Photo by Vincent Van Der Pas
"When triglycerides go up over 100 we start making abnormal forms of cholesterol--the small dense LDLs that are atherogenic and penetrate much more rapidly into the arteries than normal large LDLs.
When triglycerides start going up--and the changes start around 80-100--nearly everyone with triglycerides over 100 is making significant amounts of small dense atherogenic LDL--above 150 almost all LDL particles are small dense and atherogenic."-Dr. Patrick E. McBride, Professor of Medicine and Family Medicine, University of Wisconsin, and a member of the Expert III NCEP Panel setting cholesterol guidelines-
If you received this post via email, click here to get to the web version with all the links.
On Saturday morning, my sister-in-law and I FINALLY had a chance to catch up.
We talked for an hour staight--which is nothing for us--we'd barely scratched the surface of what we could cover--but we both had to call it quits to get on with the rest of of the stuff on our To-Do Lists.
She had some pretty good news to share--and I asked her if it was OK if I shared it with you. She said, "Sure! Go ahead." So here's what we talked about....
What's Up with My High Triglycerides? Help!
Here's the back story.
Exactly, one month ago my sister-in-law texted me a cryptic message, "Call me when you have a chance. Need your opinion."
Turns out, she'd had her annual gyno exam. Her doc had taken her lipids, and she' had just found out that her total cholesterol was too high--and her triglycerides were off-the-charts high.
She: "How can that be? I really do eat healthy. I exercise. My doc wants me to make an appointment with a cardiologist ASAP, but I don't want to go on statins, or take anything for the triglycerides. Most of my other numbers are OK--the LDLs & HDLs--but the triglycerides are sky-high. I'd really like to go 100% on the Esselstyn diet first & see if I can get those numbers down."
Me: "Well, don't get mad at me for saying this--but I've been there myself--thinking I'm eating a healthy diet, when I'm really eating "a healthy diet at home"...in addition to a load of crap out-of-the-house!
I know you make healthy meals at home--but it's probably all the rest of the stuff you're eating. The restaurants, the traveling, the cookies, cakes, & pastries your friends make, the lack of exercise when you're traveling, the wine & rum, the sugar, the dinners at friends', the crusty French bread, yada yada yada. It all adds up--and bottom line--if you're taking in more calories than your body needs--you can end up with high triglycerides!
Look, I never would have tried the Esselstyn diet 100% if he hadn't challenged me to do it. You won't know if it works until you do it 100%. Once I did it 100% & saw the results--I was convinced.
High triglycerides, are bad news. Definitely see the cardiologist. But, sure-- try the diet first to see if it can make a difference for you.
She: I've already downloaded Esselstyn's book on my Kindle. Can you send me any other info you might have that will help? I've got just 2 1/2 weeks to try this out, before I go out-of-town with my friends. I know I won't be able to do it 100% on vacation--just not possible--so I'm going to see if I can get a cholesterol test before I leave on vacation to at least see if I'm on the right track. Before I see the cardiologist.
Oh, I've been reading up on triglycerides--but send me anything you might have on the blog that would help.
Here's what I emailed her:
Here's one of the posts I've written about on triglycerides--but this one sums it all up. NOTE: In April the ranges for normal all moved downward. Now, the recommendation for the normal range is at 100 or below (no longer below 150). But as you'll read, it's best to be at 80 or below. You want to make sure you're making light fluffy LDLs, not the small dense kind. You might request the NMR particle test. And here's the link to the new American Heart Association Scientific Statement recommending that triglycerides ought to be at 100 or below--not 150.
You want me to ask Dr. Esselstyn what he suggests you do?
My note to all of you: Please read that post I sent my sister-in-law about triglycerides. It will tell you everything you ever wanted to know about these bad-boys. They're an independent risk factor for strokes & cardiovascular disease. If you've got a lot of belly fat--you probably have high triglycerides. If you're eating more calories than your body can burn off--you probably have high triglycerides. To read even more (yeah right!) about the triglyceride stroke/heart connection, click here and here and here.
How Strange is This? The day after I sent the email to my sister-in-law, Dr. Esselstyn just happened to call me at work with a library question. Of course, I asked him for some words of wisdom for my sister-in-law & for high-triglycerides in particular. Darn, I no longer have my notes--but here's what I remembered he said:
- Cut out the sugar--all kinds! (my note: be sure to read this and this)
- Cut out alcohol
- Cut out the white foods--refined flours, pastas, breads, rice, crackers, etc. If high triglycerides are a problem for you--stick to just eating whole grains--and skip foods made with whole grain flours, like breads & pastas. Even whole grain flours can raise triglycerides in folks who are overweight and insulin-resistant. Think about it--flours of any kind are "processed" & digest too quickly. Instead eat quinoa, wheatberries, hulled barley, steel-cut oats. Flourless sprouted breads, like the Ezekiel brand, are a better choice if you need a bread.
- Remember! Green leafy vegetables are the Main Event when it comes to making blood vessels "heart attack proof". Load up on vegetables over grains!
- No fruit juices--and be careful not eat too many fruits, either, if you have high triglycerides. Stick to the ones with the lowest sugar content. (my note: the fruits lowest in fructose include strawberries, berries, cantelopes, grapefruit, peaches) Source: AHA statement quoted on CardioBrief
- Avoid smoothies made with fruit! It can cause a rapid rise in blood sugar for some people. I see it happen a lot!
- Avoid dried fruit--too much sugar! Especially high sugar fruits like dates & raisins.
Oh heck--I really really don't want you to miss the Triglyceride Post I emailed to my sister-in-law--so, just in case you don't click that link--I at least want to make sure you get some of the key points:
- If your triglycerides are under 80 you are making "normal large" LDLs that are not very atherogenic (think atherosclerosis; arterial plaque; hardening of the arteries)
- When triglycerides are over 150 (there are just too many particles floating around with no where to go) they briefly get inserted into the LDLs and change the LDLs into "small dense atherogenic" particles.
- Stealth LDL: That's what you call what was once a normal LDL particle that's been penetrated by free-floating triglycerides. When triglycerides are too high they are able to change the LDL into "small dense dangerous" LDL that oxidizes very easily (a bad thing) and penetrates rapidly into the arteries. Note: Triglycerides are not supposed to penetrate the LDLs!!
- Normal LDL: It's difficult for normal LDL (large & fluffy) to penetrate into the wall of an artery!
- When triglycerides are between 80-100 you start to make abnormal LDL. Some of it starts changing into the "small dense atherogenic" variety at this level. (If changes start happening over 80--it looks to me like the only safe triglyceride number is under 80!)
- When triglycerides are over 100--according to Dr. McBride--you've turned the corner & "are making at the very least, a significant amount of "small dense" LDL."
- When triglycerides are above 150, almost all of the LDL particles become "small dense atherogenic".
- Dr. McBride served on the III NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults that set the guidelines for triglycerides (and cholesterol) back in 2002. He advocated for the normal level to be under 100--and he strongly believes that the current level will go down to 100 when the next guidelines come out. Note: in April 2011 the AHA issued a Scientific Statement recommending the new normal be under 100. Find that here.
- Big clue that your triglycerides are probably too high? Abdominal obesity aka belly fat. That's the engine--the symptom--that starts the cascade toward atherosclerosis; heart disease; stroke; type II diabetes. It's a big reason for triglycerides producing nasty stealth LDL. Read "This Belly Fat is Going to be the Death of Me and Now I Understand Why." and "Lose That Terrible Horrible Inflammatory Disease-Causing Visceral Belly Fat with Whole Grains? Tufts Researchers Say It Helps!"
- According to Dr. McBride, if you have abdominal obesity, the chances are greater that you are producing the abnormal dangerous "small dense" form of LDL.
- If you overconsume sugar, soda pop, saturated fats, trans fats, refined carbohydrates, and "fried apple pies"--and you are consuming more calories than you need--your body doesn't know what to do with all that junk--and you end up with lots of rich triglycerides--that are very inflammatory and very atherogenic--floating around--just looking for an LDL to penetrate and turn it into "small dense dangerous" LDL!
Before my sister-in-law went on her week vacation with her gal pals, she wisely had her blood drawn for a cholesterol test. She'd been on the Esselstyn diet for just 2 1/2 weeks--eating no-fat, no meat, no cheese, no-oil, no refined grains.
She knew it wouldn't be as good as if she'd been on the diet for 4 weeks--but at least she's get some idea if it could improve her lipids.
Test results: Her total cholesterol dropped 100 points! Amazing! Full disclosure: for some unknown reason, the lab only measured her total cholesterol--not what she really needed--a full lipid panel. But she figures the triglycerides & LDLs must be going down if her cholesteol levels came down so much in just 2 1/2 weeks. She'll be following up with a full lipid panel.
Other good news: In spite of her one week of transgressions on vacation--she's back to the Esselstyn diet--and she's losing weight. Best of all, she's losing belly fat! She's committed to stick with it. She'd rather lower her triglycerides with diet instead of drugs. Besides, only diet can help reduce weight.
What My Sister-in-Law is Up Against. She Lives in the Southern "Stroke Belt", Her Friends Think Health is All About Genes, Not Diet & Everyone Likes to Eat Out
She's swimming against the stream in her neck of the woods. She's the odd girl out in her social circle.
Everyone loves butter, meat, cheese, pastries, fried foods, good old Southern cooking, and eating out.
Lately, everyone's complaining about being so forgetful. They thinks it just normal aging.
Uh?? Think again, folks!
Check out this "hot off the press" article published online in Stroke, Sept. 1, 2011 Buchman, AS etal "Cerebrovascular Disease Pathology and Parkinsonian Signs in Old Age". It's summarized in the NPR Blog, Shots:
"Old people who don't have signs of cardiovascular disease still may have suffered microscopic strokes that don't show up on conventional tests. The small strokes may impair their ability to walk, balance and function just the same.
Scientists examined the brains of 418 priests and nuns after they died. The researchers found that one-third of the brains that had seemed normal using conventional tests while the people were alive actually had damage to tiny blood vessels. The damage was so slight it was impossible to see without a microscope.
The people whose brains had these tiny signs of hardened arteries and stroke were most likely to have had shuffling gait and other movement problems while they were still alive."
If you've been eating the standard American diet--and you're eating out a lot, there's a good bet that what we take to be the "normal forgetfulness of aging"--isn't exactly normal. It could be teeny weeny imperceptible strokes. Now that's one scary thought!
"Dr. Megan C. Leary of UCLA examined over 5,500 MRIs of the brains of 50 year olds & found many had tiny white spots that indicated that they had unknowingly experienced tiny, imperceptible strokes. These "brain attacks" have the same history and cause as heart attacks. See "Annual Incidence of First Silent Stroke in the U.S" Cerebrovasc Dis 2003;16(3):280-5.
According to Leary, "'Silent strokes' are epidemic in this country. While they occur in parts of the brain where they don't cause symptoms right away, the word 'silent' should be put in quotes, because their effects accumulate over the years.''
While a single silent stroke may have no impact, repeated ones lead to memory lapses, mood problems and difficulty walking. They are also a sign that people are especially prone to full-blown strokes.
Keep on eating the same way at age 60, 70, & 80 and there's a good chance that those tiny strokes will add up to increasing memory lapses, and progress on to dementia--depending upon what part of the brain has been affected.
What's good for the blood vessels of the heart, is good for the blood vessels of the brain."
Dr. Caldwell Esselstyn, Jr., Prevent & Reverse Heart Disease lecture 6/18/2010. see also: The Rotterdam Scan Study; "Silent Brain Infarcts and the Risk of Dementia and Cognitive Decline," New England Journal of Medicine 2003 Mar 27;348(13):1215-2; "Silent Brain Infarcts: a systematic review," Lancet Neurology 2007 Jul;6(7):611-9.
As for all that rich Southern cooking--forget about it! It's killing brain cells and giving the South a new claim to fame: It's known as The Stroke Belt.
The "brain-damaging suspects" are likely to be the much-loved traditional Southern diet of fried, salty, & fatty foods along with too little exercise--all of which contribute to hypertension, excess weight, & diabetes--the biggies responsible for stroke risk.
I posted about the brand new REGARDS Study, the Stroke Belt & how the Southern diet is affecting cognitive impairment on July 26, 2011. No need to repeat what I wrote, just click here to refresh your memories.
Two of my favorite quotes about the REGARDS study:
"This is a very strong alarm signal. [The finding suggests that] if you want to keep your marbles, you need to control your blood pressure, excessive weight and other risk factors for stroke."
Dr. Gustavo C. Roman, the head of the neuroepidemiology section of the American Academy of Neurology, commenting on the article.
[Problems like high blood pressure and diabetes are likely to be "affecting blood flow to the brain, even if it's not causing a visible stroke. An undersupply of blood can also cause problems with brain cells that lead to cognitive decline."
Dr. Kenneth Langa, a professor of Internal Medicine at the University of Michigan, commenting on the article.
Restaurant Madness - From "Cook This, Not That"
My sister-in-law's friends like to eat out. Who doesn't? It's nice to have someone else do the cooking.
But, once you really know what's in all that restaurant food--most of us will run back to our own kitchens.
Unfortunately, twice a week my sister-in-law has a pretty much mandatory "luncheon meeting" at a restaurant with her business partner. Sort of non-negotiable.
Last week, on my weekly public library run I picked up one of those "Cook This Not That" books. OMG! I started reading it before I went to sleep--and I couldn't stop interrupting my husband's own reading with, "Listen to this!" "OMG! Listen to this one--it's even worse."
The book shocked me! No wonder most Americans are overweight.
We haven't a clue what's in that restaurant food--so a big "Thank You" goes out to David Zinczenko & Matt Goulding for collecting all this incriminating nutritional info. I suspected it--but I really didn't know it was that bad.
And to think how much I used to love Molten Chocolate Lava Cake. Never again!
Chili's Molten Lava Cake - 1,070 calories, 51 g fat, (26 g saturated), 143 carbs
No wonder restaurants don't want to post the nutritional info on their menus.
These aren't the worst offenders--but here's a sampling of some of the meals that even health-conscious folks might consider ordering.
Marie Callender's Spanish Omelette: 1,550 calories, 78 g fat (25 g saturated), 2,980 mg sodium
Baja Fresh Chips and Gaucamole: 1,340 calories, 83 g fat (8 g saturated), 950 mg sodium
California Pizza Kitchen Tuscan Hummus with pita: 861 calories, 4 g satuated fat, 1,562 mg sodium
Ruby Tuesday Buffalo Shrimp Quesadilla: 1,465 calories, 89 g fat, 3,528 mg sodium
Houlihan's Fire Grilled BBQ Salmon Salad: 1,182 calories, 61 g fat (9 g saturated), 1,719 mg sodium
T.G.I. Friday's Santa Fe Chopped Salad: 1,800 calories
Panera Bread Tuna Salad on Honey Wheat Sandwich: 750 calories, 47 g fat (9 g saturated), 1,130 mg sodium
Chipotle Grilled Chicken Fajita Burrito: 870 calories, 30 g fat (13 g saturated), 1,940 sodium
Just for kicks, borrow a copy of this book from your library--or check out the worst vegetarian restaurant meals (check out the side-panel on the left) and then click through the slideshow of the 20 worst new foods in America.
Cook This! Enlightened Appetite for Reduction Tortilla Soup
Enlightened Isa's "Appetite for Reduction" Tortilla Soup - 223 calories, 1.5 g fat (0 g saturated), 8.7 g fiber
No conversation with my sister-in-law is complete without sharing recipes--the new finds-that-we've tried out--and loved!
Funny, how she is always trying recipes that I never even noticed--even though we both share a lot of the same cookbooks. I'm definitely going to reap the benefits of her expert cooking now that she's going Esselstyn.
She: "Have you tried Isa's Tortilla Soup in Appetite for Reduction? We all loved it. But I cut the jalapenos down to just one."
Me: "Nope. I never even noticed it in the cookbook. But I'll check it out as soon as I hang up!"
And I did, later that day. A big winner. Here's my enlightened version.
It looks like a stew or a chili--but it's a soup. Hearty, spicy, and a big one-bowl meal.
Appetite for Reduction Tortilla Soup---My Enlightened Version
click here for the recipe on one page
Serves 6 generously. Add a salad & an ear of corn for a terrific meal!
1 medium onion, chopped (Isa used a small one)
1 jalapeno, seeded & sliced thinly (Isa says use 2)
1 poblano pepper, seeded & chopped into 1/2 inch pieces (this is the large dark green one--ask your grocer--I had to) OK to use a sweet green pepper, but go with the poblano!
4 cloves garlic, chopped
(Isa also recommended 1/4 tsp red pepper flakes. I left these out to see if the soup needed it--and it was hot enough without them--and I like heat!)
1 tsp salt (optional, always)
28 ounce can of crushed Glen Muir Fire-Roasted Tomatoes
3 cups of low-sodium vegetable broth (plus extra for sauteeing the vegetables)
4 ounces of fresh small corn tortillas--bake or toast these until they are crisp. Watch them carefully so they don't burn. (Isa uses 4 ounces of baked corn tortilla chips)
1 tablespoon ground cumin
1 (15 ounce) can of pinto beans, drained & rinsed
1 cup of frozen or fresh corn. (I like using Trader Joe's frozen Roasted Corn)
1/2 cup chopped fresh cilantro, plus extra for garnishing
Juice from 1 juicy lime
1. Preheat a 4 quart soup pot over medium high heat. Dry saute the onions, jalapeno, & poblano peppers until the onions are translucent, about 5 minutes. Add a little vegetable broth if the onions start to stick or dry out--to deglaze the pan.
2. Add the crushed tomatoes, the 3 cups of vegetable broth, and the cumin to the pot. Mix well.
3. Crush the crisped tortillas into crumbs (some bigger pieces are OK) & add about 1/2 of them to the pot--reserving the rest for garnish. (I ended up adding all of them to the pot, because I didn't read the directions carefully & it thickened the soup, nicely) You want the crumbs to "melt" into the soup.
4. Cover, & bring to a boil. Lower the heat to a simmer, add the beans, corn, & cilantro.
5. Simmer for 5 more minutes.
6. Add the lime juice, taste for seasonings.
7. Ladle soup into bowls, & top with remaining tortilla crumbs & remaining cilantro.
1/6th of the recipe
I'd love to hear about your favorite Appetite for Reduction recipes!
Anyone have some suggestions for "safe foods" when you absolutely have to eat out?