Q: My triglyceride level is 205 mg/dL, which my doctor says is
slightly high. What can I do to lower it?
By the Faculty of Harvard Medical School
Q: My triglyceride level is 205 mg/dL, which my doctor says is slightly high. What can I do to lower it?
A: Triglycerides are a type of fat found in food and made by the body. Our bodies need triglycerides for energy. As with LDL (“bad”) cholesterol, too much is bad for the arteries and the heart. But knowing when to treat high triglycerides – and even whether to test them in the first place – isn’t as clear cut as it is for cholesterol.
An extremely high triglyceride level – 1,000 mg/dL or more – spells trouble, because it can lead to inflammation of the pancreas. But what about levels that aren’t that high but are still above normal? Experts are not sure. The U.S. Preventive Services Task Force says there’s not enough evidence to recommend routine triglyceride screening. The federal government’s National Cholesterol Education Program said they should be given “increased weight” in cholesterol management and set cutoffs for normal, borderline, high, and very high levels (see graphic).
If you have had any fatty food to eat or drink for 12 to 14 hours before a blood test, your level of triglycerides may come back high. So your result – 205 – is high only if you had been fasting before the blood test. These days, doctors often test the different types of cholesterol and triglycerides at the same time. That’s why you should avoid eating or drinking anything with fat in it (like coffee with cream) for 12 to 14 hours before your blood test.
One reason doctors are paying more attention to triglyceride levels lately is that an elevated triglyceride level is one of the telltale signs of metabolic syndrome. A syndrome is, by definition, a group of signs and symptoms that occur together because of an underlying condition. For metabolic syndrome, that group includes a large waistline, high blood pressure, high blood sugar, and low HDL (“good”) cholesterol, in addition to high triglyceride levels. People with metabolic syndrome (also known as insulin-resistance syndrome or syndrome X) are several times more likely to have a heart attack or stroke. And their risk of developing diabetes is even greater.
So how can you lower you triglyceride level? Many of the steps you should take are the same ones you should take to protect your heart and health overall. If you’re overweight, shed a few pounds. Get regular aerobic exercise (the kind that increases your heart rate). Avoid the saturated fats in meat and dairy products, and the trans fats in stick margarine, cookies and many snack foods.
Alcohol is a dilemma. Research shows that moderate amounts are good for your heart, but for many people, even moderate drinking ramps up triglyceride levels. And diet? High-carb/low-fat eating will increase your triglycerides and lower your HDL.
If you’re taking a statin to lower your LDL (“bad”) cholesterol, one side benefit may be reduced triglyceride levels. Depending on the dose, statins can lower triglycerides by 20 percent to 40 percent.
Niacin (sometimes called nicotinic acid), one of the B vitamins, is a “threefer:” It cuts LDL cholesterol a little, increases HDL (“good”) cholesterol a lot, and also lowers triglycerides. Some people are bothered by skin redness and flushing when they take niacin. Slow-release formulations may help with that problem. You can also try popping an 81-mg aspirin before you take niacin.
Fibrates, which include gemfibrozil (Lopid) and fenofibrate (Tricor), are an alternative to niacin. They reduce triglycerides by as much as 60 percent while raising HDL by up to 25 percent. The drawback: They may increase LDL levels. Sometimes people will be prescribed a statin to offset that problem, but be careful. The statin-fibrate combination can lead to muscle pain and weakness, which in extreme cases can be life threatening.
Finally, the omega-3 fats in fish and fish oil capsules are another triglyceride-lowering option. In studies, people taking 3 grams of fish oil daily have reduced their triglycerides by 30 percent.
Submit questions to the Harvard Medical School Adviser at www.health.harvard.edu/adviser. Unfortunately, personal responses are not possible.
