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Is Diet Enough to Prevent Heart Disease?

I am 37 and just learned that my triglycerides are at 1,600, my thyroid is underactive, and I have type 2 diabetes. My doctor wants me to take thyroid medicine. I read that I am very high-risk for atherosclerosis, but I also read that atherosclerosis can be reversed with a strict diet that includes soluble fiber. True?

Answer (Published 8/13/2009)

Triglycerides are the form in which fat moves through the bloodstream to your body's tissues. Whenever your LDL ("bad") cholesterol is measured, triglycerides are checked, too. High triglyceride levels can be genetic, and may be related to obesity or untreated diabetes. Levels lower than 150 milligrams per deciliter (mg/dL) are considered normal, and levels above 200 mg/dL are considered too high. However, those parameters may be changing in light of recent research on cardiovascular health. Desired normal levels may be as low as 100 mg/dl.

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Atherosclerosis is a condition in which cholesterol-rich plaque builds up along the arterial walls. In time, the plaque may grow large enough to block the artery. If the plaque is disturbed, platelets may begin to accumulate at the site and form a thrombus, or clot, which can continue to grow until it completely blocks an artery, cutting off the oxygen supply to a vital organ. Alternatively, a clot can break free from the blood vessel wall (become an embolus) and become lodged somewhere else further downstream. This could lead to a heart attack or stroke if the clot blocks the blood and oxygen supply to a major artery leading to the heart or brain.

I discussed your question with Stephen R. Devries, M.D., a preventive cardiologist at Northwestern Memorial Hospital in Chicago and a graduate of the Arizona Center for Integrative Medicine. He notes that while diet should always be the starting point in an effort to prevent atherosclerosis, given your diabetes and very high triglycerides, you need to do more than that.

Your triglycerides are 10 times normal and put you at risk for complications including pancreatitis and heart disease, Dr. Devries said. He recommended that you seek to improve your diabetes control by carefully limiting high glycemic foods and reducing saturated fats, and following your doctor’s advice to take thyroid medication, which can, incidentally, help lower high triglycerides. Dr. Devries also suggested talking to your doctor about taking fish oil supplements, which have been shown to reduce triglycerides by 50% when taken in doses up to four grams a day. I agree with all of these recommendations.

Andrew Weil, M.D.

Learn more about type 2 diabetes.

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