Arts & Entertainment

By Fr. Francis Pizzarrelli

Father Frank Pizzarelli

The Christmas season is upon us. The village of Port Jefferson is decked out with lights and wreaths — there is definitely a spirit of Christmas in the air. 

The world is a crazy place. The violence and hate has become infectious, but the reason for the season has taken a hold of us once again in a number of places. People are reaching out and bridging differences. 

One such instance is Christmas Magic, an event that magically touches hearts old and young alike with the spirit of giving, sharing and serving others. Started more than 25 years ago by a young attorney who wanted his children to understand the real meaning of Christmas, his act of kindness and generosity has touched thousands of people across our county every Christmas season. 

Hundreds of caring high school students to college students, from youth programs and church communities sacrifice their time and reach out to thousands of children living in our shelters during the holiday season.

Close to 3,000 people gathered at Carnegie Hall on the second Monday in December this year for a Christmas concert. The headliners were powerful: Andy Cooney and his band, the Hibernian Festival Singers, the Irish Tenors, the New York Tenors and eight young men who have become a band of brothers supported by an extraordinary female voice that makes the H.I.M.S. and Her such an extraordinary musical talent.

This band of brothers are young men who are broken and wounded, from all over, trying to reclaim their lives while living in a long-term nontraditional treatment program for addictions. The story of these men is a story of powerful change and transformation. Their performance at Carnegie Hall brought that packed house of concertgoers to their feet. It was a night of inspiration to remember.

A few days before their performance at Carnegie Hall these gifted and talented men volunteered to sing Christmas carols at the retirement home for the Dominican Sisters at their motherhouse in Amityville. I started to visit these sisters every Advent because I’m a product of Dominican education. In my junior high school years, I was profoundly influenced by three very dynamic women of faith. This has been my simple way of saying thank you.

After serving the church in a variety of leadership roles for more than 50 years, my former eighth-grade teacher took a job at Pax Christi, an emergency men’s shelter in Port Jefferson. She began working five days a week until she was 85 years old cleaning toilets, making beds and bringing hope to countless men who thought their lives were hopeless.

Today Sr. Beata is in her mid-90s. She is still as sharp as can be but has a difficult time getting around. The sisters she lives with range in age from their mid-70s to 107 years old. 

After caroling that Saturday morning, the young men walked among these extraordinary women hugging and kissing them; the room was aglow. The sister who is 107 years old came over to me to thank me for bringing these young men. She said it was her greatest Christmas present. All her family has died and her friends as well. She has no visitors. After one of the young men hugged her she started to cry. She hadn’t been hugged in over a year and she said thank you for helping her feel alive again.

As we drove home, these men on the road to recovery and wellness were on fire — not realizing how in their brokenness with their simple carols they brought so much joy to a community of women who were such a source of hope and light for so many generations.

Christmas seems to be that time of year to remind each other of the profound goodness that lives within each of us and to be conscious that each one of us has the power to make a difference that really does count.

Merry Christmas!

Fr. Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.

MEET BEAUX!

This week’s shelter pet is Beaux, a handsome 2½- year-old Shepherd mix rescued from a high kill shelter in Texas and now safe at Kent Animal Shelter. 

Beaux has such soulful eyes and is as sweet as can be. He’s looking for someone to spend the rest of his days with. Could that be with you? He comes neutered, microchipped and is up to date on his vaccines. 

Kent Animal Shelter is located at 2259 River Road in Calverton. The adoption center is open from 10 a.m. to 4 p.m. every day. 

For more information on Beaux and other adoptable pets at Kent, call 631-727-5731 or visit www.kentanimalshelter.com.

‘TIS THE SEASON

While admiring the Promenade of Trees at the Stony Brook Village Center, Gerard Romano of Port Jefferson Station stopped in front of the clothing store LOFT and captured this festive scene using a wide-angle lens. The 66 decorated trees will remain on display through Jan. 1.

Send your Photo of the Week to leisure@tbrnewspapers.com.

Priya Kapoor. Photo by Heidi Sutton

By Heidi Sutton

Priya Kapoor came to the Smithtown Historical Society in 2016 as the director of development and public relations. This January she was made interim executive director and was confirmed as the permanent executive director of the society in March. Her responsibilities include overseeing the 22-acre property and the buildings on the campus, as well as organizing and managing over 100 fundraising and community events held by the society each year. I recently had the opportunity to interview Ms. Kapoor about her new position.

How is Smithtown rich with history? 

Smithtown is one of the oldest towns on Long Island, and we’re very fortunate to have a lot of that history still available to us. 

The founding of Smithtown can be dated back to 1665; Richard Smith, town founder, was said to have made a deal with a local Native-American chief that any land Smith could encircle while riding a bull in one day would be his. By choosing the longest day of the year, Smith acquired the land known today as Smithtown. He was also granted land patents by the English government in 1665 and 1675.

Over 20 buildings throughout the Town of Smithtown are listed on the National Register of Historic Places. It’s a rare treat to be able to walk down the street and see the same buildings your grandparents and great grandparents grew up with!

What are some things the historical society does?

The historical society puts on 100 events a year — everything from adult education classes (cooking and crafting, for example) to summer camp programs, annual fairs like the Heritage Fair every September, and we host a monthly Historical Book Club as well. Not to mention our Farm Program, maintaining our historical buildings, etc.

What kind of events does the society offer to the community?

Each event is a little different. We host events like the President’s Valentine Brunch and the Holiday Luncheon — opportunities for our members and the community at large to celebrate holidays with us. And, of course, our annual fairs: the Spring Farm Festival, the Heritage Fair and the Heritage Country Christmas Fair. Again, it’s all about bringing our community together in a way that honors our history — we try to have traditional craftspeople like spinners, weavers, blacksmiths, etc. at all our fairs.

What types of programs does the society offer?

Our adult education classes often focus on crafting (we had a felt dryer ball making class, for example) or cooking (I taught two Indian cooking classes) — something educational in nature that our community might not have a lot of experience in. These go hand in hand with our annual lecture series, in March and September/October, and exhibit openings at the Caleb Smith House Museum in March.

What event do you look forward to every year?

I’m fond of the Spring Farm Festival, an annual event that happens in late April-early May. Our sheep get sheared, we have lots of traditional craft demonstrations (wool dying, wood carving, cheese making, etc.), as well as a robust vendor area. It’s really the first sign that spring has come back, and what’s better than that!

What programs have you implemented?

We try to come up with new and exciting events each year. For example, in July 2018 we started the Water Festival, which was attended by over 100 people. The festival included sprinklers and water games for children, and we hope to grow this event in the coming years.

This past year we also hosted the Nesconset Chamber of Commerce’s Project Haunt in our Rockwell Barn Complex. Local high schoolers transformed our space into a spooky museum of horror-themed attractions, as well as gave kids a safe space to trick or treat.

We are currently in the process of restoring the Obadiah Smith House, ca. 1700, which is the oldest of our properties. We have received a grant from the Preservation League of New York State for the initial assessment, and we hope to take this project further in the coming years.

The other newest program implemented is our Patch Partnership with the Girl Scouts — available in both an online format and one where the Scout comes to the historical society. Through this program Girl Scouts learn about life on the farm and women in Long Island’s history.

What is your vision for the future in terms of new events?

We have adult education classes, we have children’s programming — I’d like to see more events that focus on families. We’ve run a few in the past where the parents help their kids build or create something, but those programs are definitely few in number compared to our other programming. In addition to new events, we also hope to come up with new initiatives to help the local community and give back to others.

Do you have a strong support system?

We couldn’t operate without one! Between our dedicated volunteers and staff, the community at large and our local government officials, we’ve got a very strong support system. We are especially thankful to our board members, for their guidance and support.

Are you looking for volunteers?

We are very fortunate to have a dedicated and hardworking volunteer base, and we express utmost gratitude to them for their efforts. But we are always looking for more volunteers to help us with our farms, grounds and events. We’re always on the lookout for volunteers. Our needs vary from mass mailings to grounds work, decorating for the holidays to manning an admissions table at one of our fairs. We’re also in the process of creating a volunteer orientation to help ease interested folks into the society. 

What historic buildings are on the property? 

We have four historic buildings on our main campus: the Roseneath Cottage (ca. 1918), the Judge John Lawrence Smith Homestead (ca. 1750), the Franklin O. Arthur Farm (ca. 1740) and the Epenetus Smith Tavern (ca. 1740). We also have the Caleb Smith House (ca. 1819) and the Obadiah Smith House (ca. 1700) under our care, though they are off-campus. 

The Roseneath Cottage, our youngest building, serves as our main office; this arts and crafts bungalow underwent a complete restoration (and renovation!) when it became our headquarters. The homestead, while originally built by the Blyndenburgh family, became the family home and office of Judge John Lawrence Smith in the 1800s. As his health declined and he got older, court was moved from Riverhead to be tried in his personal chambers. It’s currently set up as it would have been during his life, complete with his study and parlor. 

The farm and the farmhouse have undergone some change throughout their lives; while the oldest part dates from the early 18th century, additions were made throughout the 19th and 20th centuries. The complex also includes a 19th-century barn (home to our sheep, pony and chickens!) and carriage house. 

The final historic home on the property would be the tavern; the pre-Revolutionary War structure was originally found on the corner of Middle Country and North Country roads in 1972, after having been moved twice before. It was a popular stop on the Brooklyn to Sag Harbor stagecoach route in the 1770s, and was used often by British soldiers during the Revolutionary War. Much like the farmhouse, the tavern has undergone some alterations throughout the centuries; the oldest bit dates to the 17th century, the main portion circa 1740; there were additions and alterations in the 19th and 20th centuries.

What is so special about Smithtown?

Smithtown is a town that really cares about its history and celebrates it. We have community members come to our events and say that it’s a tradition in their family to attend; they came as a kid with their parents and are excited to bring their own children today. The support we get from the town government also speaks to this — they’re very aware that one of the most special things about Smithtown is its history, and they go to every length to help preserve that. 

What do you love about your job?

I love that my job allows me to stay connected with the Smithtown community, while being able to add to it in a positive and impactful way.

Why is it so important to preserve our local
history?

Smithtown, up until 50 years or so ago, was pretty rural. It can be hard for today’s kids to imagine the open space, farms, etc. that used to make up their towns, especially when they get a look at Main Street today! Knowing where you come from is important; acknowledging those who came before you adds meaning to where you are now. For us to see clearly where we came from, that’s how we appreciate everything we have today.

By Irene Ruddock 

‘Self Portrait,’ oil

Terence McManus is a retired social worker with a master’s degree from Adelphi University. A self-taught artist, he has participated in over 100 exhibits and juried competitions winning over 60 awards. He has had portraits exhibited at the Butler Institute of Art and at the Heckscher Museum. McManus is a signature member of both the Pastel Society of America and the Connecticut Pastel Society, and a member of the prestigious Salmagundi Club in NYC, as well as other art organizations across the country.

Recently, I was able to interview McManus at his studio.  

How did you decide to become an artist and, specifically, a portrait painter? 

I can’t remember not considering myself an artist. When I was in the first grade, I remember proudly telling people that I was an artist. And even as a young child, it was a person’s face that fascinated me and I copied faces from magazines. In high school I did posters of friends running for elections, in college I did portraits of my friends and their girlfriends, etc.

Was there someone who influenced you? 

When I was 10, I was thrilled to get my Jon Gnagy set of drawing instructions, but, seriously, I have not had any formal art training. The one art course that I took in college was a disaster because the instructor was an abstract artist and I was a Norman Rockwell fan! Instead, I have learned from books, videos, magazines and demonstrations and practice. 

Can you demystify the art of portraiture?

In painting a portrait, it is important to make sure the features are positioned correctly. I leave out details when starting a painting, except I paint the eyes in quickly. With the person looking back at me, I feel a connection with the subject. After I sketch in the positions, I apply the pastel or paint in the traditional manner, going from darks to lights. I frequently view the portrait backwards in a mirror to see the painting from a different perspective which helps to check on accuracy. Once the positions are correct, doing a portrait is not so different from doing a still life. You can use any color you wish, but you must have the values correct. Just look for the light and dark values, and like a puzzle, it would come together.

If you paint from photographs, what is the single most important thing that must be present in that photograph? 

I prefer to use my own photos since using the photos made by others is their vision, not mine. I look for how the light hits the face, creating drama and the feelings I wish to bring out in the painting.

In this increasingly image-conscious society, how do you compete with photographs and why are painting portraits different? 

A good photographer can capture real emotion, but most are just an image of the person for that second. A portrait artist usually tries to bring out the subject’s life experience. The artist can add or subtract or emphasize different aspects to reflect this. 

What is the hardest part about painting a portrait? 

It depends if I am painting for myself or for a commission. When it is for myself, I am trying to capture a feeling more than accuracy. With a commission, it is the exact likeness that is most important to the client, but I still aim to paint a good painting that can stand by itself.  

Do you like painting animals? 

I love painting animals. How can you not love those eyes looking at you? But like humans, aside from the eyes, their body language can convey much as well. 

In your view, what is the magical element that makes for a great portrait painting?

It is the intensity of the emotion that comes across and how well it is done, regardless of the style that makes for an interesting and unique portrait. 

Are there any portrait artists’ work that you feel personally drawn toward?

I love Rembrandt for his dramatic use of light, John Singer Sargent and Thomas Eakins for their realistic but painterly portraits, Alice Neel for her unique expressive style and Burton Silverman for his outstanding portraits.

If you could paint a portrait of anyone, whom would that be? 

Alexander the Great! Educated by Aristotle, king at 20, ruler of most of the world by 30. What strength and determination would his face reveal!

How can you be contacted for commissions?  

I may be reached by email at mcmfam99@optonline.net. 

All images courtesy of Terence McManus

By David Dunaief, M.D.

Dear Santa,

Dr. David Dunaief

This time of year, people around the world are no doubt sending you lists of things they want through emails, blogs, tweets and old-fashioned letters. In the spirit of giving, I’d like to offer you some advice.

Let’s face it: You aren’t exactly the model of good health. Think about the example you’re setting for all those people whose faces light up when they imagine you shimmying down their chimneys. You have what I’d describe as an abnormally high BMI (body mass index). Since you are a role model to millions, this sends the wrong message.

We already have an epidemic of overweight kids, leading to an ever increasing number of type 2 diabetics at younger and younger ages. According to the Centers for Disease Control and Prevention, as of 2015, more than 100 million U.S. adults are living with diabetes or prediabetes. It complicates the issue that approximately two-thirds of the U.S. population is overweight and/or obese. This is just one of many reasons we need you as a shining beacon of health.

Obesity has a much higher risk of shortening a person’s life span, not to mention quality of life and self-image. The most dangerous type of obesity is an increase in visceral adipose tissue, which means central belly fat. An easy way to tell if someone is too rotund is if a waistline, measured from the navel, is greater than or equal to 40 inches for a man, and is greater than or equal to 35 inches for a woman. The chances of diseases such as pancreatic cancer, breast cancer, liver cancer and heart disease increase dramatically with this increased fat.

Santa, here is a chance for you to lead by example (and, maybe by summer, to fit into those skinny jeans you hide in the back of your closet). Think of the advantages to you of being slimmer and trimmer. Your joints wouldn’t ache with the winter cold, and you would have more energy. Plus, studies show that with a plant-based diet, focusing on fruits and vegetables, you can reverse atherosclerosis, clogging of the arteries.

The importance of a good diet not only helps you lose weight, but avoid strokes, heart attacks and peripheral vascular diseases, among other ailments. But you don’t have to be vegetarian; you just have to increase your fruits, vegetables and whole-grain foods significantly. With a simple change, like eating a handful of raw nuts a day, you can reduce your risk of heart disease by half. Santa, future generations need you. Losing weight will also change your center of gravity, so your belly doesn’t pull you forward. This will make it easier for you to keep your balance on those steep, icy rooftops.

Exercise will help, as well. Maybe for the first continent or so, you might want to consider walking or jogging alongside the sleigh. As you exercise, you’ll start to tighten your abs and slowly see fat disappear from your midsection. Your fans everywhere leave you cookies and milk when you deliver presents. It’s a tough cycle to break, but break it you must. You — and your fans — need to see a healthier Santa. 

You might let slip that the modern Santa enjoys fruits, especially berries, and veggies, with an emphasis on cruciferous veggies like broccoli florets dipped in humus, which have substantial antioxidant qualities and can help reverse disease. And, of course, skip putting candy in the stockings. No one needs more sugar, and I’m sure that, over the long night, it’s hard to resist sneaking a piece, yourself.

As for your loyal fans, you could place fitness videos under the tree. In fact, you and your elves could make workout videos for those of us who need them, and we could follow along as you showed us “12 Days of Workouts with Santa and Friends.” Who knows, you might become a modern version of Jane Fonda or Richard Simmons or even the next Shaun T!

How about giving athletic equipment, such as baseball gloves, footballs and basketballs, instead of video games? You could even give wearable devices that track step counts and bike routes or stuff gift certificates for dance lessons into people’s stockings. These might influence the recipients to be more active.

By doing all this, you might also have the kind of energy that will make it easier for you to steal a base or two in this season’s North Pole Athletic League’s Softball Team. The elves don’t even bother holding you on base anymore, do they?

As you become more active, you’ll find that you have more energy all year round, not just on Christmas Eve. If you start soon, Santa, maybe by next year, you’ll find yourself parking the sleigh farther away and skipping from chimney to chimney.

The benefits of a healthier Santa will ripple across the world. Think about something much closer to home, even your reindeer won’t have to work so hard. You might also fit extra presents in your sleigh. And Santa, you will be sending kids and adults the world over the right message about taking control of their health through nutrition and exercise. That’s the best gift you could give!

Wishing you good health in the new year,

David

P.S. I could really use some new baseballs, if you have a little extra room in your sleigh.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician. 

٭We invite you to check out our new weekly Medical Compass MD Health Videos on Times Beacon Record News Media’s website, www.tbrnewsmedia.com.٭

Baked Stuffed Clams

By Barbara Beltrami

At this time of year, I love to ask any Italian-Americans I know what they are cooking for Christmas Eve because so many of them celebrate it with a grand meal that includes seven or more different kinds of fish, a custom most sources attribute to the Roman Catholic tradition of the fasting vigil awaiting the midnight birth of Jesus. 

What I enjoy about the answers I get is the incredible variety of fish courses that each family considers the absolutely inviolable menu. The only constant, as far as I can tell, is baccala, or salt-cured cod, and from there the meal proceeds on to a pasta, usually with some sort of seafood sauce, clams, shrimp, something fried and, in many extravagant cases, finally lobster. 

If you think of Christmas Eve as a special night or occasion, if you like fish, if you like Italian food, then by all means use these recipes and others or get yourself invited to one of these hours long repasts that surely is not just one of the highlights of the holiday but also one of the best Italian-American culinary traditions.

Baccala (Dry Salted Cod)

YIELD: Makes 4 to 6 servings.

INGREDIENTS:

1 pound dry salted cod, cut into 3-inch pieces

1/3 cup olive oil

2 large onions, coarsely chopped

3 pounds potatoes, scrubbed and coarsely chopped

One 28-ounce can diced tomatoes with juice

2 tablespoons capers, rinsed and drained

1 tablespoon fresh oregano or 1 teaspoon dried

½ cup chopped fresh parsley

1 garlic clove, minced

1½ teaspoons hot red pepper flakes

DIRECTIONS:

Changing the water at least 6 times, soak the cod in a bowl or pan of cold water for 24 hours in a cool place. Taste a piece to determine if it is too salty. If it is, soak longer. In a large pot heat oil, add onions and cook, stirring occasionally, until soft and translucent. Add potatoes and stirring frequently, cook until golden brown. Add 3½ cups water to pan and bring to a boil; reduce heat, cover and cook 5 minutes. Uncover pot, add tomatoes, capers, oregano, parsley, garlic and pepper flakes; stir; gently lay cod on top, cover pan and carefully turning fish once midway through, simmer until it is cooked through, about 30 minutes. Serve hot, warm or at room temperature with garlic bread and black or green Italian olives.

Spaghetti with Anchovy Sauce

YIELD: Makes 4 to 6 servings.

INGREDIENTS:

1 pound spaghetti

½ cup extra virgin olive oil

4 garlic cloves, minced

4 to 6 salted or oil-packed anchovies, rinsed

½ teaspoon hot red pepper flakes

DIRECTIONS:

Cook spaghetti according to package directions, reserving ½ to 1 cup of pasta water. Meanwhile, in a small skillet combine oil and garlic and cook over low heat until garlic is softened but not browned. Add anchovies and with a fork, mash well; add pepper flakes, stir and cook 2 to 3 minutes. Set aside to keep warm, then toss with cooked spaghetti, adding some of the pasta water if too dry. Serve hot or warm with a well-chilled dry white wine and breadsticks.

Baked Stuffed Clams

Baked Stuffed Clams

YIELD: Makes 4 to 6 servings.

INGREDIENTS:

2 cups bread crumbs, seasoned with coarse salt and freshly ground black pepper to taste

1/3 cup extra virgin olive oil

2 garlic cloves, minced

½ cup chopped fresh Italian parsley

Freshly squeezed juice of one lemon

24 cherrystone or littleneck clams, scrubbed and opened, top shell discarded

2 cups clam juice

2 lemons cut into wedges

DIRECTIONS:

Preheat oven to 400 F. In a medium bowl combine bread crumbs with salt and pepper; then add oil, garlic, parsley and lemon juice. Place clams in nonreactive baking pan and carefully pack about two teaspoons of bread crumb mixture on top of each one, Being careful not to wash away bread crumbs, pour clam juice around clams. Bake 15 to 20 minutes, until bread crumb mixture starts to brown. Remove from oven, drizzle a little of cooking liquid over them and serve hot with lemon wedges and prosecco.

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Ice sculptors wanted

While the Suffolk County Vanderbilt Museum, 180 Little Neck Road, Centerport is currently celebrating the holidays with tours of the decorated mansion, it is looking ahead to its next major event, Ice Fest at Eagles Nest. The museum is seeking ice artists to feature their work at the museum’s first ice sculpture festival, to open in February 2019.

“We are looking for all ice sculptors who would like to participate in this exhibit and showcase their talents,” said Jim Munson, the Vanderbilt’s operations supervisor. “We are looking for live demonstrations as well as ice sculpture displays that will help advertise the artists’ businesses,” he added.

In return for their effort and contribution, participants will receive signage that identifies their business at each sculpting site, recognition on the Vanderbilt website, publicity releases sent to regional media, free advertising for six months on the Vanderbilt Reichert Planetarium dome, a one-year associate membership, which includes free passes to planetarium shows and guided mansion tours and more. 

To secure a spot in this year’s Ice Fest, or to obtain more information, please contact Jim Munson at 631-379-2237 or email jim@vanderbiltmuseum.org.

Photo by Donna Newman

St. James R.C. Church, 429 Route 25A, Setauket invites the community to experience the beauty and wonder of its traditional Neopolitan Nativity scenes, courtesy of Rev. Gerald Cestare, every day through Jan. 13 from 9 a.m. to 9 p.m. (except Christmas Eve/Day and New Year’s Eve). 

Celebrating its 30th anniversary, this year’s display, located once again in the Parish Center, contains thousands of figures, buildings and miniatures; even if you have seen this display in the past, there is always something new! Fr. Jerry invites everyone to share in this wonderful depiction of the true gift of Christmas, a tradition handed down to him from his grandfather. Free event. Call 631-941-4141.

Studies show that walking a modest distance can reduce triglyceride levels. Stock photo
Reducing carbohydrates may be more important than restricting calories

By David Dunaief, M.D.

Dr. David Dunaief

Triglycerides are part of the lipid, or cholesterol, profile. They get less attention than the other substances, HDL (“good”) and LDL (“bad”) cholesterol, but they’re no less significant. 

For 30 years, we have debated whether a high triglyceride level is a biomarker for cardiovascular disease — heart disease and stroke — or an independent risk in its own right (1, 2). Either way, triglycerides are important.

What are they? The most rudimentary explanation is that they are a kind of fat in the blood. They are composed of sugar alcohol and three fatty acids. Thus, it’s no surprise that alcohol, sugars and excess calorie consumption may be converted into triglycerides.

Risk factors for high triglycerides include obesity, smoking, a high carbohydrate diet, uncontrolled diabetes, hypothyroidism (underactive thyroid), cirrhosis (liver disease), excessive alcohol consumption and some medications (3).

What levels are normal? Optimal levels are <100 mg/dL; however, less than 150 mg/dL is considered within normal range. Borderline triglycerides are 150–199 mg/dL, high levels are 200–499 mg/dL, and very high are >500 mg/dL (3).

While medicines that focus on triglycerides, fibrates and niacin can lower them significantly, this reduction may not result in clinical benefits, such as reducing the risk of cardiovascular events. The ACCORD Study, a randomized controlled trial, questioned the effectiveness of medication; when these therapies were added to statins in type 2 diabetes patients, they did not further reduce the risk of cardiovascular disease and events (4). Instead, it seems that lifestyle modifications may be the best way to control triglyceride levels. Let’s look at the evidence.

Exercise — timing and intensity

If you need a reason to exercise, here is a really good one. Study results showed that walking a modest distance with alacrity and light weight training approximately an hour after eating (postprandial) reduced triglyceride levels by 72 percent (5). However, if patients did the same workout prior to eating, postprandial triglycerides were reduced by 25 percent. This is still good, but not as impressive. 

Participants walked a modest distance of just over 1 mile (2 kilometers). This was a small pilot study of 10 young healthy adults for a very short duration. The results are intriguing, nonetheless, since there are few data that give specifics on the optimal amount and timing of exercise.

Exercise trumps calorie restriction

There is good news for those who want to lower triglycerides: Calorie restriction may not be the best answer. Instead, we probably should be looking at exercise and carbohydrate intake.

In a well-controlled trial, results showed that those who walked and maintained 60 percent of their maximum heart rate, which is a modest level, showed an almost one-third reduction in triglycerides compared to the control group (maintain caloric intake and no exercise expenditure) (6). Those who restricted their calorie intake saw no difference compared to the control. This was a small study of 11 young adult women. Thus, calorie restriction was trumped by exercise.

Carbohydrate reduction, not calorie restriction

In addition, when calorie restriction was compared to carbohydrate reduction, results showed that carbohydrate reduction was more effective at lowering triglycerides (7). In this small, but well-designed study, patients with nonalcoholic fatty liver disease were randomized to one of two diets, lower calorie (1200–1500 kcal/day) or lower carbohydrate (20 g/day). Both groups lost similar amounts of weight and significantly reduced triglycerides, but the lower carbohydrate group reduced triglycerides by 55 percent versus 28 percent for the lower calorie group. The reason for this difference may have to do with oxidation in the liver and the body as a whole. However, the weakness of this study was its duration of only two weeks.

Fasting versus nonfasting blood tests

The paradigm has been that, when cholesterol levels are drawn, fasting levels provide a more accurate reading. Except this may not be true.

NHANES III data suggest that nonfasting and fasting levels yield similar results related to all-cause mortality and cardiovascular mortality risk. LDL levels were similarly predictive, regardless of whether a patient had fasted or not. The researchers used 4,299 pairs of fasting and nonfasting cholesterol levels. The duration of follow-up was strong, with a mean of 14 years (8).

With regards to stroke risk assessment, nonfasting triglycerides may be more valuable than fasting. In a study involving 13,596 participants, results showed that as nonfasting triglycerides rose, the risk of stroke also rose significantly (9). Compared to those who had levels below 89 mg/dL (the control), those with 89–176 mg/dL had a 1.3-fold increased risk of cardiovascular events, whereas those within the range of 177–265 mg/dL had a twofold increase, and women in the highest group (>443 mg/dL) had an almost fourfold increase. The results were similar for men, with a threefold increase.

The benefit of nonfasting is that it is more realistic and, according to the authors, also involves remnants of VLDL and chylomicrons, other components of the cholesterol profile that interact with triglycerides and may affect the inner part (endothelium) of the arteries.

What have we learned? Triglycerides need to be discussed. Elevated triglycerides may result in heart disease or stroke. The higher the levels, the more likely there will be increased risk of mortality — both all-cause and cardiovascular. Therefore, we ideally should reduce levels to less than 100 mg/dL.

Lifestyle modifications using carbohydrate restriction and modest levels of exercise after a meal may achieve the best results, though the studies are small and need more research. Nonfasting levels may be as important as fasting levels when it comes to triglycerides and the cholesterol profile as a whole; they potentially give a more realistic view of cardiovascular risk, since we don’t live in a vacuum and fast all day.

References:

(1) Circulation. 2011;123:2292-2333. (2) N Engl J Med. 1980;302:1383–1389. (3) nlm.nih.gov. (4) N Engl J Med. 2010;362:1563-1574. (5) Med Sci Sports Exerc. 2013;45(2):245-252. (6) Med Sci Sports Exerc. 2013;45(3):455-461. (7) Am J Clin Nutr. 2011;93(5):1048-1052. (8) Circulation Online. 2014 July 11. (9) JAMA 2008;300:2142-2152.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.    

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