Triglycerides
Triglycerides
9 Ways to Lower Blood Fats
Triglycerides, along with cholesterol, are the major sources of fat circulating in your blood. Both are needed—cholesterol for building strong cells, triglycerides for energy—but when either remains at high levels for long periods of time, trouble results.
In the case of cholesterol, that trouble is clogged arteries. In the case of triglycerides, however, the trouble is not well-defined. "If you get very technical, it's probably safe to say that triglycerides are not independently important in heart disease," says John LaRosa, M.D., director of the Lipid Research Clinic at George Washington University School of Medicine and chairman of the American Heart Association's Nutrition Committee.
"But in practical terms," he continues, "high triglycerides are often associated with low levels of HDL cholesterol (the good cholesterol) and indicate a problem that's causing you to carry fat particles in the blood that do cause vascular disease. So they should be looked at as a danger signal."
Normal triglyceride levels can run from 40 to 250 milligrams per deciliter (mg/dl), a fairly broad range. Generally, levels of 250 mg/dl to 500 mg/dl are considered "borderline elevated," while levels over 500 mg/dl are considered "high." The safest best is to keep your triglyceride levels below 150.
Keep in mind that triglycerides can be controlled in many of the same ways as cholesterol. To improve one is to improve the other. If your doctor has warned you to lower your triglyceride levels, fine—these tips will help. If he's told you to lower your LDL cholesterol (the bad stuff), fine—these tips can't hurt. It's one of those rare situations where you just can't lose either way, as long as you follow the tips.
Cut the fat. "Diet is the best way to reduce triglycerides," says Robert DiBianco, M.D., associate clinical professor of medicine at Georgetown University and director of cardiology research at Washington Adventist Hospital in Takoma Park, Maryland.
His recommendation for reducing triglyceride levels is to cut back on fat in the diet. "The lower the better when it comes to fat," he says. Reducing fat intake to less than 30 percent of daily calories is a good start, although "shooting for 20 percent would be an ideal range," Dr. DiBianco says. "And keep saturated fats at less than 10 percent."
The Alternate Route
When Nothing but Rice Is Nice Even its developer called it disagreeable medicine. In fact, said Walter Kempner, M.D., there's only one excuse for ever using it. "It helps." The year was 1944, and the disagreeable medicine Dr. Kempner was speaking of was the rice diet he'd just discovered. Some of his most critically ill patients had apparently been cured by eating a diet of almost nothing but rice and fruit. Forms of that diet are still in use today, and some call it a forerunner of the healthy-for-your-heart Pritikin Diet, among others. In some places, the rice/fruit diet is still being recommended for its ability to reduce fats from the blood and lower body weight. "We use the rice/fruit diet in people with really high triglyceride levels to clear them out," says Sonja Connor, M.S., R.D. "It also helps them with weight loss, because it's practically fat-free. "People don't have much of a tolerance for it," she adds. Yet some people can apparently tolerate a steady diet of rice and fruit long enough to have an effect. "We had a patient recently who went from blood triglyceride levels of 1,000 mg/dl down to 117 mg/dl in a couple of months," says Connor. "And she went out and did this herself using that diet—we didn't have to supervise her at all." But, Connor notes, "she wasn't the typical patient." A diet this extreme should never be attempted without the approval of your doctor, however. And most doctors are not crazy about recommending it. How long must you subsist on rice and fruit to see results? "Not long at all," Connor says. "You start getting results on this diet right away—two or three days. If we can motivate people to get rid of all fats from their diets on a short-term basis," she explains, "we could help eradicate the problem and they could start adding some fats back in." |
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Go in stages. One way to reduce fats to that low 20 percent level is to proceed in stages. For example, reduce your fat intake to 30 percent of calories for one month (current American levels are about 40 percent). Then return to your doctor to see if there's been an improvement in your triglyceride level. If so, he'll probably congratulate you and ask you to stay on this diet. If not, reduce your fat intake to 25 percent for one month and see what happens.
If you see no improvement at that level, lower your fat intake to 20 percent for two months. This fat level virtually ensures that you'll be getting a good portion of your calories from complex carbohydrates, and that should bring about a reduction.
Make carbohydrates complex. Populations who eat diets high in complex carbohydrates just don't have a triglyceride problem. "Substitute complex carbohydrates for fats whenever possible," advises Sonja Connor, M.S., R.D., a research associate professor of clinical nutrition at Oregon Health Sciences University. But beware of adding fat back in with traditional cooking habits. "The recipes most people have for [complex carbohydrates such as] pasta, rice, beans, and other grains force you to cook them in the company of large amounts of fat."
What you'll need to do, she says, is search out recipes for lasagna and pasta salads, scalloped potatoes, and other high-carbohydrate meals that are also low in fat. "That's the hardest thing to work on," Connor says. "There are relatively few recipes for high-carbohydrate, low-fat dishes that don't make you end up eating nothing more than plain spaghetti without any sauce." Is it worth the effort to find and prepare such dishes? "You bet," she says.
Cut the candy. "Simple carbohydrates—candy, sugar, and other sweets—are a major contributor to high triglyceride levels," says Dr. DiBianco. He recommends forgetting about sweets.
Dr. LaRosa agrees. "Low-fiber, simple carbohydrates are probably the biggest offenders of all," he says. "There's no question that simple carbohydrates are a problem."
Trim down. "Weight loss is very important," says Dr. DiBianco. "The amount of weight that needs to be lost depends on your ideal body weight, but you don't need to lose all your excess weight to see a change in triglycerides."
Just 10 pounds can bring about a reduction in people who are 20 to 30 percent overweight. Though you don't have to reach your perfect weight to bring down triglycerides, "you should try to maintain a weight that's not more than 5 or 10 percent above the ideal," Dr. DiBianco says.
Burn it off. "Exercise lowers triglyceride levels," says Dr. LaRosa. "Though it's hard to tell whether it's a result of weight loss or better metabolism; but it could be both."
The reason for such uncertainty about how exercise helps reduce triglyceride levels stems from studies showing that 1 hour of vigorous exercise three times a week can lower triglyceride levels even when weight doesn't change.
But regardless of how it produces results, exercise does work in reducing triglycerides and is highly recommended by all our experts. Check with your doctor before starting any exercise program, however.
Avoid alcohol. "I think alcohol intake is the biggest aggravator of high triglyceride levels going," says Dr. DiBianco. "Avoiding even small doses of alcohol is important."
Fix it with fish. "It's been pretty well documented that fish oil has its most marked effect on triglycerides," says Carl Hock, Ph.D., an assistant professor of medicine at the University of Medicine and Dentistry of New Jersey, New Jersey School of Osteopathic Medicine.
Several studies have demonstrated the triglyceride-lowering abilities of omega-3 fatty acids, the type found in fish oil. Though most studies use fish oil capsules to ensure accuracy, you can get an equivalent amount by eating fish regularly, or by combining a high-fish diet with occasional use of capsules.
Most studies have used about 15 grams of fish oil a day, equivalent to an 8-ounce serving of salmon, herring, or mackerel. Newer studies, however, have produced the same results with 10 grams per day.
"You can get enough fish in the diet to bring triglycerides down," says Dr. DiBianco. "In fact, the fish oils seem to be most beneficial in those patients who are lacking it in their diets from a regular intake of fish. If somebody's eating fish as a part of his regular diet, he should be okay."
PANEL OF ADVISERS
Sonja Connor, M.S., R.D., is a research associate professor of clinical nutrition at Oregon Health Sciences University School of Medicine in Portland and coauthor of The New American Diet.
Robert DiBianco, M.D., is associate clinical professor of medicine at Georgetown University in Washington, D.C., and director of the cardiac risk factor reduction program and cardiology research at Washington Adventist Hospital in Takoma Park, Maryland.
Carl Hock, Ph.D., is an assistant professor of medicine at the University of Medicine and Dentistry of New Jersey, New Jersey School of Osteopathic Medicine in Camden.
John LaRosa, M.D., is director of the Lipid Research Center at George Washington University School of Medicine in Washington, D.C., and chairman of the American Heart Association's Nutrition Committee.
