Managing high triglycerides at the table: what not to eat

Managing high triglycerides at the table: what not to eat

Triglycerides are the main type of fat circulating in the blood. Sometimes their levels can exceed an alert threshold; these are cases of hypertriglyceridemia, a technical term that hides a very simple concept: having high triglycerides.

Nutrition is an indispensable ally against this condition. But what happens if you have high triglycerides? When to be concerned? And what not to eat with high triglycerides to bring them back to normal and prevent them from rising again?

What are the symptoms when you have high triglycerides?

Unfortunately, high triglycerides do not trigger obvious symptoms. In the face of this apparent silence, health risks can increase. Here's what ailments high triglycerides can give:

• Slightly high levels (between 150 and 199 mg/dL) endanger heart and artery health. In fact, hypertriglyceridemia is an independent cardiovascular risk factor, that is, it increases the risks run by the heart and blood vessels independently of other known risk factors, such as hypertension or high cholesterol. If, then, 200 mg/dL is reached and exceeded, cardiovascular risk increases to such an extent that it may be necessary to take medication to reduce hypertriglyceridemia. In fact, at 200 mg/dL and above, triglycerides are officially considered high.
• The situation becomes even worse at 500 mg/dL and above. At these concentrations, triglycerides are considered very high, and in addition to the risks to the heart, the risks to the pancreas also increase, which can go into an inflammation commonly known as pancreatitis.

Added to these increased risks is the fact that blood triglyceride levels can spike due to the presence of other health problems such as:

• thyroid diseases
• liver disorders
• kidney problems
• type 2 diabetes
• metabolic syndrome
• obesity

Why triglycerides rise: the role of diet

The tendency to have high triglycerides may be written in the genes, but familiarity and the health problems just listed are not the only risk factors for hypertriglyceridemia; indeed, lifestyle can play a major role in the rise in blood triglycerides.

Both smoking and excessive alcohol consumption are recognized risk factors for hypertriglyceridemia. In addition, dietary habits that compromise the energy and nutritional balance of the diet can also lead to elevated triglycerides; the fact that conditions associated with diet (type 2 diabetes, metabolic syndrome, obesity, or even, more simply, being overweight) are also associated with hypertriglyceridemia is already indicative of this.

In particular, increased triglycerides may depend on:

• Fromoverfeeding;
• from an excess of simple sugars (such as simple table sugar and the added sugars found in many industrial foods, such as yogurt, sweets, desserts, and baked goods);
• from overwhelming consumption of carbohydrate sources with ahigh glycemic index (such as refined flours or white bread and rice);
• from a diet too high in saturated fats (those particularly abundant in many foods of animal origin, such as meats and various dairy products).

If taken in excess, sugars are converted to triglycerides in the liver, which can end up accumulating them inside developing a condition called nonalcoholic liver steatosis (or NAFLD, from Non-Alcoholic Fatty Liver Disease).

The liver is also responsible for the production of VLDL(Very Low-Density Lipoprotein), one of the types of particles that transport triglycerides in the blood. Another type of triglyceride transporter are chylomicrons, particles that derive, instead, from the intestines and are formed as a result of the absorption of food-derived fats.

This is why too much fat in the diet can raise triglycerides: these fats are absorbed and distributed to the rest of the body precisely in the form of triglycerides. However, not all fats in food are equally dangerous in terms of the risk of hypertriglyceridemia; in fact, some can even help lower it.

What are the foods to avoid for high triglycerides?

Therefore, while foods to limit when you have high triglycerides include several of animal origin, there are foods of animal origin that can be considered true allies against hypertriglyceridemia.

The former include the aforementioned meat, high-fat milk and dairy products, poultry, and eggs. These foods contain significant doses of saturated fats that can promote or support increased blood triglycerides and therefore should be consumed in moderation.

The latter correspond, however, to fish, particularly oily fish, one of the best dietary sources of Omega 3, polyunsaturated fatty acids known precisely for their ability to lower triglycerides.

Salmon, tuna, swordfish, herring, sardines, anchovies and, in general, oily fish provide significant doses of the biologically active Omega 3 (EPA - eicosapentaenoic acid - and DHA - docosahexaenoic acid). Introducing them into the diet to replace foods of animal origin rich in saturated fats helps to ensure an allied diet against hypertriglyceridemia.

Unfortunately, however, achieving the daily dosages needed to hope to achieve a reduction in blood triglycerides by Omega 3 by relying on food alone is difficult (not to say impossible). In fact, as much as 2 grams per day of a combination of EPA + DHA is needed to maintain normal blood triglyceride levels.

This is why it is very useful to combine the diet for high triglycerides with Omega 3 supplements, which not surprisingly can carry the nutritional claim on the label authorized by the European Food Safety Authority (Efsa) that "DHA helps maintain triglyceride levels in the normalrange." To use them correctly, effectively and safely, however, it is necessary to remember that:

• The supplement chosen to manage the problem must contain DHA in combination with EPA;
• the product should be able to provide 2 grams of EPA + DHA per day;
• A total daily intake of more than 5 grams of EPA + DHA should never be exceeded.

Other principles of nutrition against high triglycerides include:

• a more general reduction in fat intake, especially when exceeding 500 mg of triglycerides per dL of blood, limiting it to less than 30 percent of daily calorie intake, to limit the increase in chylomicrons after meals and, consequently, the risk of pancreatitis. Better, then, not to overindulge in condiments and fatty cuts of meat, cook chicken without the skin, choose part-skim milk and low-fat dairy products, and prefer simple cooking methods;
• Reduce the intake of carbohydrate sources and replace refined ones with whole grain sources because of their lower glycemic index. Better, therefore, to avoid nonwhole wheat pasta, white rice, white bread, and baked goods made from refined flours (such as 00 and 0 flour), preferring instead whole wheat pasta, whole wheat bread, brown rice, and, more generally, whole grains and their derivatives;
• avoid sugar-rich drinks (including fruit juices) and reduce the use of sugar as a sweetener (including brown and whole grain);
• Do not overdo the consumption of sweets. Here, for example, is what you can eat for breakfast with high triglycerides: a few slices of whole-wheat bread with some cow's ricotta cheese, eaten accompanied by an unsweetened beverage, for example, a cup of barley;
• Limit alcohol consumption.

With proper nutrition, it is also possible, if necessary, to lose some weight. A weight loss of 5-10% is sufficient to see triglycerides decrease.

This is also why it is advisable to combine an appropriate diet to promote the reduction of hypertriglyceridemia withregular physical activity, especially aerobicexercise(such as brisk walking, running, swimming, and cycling).

Bibliographical references

2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal (2020) 41, 111188. doi:10.1093/eurheartj/ehz455

European Commission. Food and Feed Information Portal. Health Claims. Last Viewed March^15th, 2023

 Harvard Health Publishing. Harvard Medical School. Understanding triglycerides. March 1, 2020. Last Viewed March^15th, 2023.

 Karanchi H, Muppidi V, Wyne K. Hypertriglyceridemia. 2022 Aug 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. PMID: 29083756

 MedlinePlus. Triglycerides. https://medlineplus.gov/triglycerides.html. Last Viewed March^15th, 2023

 NHS. Cambridge University Hospitals. Dietary advice for management of High Triglycerides. https://www.cuh.nhs.uk/patient-information/dietary-advice-for-management-of-high-triglycerides/. Last Viewed March^15th, 2023.

 Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Executive Summary. https://www.nhlbi.nih.gov/files/docs/guidelines/atp3xsum.pdf