I am 42, male with high triglycerides. What to do?

Question

Hi doctor,

I am a 42-year-old male who was recently told that I have high triglyceride levels on my routine blood test. My triglycerides are 365 mg/dL, total cholesterol is 245 mg/dL, LDL is 148 mg/dL, and HDL is 34 mg/dL. My doctor mentioned that these levels put me at risk for heart disease and pancreatitis. I have a family history of type 2 diabetes and high cholesterol, and my fasting blood sugar is 118 mg/dL, which I was told is borderline high. I also have a mild fatty liver seen on ultrasound.

Over the past year, I have gained about 13 pounds and noticed increased tiredness, especially after meals. I do not smoke, but I occasionally drink alcohol on weekends. I would like to know what lifestyle changes and dietary modifications can help lower my triglycerides.

Should I completely avoid carbohydrates and fats, or just limit them? Are medications like Fenofibrate or statins necessary at this stage, or can diet and exercise alone bring the levels down? How long does it typically take to see improvement, and how often should I repeat my lipid profile?

Please advise.

Answer 1

Hi

Welcome to icliniq.com

I understand your concern and will try to answer your queries with the best of my knowledge. All your concerns are related to lifestyle. So in a nutshell, improving your lifestyle by eating healthy, increasing physical activity, and doing moderate exercise (150 minutes a week), and losing weight will address all your concerns (fatty liver, high triglycerides and risk of diabetes).

Regarding lifestyle changes,

Diet: follow the plate method (half plate with veggies and salad, quarter with proteins, and quarter with carbohydrates), as it can be practical and easy to apply. Avoid alcohol, and avoid sugars and salts.
A total of 150 minutes of moderate exercise per week must be done.
Increase physical activity (taking stairs, moving around more than sitting, walking while talking on the phone).
Stress management- breathing exercises, yoga, and sleep hygiene.
Water intake must be around three liters per day.

Regarding starting medication, this depends on your cardiovascular risk. It can be calculated using the cardiovascular risk calculator. In general, you can try one to three months of diet and lifestyle changes and check the triglyceride levels again. If that works, continue lifestyle changes, and if it does not decrease the triglyceride levels, then you can start medications.

Regarding repeating the test, if after intervention (lifestyle or medication) values are improving, then the test is repeated after three months, and once the values are normal, the test is done once in six months or once a year.

Hope I was able to address your concerns well. If you have any further queries, I will be happy to help.

Thank you.