A Nutritional Approach to Triglycerides
An Interview with Track Your Plaque Expert
Nutritionist Gay Riley, MS, RD, CCN
Triglycerides are an ingredient that your body can use to make a number of unwanted lipoprotein particles. Fortunately, triglycerides are among the most susceptible fats to dietary manipulation. In this Special Report, we interview Track Your Plaque expert in nutrition, Gay Riley, MS,RD, CCN on her unique approach to her patients with high triglycerides.
.
TYP: Triglycerides are responsible for creating an entire panel of undesirable lipid and lipoprotein particles in blood that cause coronary plaque growth, like small LDL particles, VLDL, and even a drop in HDL.
In your approach using Medical Nutrition Therapy, do you advise your patients to choose specific foods to reduce triglycerides? Are there specific foods to avoid that raise triglycerides?
Gay Riley: Elevated serum triglycerides are usually associated with insulin resistance, or the ineffectiveness of insulin to reduce blood sugar. Increased circulating insulin levels cause multiple problems with blood chemistry and homeostasis. One of the major problems is hardening of the arteries and plaque build up in the vessels. Because of this, dietary carbohydrate needs to be controlled.
Reduction and avoidance of high sugar, refined, processed, and packaged foods, alcohol, and sugary beverages is recommended. Adding more fresh produce (a useful rule-of-thumb is two vegetables for every fruit), high fiber carbohydrates like green leafy vegetables, tomatoes, and other non-starchy vegetables, berries, citrus, and melon.
Starchy vegetables that are not white, like beans, lentils, sweet potato, and acorn squash are good choices. Mono and polyunsaturated oils from natural nuts, plants, different oils such as olive, canola, sesame, peanut, etc and fatty cold water fish are equally important.
The cellular membrane phospholipid layer is made up of the fats we eat and should be fluid and permeable. Bad diets high in sugar, saturated and trans-fats cause the membrane to become hard and impermeable to nutrients that need to move freely in and out of the cell, thus insulin resistance. The more of the good fats you eat, the more permeable the cellular membrane becomes allowing for healthy metabolism of sugar in the blood.
Good fats also create an anti-inflammatory condition in the blood by producing more anti-inflammatory hormones like prostaglandins. Saturated and trans-fats, on the other hand, produce more inflammatory prostaglandins, which creates a hyper-inflammatory state leading to conditions like high blood pressure, heart disease, and a host of other medical problems.
Green leafy vegetables and citrus fruit increase blood pH and lower blood acidity. This is extremely important to total health. That is why we nutritionists run the vegetable/fruit issue into the ground.
Whole grains and fiber are important for slowing the absorption of carbohydrate into the blood and keeping blood sugar and insulin at a steady state. In other words, fibers smooth out blood sugar?no peeks and valleys in insulin and blood sugar.
For correcting hypertriglyceridemia or high triglycerides, a diet with 50% carbohydrate, 20% protein, and 30% fat is a recommended starting point. Depending on the individual, the carbohydrate recommendations could be even lower.
TYP: Are there differences among various carbohydrate foods and their effects on triglycerides? Is this a matter of glycemic index?
Gay Riley: There is evidence that supports the use of the glycemic index to control blood sugar and insulin levels. The higher the food is on the index, the higher and faster it causes insulin blood levels to rise. So trying to eat foods with a glycemic index of 50 or lower is a good idea. (Go to glycemicindex.com for more information on glycemic index, including an extensive database of glycemic indexes of various foods assembled by the world expert on the subject, Dr. Jennie Brand-Miller.)
TYP: How effective is weight loss for reduction of high triglycerides?
Gay Riley: It can be highly effective if insulin resistance is reduced, the food choices I mentioned are incorporated into the diet, and daily EXERCISE and activity is practiced. If you use a pedometer, 15,000 steps a day is effective for weight loss. Most of us get in 500–3000 steps. If insulin resistance is not treated, weight loss can be impossible.
TYP: Have you found any specific nutritional supplements useful to help control either insulin resistance and/or high triglycerides?
Gay Riley: I have incorporated cinnamon into my practice with most of my clients and have found it very useful for just this purpose.
Methyl Hydroxyl Chalcone Polymers (MHCP), the most active phenolic compounds isolated in cinnamon, have been found to increase sugar metabolism. MHCP increased glucose metabolism 20-fold in vitro. MHCP has been found to increase insulin sensitivity by activating key enzymes that stimulate insulin receptors and inhibiting enzymes that block them, leading to maximal phosphorylation (activation) of the insulin receptor. This activity results in increased cell sensitivity to insulin and increased glucose cell uptake.
MHCP is capable of increasing cell uptake of glucose even in the absence of insulin. A small study conducted by University of Peshwar and Agricultural Research Service studied the effects of cinnamon on blood sugar levels. They determined that doses of 1–6 grams daily reduced blood glucose 18-29% over 40 days. (1 gram is about ¼ tsp.)
Since insulin activity is also intimately involved in lipid metabolism, cinnamon also decreases total cholesterol, LDL cholesterol, and triglycerides. The same study noted 23–30% decrease in triglycerides, total cholesterol 12–26%, and LDL 7–26%. Changes in HDL were inconsistent.
I try to find palatable ways for my clients with elevated triglycerides, blood glucose, and cholesterol to incorporate cinnamon into their diet. Popular ways to include cinnamon include oatmeal, yogurt, mixed in peanut butter (without hydrogenated oil, of course!), or applesauce.
Some more background info on triglycerides from Gay Riley:
What the heck is "hypertriglyceridemia"?
Triglyceride is fat (lipid) in the body. Broken down, the term "hypertriglyceridemia" means:
hyper (too much) - triglyceride (fat) - emia (in the blood).
Simply, elevated triglycleride levels. When triglycerides are elevated, other fats in the blood may also be elevated, specifically Very Low Density Lipoproteins (VLDL) and small LDL.
Elevated triglycerides can be seen with high, normal, or even low cholesterol. The most common nutrition-related causes for hypertriglyceridemia are obesity, diabetes, and alcoholism.
Hypertriglyceridemia can be a side effect to other physical conditions and to some medications.
Diseases or physical conditions that may elevate triglyceride levels
* Alcoholism
* Bulimia
* Cushing's disease
* Glycogen storage diseases
* Lupus
* Nephrotic Syndrome?usually a consequence of diabetes
* Obesity
* Pregnancy
* Poorly managed diabetes
Medications that may elevate triglyceride
* Some beta blockers
* Cimetidine
* Corticosteroids
* Chemotherapy
* Estrogen
* Furosemide
* Isotretinoin
* Phenothiazines
* Some thiazide diuretics
Editor's note:
Triglycerides are a hugely ignored area in medicine. But triglyceride management can be crucial for your plaque-control program. Don't underestimate the importance of food choices for reduction of triglycerides. Gay Riley's helpful comments can point you in the right direction.
Remember: In the Track Your Plaque program, we aim to reduce triglycerides to 60 mg/dl or less, particularly if you have small LDL, IDL, or VLDL. Along with your food choices, fish oil is an important part of your triglyceride-reducing efforts. For more discussion on the implications of triglycerides and how to reduce them, see Triglycerides: Mother of Meddlesome Particles
Gay Riley, MS, RD, CCN
Gay Riley is a nationally known Certified Clinical Nutritionist (CCN) and author of The Pocket Personal Trainer. With over 20 years experience in counseling corporations, groups, and individuals on healthy nutritional practices, Gay provides online nutritional advice through her website, www.NetNutritionist.com. Gay specializes in Medical Nutrition Therapy (MNT) for nutritional management of medical conditions such as diabetes, high cholesterol, food allergies, and eating disorders.
Gay's newest project is to provide an intensive weight management experience using the exciting Bodybugg™ technology. Gay says that the Bodybugg™ device allows you to measure actual calories burned and consumed and take the guesswork out of weight loss. Gay's clients receive email support and monitoring for daily calories burned and calories consumed. Gay offers personal recommendations to help clients achieve health, fitness and nutrition goals.
Gay says that "the Bodybugg™ is the most accurate tool and motivator I have ever used in my 20 years of working with people to lose weight. I myself have worn my Bodybugg™ for the past 14 months and have lost 12 pounds and 3% bodyfat. For me, that's an accomplishment because I love food. My clients learn their individual energy balance and adjust daily caloric intake to the calories they burn. From my PC, I see what each Bodybugg™ user burns and eats daily. I make exercise, fitness, food, lifestyle and supplement recommendations to people with all types of goals—athletes, heart patients, the mom that is trying to lose her baby weight, the person with food allergies or just trying "not to gain weight". Each person gets their own plan of action and me as their Bodybugg™ coach."
Gay is on the advisory board for the National Academy of Sports Medicine (NASM) and on the board for the International and American Association of Clinical Nutritionists. She can be contacted through her website, www.NetNutritionist.com.
trackyourplaque.com |
