Familial Hypertriglyceridemia

Familial hypertriglyceridemia is a common disorder passed down through families in which the levels of triglycerides in a person’s blood are higher than normal. This condition is not associated with a significant increase in cholesterol levels. Recently I had the opportunity to assist in the treatment of a patient who suffered from familial hypertriglyceridemia. I’m glad I had the opportunity to take part in this case because I really learned a lot from this patient, his conditions, and how all of the components in life can affect the rest of your life and health.

The patient was a male, 39 years of age, and was suffering from hypertriglyceridemia. His condition was also exacerbated by his weight, insulin resistance, and alcohol consumption. The patient’s peripheral vascular disease raised suspicion for familial dysbetalipoproteinema. The gentleman was a non-traditional student at a nearby college, majoring in mechanical engineering. He was also married with two daughters. The patient was the main food preparer in the household and was open and willing to learn new ways of cooking (low-fat) for his family.

Here were the patient’s labs values:
Cholesterol: 254 mg/dl (160-200: normal)
TGs: 1029 mg/dl (35-160: normal)
Glucose: 127 mg/dl (70-109: normal)
HDL: 36.3 mg/dl (40-60: normal)

I’ve noticed it’s always important to put the normal range for each lab value because different facilities/healthcare agencies could have different normal ranges, depending on their measuring tools.

The patient’s typical diet consisted of:
Breakfast:
– Once a week
– Breakfast sandwich
– Danish (sometimes)
– Coffee
Lunch:
– 12p-1pm
– Leftovers- dinner
– Salad- chicken, shredded cheese, Ranch/Italian dressing)
– Sandwich- turkey/ham, wheat/rye bread –or- Chicken hoagie with mustard
Dinner:
– Lean chicken breast (grilled/baked)
– Olive oil
– Bread crumbs
– Vegetables (variety)
– Shredded cheese (Mozzarella or cheddar)
Bedtime Snack:
– Pretzels

So after speaking with the patient, learning his diet habits, and hearing about his lifestyle factors, as well as other miscellaneous habits, we developed a few goals for him to strive for.
Goal 1: The patient mentioned that he drinks 2-3 cans of soda a week. So, we asked if he can cut that out of his diet. And he said he could.
Goal 2: The patient mentioned that he’s very tech savvy so we asked if he could keep a food log on through a Smart phone application. And he said he could.

We also gave the patient education materials on:
– Dean Ornish program
– Nutrition Therapy for high TG levels
– High TG Meal Tips
– Fat-Restricted Diet

It was clear to me that the patient was at risk for developing pancreatitis from the amount of pressure that his pancreas was experiencing from the fat in his diet. So, to avoid this, we recommended that the patient restrict his fat intake to 15% of his daily energy intake. This is a good starting point for this patient. This way we can work together to get his fat (and protein) levels down and take those important baby steps towards decreasing his fat intake even more, hopefully, in the future.
10

The Big “C” in Food

eggs

People everywhere are looking for easy and affordable ways to add healthy protein to their diet. It seems that eggs appear to be the perfect little protein package. But since the advice from health professionals seems to change often about eggs, consumers are becoming increasingly confused. Healthy consumers really shouldn’t worry about this but, individuals who at-risk for cardiovascular disease (CVD) or who have CVD, may want to be aware of this.

What seems to be more important than the food itself is the total cholesterol intake from food. Regardless of where the cholesterol comes from, like eggs or other animal products, consumers who are more susceptible to CVD should keep account of the cholesterol and saturated fat that they are consuming from these food sources.

Remember that eggs are contained in many foods, including bread, cakes, ice cream, muffins and even such entrees as breaded fish, meat dishes and meatloaf. Each of those might add just a fraction of an egg per serving, but together they can increase your cholesterol intake, especially since many of those items contain other ingredients that can be high in cholesterol and saturated fat, such as butter or cream.

Consumers should be careful about not confusing dietary cholesterol with blood cholesterol (LDL, HDL, and triglycerides). The major contributing factor of blood LDL cholesterol is saturated fat. There is a recommendation to limit dietary sources of saturated fat, largely found in dairy and animal protein. Although the saturated fat in eggs is relatively low compared with that in many other animal-based protein sources (one large egg has less than 2g of saturated fat), many of the foods that often accompany eggs (such as bacon, butter, cheese and sausage) are high in saturated fat as well. The combination of foods high in cholesterol, like these, can really add up.

According to the 2010 Dietary Guidelines for Americans, cholesterol intake by men averages about 350 mg per day, which exceeds the recommended level of less than 300 mg per day. Average cholesterol intake by women is 240mg per day. Independent of other dietary factors, evidence suggests that one egg (including egg yolk) per day does not result in increased blood cholesterol levels, nor does it increase the risk of cardiovascular disease in healthy people. Consuming less than 300mg per day of cholesterol can help maintain normal blood cholesterol levels. Consuming less than 200mg per day can further help individuals at high risk of cardiovascular disease.

On the plus side, eggs have many nutritional benefits. They’re a good source of high-quality protein, with relatively few calories (6.3 grams of protein for only 72 calories in a large egg). Eggs also contain vitamins B12 and D, and several essential micronutrients, including choline (important for brain health) and lutein (for eye health).

NHANES satd fat

cholesThe Washington Post