How to Lower Triglycerides & LDL Cholesterol
Cholesterol Level Targets
The tests that check your total cholesterol and other blood lipids (fats) is a fasting lipid profile. According to American Diabetes Association Standards of Medical Care for Diabetes—2013 most adults with diabetes should have this test once every year. A lipid profile measures the following three items, plus total cholesterol:
1. low-density lipoproteins, known as LDL (bad) cholesterol
2. high-density lipoproteins, known as HDL (good) cholesterol
3. triglycerides, a fat that primarily comes from food
1. LDL (Bad) Cholesterol
Target: Below 100 mg/dl*
High levels of LDL (above 160 mg/dl) can result in plaque buildup, increasing the risk of atherosclerosis, or hardening of the arteries, which can lead to heart attack or stroke. Getting your LDL to goal level is priority No. 1 to prevent or delay cardiovascular disease.
*Note: For individuals with cardiovascular disease, a lower LDL cholesterol goal of below 70 mg/dl, which typically requires a statin medication, is recommended by the American Diabetes Association (ADA).
2. HDL (Good) Cholesterol
Target for men: Greater than 40 mg/dl
Target for women: Greater than 50 mg/dl
Target: Below 150 mg/dl
People with prediabetes and type 2 diabetes tend to have low levels of HDL cholesterol and high levels of triglycerides.
Weight Loss Can Lower Triglycerides and LDL Cholesterol
It doesn't take dramatic weight loss to lower LDL and triglyceride levels. Just 5 to 10 pounds can make a difference, says Jerry Blaine, M.D., who specialized in cholesterol management, lipid disorders, hypertension, and preventive medicine, including at the Lipid Clinic at Lahey Hospital and Medical Center in Burlington, Massachusetts, before retiring in 2013.
The same applies to triglycerides. The more calories you eat and don't burn off, the more you store, which can lead to higher-than-normal triglyceride levels.
Additionally, there are other trim-down steps you can take to lower your LDL cholesterol and triglycerides:
-- Set a goal to lose 5-10 percent of your total body weight. For example, a 200-pound adult would aim to lose 10-20 pounds. Once the weight is off, keep up your healthy lifestyle to maintain your new weight.
-- Cut 200-500 calories a day from the number of calories it takes to maintain your weight. Reducing caloric intake will lower both LDL and triglycerides.
Choose Foods that Help Improve Your LDL and HDL Levels
Following a healthy eating plan can play a big role in your overall health, including your blood sugar and blood lipid control. What you eat and your cholesterol levels go hand in hand.
Foods that can help lower cholesterol:
Fiber (oats, legumes, berries), healthy fats (olive oil, avocados, nuts), and plant stanols or sterols (found in small amounts in vegetable oil, nuts, legumes, whole grains, fruits, and vegetables and are also added to foods) have all been shown to help lower cholesterol.
Other ways to improve cholesterol:
-- Reduce sugar intake: Cut the amount of added sugars you eat. This is especially important for people with high triglycerides. The grams of sugars on the Nutrition Facts label of a food package, however, doesn’t tell you if sugars have been added (some of the sugars included in that amount might come naturally from fruit or dairy ingredients). Instead, look at the ingredients list for items such as sugar, corn syrup, high fructose corn syrup, molasses, maple syrup, or agave to see if there are added sugars in the product. Natural sugars, such as those found in fruit and dairy products, are also counted as sugars on the Nutrition Facts label. Limit how much sugar you use to sweeten drinks or in recipes.
-- Limit high-cholesterol foods: People with diabetes should consume no more than 200 milligrams of cholesterol per day, according to the ADA.
Healthy Fats Can Help Lower Cholesterol
Replace unhealthy fats, such as saturated and trans fats, with monounsaturated fats and polyunsaturated fats rich in omega-3 and omega-6 fatty acids. To eat more omega-3 fats, include fatty fish, flaxseed or ground flax, and walnuts in your eating plan. The oils that contain omega-3 fats are olive and canola oils. The ADA recommends eating two servings of omega-3-rich fish (salmon, trout, mackerel, herring, sardines, tuna) per week as part of a heart-healthy diet. The oils high in omega-6 fats are corn, soybean, and sunflower oils.
Eat less of these unhealthful fats:
-- Saturated fat: The biggest food contributor to elevated LDL cholesterol is saturated fat. To remedy the cause-and-effect relationship between saturated fat and LDL, the ADA recommends limiting saturated-fat intake to less than 7 percent of your daily calories. So if you're trying to eat no more than 2,000 calories a day, that would mean eating no more than 140 calories from saturated fat daily, or 15 grams of saturated fat.
-- Trans fat: The ADA also recommends avoiding foods that contain trans fat. Although many restaurants and manufacturers advertise products as having zero trans fat, if the ingredients include shortening, partially hydrogenated vegetable oil, or hydrogenated vegetable oil, the food likely contains trans fat. Labels are not required to list trans fat if the total is less than 0.5 grams per serving. Eating multiple servings of such foods means trans-fat intake can add up.
Medications Can Lower LDL and Triglycerides
To get cholesterol and triglycerides into the target zone, many people with diabetes need to add medications to their healthy eating and exercise plans. Reducing elevated LDL (bad) cholesterol is typically the top priority. To achieve the target goals, many people need to take a medication in the statin category.
The American Diabetes Association recommends that statin therapy be added for people who have:
- a lower risk of cardiovascular disease and whose LDL cholesterol doesn’t hit the target of 100 mg/dl or less with healthy lifestyle change.
- cardiovascular disease and who don’t reach the LDL cholesterol target of 70 mg/dl or less.
Statin medications are most effective at lowering LDL cholesterol. All medications should be prescribed and monitored by a health care provider.
Common statins include:
- Crestor (rosuvastatin)
- Lipitor (atorvastatin)
- Mevacor (lovastatin)
- Zocor (simvastatin)
- Pravachol (pravastatin)
- Lescol (fluvastatin)
- Livalo (pitavastatin)
Other medications that lower both LDL cholesterol and triglycerides:
- Advicor (statin and niacin combo)
- Vytorin (statin and Zetia [ezetimibe] combo)
- Prescription-strength niacin
Other medications prescribed to lower LDL cholesterol:
- Bile acid sequestrants, such as Questran (cholestyramine) or Colestid (colestipol)
- Welchol (colesevelam), a bile acid sequestrant that can also lower blood glucose
- Zetia (ezetimibe)
Other medications prescribed to lower triglycerides:
- Prescription-strength fish-oil pills
Other medications to lower cholesterol and blood pressure:
- Caduet (atorvastatin and amlodipine)
Medications that have been found to increase triglycerides:
- Birth-control pills
- Tamoxifen, a breast cancer drug
The Effects of Alcohol on Triglycerides and LDL
Moderate alcohol intake can increase HDL (good) cholesterol, and that’s a plus. It also might increase insulin sensitivity and cause other positive health responses. The recommendation for alcohol use is mild or moderate consumption. Using alcohol in moderation is considered one drink a day for women and two drinks a day for men.
Note: The beneficial effects of alcohol are not great enough to endorse the use of alcohol if you do not already drink. Talk with your health care provider about the pluses and minuses of alcohol for you and your health.
Stop Smoking to Lower Cholesterol
The ADA recommends if you smoke to quit to improve diabetes management. Quitting smoking can also improve your overall health and reduce your risk of cancer.
There are numerous programs, support systems, and medications available to help you quit smoking. Studies show it might take a few tries to quit your smoking habit for good. Not smoking when you have diabetes can help you reduce your risks of cardiovascular disease and other diabetes complications.