Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients.

Podcast Summary

Introduction

Dr. Warrick Bishop, a practicing cardiologist and patient education advocate, hosts this episode featuring Dr. Karam Kostner to discuss triglycerides—a commonly misunderstood but important marker of heart health. The episode explores what triglycerides are, why they matter for cardiovascular health, and evidence-based strategies for managing elevated levels.

Key Takeaways:

• Triglycerides are fats (lipids) found in cell membranes, transported in the bloodstream via proteins, and stored primarily in adipose tissue as the main component of body fat.

• Triglycerides fluctuate significantly after meals and calorie intake, unlike cholesterol, making a 12-hour fasting measurement essential for baseline assessment; non-fasting levels should also be monitored.

• Normal triglyceride levels are below 2.5 millimole per liter; levels above 10 mmol/L in the fasting state significantly increase the risk of acute pancreatitis.

• High triglycerides promote dangerous small, dense LDL particles that more easily penetrate artery walls, contributing to atherosclerosis and cardiovascular disease risk.

• Major drivers of elevated triglycerides include obesity, diabetes, smoking, hormonal changes (estrogen, testosterone, contraceptive use), genetic conditions, and excessive alcohol intake (4-5+ standard drinks daily).

• Low thyroid function (hypothyroidism) and heavy alcohol consumption are often-overlooked clinical causes of raised triglycerides that warrant assessment.

• Non-pharmacological interventions are highly effective: reducing saturated fat intake, weight loss, smoking cessation, regular exercise, and alcohol reduction.

• Fish oil supplementation with long-chain omega-3 fatty acids (EPA/DHA) is particularly effective for triglyceride reduction, requiring 4 grams daily from high-strength supplements since adequate amounts cannot be obtained from dietary fish alone.

• Statins have limited effectiveness for triglyceride management (20-40% reduction), making dietary modification the cornerstone of treatment for hypertriglyceridemia.

• Carbohydrate reduction may be a significant triglyceride driver, particularly in pre-insulin resistant individuals, suggesting personalized dietary approaches may be more effective than universal saturated fat reduction.