Triglycerides: Causes, Risks, and How to Lower Them

What Is Triglycerides?

Triglycerides are a type of fat (lipid) found in your blood. When you consume more calories than your body immediately needs, it converts those excess calories—whether from fats, carbohydrates, or proteins—into triglycerides. These triglycerides are stored in your fat cells. Later, hormones release them for energy between meals. This biomarker measures the concentration of these fats in your bloodstream, providing a critical snapshot of your metabolic health and energy storage status.

Doctors routinely order a triglyceride test as part of a lipid panel, which also includes measurements of total cholesterol, LDL ("bad") cholesterol, and HDL ("good") cholesterol. This test is essential for assessing cardiovascular disease risk. According to the American Heart Association, elevated triglyceride levels are a significant marker for metabolic syndrome—a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes. Monitoring triglycerides helps in evaluating the effectiveness of lifestyle changes or medications aimed at improving lipid profiles.

Triglycerides are primarily related to the digestive system (where they are absorbed and packaged), the liver (which processes and creates them), and the cardiovascular system. High levels contribute directly to atherosclerosis, the hardening and narrowing of arteries, by promoting the buildup of plaques. They are also intimately linked to pancreatic health, as severely high levels can trigger acute pancreatitis, a dangerous inflammation of the pancreas.

Normal Triglycerides Ranges

By Age and Gender

Triglyceride levels are typically measured in milligrams per deciliter (mg/dL) in the United States. The SI unit is millimoles per liter (mmol/L). The following table outlines ranges based on guidelines from the National Cholesterol Education Program (NCEP) and the American Heart Association (AHA).

*Note: For children, the American Academy of Pediatrics defines borderline high as 100-129 mg/dL and high as ≥130 mg/dL. All values assume a 9-12 hour fasting state. To convert mg/dL to mmol/L, divide by 88.6. For example, 150 mg/dL ≈ 1.7 mmol/L.

What "Normal" vs "Optimal" Means

The "normal" range, often called the reference range, is statistically derived from a healthy population and indicates levels not typically associated with immediate disease risk. A result under 150 mg/dL is considered within the normal reference range for adults. However, "optimal" ranges are more stringent and reflect levels associated with the lowest possible risk for long-term cardiovascular events. Leading cardiology guidelines now emphasize that an optimal fasting triglyceride level is below 100 mg/dL (1.1 mmol/L).

This distinction matters profoundly for preventive health. While a level of 145 mg/dL is technically "normal," it may still indicate underlying insulin resistance, excess visceral fat, or a diet too high in refined carbohydrates. Striving for an optimal level, rather than just a normal one, is a proactive approach to reducing inflammation, improving arterial health, and lowering the lifetime risk of heart attack and stroke. It shifts the focus from merely avoiding disease to actively promoting metabolic wellness.

What Do Abnormal Results Mean?

High Triglycerides Levels

Causes:

1. Diet: Excessive intake of refined carbohydrates (white bread, pastries, sugary drinks) and saturated/trans fats.
2. Obesity and Metabolic Syndrome: Excess body fat, particularly around the abdomen, is strongly linked to high triglycerides.
3. Poorly Controlled Type 2 Diabetes: Insulin resistance prevents the body from properly using glucose, leading to increased triglyceride production.
4. Hypothyroidism: An underactive thyroid gland slows metabolism, which can impair lipid processing.
5. Chronic Kidney Disease: Impaired kidney function can disrupt the body's lipid balance.
6. Certain Medications: Including beta-blockers, diuretics, corticosteroids, and some HIV treatments.
7. Genetic Factors: Familial hypertriglyceridemia is an inherited condition leading to very high levels.

Associated Symptoms: High triglycerides themselves cause no symptoms. However, when levels are severely elevated (over 500 mg/dL), they can increase the risk of acute pancreatitis, which causes sudden, severe abdominal pain, nausea, and vomiting. More commonly, high triglycerides are a silent partner in atherosclerosis. When to See a Doctor: You should consult your healthcare provider if your fasting lipid panel shows a level at or above 150 mg/dL. Seek immediate medical attention if you experience severe abdominal pain, especially if you have a known history of very high triglycerides, as this could signal pancreatitis.

Low Triglycerides Levels

Causes:

1. Malnutrition or Malabsorption: Conditions like anorexia nervosa, celiac disease, or Crohn's disease can prevent adequate nutrient absorption.
2. Hyperthyroidism: An overactive thyroid accelerates metabolism, potentially burning through fat stores too quickly.
3. Very Low-Fat Diets: Extremely restrictive diets that severely limit all fat intake.
4. Certain Medications: Statins, fibrates, and high-dose omega-3 fatty acid supplements are designed to lower lipids.
5. Chronic Obstructive Pulmonary Disease (COPD): The hypermetabolic state in advanced COPD can deplete energy stores.
6. Genetic Disorders: Rare conditions like abetalipoproteinemia impair fat absorption and transport.
7. Recent Weight Loss or Cachexia: Rapid fat loss from illness or extreme dieting.

Associated Symptoms: Symptoms are typically related to the underlying cause, such as fatigue, unintended weight loss, muscle weakness, or deficiencies in fat-soluble vitamins (A, D, E, K). When to See a Doctor: A consistently low triglyceride level (below 40 mg/dL) without an obvious cause like medication warrants investigation. Discuss it with your doctor, especially if accompanied by other symptoms like fatigue, weight loss, or digestive issues.

How to Improve Your Triglycerides Levels

Diet and Nutrition

Focus on a heart-healthy dietary pattern. Specific foods that help include fatty fish like salmon (aim for two 3.5-oz servings per week), high-fiber foods like oats and beans (25-35 grams daily), nuts (a handful of walnuts or almonds daily), and olive oil (replace saturated fats with 1-2 tablespoons daily). Foods to avoid are sugary beverages, refined grains (white bread, pasta), baked goods, red meat high in saturated fat, and alcohol, which can significantly raise triglycerides in some individuals.

Top 10 Foods for Managing Triglycerides:

Lifestyle Changes

Exercise Recommendations: The AHA recommends at least 150 minutes of moderate-intensity aerobic activity (brisk walking, cycling) or 75 minutes of vigorous activity (running, swimming) per week. Importantly, exercise helps your muscles use triglycerides for fuel. Even a single session can lower levels. Sleep and Stress Management: Aim for 7-9 hours of quality sleep per night. Sleep deprivation and chronic stress raise cortisol levels, which can increase triglyceride production. Practices like mindfulness, yoga, or deep breathing can be beneficial. Supplements:

• Omega-3 Fatty Acids (Prescription): Icosapent ethyl is an FDA-approved, high-dose prescription omega-3 derived from fish oil, shown in the REDUCE-IT trial to significantly reduce cardiovascular events in high-risk patients with elevated triglycerides.
• Omega-3 Fatty Acids (Over-the-Counter): Fish oil supplements with combined EPA and DHA (2-4 grams daily under doctor's supervision) can lower triglycerides by 20-30%. Evidence Level: High.
• Niacin (Vitamin B3): Prescription-strength niacin can lower triglycerides by 20-50%, but side effects (flushing) are common and its role in preventing heart events is debated. Evidence Level: Moderate.
• Fiber Supplements (Psyllium): 10+ grams daily can modestly improve lipids. Evidence Level: Moderate.

Always consult your doctor before starting any supplement regimen, especially at high doses.

Related Tests to Consider

For a complete picture of your cardiovascular and metabolic health, triglycerides should be interpreted alongside other key biomarkers:

1. HDL Cholesterol – High triglycerides are often paired with low HDL ("good") cholesterol.
2. LDL Cholesterol – The core target for cholesterol-lowering therapy.
3. HbA1c – Measures 3-month average blood sugar, crucial for assessing diabetes risk, a major cause of high triglycerides.
4. C-Reactive Protein (hs-CRP) – A marker of inflammation, which is elevated in metabolic syndrome.
5. Apolipoprotein B (ApoB) – Measures the number of atherogenic particles, often a more accurate risk predictor than LDL alone.
6. Insulin – Fasting insulin can reveal insulin resistance long before blood sugar rises.

Testing these together helps differentiate between dietary causes, genetic factors, and insulin-related metabolic dysfunction, guiding more personalized treatment.

When to Get Tested

Recommended testing frequency: The CDC and AHA recommend that all adults aged 20 or older have a fasting lipid panel, including triglycerides, checked every 4-6 years if risk is low. More frequent testing (annually or as directed) is advised if you have risk factors. Risk factors that warrant more frequent testing: A family history of heart disease or high cholesterol, personal history of heart disease, stroke, or diabetes, being overweight, smoking, high blood pressure, or if you are already on lipid-lowering therapy. How to prepare for the test: For an accurate triglyceride reading, a 9-12 hour fast (water only) is required. You should also avoid alcohol for 24 hours prior. The test is a simple blood draw, usually done in the morning. Inform your doctor of all medications and supplements you take.

Frequently Asked Questions

1. Is a triglyceride level of 200 mg/dL dangerous?

A level of 200 mg/dL is considered high and increases your cardiovascular risk. It warrants a discussion with your doctor about lifestyle interventions and possibly medication, depending on your overall risk profile.

2. Can you have high triglycerides with normal cholesterol?

Yes, this is possible. It often indicates a diet high in sugars and refined carbs rather than saturated fat, or it may point to metabolic syndrome. It still requires management.

3. How quickly can I lower my triglycerides with diet?

Dietary changes can lower triglycerides relatively quickly—often within a few weeks. Reducing sugar, refined carbs, and alcohol while increasing fiber and healthy fats has a direct and measurable impact.

4. What is a dangerously high triglyceride level?

Levels above 500 mg/dL significantly increase the risk of acute pancreatitis. Levels above 1000 mg/dL are considered very high risk and require immediate medical intervention to prevent this serious complication.

5. Do triglycerides cause weight gain, or does weight gain cause high triglycerides?

It's a cycle. Excess calories lead to high triglycerides and weight gain. The resulting insulin resistance from weight gain, particularly abdominal fat, then makes it harder for your body to clear triglycerides, perpetuating the problem.

6. Are triglycerides worse than LDL cholesterol?

They are independent risk factors. LDL is the primary target for drug therapy, but high triglycerides are a key marker of residual cardiovascular risk and metabolic dysfunction, even when LDL is controlled.

7. Is 75 mg/dL a good triglyceride level?

Yes, 75 mg/dL is an excellent (optimal) level, well below the 100 mg/dL target, and is associated with lower cardiovascular risk.

8. Can stress really raise my triglyceride levels?

Yes. Chronic stress elevates cortisol and can lead to increased liver production of triglycerides and promote unhealthy eating habits, both of which raise levels.

9. Why do I need to fast for a triglyceride test?

Eating, especially a fatty meal, causes a temporary surge in triglycerides. Fasting provides a standardized baseline to accurately assess your underlying, steady-state level.

10. If I have high triglycerides, should I avoid all fats?

No. You should avoid saturated and trans fats, but increasing intake of healthy unsaturated fats (from fish, nuts, avocados, olive oil) is a key strategy for actually lowering triglycerides and improving your overall lipid profile.

Disclaimer: This information is for educational purposes. Always consult your healthcare provider for personalized medical advice, diagnosis, and treatment. Sign up for HOP to analyze your labs with AI and get personalized insights into your triglyceride levels and overall metabolic health. Start your analysis now.