As health consumers, we are constantly becoming more educated about all the factors that control our heart health. It is part of what I like to call “Informed, Self-directed Healthcare” (ISH).

If you have heart disease, you have no doubt had your cholesterol tested numerous times. The standard “Friedewald test” or “lipid panel” as it has come to be known provides three critical measures of your blood lipids:

  1. LDL cholesterol: This is the “bad” cholesterol that promotes heart disease.
  2. HDL cholesterol: This is the so-called “good cholesterol” as it is thought to actually remove LDL cholesterol from your arteries.
  3. Triglycerides: This is a form of “blood fat” that also helps contribute to heart disease.

It is a little known fact that the standard Fiedewald lipid panel does not directly measure your LDL cholesterol. Rather, it uses triglycerides as part of an equation that crudely calculates your LDL cholesterol. That calculation can be off by as much as 50 percent, and if your triglycerides are too high (over 400 mg/dL), the calculation is considered invalid.

Your doctor has no doubt discussed your LDL cholesterol with you and the need to keep it low (optimum levels are now set at below 100 mg/dL for healthy persons and below 70 mg/dL for those with known heart disease). The more informed doctors are also advising patients that their HDL levels be no lower than 40 mg/dL for men and 50 mg/dL for women and that the ratio between the two (LDL to HDL) should ideally be two or less.

But what about triglycerides?

Has your doctor even mentioned them to you or provided counseling on how to lower them if they are high? Triglycerides are an independent risk factor in the development of coronary artery disease, even at levels previously thought to be normal (below 150 mg/dL). This can be true even among those with normal cholesterol values.

So where do triglycerides come from? Your liver produces a particle called “very low-density lipoprotein” (VLDL) which is loaded with triglycerides.The higher your triglycerides, the more VLDL you have. Often, triglycerides are increased simply due to genetic factors. These genetic factors can cause triglycerides to exceed several thousand mg/dL. More common causes for high triglycerides include excess weight, high-carbohydrates diets, and having diabetes or even prediabetes.

When the VLDL particles come into contact with cholesterol particles (both LDL and HDL), the triglycerides in the VLDL are transferred into the LDL and HDL particles and they literally “fill up” with triglycerides. The triglyceride-filled LDL and HDL particles are targeted by enzymes in the blood and liver that chemically “squeeze” these particles into smaller LDL and HDL particles. The smaller LDL particles more easily penetrate the arterial wall and the smaller HDL particles are less effective at removing cholesterol, thereby accelerating the formation of dangerous plaques. Recall that it is the rupture of even small arterial plaques that trigger heart attacks. Triglycerides are the culprit that help drive this deadly transformation. This process begins to pick up speed when triglycerides exceed 45 mg/dl and can shift into “high-gear” when they exceed 100 mg/dL.

It is crucial that you (and your doctor) pay close attention to triglycerides if you want to significantly reduce your risk of heart attack.

Here are 10 steps you can take, including things you SHOULD NOT do, to lower your triglycerides.

1. Lose weight

Yes, lowering triglycerides is yet another benefit of weight loss. Talk to your doctor about achieving a body mass index (BMI) of under 25.

2. Exercise

Exercise will accelerate weight loss and promote other beneficial full-body benefits that will further reduce triglycerides. Your doctor should recommend an appropriate exercise regimen based on your current health status.

  • 3. Fish oil

    The omega-3 fatty acids in fish oil are extremely effective at reducing triglycerides. Discuss taking a fish oil supplement with your doctor. Typical doses of around 1000 mg of the active ingredients EPA and DHA are often recommended (note that a typical fish oil capsule is not 100 percent active ingredients, so you have to read the label to determine how many capsules you need to take). A high-concentration prescription form of fish oil called “Lovaza” is available but is rather expensive compared to what you can easily find in a local supplement store or supermarket.

    4. Go low carb

    Substantially reduce or eliminate wheat-based foods like breads, pasta, pretzels, chips, bagels, and breakfast cereals as well as starchy foods like white and brown rice and potatoes. Reducing the high glycemic index effect of these foods is the factor that reduces triglycerides. 

    5. Eliminate high-fructose corn syrup

    This particularly nasty food product is unfortunately found almost universally as a sweetener in everything from soda to beer and even bread. High-fructose corn syrup is a high glycemic index product that can cause triglycerides to skyrocket 30 percent or more.

    6. Niacin

    This natural supplement in doses of 500 to1500 mg is very effective in reducing triglycerides but should only be taken at the advice and under the care and supervision of your physician. Niacin will also raise your HDL cholesterol and lower your LDL cholesterol. The main problem some people experience with taking niacin is a hot, itchy flush that usually subsides after a few days or weeks. Taking a time-released form also helps (there are both over-the-counter as well as prescription products your doctor can discuss with you). Despite their heavy advertising, stay away from nicotinamide and “no-flush niacin” (inositol hexaniacinate), as neither of these are effective.

    7. Green tea

    It seems that green tea is good for so many things, and that includes addressing high triglycerides. The catechin flavonoids in green tea can reduce triglycerides by up to 20 percent. The catch is you need to be a BIG tea drinker to benefit as about 600 to 700 mg of green tea catechins are required to achieve the triglyceride lowering effect (the equivalent of six to 12 cups per day since the catechin content of tea varies greatly). Alternately, nutritional supplements are available that provide green tea catechins in a more concentrated form.

    8. Beware of thiazolidinediones

    This class of drugs was once routinely prescribed for diabetes treatment and to reduce triglycerides. Actos® (pioglitazone) and Avandia® (rosiglitazone) are the most popular examples of these drugs. Rosiglitazone has been implicated in promoting heart disease and there is concern that pioglitazone may exhibit the same effect. Make certain to discuss these concerns with your doctor if you are on this drug or considering it..

    9. Fibrates

    Fibrates (e.g. Ticor® or fenofibrate) are another class of prescription drugs you can discuss with your doctor to reduce triglycerides up to 40 percent. Fibrates will also modestly raise your HDL cholesterol.

    10. Avoid saturated and trans-fats

    While the good fats such as omega-3s can lower triglycerides, the “bad” fats will raise them.

    BONUS STEP: Avoid alcohol

    All forms of alcohol can increase triglycerides in persons who are sensitive to alcohol. It may not be easy, but alcohol avoidance may be one more thing to try if your triglycerides stubbornly refuse to go down!

    There you have it, another blueprint for following a path of Informed, Self-directed Healthcare. Be certain to bring up the subject of your triglyceride level with your doctor the next time you see him or her and discuss the simple steps above for lowering it. It is one more, and often neglected way, to take control over your heart disease.