so you started eating more plants, your cholesterol probably went down, maybe you lost some weight but
your triglycerides actually went up. uh-oh. is it a concern? can we fix it? science has all the answers
triglycerides are a type of fat carried in our bloodstream and high triglycerides are associated
with cardiovascular risk, we covered it last week. so of course seeing their triglycerides go up
leaves people concerned. and what do we do when we have a health concern nowadays? we google it
but the internet gives us conflicting advice. because of course it does. some people say, eat
a lot of carbs, keep your cholesterol real low, if your triglycerides go up a bit, meh
other people say, no, fix your triglycerides, get rid of the carbs, eat steaks, butter etc
your triglycerides will drop like a ton of bricks. yeah, your cholesterol is going to shoot up...
ignore it. focus on triglycerides. so we gotta pick one side, right? cholesterol or triglycerides?
of course this dilemma is an internet illusion. the reality is we can have great cholesterol
and great triglycerides at the same time. and that's the normal, the usual thing to do, we're
not supposed to walk around with an astronomical parameter and just hope scientists are wrong and
it doesn't matter. we can have the double whammy, best of both worlds, and we've known how to do
it for decades. scientists tested three diets head to head. one a bit higher in carbs, one
higher in protein and another higher in fat. same total calories across and all three diets were
designed to be pretty healthy. in the words of the authors, all three diets were reduced in saturated
fat, cholesterol and sodium and rich in fruits, vegetables, fiber, potassium and other minerals
so the question was, if your diet is already pretty healthy to begin with can you optimize your blood
work even more, both cholesterol and triglycerides, by playing with the proportions of the nutrients?
the results were pretty striking. all three diets lowered serum cholesterol. that was expected from
their low saturated fat content. but their effect on triglycerides was very different. the protein
and fat diets lowered triglycerides, while the carb diet did not. so this means carbs are poison
and we have to eliminate them all, right? no, all three diets were pretty high in carbohydrate.
it is true that a very high carbohydrate intake can raise triglycerides, but it depends on context.
on total caloric intake, on type of carbohydrate eaten and also on individual tolerance. some people
can eat whatever they want and still have great triglycerides. and we secretly hate them. but for
those of us who do see their triglycerides go up this gives us some options. we can tweak our diet
and lower both cholesterol and triglycerides, get that double whammy while still being on a healthy
diet. it's win-win. okay let's look at exactly how to do this and get that double whammy in our lives
just a quick reminder that ldl-cholesterol and triglycerides are estimates of this thing called
apoB, which is the root of cardiovascular risk as we saw last week. so those estimates are useful
but it's good to bear this in mind to avoid misunderstandings. okay, one of the keys to
get the double whammy, the best of both worlds, is the type of fat we eat. fat as a whole is neither
good nor bad. in the study the diet richer in fat favored unsaturated fat, specifically
monounsaturated. so it included a lot of olive oil, nuts, avocados etc. so that's one reason they
were able to keep the cholesterol low as well. we'll come back to this. another very striking
thing was that the differences were small. only 10% difference between the diets. for example,
the carb diet had 58% of calories from carbs while the other two had 48. so a relatively
small tweak gave substantial improvements, we don't necessarily need to do these wild swings between
super low fat and super low carb, plenty of options in between to fit everybody. people message me all
the time saying "i was on this super low fat diet or super low carb diet and i hated it and i couldn't
stick with it, can i still be healthy?". abso- freaking- lutely. the internet paints this cartoonish picture
with the extreme views, we can't trust stuff on the internet, everybody knows that... huh? what's that?
this is also on the internet? as i was saying, the internet is an incredible place, definitely don't
log off, you don't want to miss out on all the incredible information... okay let's look at the
actual foods, what this actually looks like in real life to get that double whammy. first, weight loss
lowers triglycerides so if i have some extra weight to lose that's one of the most powerful
strategies right there. now, dietary tips: the first thing are refined carbohydrates. white pasta, white
bread, artificial breakfast cereal, sweets, soda etc. having a little bit of sugar once in a while in
the background of a healthy diet is not a big deal but if your triglycerides are too high chances are
you're above your personal set point. try replacing some of the refined grains with whole grains
or replace a sugary dessert with a chia pudding which gets you those healthy fats without the
simple sugars, that powerful shift the study showed us. chia seeds are rich in omega-3s which help
lower triglycerides. flax is also phenomenal for that so adding some ground flaxseed to your chia
pudding can give it an extra boost. by the way, the study showed both protein and fat work to
lower triglycerides so which one should we go for? protein actually lowered lipids a little bit more
but it also caused more adverse reactions in some people, and their fat diet used monounsaturated
fats as we saw but we know polyunsaturated fats usually perform a little better as we'll see in
a minute. bottom line, it's a little hard to say which diet is definitely superior but the beauty
of this is it gives us options. some people may do well on higher protein, others on higher fat and
others may be fine with higher carb without even having high triglycerides to begin with. all three
diets had a healthy foundation, as we saw, so once you have that, the tweaks, the nutrient proportions
are mainly personal preference. alright, moving on, more tips. still on refined carbohydrates,
instead of a can of soda try a berry and peanut butter smoothie. absolutely delicious and got some
healthy fats, got the protein, got the sweetness, win-win! other drinks that pack a lot of simple
sugars and can spike your triglycerides include sweetened tea, coffee drinks with a lot of sweet
additives and even fruit juice if it's in large amounts. favor water or unsweetened tea. coffee
in reasonable amounts is okay too if you tolerate it well and have good blood pressure
another drink many people don't associate with high triglycerides is alcohol, it can have a
powerful triglyceride raising effect so moderating alcohol consumption can help a lot. okay, what if
you don't have any processed foods, no alcohol and you still have high triglycerides? natural sugars
can raise triglycerides in some people if eaten in large amounts so here are some more ideas: dried
fruit in large quantities can raise triglycerides. alternative snack ideas include cashew cheese or
unsweetened yogurt, preferably low-fat if it's dairy or plant yogurt if you prefer. are your
triglycerides still high after all of that? then we gotta take it up a notch. take the whole grains
in your plate, the quinoa, the corn etc, replace 10 or 20% with some avocado, for example. notice you're
swapping foods but maintaining a healthy dietary pattern overall, so you find a balance that works
for you without compromising. it's win-win. why do i keep saying win-win?? we'll edit this out, right?
okay, another tweak, starchy vegetables. say your meal is potatoes, greens and some higher protein
food. lentils or soy or fish depending if you eat animal foods or not. shift some of the starch
to the greens and protein. it doesn't have to be dramatic, just 10 or 20% could be enough. okay, quick
parenthesis. i get this triglyceride question a lot from people on plant-based diets but if you eat
some animal products and your triglycerides are high the principle is exactly the same. in fact, in
the study the protein diet had a solid amount of plant protein but it also had some animals, it was
about 50-50 and they were able to get the double whammy by focusing on lean meats, low-fat dairy and
having that fiber and that unsaturated fat from the plants in there. alright, moving on. in some
people even whole fruit in very high amounts can bump triglycerides as well. this is lower on the
totem pole than the other items we looked at, but if you've already optimized all of those and your
triglycerides are still high and you're eating a truckload of fruit consider replacing some of it
with a handful of walnuts for example, which are also rich in omega-3s. also, some fruits may be
easier on the triglycerides, for example berries or citrus and depending on your genetics medication
may help you as well, talk to your doctor. okay, hold on a second. i can get a double whammy, both
great cholesterol and great triglycerides, just by tweaking some healthy foods? this has to be
a brand new discovery, right? actually this trial was published 16 years ago and the evidence goes
even farther back. here's an even older study, a large analysis of 60 clinical trials, highest
standard of evidence. replacing carbohydrates with saturated fat (that's the fatty meats and butter)
lowers triglycerides but raises ldl-cholesterol, so that's sophie's choice, that compromise. but
replacing carbs with monounsaturated fats (that's the olive oil, avocados etc) lowered
both triglycerides and ldl-cholesterol. double whammy. and replacing carbs with polyunsaturated
fats (that's the nuts and seeds and fatty fish) also gave the double whammy and actually worked
even better for cholesterol. when we understand the mechanics we get to eat our cake and have
it too. pun intended. here are some life strategies to cut back on the added sugar and here's more on
triglycerides and cholesterol and what these metrics really mean. both good. it's win-win