Going to the doctor for your fasting lipid panel results can be an exercise in confusion. You will get numbers for your total cholesterol, LDL cholesterol (“unhealthy” cholesterol), HDL cholesterol (“healthy” cholesterol), and triglycerides. Although the major emphasis in treating abnormal lipid panel results focuses on getting LDL cholesterol below a certain level, your doctor might also make recommendations about your HDL and triglycerides.

If your fasting triglycerides are above 150 but below 500, there is a decent chance you might be leaving the doctor’s office with more questions than answers, as this range can be a gray zone.

Why Do We Care about Triglycerides?

Triglycerides are a harbinger of cardiovascular disease: people with higher triglycerides have a higher risk of cardiovascular disease.^[1] However, it is less clear whether triglycerides themselves cause the increased risk; high triglycerides often occur alongside numerous other abnormalities, including high blood sugar, low HDL cholesterol, obesity, diabetes, and high blood pressure.^[1] Additionally, there are qualitative differences between specific types of cholesterol and fats in the bloodstream.

As you can tell, the links between different cholesterol and fat fractions get complicated quickly, and it becomes difficult to disentangle which factor causes what. Nevertheless, we know that high triglycerides are linked to an increased risk of cardiovascular disease.

What Is Considered a High Triglyceride Level?

The range of triglyceride results is pretty wide. Most consensus panels have created a categorization similar to the following:

Table 1: Triglyceride Ranges

Both lifestyle and non-lifestyle factors can contribute to high triglycerides. The most common non-lifestyle factors are 1) inherited genetic problems, including familial combined hyperlipidemia, familial hypoalphalipoproteinemia, and monogenic familial hypertriglyceridemia (I know—these are a mouthful), each of which affects about one percent of the population, 2) thyroid problems, 3) kidney disease, 4) pregnancy, and 5) medications.

Table 2: Partial List of Medications That Can Raise Triglycerides^[2]

Several lifestyle factors affect triglyceride levels. One recent review states that people eating plant-based diets over the long term have lower triglyceride levels, but interventional trials have been less consistent.^[4] Randomized control trials show that triglycerides may increase or decrease when switching to a plant-based diet; most reviewed trials show a shift of less than 25 in either direction.^[4] Excessive alcohol intake and a sedentary lifestyle can also raise triglycerides.^[5]

How Can I Lower My Triglycerides?

When it comes to medications, the recommendations can be a bit fuzzy. There is no great evidence that driving down mild to moderate triglyceride levels with medications specifically targeted at triglyceride levels significantly improves cardiovascular disease risk.[6] In the context of relatively normal cholesterol results and no other obvious causes of high triglycerides, the standard treatment of borderline to mild hypertriglyceridemia involves lifestyle changes. On the other hand, people in the very high or severe range may be at increased risk of pancreatitis, and prescribing medication to specifically lower triglycerides is often indicated in such circumstances.

The recommended lifestyle changes for lowering triglycerides reflect the lifestyle-related risk factors mentioned above. Moderate to high-intensity aerobic exercise can lower triglycerides by 10–20 percent.^[5] Reduced alcohol intake may improve triglycerides, especially if there is an issue with excessive intake or an individual has a predisposition to high triglycerides.^[5] The standard dietary recommendation for mildly elevated triglycerides is to reduce refined carbohydrate intake, particularly sugars. Fruit juices, refined flour, sweets, and any plant with the fiber removed should be off limits. You might also consider eating more low-glycemic index foods (foods that do not raise blood sugar as high or as quickly as other foods); however, solely focusing on glycemic index has not always been shown to significantly control triglycerides.^[6][7][8] Those with high triglycerides should also monitor fat intake and avoid added fats.^[6] Finally, a frequently asked question is whether people should boost their omega-3 fats. The short answer is that I do not recommend fish oil or omega-3 supplements for mild to moderately high triglycerides.

In summary, irrespective of non-lifestyle factors contributing to high triglycerides, I recommend a healthy lifestyle with limited alcohol, regular exercise, and a high-fiber plant-based diet without added fats that avoids white flour, added sugars, and juices.

References

1. Graham I, Cooney MT, Bradley D, Dudina A, Reiner Z. Dyslipidemias in the prevention of cardiovascular disease: risks and causality. Curr Cardiol Rep 2012;14:709-20.
2. Brunzell JD. Clinical practice. Hypertriglyceridemia. The New England journal of medicine 2007;357:1009-17.
3. Speroff L, DeCherney A. Evaluation of a new generation of oral contraceptives. The Advisory Board for the New Progestins. Obstet Gynecol 1993;81:1034-47.
4. Chapman MJ, Ginsberg HN, Amarenco P, et al. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. Eur Heart J 2011;32:1345-61.
5. Jenkins DJ, Wolever TM, Kalmusky J, et al. Low-glycemic index diet in hyperlipidemia: use of traditional starchy foods. The American journal of clinical nutrition 1987;46:66-71.
6. Goff LM, Cowland DE, Hooper L, Frost GS. Low glycaemic index diets and blood lipids: a systematic review and meta-analysis of randomised controlled trials. Nutr Metab Cardiovasc Dis 2013;23:1-10.