Going even lower
If reducing your intake of saturated fat, cholesterol, and trans fat does not get you to your LDL goal, you might try two additional strategies.
First, try adding plant stanols or sterols to your diet. These are derived from natural plant components such as soy. They reduce the absorption of cholesterol in the digestive tract, resulting in lower total and LDL cholesterol levels. They can be found in some soft margarine products, orange juice, and select other foods, and also in supplement form. If you choose to use one of the margarine products, be sure to adjust your calorie level to account for the calories contained in the product, and if you use the orange juice, take the grams of carbohydrate into account. Plant stanol or sterol intake of 2–3 grams per day has been found to lower LDL cholesterol by 6% to 15%.
A second strategy is to add more foods high in soluble fiber to your diet. See “Sources of Soluble Fiber” for a list of foods that contain soluble fiber. A total fiber intake of 20–30 grams per day is part of the diet recommended by the NCEP. By increasing their soluble fiber intake by only 5 to 10 grams per day, most people can reduce their LDL cholesterol by about 5%.
Managing your weight and engaging in regular physical activity are also fundamental components of the NCEP-recommended changes. If you are at a healthy weight, work with your physician to prevent weight gain. Develop strategies for weight maintenance, and anticipate high-risk occasions for possible weight gain (for example, times of significant stress). If you are overweight, start with a weight-loss goal of 10% through dietary changes, portion control, and daily physical activity. You should also consider regular visits with your physician to follow up and examine your progress. Any increase in physical activity should take into consideration your current heart health, your age, and your physician’s assessment of your limitations and goals. Once you get the OK to exercise, try 30 minutes of moderate-intensity activity on most, if not all, days of the week — even if you are not overweight.
Triglycerides in the blood come from the foods we eat. Calories that are not immediately used by the body are converted into triglycerides and transported to the fat cells to be stored. Like LDL cholesterol, excess triglycerides in the blood are linked to a higher risk of coronary artery disease.
If triglycerides remain elevated once LDL cholesterol is reduced to your goal, losing weight and engaging in regular physical activity should become your primary focus. Overweight and lack of physical activity are strong contributors to high triglycerides, so working with your health-care provider to start a program of weight loss and daily exercise could lead to an improved triglyceride level.
In addition to reducing your calorie intake and exercising, there are some other changes that can lower your triglyceride level. First, reduce your intake of refined or processed carbohydrates, such as candy, table sugar, white flour, and baked goods made with white flour. These foods can promote an increase in triglycerides. Excessive intake of these foods may also increase blood glucose, and it is very common to see high blood triglycerides when diabetes is not well controlled.
Eat foods rich in monounsaturated and polyunsaturated fats instead of those that contain refined sugar. Substituting fish rich in omega-3 fatty acids (found in fatty fish such as salmon, sardines, and tuna) may also lower triglycerides. Omega-3 fish oil capsules may be therapeutic in some cases, but over-the-counter fish oil supplements have been found to contain varying amounts of fish oil, so only prescription supplements are recommended at this time. Discuss the risks and benefits of taking fish oil with your physician. High doses can cause excessive bleeding in some people.