Personalizing the Plan

The Plan is ideal for anyone, regardless of your cholesterol But some aspects of the plan will differ slightly if you have metabolic syndrome or high triglycerides. For instance, you may need te exercise more, limit calories, and But some aspects of the Plan will differ slightly if you have metabolic syndrome or high triglycerides. For instance, you may need te exercise more, limit calories, and take certain supplements.

If You Have Metabolic Syndrome

You read about metabolic syndrome in this topic. People who have metabolic syndrome tend to be overweight, with much of their fat settled around their abdomens. They also tend to have insulin resistance (in other words, are on their way to developing diabetes) and are relatively inactive.

If you have metabolic syndrome, you’ll need to lose weight. There’s simply no way around this recommendation. In Chapter 4 we’ll help you determine a daily caloric target based on your sex, age, physical activity level, and current weight.

You’ll also need to follow the Plan closely if you have metabolic syndrome. No cheating, no halfway there for you. Certain elements, particularly fish-oil supplements, soluble fiber (from beans, whole grains, etc.), and exercise will be particularly important to help you increase your HDL and reduce your triglycerides. And your doctor may start you on a medication such as metformin, which has been shown to improve insulin resistance and even help prevent the development of diabetes. We’d also like you to:

Consider chromium supplements. (More on chromium in Exercise Chapter )plements may iniprove insulin sensitivity.

Control your alcohol intake. While alcohol will increase your HDL, too much canalso increase triglycerides. Our advice to you is the same we’d give anyone else—if you drink, drink moderately. That means no more than one drink a day for women and anyone over 65, and no more than two drinks a day for men under 65.

Control your blood pressure. The Plan should help lower your blood pressure, but your doctor may also decide to start you on blood pressure medication, such as a calcium channel blocker or ACE inhibitor. Beta-blockers, another type of blood pressure medication, may increase trighycerides and reduce HDL. While they may be the best choice for some patients, they’re generally not the first choice for most.

If You Have High Triglycerides

If your triglyceride level is high, you usually also have an increase in VLDL remnants (see page 22), and thus a high VLDL count. Treatment depends on just how high your triglyceride level is.

Borderline High Triglycerides (150-199)

Follow the  Plan. If your BMI is 26 or higher, you need to lose weight—one of the best ways to lower your triglycerides. The Plan also calls for fish-oil supplements, which can reduce triglycerides.

Add two days of physical activity. Although the Plan calls for at least four days of moderate to intense physical activity, if you have a high triglyceride level, increase that activity to six days. Of course, if you aren’t used to exercising, get the green light from your doctor first, and start slowly.

Talk to your doctor about medication. If you have CHD or other risk factors (such as diabetes), your doctor may consider treating you with the cholesterol-lowering drugs nicotinic acid or fibrates. (For more on these medications, see chapter 8.)

High Triglycerides (200-499)

The recommendations above apply to you also. Plus, it’s more likely your doctor will simple starches/processed carbohydrates. Start you on medication. You should also try to avoid alcohol, excess calories, and

Very High Triglycerides (more than 500)

It’s very important. that you get your triglycerides into a safer level as quickly as possible to prevent acute pancreatitis, an inflammation or infection of the pancreas. So it’s quite likely your doctor will start you on medication (most likely fibrates and nicotinic acid), particularly if your triglyceride level is more than 1,000.