At least half of the people I see have high triglycerides. This is because there are very good medications for high cholesterol and LDL levels, but triglycerides do not respond nearly as well to these meds, and so lots of these folks are referred to us. However triglycerides are exquisitely sensitive to a number of lifestyle factors. This is both good and bad. Good in that if the lifestyle changes can be made triglyceride levels can fall a great deal, but bad in that the patient has to make the commitment to change behavior, and to make that changed behavior last a lifetime, and also bad that from the doctor’s point of view prescribing a medicine is easy, but counseling for multiple behavior changes is both time-consuming and complex. So the more that you, the patient, understand about lowering triglycerides the greater the chance that you will be successful, and decrease your risk of heart and vascular disease.
It is also important to understand that high triglycerides are often associated with a number of other conditions that together are referred to as the "metabolic syndrome". In addition to high triglycerides, these include low HDL, diabetes or high risk of diabetes, and high blood pressure. The factors listed below as being important in controlling triglycerides are also important in controlling the other aspects of the metabolic syndrome.
Here are the most important factors:
- Diabetes. Poorly controlled diabetes will often lead to very high triglyceride levels, and controlling diabetes is very important in lowering triglycerides.
- Alcohol. Patients with high triglycerides are often exquisitely sensitive to alcohol and ideally should discontinue alcohol altogether. It is important to understand that one twelve ounce beer is equivalent to one glass of wine or one shot of whiskey. Most people would see having six shots of whiskey every night has too much, but it is remarkable how many are willing to drink six beers every night without thinking twice about it. Not only is this a great deal of alcohol, it is also over 600 calories as even light beer has 110 calories per 12 ounces.
- Weight reduction and exercise. Both very important if you are overweight. Even modest weight loss in the five to ten pound category improves triglycerides, and also reduces blood pressure and risk of diabetes. The appropriate diet is low in simple sugars (that is sugar, cookies, cakes and pastries, and ordinary white bread), high in fiber and complex (whole-grain) carbohydrates, low in saturated fat but not low in total fat (canola oil and olive oil are fine) and high in omega-3 fatty acids, both as fish and as supplements. Very few of us are aware of either how much sugar is in the juices and sodas we drink (a 12 ounce Coke has 8 teaspoons of sugar) or how much saturated fat is in beverages such as coffee (a medium light from Dunkin doughnuts contains one quarter cup of cream!). Seeing a dietitian is extraordinarily helpful in making these changes as diet can be complicated. Much more information is also available at the related website of our Center for Applied Nutrition, at http://www.umassmed.edu/can/index.aspx
- Flax oil is an omega-3 supplement that is very useful for lowering triglycerides. Flax oil is the vegetarian form of omega-3 fatty acids, and is often easier to take than fish oil. For lowering high triglycerides it takes a fairly large amount of omega-3 fatty acids, and we usually recommend one to two tablespoons of the oil daily, generally taken before the evening meal. It is available from health food stores and from Trader Joe's and must be kept refrigerated. One tablespoon is the equivalent of 12 capsules! Flax oil can lower triglycerides as much as 50%.