In his previous post, Dr. Davis explained what triglycerides are and why they are so important. In this blog he will describe different methods for controlling your triglyceride numbers.
Here are the strategies to consider:
- Reduction in processed carbohydrates - Snacks like corn and potato chips, and wheat-flour containing foods like breads, pasta, pretzels, chips, bagels, and breakfast cereals are, by far, the worst culprits. So are soft drinks, candy, and other junk foods. The reduction of high- and moderate-glycemic index foods (foods that trigger rapid surges in blood sugar) is the factor that reduces triglycerides. High triglycerides therefore develop on a low-fat diet, which flies in the face of the dietary advice that has been dispensed for the last 30 years. For this reason, I do not advocate low-fat diets like the Ornish program. Reducing your exposure to wheat-containing snacks and processed foods is an especially useful and easy-to-remember strategy that dramatically reduces triglycerides and VLDL.
- Weight loss to ideal weight or ideal BMI (25). If achieved with a reduction in processed carbohydrates, the effect will be especially significant. Exercise will compound the benefits of weight loss, triggering an even larger drop in triglycerides.
- Elimination of high-fructose corn syrup - This ubiquitous sweetener is found in everything from beer to bread. High-fructose corn syrup causes triglycerides to skyrocket 30% or more.
- Fish oil - Omega-3 fatty acids in fish oil can drop triglycerides like a stone. Many fish oil supplements come as a 1000 mg capsule, providing 180 mg EPA, 120 mg DHA per capsule. We find that 4000 mg fish oil to provide 1200 mg of EPA +DHA per day is a good starting dose; higher doses should be discussed with your physician, though we commonly use 6000-10,000 mg per day (or 1800-3000 mg EPA + DHA) without ill-effect. Flaxseed oil, while beneficial for health, does not correct lipoprotein patterns. You might consider a concentrated fish oil preparation (e.g., LovazaTM, a prescription preparation, or “pharmaceutical grade” preparations from the health food store) if you and your doctor decide a high dose is necessary.
- Niacin (vitamin B3) in doses of 500-1500 mg is an effective method to reduce triglycerides. Niacin also raises HDL, increases large HDL, reduces the number of small LDL particles, reduces VLDL, and modestly reduces total LDL. The preferred forms are over-the-counter Slo-Niacin ® and prescription Niaspan ®, the safest and best tolerated. Immediate-release niacin (just called niacin or nicotinic acid on the label) can also be taken safely, provided it is taken no more frequently than twice per day. Total daily doses of >500 mg niacin should only be taken under medical supervision. Avoid nicotinamide and “no-flush niacin” (inositol hexaniacinate), neither of which have any effect whatsoever.
- Green tea - The catechins (flavonoids) in green tea can reduce triglycerides by 20%. Approximately 600-700 mg of green tea catechins are required for this effect, the equivalent of 6-12 servings of brewed tea. (Tea varies widely in catechin content.) Nutritional supplements are also available that provide green tea catechins at this dose. The weight loss accelerating effect of green tea may add to its triglyceride-reducing power.
- Phosphatidylcholine - This naturally-occurring food substance and nutritional supplement found in egg yolks, lecithin, soy, and corn can reduce triglycerides 10-30% when 2700-3000 mg is taken per day. Phosphatidylcholine is one of an emerging class of interesting substances called phospholipids that are showing promise for correction of triglycerides and raising HDL cholesterol.
The thiazolidinedione prescription drugs (Actos ®, or pioglitazone, and Avandia ®, or rosiglitazone), usually prescribed for pre-diabetes or diabetes, can reduce triglycerides by 30%; Actos ® may be more effective than Avandia ® in this regard. However, these agents are accompanied by weight gain. Avandia ® has also been recently cited as possibly raising risk of heart attack. The fibrate class of prescription drugs (fenofibrate, or Tricor ®, and gemfibrozil, or Lopid ®) reduce triglycerides 30-40%, i.e., almost as effectively as fish oil.
Reduction in triglycerides cascades into multiple “downstream” benefits, including reduced VLDL. Less VLDL means less LDL cholesterol, particularly the dangerous small LDL particles. It also means higher HDL cholesterol. Nutritional efforts to reduce triglycerides, like reduction of snack foods and processed carbohydrates, can also mean more weight loss, less abdominal fat, lower blood sugar, lower blood pressure, reduced inflammatory responses, and just plain feeling better. Imagine that.
Should we regard triglycerides as the most important number on your cholesterol panel?
Perhaps, though HDL and LDL are important in their own ways, too. It certainly should never be ignored.
To find out more about the importance of triglycerides to managing your cholestrol, read this.