The Best Ways to Lower Triglycerides
Getting your triglycerides back into a healthy range often requires a one-two punch: healthier habits plus medication. We'll walk you through your options. by Lambeth Hochwald Health Writer
It’s easy to panic if your doctor tells you that your triglycerides are trending high. And if they're above 150 mg/dL (fasting), you certainly have company: About one third of U.S. adults are dealing with high tri's too.
The reasons doctors start to worry when triglycerides, which are a type of blood fat, inch their way up: The extra fat can begin to deposit along artery walls, contributing to an increased risk profile for heart disease and stroke (along with abnormal HDL, LDL, and diabetes which often occur in people with high TGs. Also concerning? High triglycerides can interfere with your production of good cholesterol (HDL), while prompting bad cholesterol (LDL) to convert to a form that damages your arteries. Extra-high triglycerides can also lead to inflammation of the pancreas, a gland responsible, among other things, for secreting digestive enzymes such as insulin.
So yeah: Having high triglycerides isn't great for your body. But there is one really important thing to remember: There's a ton you can do to get them back into a healthier range (anything below 100 mg/dL is optimal), starting with these strategies.
#1: Find a Workout You Can Stick With
When you get your heart pumping, your muscles tap some of your triglycerides for energy—which is a good thing! In fact, the more you move, the greater the effect. Walking fast, climbing stairs, bicycling, it almost doesn’t matter what it is. It’s impossible to put a number to just how much exercise you need to reduce triglycerides, but a smart approach is to aim for some kind of moderately intense exercise for at least 2.5 hours each week, says the American Heart Association.
What's also great? You don’t need to shed weight to get the triglyceride-lowering magic going. All movement helps. Some of the assist is unrelated to triglycerides specifically, but good for cholesterol levels overall. For example, exercise helps increase levels of HDL cholesterol, which helps sweep away the plaque buildup that can harden in your arteries. (Quick aside: Triglycerides and cholesterol are both types of blood fat, but they're not the same. The body burns triglycerides for fuel; it uses cholesterol to build cells and produce certain hormones.)
Is it any surprise that in a Stanford University study, the cholesterol levels of middle-age male runners were significantly lower (triglycerides included) than that of peers who didn’t move their bodies much? The runners’ HDL cholesterol levels were higher, too.
This is all fine and good, you think. But how are you actually going to stick with it? The trick isn't really a trick at all: It's just about finding an exercise routine you actually like. As you explore what that might be, focus on making little changes like walking up the stairs instead of taking the elevator, or parking in the farthest spot from the entrance to your local mall.
“I strongly believe that you don’t have to run, play racquetball, or follow an intensive interval-training regimen [to lower triglycerides],” says Stephen Sinatra, M.D., a board-certified cardiologist in Manchester, CT, and founder of the HeartMD Institute. “I prefer to suggest that people walk the dog, go ballroom dancing, or swim,” he adds. “I like to suggest forms of exercise where you get some training effect [without] the intensive start/stop—what I call aggressive forms of accelerating the heart.”
#2: Clean Up Your Diet
You know what this is about: Limit foods that are rich in saturated fat, refined carbohydrates, and trans fats, and your tri's will likely respond in kind. Avoiding sugary snacks and baked goods can help, too, by keeping your blood sugar levels more even, says Robert Greenfield, M.D., medical director of non-invasive cardiology and cardiac rehabilitation at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA. “In fact, uncontrolled blood sugar is a major factor in causing high triglycerides.”
When your glucose levels are high, your body reponds by converting some of that sugar into fat (yep, in the form of tri's) that it can use later. The American Heart Association recommends having no more than 6 ounces of sweet drinks (lemonade, juice, coffees) a day, and no more than 6 teaspoons (24 g) of added sugar a day for women, and no more than 9 teaspoons (36 g) for men.
For actual meals, swap a few dinners of red meat for fatty fish such as salmon, herring, mackerel, and albacore tuna, says On Chen, M.D., an interventional cardiologist at Stony Brook Medicine in Commack, NY. They're all rich in omega-3 fatty acids, which fight inflammation and high tri's, too. The AHA suggests aiming for at least three servings of fish a week if you're above that 150 cut-off.
Also find foods that are rich in fiber—especially soluble fiber, such as oats, brown rice, fruits (apples, plums, blueberries), vegetables (carrots, corn), barley, and legumes. Soluble fiber helps move fat out of the intestines before it can be absorbed.
Demote starchy foods like pasta and rice to side dishes instead of the main event. The body breaks them down into sugar, which can in turn be processed into tri's when you eat a lot of them.
Need a snack? Reach for small servings of foods packed with healthy unsaturated fats, such as avocado, olives, nuts, and seeds. You'll avoid a blood-sugar spike and satisfy hunger pangs.
Smart diet changes like these has an added benefit: You may drop a few lbs, too.
#3: Ask About Fish Oil Supplements
As important as exericse and diet are to heart health, treating high triglycerides usually requires an extra punch. And that's where omega-3 fish-oil supplements often come in.
Dr. Greenfield recommends looking for fish-oil formulations that are ‘purified’ and contain both key types of omega-3s, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), for lowering triglycerides.
After checking with your doctor, Dr. Greenfield and others recommend taking 2 to 4 grams of EPA/DHA per day to lower high triglycerides. Since dietary supplements aren’t regulated in the U.S., look for the USP Dietary Supplement Verification seal so that you can be more confident that you’re getting what it says on the label.
It’s also a good idea to take them with food, and spread out through the course of the day, to avoid side effects such as nausea and burping up a fishy taste.
“Fish oil dietary supplements have an excellent track record thus far and have health maintenance benefits for the typical person who doesn’t eat oily fish regularly,” explains Ann C. Skulas-Ray, Ph.D., assistant professor in the department of nutritional sciences at The University of Arizona College of Agriculture and Life Sciences in Tucson, AZ.
She notes, however, that the surest bet for getting a consistent dose of fish oil is a prescription formulation. These are “tightly regulated by the FDA for consistency... and less likely to result in a patient getting the wrong dose of EPA and DHA,” she says. Dr. Suklas-Ray is the writing group chair for the AHA’s science advisory board on prescription omega-3 fatty acids for lowering triglycerides.
#4: Ask Your Doctor about New Triglyceride-Lowering Medications
Speaking of those prescription fish-oil formulations: Doctors now turn to these meds for people with stubborn triglyceride levels over 500 mg/dL. (The FDA OK’s them only for people with these high levels, actually.) Non-prescription fish oil formulations are also an option.
Studies indicate the prescription fish oils can lower triglycerides by 50% or more, though the dose you take and the level of your triglycerides when you start will make a difference. Options include Lovaza (omega-3-acid ethyl esthers), which contains EPA and DHA. A drawback to this formulation is that it can raise LDL cholesterol.
Another prescription fish oil, Vascepa (icosapent ethyl), is pure EPA and doesn’t carry this same LDL-elevating risk. In a recent study, the formula was found to cut the risk of death due to cardiovascular causes, heart attack, and stroke by 25% with high (4g) daily doses.
Also in the medicine bag for high triglycerides: A class of acids known as fibrates. Fibrates such as Lopid (gemfibrozil) and Antara or Fenoglide (fenofibrate), which can be effective in lowering high triglycerides, also tend to raise HDL levels by 10% to 15%.
Which direction should you turn? “Whether to begin taking these medications is a discussion you should have with your healthcare provider,” says Dr. Chen.