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If your triglycerides are high, you’ve probably been told to lose weight and cut out sugar and/or carbs. Boo.
The conventional advice for this problem is so unhelpful! Weight loss from dietary change is almost always temporary. Our bodies fight to regain lost weight.
And focusing on what not to eat is a surefire way to crave it. It also leaves you with a vacuum when you’re hungry. “What can I eat?”
I am not in the business of setting people up for failure.
So let’s take a look at what you can add to the menu to address high triglycerides! Much of this will sound familiar, but we’ll look at it through the triglyceride lens. But first, a bit of background.
What are triglycerides anyhow?
Triglycerides usually get measured along with cholesterol, but they’re not the same thing. Triglycerides are basically fat. If we eat more than is needed at that moment, our body converts the extra food to fat, which gets transported through the bloodstream for storage, for when it is needed. All good and normal.
But sometimes the level of triglycerides in the blood gets too high, which turns out to be quite a reliable predictor of heart and stroke risk. If your triglycerides are high, you’re likely to have other markers of risk, including high blood pressure, high blood sugars, and/or low HDL (healthy) cholesterol.
Your doctor may or may not mention high triglycerides! Heart disease experts debate whether they actually contribute to clogged arteries, or whether they’re just a canary in the coal mine. For our purposes though, it doesn’t matter. The health habits that lower triglycerides generally help with these other problems and cardiovascular risk in general.
It’s worth watching triglycerides, because they do tend to respond to changes in health behaviours, like food and movement, more than cholesterol levels do, which is helpful if we’re looking for non-weight measures of health.
How high is too high?
Values above 1.7 mmol/L will generally get a red flag. (That’s 150 mg/dL in the US.) The American Heart Association statement on triglycerides actually classifies this as just “borderline high,” but I prefer my early warning signals earlier, so we can take action before things get worse.
However, note that triglycerides can fluctuate, and the blood test is usually done these days without fasting, which may bump it up as much as 20%, depending on what you ate before the test. So if it’s a bit over 1.7 (150) just once, no cause for real worry. You should be able to get it re-tested a few months later, and meanwhile, you can try some of the strategies below.
If your triglycerides go above 2.26 mmol/L (200 mg/dL) though, that’s definitely considered high, and above 5.65 mmol/L (or 500 mg/dL) is “very high.”
Above 11.3 mmol/L (or 1000 mg/dL), which is much more rare, can put you at increased risk of pancreatitis — inflammation of the pancreas — which can be quite serious. If that’s the case, your doctor will surely mention it and suggest some additional measures, including hopefully a consult with a dietitian.
So what can you eat to help?
For moderately elevated triglycerides (between 1.70 mmol/L or 150 mg/dL and 5.65 mmol/L or 500 mg/dL) , try adding these seven foods to the menu:
1. Nuts and seeds
Nuts come up all the time in my posts right? Because in addition to lowering triglycerides by 5-10%, eating a good quarter cup or more daily has been shown to lower LDL (lousy) cholesterol by 5-7% and, more importantly, reduce the incidence of major cardiovascular events by 28%. That’s huge! Plus they’re versatile and satisfying. Awesome.
Worried about all those calories in light of the suggestion to lose weight? Don’t be. We need to eat something, and nuts have been shown to help us feel more full and satisfied, taking the place of other foods. People who eat more nuts don’t tend to gain more weight.
Same thing with the fat in nuts. Most people know this, but I still occasionally get someone who is worried about it. Don’t be! People who eat more of the kinds of fat in nuts tend to have fewer heart problems.
So reach for nuts if you’re feeling snacky, spread peanut butter on your (whole grain) toast, toss nuts on your salad or in your oatmeal, or get creative and make nut-based creamy sauces. (Join me in a virtual cook-along to make one such dish next week.)
And if allergies are a concern in your house, seeds offer similar nutrition. Pumpkin, sunflower, ground flax, chia, hemp, and sesame seeds are all great for jazzing up your meals too.
2. Fish – the fattier the better
Fish is a source of omega-3 fat, which can help lower triglycerides. The more omega-3 you get, the more your triglycerides go down.
But it does take a lot of omega-3 to make a big dent in triglycerides. So if you like fish, build it into your meal plan at least once or twice a week. Order it when you eat out. Fattier fish like salmon, trout, sardines, and halibut are better, but any fish helps, especially if it takes the place of a steak or sausages.
(Note that if you have fish more than 4-5 times a week your potential exposure to mercury and other contaminants may be an issue. Talk to a dietitian – this is easy to work around if you know which fish to choose.)
If that much fish isn’t for you, what about omega-3 supplements? They can help decrease triglycerides too, but talk to your doctor before going down that path. The 2021 Canadian guidelines actually recommend against over-the-counter omega-3 supplements, because although they can lower triglycerides, we don’t have great evidence that they actually reduce cardiovascular risk. And your doctor may suggest other options.
What about omega-3 from plants like flax, chia, walnuts, and some oils such as canola and soybean? Unfortunately that type of omega-3 has little or no effect on triglycerides. Those foods can be beneficial for other reasons, but don’t waste your money on flax oil supplements.
Bottom line: If you like fish, great. If not, it’s not clear that an omega-3 supplement does much good.
3. Olive and other liquid oils
The type of fats found in olive and other liquid cooking oils can also help lower triglycerides, so reach for them first, unless butter, ghee, or coconut oil are critical to the taste or texture of your dish. And don’t forget other ways to get olive oil, including vinaigrettes, pesto, and sun-dried tomatoes packed in it. Yum!
4. Whole grains
Shifting more of your grains to whole grains, especially those rich in soluble fibre, like barley and oats, can also help with triglycerides, especially if you have type 2 diabetes.
Should you eliminate grains altogether? Certainly a low-carb diet can lower triglycerides, at least in the short run. (Like weight loss, improvements in risk markers tend to fade with time.) So if a restrictive diet isn’t for you, these other strategies work too. We have options!
So think popcorn, Triscuits, sprouted grain toast, farro, quinoa, whole-grain tortillas and more, in addition to the barley and oats listed above. We’re still aiming for grains and starches to make up just a quarter or so of any given meal, but they can make heart-healthy eating more satisfying (and affordable), so enjoy!
People sometimes shy away from fruit because it’s a source of fructose, a type of sugar which has been implicated in elevated triglycerides. But again, the issue is how much? Very high levels of fructose can certainly raise triglycerides, but typically people who get that much are drinking it – think fruit juice, smoothies, cola, ginger ale, or sweetened iced tea.
The amount of fructose you’d get from eating a few servings a day of whole fruit isn’t a concern for triglycerides. In fact, fruit can help when you want something sweet, thanks to the fibre, which can help fill you up.
6. Low-sugar, low-alcohol beverages
Too much alcohol, like sugar-sweetened beverages, can certainly drive up triglycerides. So again, our focus should be on what’s your alternative? If you want more than water, here’s a post I wrote with ten other beverages that can fit nicely in a heart-healthy diet.
How much alcohol is too much? If your triglycerides are moderately elevated, the typical one to two drinks a day guidance might be okay, assuming they don’t tip you into having more calories than needed. (Keep in mind that a “drink” in the Canadian guidelines is considered a 12-oz beer or a 5-oz glass of wine, smaller than most bar and restaurant offerings.)
But if your triglycerides are in the “very high” zone, you’d be wise to abstain from alcohol altogether until it’s resolved.
No surprise here, but a reminder that high-vegetable dietary patterns like DASH, Omni-Heart, and Mediterranean are triglyceride-friendly too.
Making vegetables the central feature of your meals might take some practice and experimenting, but they can be flavourful and interesting, like this eggplant with yogurt-tahini sauce. Here are some ideas I put together to help you get more vegetables in the mix.
If your triglycerides are *very* high
If your bloodwork comes back with triglycerides of 5.65 mmol/L (500 mg/dL) or more, in addition to avoiding alcohol as mentioned above, it can actually help to cut back on fat significantly – even healthy fat – just until resolved.
So now you’re trying not to eat too much fat or carbohydrates, which may leave you wondering what to eat! And how much is too much? This is an unusual situation, so I’d reach out to a dietitian for support. I can help, or your doctor should be able to connect you with one if you’re not local.
At the end of the day, our guidance for heart health is fairly consistent – more vegetables, fruit, legumes, nuts, seeds, whole grains, healthy fats, fish, and other lean proteins. Hopefully this has given you a sense of how these foods can help with high triglycerides and related concerns, which are a little different from the typical LDL cholesterol focus we think of with heart disease.
Focus on these foods and you likely will cut back on refined grains and sugars, which the evidence does support, but in a way that doesn’t feel restrictive. We need to eat something, right?
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