26.2.2017 HowCanILowerMyTriglycerides?

NutritionStudies

How Can I Lower My Triglycerides?

August 1, 2013
ByThomasCampbell,MD(http://nutritionstudies.org/author/tcampbell/)

Q: I am a healthy weight and recently changed my diet to a vegan

diet. Since then, my doctor has told me that my triglycerides are
high: they are 215. Why are they high? What can I do, and is it
important for me to improve these numbers?
A:Whenyougotoadoctorandgetyourfastingcholesteroltestresults,itcanbeanexerciseinconfusion.Youwillgetnumbers
foryourtotalcholesterol,LDLcholesterol(orunhealthycholesterol),HDLcholesterol(orhealthycholesterol),and
triglycerides.Currently,themajoremphasisintreatingabnormalcholesterolresultsisingettingLDLcholesterolbelowacertain
goallevelbutyoumayalsogetadvicetokeepyourHDLhighandyourtriglycerideslow.Ifyourfastingtriglyceridesareabove
150,butbelow500,itprobablyisnotuncommontoleavethedoctorsofficewithmorequestionsthananswers,asthiscanbea
grayzone.

Whydowecareabouttriglycerides?Triglyceridesmatterbecausetheyareaharbingerofcardiovasculardisease. [ 1] Whilepeople
withhighertriglycerideshaveahigherriskofcardiovasculardisease,itcanbetrickytoknowwhetherthetriglycerides
themselvesarethetruecauseoftheincreasedrisk.Thisisbecausehightriglyceridesoftenoccurinconjunctionwithahostof
otherabnormalities,includinghighbloodsugar,lowHDL(healthy)cholesterol,obesity,diabetes,andhighbloodpressure [ 1] .
Inaddition,specifictypesofcholesterolsandfatsinthebloodstreamarelikelytobedifferentinqualitativeways.LDLparticles
(theunhealthycholesterol)arelikelytobesmalleranddenser [ 2] ,whichisevenmoredangerousthannormalLDLparticles.As
youcantell,thelinksbetweendifferentcholesterolandfatfractionsgetcomplicatedquickly,anditbecomesdifficultto
disentanglewhichfactorcauseswhat.Theonethingwecanagreeonisthathightriglyceridesarelinkedtoincreasedriskof
cardiovasculardisease.

Thereisasignificantrangeoftriglycerideresults.Mostconsensuspanelshavecreatedacategorizationsimilartothefollowing
breakdown:

Table 1: Triglyceride Ranges

TRIGLYCERIDE CLASSIFICATION TRIGLYCERIDE LEVELS

Normal Below 150

Borderline 150 to 200

High 200 to 500

Very High 500 to 1000

Severe Above 1000

Hightriglyceridescanbecausedbyavarietyofnonlifestylerelatedfactors:(1)inheritedgeneticproblems,includingfamilial
combinedhyperlipidemia,familialhypoalphalipoproteinemia,andmonogenicfamilialhypertriglyceridemia(Iknowtheyrea
mouthful),eachofwhichaffectabout1%ofthepopulation [ 2] ,(2)thyroidproblems,(3)seriouskidneydisease,(4)pregnancy,
and(5)medications.MedicationsarelistedinTable2.

Table 2: Partial List of Medications that can Raise Triglycerides [ 2]

MEDICATIONS

Estrogens (oral contraceptives) [ 3]

Some types of blood pressure lowering medications (thiazide diuretics and beta-blockers)

Glucocorticoids (steroids like prednisone)

Androgens (testosterone)

Acne medicines (isotretinoin)

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26.2.2017 HowCanILowerMyTriglycerides?NutritionStudies

MEDICATIONS

Immune System Medications (cyclosporine, tacrolimus)

Intermsoflifestyle,diet,drink,andexerciseallplayaroleintriglyceridelevels.Onerecentreview [ 4] statesthatthosepeople
eatingplantbaseddiets,overthelongterm,consistentlyhavelowertriglyceridelevels,butinterventionaltrialshavebeenless
consistent.Randomizedcontroltrialsshowthattriglyceridesmayeitherincreaseordecreasewhenswitchingtoaplantbased
dietmosttrialsreviewedshowthattriglycerideseithergoupordownbylessthanroughly25ineitherdirection [ 4] .Inaddition,
excessivealcoholintake,aswellasasedentarylifestyle [ 5] ,canraisetriglycerides.

Sowhatdowedoaboutahightriglyceridelevel?Whenitcomestomedicationstherecommendationscanbeabitfuzzy.Thereis
nogreatevidencethatdrivingdownmildtomoderatetriglyceridelevels,withmedicationsspecificallytargetedattriglyceride
levels,significantlyimprovescardiovasculardiseaserisks [ 6] .Inthecontextofrelativelynormalcholesterolresults,thestandard
treatmentofborderlinetomildhypertriglyceridemiaislifestylechanges,ifthereisnootherobviouscause(medications,etc).
Asanaside,thosepeoplewithveryhighorsevererangetriglyceridesmaybeatincreasedriskofpancreatitis,andprescribing
medicationtospecificallylowertriglyceridesinthiscaseisoftenindicated.

Lifestylechangescanmakeasignificantimpactinloweringtriglycerides.Moderatetohighintensityaerobicexercisecanlower
triglyceridesbyupto1020% [ 5] .Reducedalcoholintakemayimprovetriglyceridesaswell,especiallyifthereisanissuewith
excessiveintakeorindividualpredispositiontohightriglycerides [ 5] .Intermsofdiet,thestandardrecommendationformildly
elevatedtriglyceridesistoreducerefinedcarbohydrateintake,particularlysugars.Fruitjuice,refinedflour,sweets,andany
plantthathasthefiberremovedshouldbeofflimits.Anotherwaytoconsiderthisistotrytoeatlowglycemicindexfoods(foods
thatdontraisebloodsugarashighorquicklyasotherfoods) [ 6] [ 7] butsolelyfocusingonglycemicindexhasnotalwaysbeen
showntomakeasignificantdifferenceintriglycerides [ 8] .Thosewithveryhightriglyceridesshouldalsomonitorallfatintake
andbeverycarefulnottoconsumeanyaddedfat [ 6] .Afrequentlyaskedrelatedquestioninvolveswhetherpeopleshouldbe
boostingomega3fats,commonlyassociatedwithfishconsumption.TheshortansweristhatIdonotrecommendfishoilor
omega3supplementsformildtomoderatelyhightriglycerides.

Insummary,despitethelongexplanation,therecommendationsremainthesame:limitorreducealcoholuse,incorporate
exerciseregularly,consumeahighfiber,wholefood,plantbaseddietwithoutaddedfats,andavoidwhiteflours,addedsugars,
andjuices.Goodluck!

AspecialthankyoutoTomi,whoposedthisquestiontousontheT.ColinCampbellCenterforNutritionStudiesFacebookpage
(https://www.facebook.com/nutritionstudies).

References
1. Graham I, Cooney MT, Bradley D, Dudina A, Reiner Z. Dyslipidemias in the prevention of cardiovascular disease: risks and causality. Curr Cardiol Rep 2012;14:709-20.
2. Brunzell JD. Clinical practice. Hypertriglyceridemia. The New England journal of medicine 2007;357:1009-17.
3. Spero L, DeCherney A. Evaluation of a new generation of oral contraceptives. The Advisory Board for the New Progestins. Obstet Gynecol 1993;81:1034-47.
4. Ferdowsian HR, Barnard ND. Eects of plant-based diets on plasma lipids. Am J Cardiol 2009;104:947-56.
5. Chapman MJ, Ginsberg HN, Amarenco P, et al. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease:
evidence and guidance for management. Eur Heart J 2011;32:1345-61.
6. Rosenson R. Approach to the patient with hypertriglyceridemia. In: UpToDate. Philadelphia, PA: Wolters Kluwer Health.
7. Jenkins DJ, Wolever TM, Kalmusky J, et al. Low-glycemic index diet in hyperlipidemia: use of traditional starchy foods. The American journal of clinical nutrition
1987;46:66-71.
8. Go LM, Cowland DE, Hooper L, Frost GS. Low glycaemic index diets and blood lipids: a systematic review and meta-analysis of randomised controlled trials. Nutr Metab
Cardiovasc Dis 2013;23:1-10.

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