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 fats circulating in the blood. Sometimes their levels can exceed a warning 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 worry? And what not to eat with high triglycerides to bring them back to normal and avoid them rising again?

What are the symptoms when you have high triglycerides?

Unfortunately, high triglycerides do not trigger obvious symptoms. Despite this apparent silence, health risks may increase. Here are the disorders high triglycerides can cause:

• Slightly high levels (between 150 and 199 mg/dL) endanger the health of heart and arteries. Indeed, hypertriglyceridemia is an independent cardiovascular risk factor, meaning it increases the risks faced by heart and blood vessels independently of other known risk factors, such as hypertension or high cholesterol. If levels reach or exceed 200 mg/dL, cardiovascular risk increases to the point that medication may be necessary to reduce hypertriglyceridemia. Indeed, from 200 mg/dL triglycerides are officially considered high.
• The situation worsens further starting from 500 mg/dL. At these concentrations, triglycerides are considered very high and, besides heart risks, increase risks for the pancreas, which may undergo 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 increase: the role of nutrition

The tendency to have high triglycerides may be written in the genes, but family history and the health problems just listed are not the only risk factors for hypertriglyceridemia; in fact, lifestyle can play a fundamental role in increasing blood triglycerides.

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

In particular, the increase in triglycerides can depend:

• on an excessively abundant diet;
• on an excess of simple sugars (such as table sugar and added sugars present in many industrial foods, like yogurts, sweets, desserts and baked goods);
• on the predominant consumption of carbohydrate sources with a high glycemic index (such as refined flours or white bread and rice);
• on a diet too rich in saturated fats (those particularly abundant in many animal foods, such as meats and various dairy products).

If consumed in excess, sugars are converted into triglycerides in the liver, which may end up accumulating them inside developing a condition called non-alcoholic fatty liver disease (NAFLD).

The liver is also responsible for producing 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 intestine and form following the absorption of dietary fats.

This is why an excess of fats in the diet can increase triglycerides: these fats are absorbed and distributed to the rest of the body precisely in the form of triglycerides. However, not all fats present in food are equally dangerous in terms of hypertriglyceridemia risk; indeed, some can even help lower it.

Which foods should be avoided for high triglycerides?

For this reason, while among the foods to limit when you have high triglycerides there are several of animal origin, on the other hand there are animal foods that can be considered true allies against hypertriglyceridemia.

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

The second correspond instead to fish, particularly fatty 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, bluefish provide significant doses of biologically active Omega 3s (the EPA – eicosapentaenoic acid – and the DHA – docosahexaenoic acid). Introducing them into the diet in place of animal foods rich in saturated fats helps ensure a diet allied against hypertriglyceridemia.

Unfortunately, however, reaching the daily doses necessary to hope for a reduction in blood triglycerides thanks to Omega 3 relying solely on foods is difficult (not to say impossible). Indeed, to keep triglyceride levels in the blood normal, a full 2 grams per day of a combination of EPA + DHA is needed.

For this reason, it is very useful to combine an appropriate diet for high triglycerides with Omega 3-based supplements, which can not coincidentally report on the label the nutritional indication authorized by the European Food Safety Authority (EFSA) according to which «DHA contributes to maintaining triglyceride levels within normal range». 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 must provide 2 grams of EPA + DHA per day;
• a total daily intake exceeding 5 grams of EPA + DHA should never be exceeded.

Other dietary principles against high triglycerides include:

• a more general reduction in fat intake, especially when triglycerides exceed 500 mg per dL of blood, limiting them to less than 30% of daily calories, to limit the increase of chylomicrons after meals and, consequently, the risk of pancreatitis. Therefore, it is better not to overdo condiments and fatty cuts of meat, cook chicken without skin, choose partially skimmed 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, due to their lower glycemic index. It is better, therefore, to avoid non-whole wheat pasta, white rice, white bread, and baked goods made with refined flours (such as type 00 and type 0 flour), preferring whole wheat pasta, whole wheat bread, brown rice, and, more generally, whole grains and their derivatives;
• avoid sugary beverages (including fruit juices) and reduce the use of sugar as a sweetener (including cane and raw sugars);
• do not overconsume sweets. For example, a suitable breakfast for those with high triglycerides could be a few slices of whole wheat bread with cow ricotta, eaten accompanied by an unsweetened beverage, such as a cup of barley coffee;
• limit consumption of alcoholic beverages.

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

For this reason, it is also advisable to combine a diet suitable for promoting the reduction of hypertriglyceridemia with regular physical activity, especially aerobic type (such as brisk walking, running, swimming, and cycling).

Bibliographic 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 15^th, 2023

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