely factors include hypertensive-related damage, imbalanced omega-3/6 fatty acids, oxidized cholesterol and many more. However, rather than focusing on the latest and greatest markers and tests, I think it’s preferable to pursue dietary and lifestyle choices which tend to promote various aspects of wellness including connective tissue integrity, insulin sensitivity, low systemic inflammation and beyond.

    A recent case in point:


    Be well!


  5. JP Says:

    Update: Low carb diets are an effective way to lower triglycerides …


    Ann Intern Med. 2014 Sep 2;161(5):309-18. doi: 10.7326/M14-0180.

    Effects of low-carbohydrate and low-fat diets: a randomized trial.

    BACKGROUND: Low-carbohydrate diets are popular for weight loss, but their cardiovascular effects have not been well-studied, particularly in diverse populations.

    OBJECTIVE: To examine the effects of a low-carbohydrate diet compared with a low-fat diet on body weight and cardiovascular risk factors.

    DESIGN: A randomized, parallel-group trial. (ClinicalTrials.gov: NCT00609271).

    SETTING: A large academic medical center.

    PARTICIPANTS: 148 men and women without clinical cardiovascular disease and diabetes.

    INTERVENTION: A low-carbohydrate (<40 g/d) or low-fat (<30% of daily energy intake from total fat [<7% saturated fat]) diet. Both groups received dietary counseling at regular intervals throughout the trial.

    MEASUREMENTS: Data on weight, cardiovascular risk factors, and dietary composition were collected at 0, 3, 6, and 12 months.

    RESULTS: Sixty participants (82%) in the low-fat group and 59 (79%) in the low-carbohydrate group completed the intervention. At 12 months, participants on the low-carbohydrate diet had greater decreases in weight (mean difference in change, -3.5 kg [95% CI, -5.6 to -1.4 kg]; P = 0.002), fat mass (mean difference in change, -1.5% [CI, -2.6% to -0.4%]; P = 0.011), ratio of total-high-density lipoprotein (HDL) cholesterol (mean difference in change, -0.44 [CI, -0.71 to -0.16]; P = 0.002), and triglyceride level (mean difference in change, -0.16 mmol/L [-14.1 mg/dL] [CI, -0.31 to -0.01 mmol/L {-27.4 to -0.8 mg/dL}]; P = 0.038) and greater increases in HDL cholesterol level (mean difference in change, 0.18 mmol/L [7.0 mg/dL] [CI, 0.08 to 0.28 mmol/L {3.0 to 11.0 mg/dL}]; P < 0.001) than those on the low-fat diet.

    LIMITATION: Lack of clinical cardiovascular disease end points.

    CONCLUSION: The low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet. Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors.

    Be well!


  6. JP Says:

    Update: Fish oil may reduce damage caused by heart attack …


    “WEDNESDAY, March 4, 2015 (HealthDay News) — High doses of omega-3 fatty acids may protect against further damage in heart attack patients, a preliminary study suggests.

    The research included 374 heart attack survivors who received standard treatment and took either a 4-gram prescription-only dose of omega-3 fatty acids each day or a placebo. The researchers said that people probably couldn’t get that level of omega-3 fatty acids from diet alone. To illustrate how large a dose that is, the researchers noted that 4 grams of omega-3 fatty acids is the equivalent of eating 8 ounces of salmon.

    Using MRIs, the patients’ hearts were scanned two weeks, four weeks and six months after their heart attack.

    Compared to those taking the placebo, patients taking the omega-3 capsules had lower levels of inflammation and were 39 percent less likely to show deterioration of heart function. There was also less thickening or scarring of the areas of the heart that were not directly damaged during the heart attack. This thickening, also known as fibrosis, often develops when the surviving heart muscle works harder to compensate for the damaged tissue, according to the researchers.”

    Be well!


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