Lowering Triglycerides - Mayo Clinic

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How to Lower Cholesterol and Triglycerides

Three Parts:

Many people try to lower their cholesterol at some point. To improve your cholesterol, you need to raise your "good" cholesterol (HDL) while lowering your "bad" cholesterol (LDL) and triglycerides. This balance is important because cholesterol is found in the cell membrane of every cell in your body, keeping it flexible. Cholesterol also plays a vital role in making hormones, vitamin D and bile salts, as well as helping digest fat.Triglycerides are a form of fat that you get from food and are used by your body to store energy.While it may be tricky to control the cholesterol your body makes, you can control the cholesterol and triglycerides you get from food. Always consult with your doctor before changing your cholesterol medications or starting any supplements.


Making Diet and Lifestyle Changes

  1. Lose weight.If you're overweight, talk with your doctor about safely losing weight. Your doctor or nutritionist can work with you to create a personalized weight loss plan. Even a small amount of weight loss can help to raise your HDL levels.
  2. Include more complex carbohydrates in your diet.Complex carbohydrates offer more fiber, which can increase your HDL while lowering LDL and triglycerides. Complex carbohydrates also take longer for your body to process, so you'll feel fuller longer. This may help you lose weight as well. To include complex carbohydrates, choose:
    • Beans
    • Legumes
    • Fruit (include the rind): plums, peaches, nectarines, apples
    • Vegetables: artichokes, broccoli, brussels sprouts
    • Oats
    • Barley
    • Millet
    • Quinoa
    • Buckwheat
    • Rye
    • Whole wheat breads and pasta
    • Brown rice
  3. Make good protein choices.Choose lean meat like poultry. Avoid eating the skin which contains a lot of fat and cholesterol which may raise your LDL cholesterol levels. You can also eat wild-caught fish like salmon, cod, haddock, and tuna. These are also good sources of omega-3 fatty acids which can improve your HDL.Don't forget that beans are also a good source of protein which are high in fiber and low in fat. Try to eat one or two servings of beans a day.
    • Avoid red meat because it contains a high amount of cholesterol which can raise your LDL levels.When you do eat red meat, choose grass-fed (not corn-fed) red meat.
    • Eggs are also a good source of protein, but the yolks are high in cholesterol. Choose egg whites or limit whole eggs to one or two a day.
  4. Eat more fruits and vegetables.Not only will this increase your fiber intake, but it will also get more vitamins and minerals into your diet. Aim for a variety of fruits and vegetables. Keep in mind that green leafy vegetables also have high levels of sterols and stanols, which help to improve your cholesterol ratio. Consider including:
    • Leafy green vegetables (mustard, collard, beet, turnip greens, spinach, kale)
    • Okra
    • Eggplant
    • Apples
    • Grapes
    • Citrus fruit
    • Berries
  5. Include soluble fiber sources.Foods containing soluble fiber have been associated with lower LDL. Soluble fiber is a form of fiber that dissolves in water to form a gel that slows digestion.Scientists theorize this form of fiber helps reduce LDL by binding to cholesterol particles in the digestive tract and preventing their absorption.Some food sources of soluble fiber include:
    • Oats
    • Peas
    • Beans
    • Citrus fruit
    • Carrots
    • Barley
  6. Avoid trans fats in your diet.Trans fats are artificially produced fats that raise LDL cholesterol and triglyceride levels. Studies have linked trans fats to increased risk of heart disease, stroke, and type 2 diabetes.To protect yourself from these negative effects, avoid foods that contain trans fats such as:
    • Packaged and processed baked goods such as pies, cookies, and crackers
    • Margarine
    • Nondairy coffee creamer
    • Fried foods like French fries, doughnuts, and fried chicken
    • Refrigerated cookie dough, pizza dough, or biscuit dough
    • Snack chips like tortilla chips and potato chips
    • Luncheon meats, hot dogs, fatty snack foods
  7. Include a moderate amount of monounsaturated fats.It may be tempting to cut out all fat from your diet, but the American Heart Association recommends keeping "good" fats. These monounsaturated fats can lower bad cholesterol and triglycerides. They also have nutrients that improve cell health. To get monounsaturated fats, eat:
    • Olive oil
    • Canola oil
    • Peanut oil
    • Safflower oil
    • Sesame oil
    • Avocados
    • Peanut butter
  8. Exercise regularly.Exercise can increase your HDL levels, so if regular exercise is not already a part of your lifestyle, start an exercise routine. For example, start by walking for 30 minutes a day, five days per week. Make sure that you choose an activity that you will enjoy so that you will be more likely to stick with your program. Some good options include:
    • Walking or jogging
    • Biking
    • Swimming
    • Dancing
    • Using an elliptical walker
    • Practicing martial arts
    • Ice skating or rollerblading
    • Cross country skiing
  9. Quit smoking.Smoking can make it harder to raise your HDL levels, so if you smoke, do your best to quit. You can raise your HDL levels by as much as 10% when you quit smoking.Talk to your doctor to learn about smoking cessation programs in your area.
    • While quitting smoking improves HDL levels, especially in women, it does not lower LDL levels.
  10. Reduce your alcohol intake.If you drink, limit yourself to one drink a day (if you're a woman) or two drinks a day (if you're a man).Drinking in excess can lead to higher risk for high blood pressure, stroke, certain cancers, obesity, accidents, and suicide. Drinking too much alcohol has also been shown to increase triglycerides.
    • Drinking a moderate amount of alcohol has been linked with higher HDL levels, but you should not start drinking alcohol or begin drinking more alcohol as a way to raise your HDL levels.

Taking Medication

  1. Talk with your doctor.Your doctor will probably be the one to suggest lowering your cholesterol and triglycerides if blood tests show your levels are high. Your doctor may recommend combining any number of cholesterol-lowering medications with lifestyle changes.
    • If you're over 20 and haven't been diagnosed with cardiovascular disease, get your cholesterol levels checked every four to six years.If you have been diagnosed with cardiovascular disease, you'll need to have it checked more frequently.
  2. Take statins.Your doctor may prescribe statins which are enzymes (HMG-CoA reductase inhibitors) that effectively lower LDL cholesterol and triglycerides.But, statins also interfere with the formation of other important substances like CoQ10. Ask your doctor about taking a CoQ10 supplement (at least 30 mg/day) while taking the statins.
    • Side effects of statins include headache, nausea, muscle weakness, muscle pain, and increased risk for diabetes.
    • Statins may interact with prescription medications and herbs. Tell your physician about all medications and herbs you are taking.
  3. Take bile-acid sequestrants.These can reduce the absorption of fats and reduce the formation of cholesterol in the liver. Bile-acid sequestrants are most effective at lowering LDL but have little effect on HDL-cholesterol or triglycerides.For this reason, your doctor may prescribe them to be used along with other medications. Talk with your doctor if you have gallbladder disease, phenylketonuria, or are taking medications for your thyroid. You should not use bile-acid sequestrants since they may interfere with your medication.
    • Side effects of bile-acid sequestrants include constipation, gas, nausea, and upset stomach.
  4. Take PCSK9 inhibitors to reduce cholesterol.These inhibitors are antibodies that make up a new class of drugs. They work to prevent the formation of LDL cholesterol by the liver. Since this is a relatively new drug, more studies are needed to determine its safety and effectiveness.
    • Side effects are rare, but they include flu-like symptoms, urinary tract infections, muscle pain or spasms and diarrhea.
  5. Prevent your body from absorbing cholesterol.If you're taking statins, your doctor may also prescribe an inhibitor of dietary cholesterol absorption. When combined, they can lower your LDL cholesterol and reduce your triglyceride level to some degree. Cholesterol absorption inhibitors do this safely without disrupting your body's absorption of other nutrients.
    • Side effects include diarrhea, abdominal pain, back and joint pain
  6. Take fibrates.If statins don't effectively lower your cholesterol and triglycerides, your doctor may prescribe fibrates (like gemfibrozil and fenofibrate). Fibrates primarily reduce triglycerides while increasing HDL cholesterol.You shouldn't take fibrates if you have liver or kidney disease.
    • Side effects include upset stomach, nausea, diarrhea, headaches and muscle aches.

Taking Herbs and Supplements

  1. Use a high-dose of niacin daily.You can purchase an over-the-counter niacin supplement (niacinamide) to lower your triglycerides, lower LDL, and raise HDL. Take a supplement of no more than 1200 to 1500 mg a day or follow your doctor's recommendation. This B vitamin should not be taken if you have liver disease, an active peptic ulcer, or a bleeding disorder.
    • Side effects include hot flashes and nausea, vomiting, liver problems, gout and increased blood sugar levels.
    • Niacin is also available by prescription, which tends to be more effective. Talk to your doctor about getting a prescription niacin supplement.
  2. Take plant sterols.Ask your doctor if you should supplement with plant sterols (beta-sitosterol and gamma oryzanol). These can increase your HDL while lowering LDL.With your doctor's approval, take 1 gram of beta-sitosterol 3 times a day. Or, take 300 mg of gamma oryzanol once a day. Be sure to follow the manufacturer's instructions for use.
    • If you prefer to get plant sterols from your diet, eat seeds nuts, vegetable oils, and foods fortified with sterols (like some orange juices and yogurts).
  3. Include an omega-3 supplement.To lower your LDL and triglycerides while increasing your HDL, take a supplement (if you don't eat omega-3 fish a few times a week). Take two 3,000 mg capsules of combined EPA and DHA (total milligram count of these two fatty acids should not exceed 3,000 milligrams per capsule) every day.
    • To get omega-3 fatty acids from your diet, include salmon, mackerel, sardines, tuna, trout, flaxseed, flaxseed oil, soy products, legumes, walnuts and dark leafy green vegetables.
  4. Try a garlic supplement.Garlic may help more with lowering LDL cholesterol than increasing HDL cholesterol, but it does decrease the cholesterol ratio. Include a garlic supplement to see if this helps to improve your cholesterol ratio. Take 900 mg of garlic powder every day. Make sure that you check with your doctor first because garlic can interact with some medications, such as blood thinners.
    • Garlic supplements have also been shown to lower triglyceride levels.
  5. Consider taking a psyllium supplement.You're probably familiar with psyllium being used as a bulk forming laxative. But, using a daily psyllium husk supplement (in powder, capsule, or biscuit form) can help your body excrete more LDL cholesterol and triglycerides.Take 2 teaspoons of psyllium powder a day and follow the manufacturer's instructions.
    • Psyllium fiber is a soluble fiber and can count towards your daily fiber goal of 25 to 35 grams. 2 teaspoons of psyllium contains about 4 grams of fiber.

Community Q&A

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  • Your HDL level should be 60 mg/dL or higher while your normal triglyceride blood levels should be less than 200 mg/dL.
  • Try to drink eight 8-ounce glasses of water a day. This can help your body eliminate waste. For variety, add lemon, mint or cucumber slices. Remember to carry water with you and drink it throughout the day.
  • Decrease or eliminate sweets and food using white flours from your diet.

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