TriglyceridesThe Other Fat in Your Blood
When your doctor orders a cholesterol test, the results include a number that isn't cholesterol at all: triglycerides. These fats make up the majority of the fat in your body and your diet, serving as your primary energy storage system. While triglycerides are essential for survival, elevated levels contribute independently to heart disease risk, making them an important marker to understand and manage.
Triglycerides often fly under the radar compared to their cholesterol cousins, but they deserve attention. High triglycerides frequently appear alongside other metabolic problems like obesity, insulin resistance, and low HDL cholesterol, forming a dangerous cluster that significantly raises cardiovascular risk.
What Are Triglycerides?
Triglycerides are molecules consisting of three fatty acids attached to a glycerol backbone. They're the chemical form in which most fat exists, both in food and in your body. When you eat more calories than you need, your body converts the excess into triglycerides and stores them in fat cells for later use.
Between meals, hormones signal fat cells to release triglycerides into your bloodstream, where they travel to tissues that need energy. Your muscles, heart, and other organs can burn triglycerides for fuel. This system evolved to help humans survive periods of food scarcity, storing energy during times of plenty.
The triglyceride level measured in blood tests reflects circulating triglycerides, primarily carried in particles called VLDL (very low-density lipoprotein). After a meal, triglyceride levels spike as your intestines package dietary fat into particles called chylomicrons. This is why triglyceride tests require fasting—a recent meal can dramatically inflate results.
Normal Triglyceride Levels
| Triglyceride Level (mg/dL) | Category | What It Means |
|---|---|---|
| Less than 150 | Normal | Healthy level; continue current lifestyle |
| 150-199 | Borderline high | Lifestyle modifications recommended |
| 200-499 | High | Increased cardiovascular risk; treatment needed |
| 500 and above | Very high | Risk of pancreatitis; aggressive treatment required |
Some experts now advocate for an optimal triglyceride level below 100 mg/dL, arguing that the traditional 150 mg/dL cutoff allows too much cardiovascular risk. Triglyceride levels naturally fluctuate throughout the day and in response to meals, so a single high reading should be confirmed with repeat testing.
Health Risks of High Triglycerides
Cardiovascular Disease
Elevated triglycerides are an independent risk factor for heart disease and stroke. High triglyceride levels contribute to atherosclerosis, the buildup of plaque in artery walls. Triglyceride-rich particles may be particularly harmful when they're partially broken down, leaving behind remnants that penetrate artery walls.
High triglycerides also tend to travel with other cardiovascular risk factors. They're commonly seen alongside low HDL, small dense LDL particles, insulin resistance, and abdominal obesity. This cluster, sometimes called metabolic syndrome or atherogenic dyslipidemia, multiplies cardiovascular risk beyond what any single factor would cause.
Pancreatitis
Very high triglycerides (above 500 mg/dL) can cause acute pancreatitis, a painful and potentially dangerous inflammation of the pancreas. The risk increases substantially when triglycerides exceed 1,000 mg/dL. This is a medical emergency that requires immediate treatment to lower triglyceride levels.
Fatty Liver Disease
High triglycerides are strongly associated with non-alcoholic fatty liver disease (NAFLD), a condition where fat accumulates in liver cells. NAFLD can progress to inflammation, scarring, and eventually liver failure in some cases.
What Causes High Triglycerides?
Dietary Factors
Unlike cholesterol, which responds most to saturated fat intake, triglycerides are highly sensitive to sugars and refined carbohydrates. Excess sugar, especially fructose, gets converted to triglycerides in the liver. Alcohol also raises triglycerides significantly, as the liver prioritizes alcohol metabolism over fat processing.
Excess Calories
Consuming more calories than you burn, regardless of the source, raises triglycerides. Your body efficiently converts excess energy into triglycerides for storage.
Obesity
Excess body fat, particularly visceral fat around the organs, drives triglyceride production. Weight loss consistently lowers triglycerides, often dramatically.
Physical Inactivity
Sedentary lifestyles allow triglycerides to accumulate rather than being burned for energy. Regular physical activity helps clear triglycerides from the blood and improves the body's ability to process fats.
Medical Conditions
Type 2 diabetes and insulin resistance strongly elevate triglycerides. Hypothyroidism, kidney disease, and liver disease can also raise triglyceride levels. Some medications, including certain blood pressure drugs, steroids, and estrogen, may increase triglycerides as a side effect.
Genetics
Some people inherit genes that cause their bodies to overproduce triglycerides or clear them slowly. Familial hypertriglyceridemia can cause very high levels that require medication even with optimal lifestyle.
How to Lower Triglycerides
The good news is that triglycerides respond remarkably well to lifestyle changes. Many people can achieve dramatic reductions without medication.
Reduce Sugar and Refined Carbs
Cutting back on added sugars, sugary drinks, white bread, and other refined carbohydrates can lower triglycerides by 20-50%. This is often the single most effective dietary change.
Limit Alcohol
Even moderate alcohol consumption raises triglycerides. For people with high triglycerides, reducing or eliminating alcohol can produce substantial improvements. Those with very high triglycerides should avoid alcohol completely.
Lose Excess Weight
Weight loss powerfully lowers triglycerides. Losing 5-10% of body weight can reduce triglycerides by 20% or more. The effect is often proportional to the amount of weight lost.
Exercise Regularly
Both aerobic exercise and resistance training help lower triglycerides. Physical activity increases the enzymes that break down triglycerides and improves insulin sensitivity. Aim for at least 150 minutes of moderate activity weekly.
Eat More Omega-3 Fats
Fatty fish like salmon, mackerel, and sardines contain omega-3 fatty acids that lower triglycerides. Eating fish twice weekly provides meaningful benefits. For higher triglyceride levels, prescription omega-3 supplements may be recommended.
Medications
When lifestyle changes aren't sufficient, several medications can lower triglycerides. Fibrates (like fenofibrate) specifically target triglycerides. Prescription omega-3 fatty acids in high doses lower triglycerides by 30-50%. Statins modestly reduce triglycerides while also lowering LDL. Niacin effectively lowers triglycerides but has fallen out of favor due to side effects.
Frequently Asked Questions
Why do I need to fast before a triglyceride test?
Triglyceride levels rise substantially after eating, as your body packages and transports dietary fat. A fasting test (typically 9-12 hours without food) measures your baseline triglyceride level, which better reflects your metabolic health and cardiovascular risk.
Can stress raise triglycerides?
Yes, chronic stress can elevate triglycerides through several mechanisms. Stress hormones like cortisol promote fat storage and release, and stress often leads to behaviors that raise triglycerides, like overeating, poor food choices, and reduced physical activity.
Are triglycerides and cholesterol the same thing?
No, they're different types of lipids (fats). Cholesterol is a waxy substance used to build cells and make hormones. Triglycerides are fats used for energy storage. Both are measured in lipid panels because both affect cardiovascular health, but they have different functions and respond to different interventions.
How quickly can triglycerides be lowered?
Triglycerides can drop significantly within weeks of making lifestyle changes, particularly reducing sugar and alcohol intake. Some people see their triglycerides cut in half within 2-3 months of comprehensive lifestyle modification.