EP162: Doctor Warrick and Doctor Kostner Talking Triglycerides

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 author dedicated to patient education, interviews Dr. Karam Kostner about triglycerides—an often-misunderstood but important lipid in cardiovascular health. This episode explores what triglycerides are, why they matter for heart health, and practical strategies for managing elevated levels through lifestyle and medical interventions. Key Takeaways: Triglycerides are fats (lipids) that sit on cell membranes and transport proteins in the bloodstream, and comprise most of the body's stored fat in adipose tissue like belly fat. Unlike cholesterol, triglyceride levels fluctuate significantly with food intake and should be measured after a 12-hour fast for baseline assessment, though non-fasting levels also provide valuable information about daily patterns. Very high triglycerides (above 10 mmol/L in fasting state) significantly increase the risk of pancreatitis, a serious inflammatory condition of the pancreas. High triglycerides contribute to cardiovascular disease by promoting the formation of small, dense LDL particles that are more likely to deposit in artery walls, potentially accelerating atherosclerosis. Key drivers of elevated triglycerides include obesity, diabetes, smoking, hormonal changes (estrogen, testosterone), alcohol consumption (4-5+ standard drinks daily), low thyroid function, and genetic conditions affecting triglyceride metabolism. Non-pharmacological approaches are highly effective for triglyceride reduction: reducing saturated fat intake, losing weight, quitting smoking, exercising, limiting alcohol, and supplementing with omega-3 fish oil (EPA/DHA). Fish oil supplements are more practical than eating fish for triglyceride reduction, requiring 4 grams of EPA/DHA daily—equivalent to eating salmon three times daily, achievable through high-strength capsules or liquid supplements. Statins are ineffective for triglyceride management specifically, lowering them only 20-40%, making dietary and lifestyle interventions the primary treatment strategy for hypertriglyceridemia.