High Triglycerides – Test, Diagnosis, Treatment

High Triglycerides/A triglyceride (TG, triacylglycerol, TAG, or triacylglyceride) is an ester derived from glycerol and three fatty acids (from tri- and glyceride). Triglycerides are the main constituents of body fat in humans and other vertebrates, as well as vegetable fat.[rx] They are also present in the blood to enable the bidirectional transference of adipose fat and blood glucose from the liver, and are a major component of human skin oils.[rx]

Triglycerides are a type of fat. They are the most common type of fat in your body. They come from foods, especially butter, oils, and other fats you eat. Triglycerides also come from extra calories. These are the calories that you eat, but your body does not need right away. Your body changes these extra calories into triglycerides and stores them in fat cells. When your body needs energy, it releases the triglycerides.

Having a high level of triglycerides can raise your risk of heart diseases, such as coronary artery disease.

Causes High Triglycerides

Factors that can raise your triglyceride level include

  • Regularly eating more calories than you burn off, especially if you eat a lot of sugar
  • Being overweight or having obesity
  • Cigarette smoking
  • Excessive alcohol use
  • Certain medicines
  • Some genetic disorders
  • Thyroid diseases
  • Poorly controlled type 2 diabetes
  • Liver or kidney diseases

How are high triglycerides diagnosed?

There is a blood test that measures your triglycerides, along with your cholesterol. Triglyceride levels are measured in milligrams per deciliter (mg/dL). The guidelines for triglyceride levels are

Category Triglcyeride Level
Normal Less than 150mg/dL
Borderline high 150 to 199 mg/dL
High 200 to 499 mg/dL
Very high 500 mg/dL and above

or

A simple blood test can reveal whether your triglycerides fall into a healthy range:

  • Normal — Less than 150 milligrams per deciliter (mg/dL), or less than 1.7 millimoles per liter (mmol/L)
  • Borderline high — 150 to 199 mg/dL (1.8 to 2.2 mmol/L)
  • High — 200 to 499 mg/dL (2.3 to 5.6 mmol/L)
  • Very high — 500 mg/dL or above (5.7 mmol/L or above)

Levels above 150mg/dl may raise your risk for heart disease. A triglyceride level of 150 mg/dL or higher is also a risk factor for metabolic syndrome.

Why do high triglycerides matter?

High triglycerides may contribute to hardening of the arteries or thickening of the artery walls (arteriosclerosis) — which increases the risk of stroke, heart attack and heart disease. Extremely high triglycerides can also cause acute inflammation of the pancreas (pancreatitis).

High triglycerides are often a sign of other conditions that increase the risk of heart disease and stroke, including obesity and metabolic syndrome — a cluster of conditions that includes too much fat around the waist, high blood pressure, high triglycerides, high blood sugar and abnormal cholesterol levels.

High triglycerides can also be a sign of:

  • Type 2 diabetes or prediabetes
  • Metabolic syndrome — a condition when high blood pressure, obesity and high blood sugar occur together, increasing your risk of heart disease
  • Low levels of thyroid hormones (hypothyroidism)
  • Certain rare genetic conditions that affect how your body converts fat to energy

Sometimes high triglycerides are a side effect of taking certain medications, such as:

  • Diuretics
  • Estrogen and progestin
  • Retinoids
  • Steroids
  • Beta blockers
  • Some immunosuppressants
  • Some HIV medications

Treatments for High Triglycerides

You may be able to lower your triglyceride levels with lifestyle changes:

  • Controlling your weight
  • Regular physical activity
  • Not smoking
  • Limiting sugar and refined foods
  • Limiting alcohol
  • Switching from saturated fats to healthier fats

What’s the best way to lower triglycerides?

Healthy lifestyle choices are key

  • Get more physical activity – Exercise can have a big impact on triglyceride levels. Experts recommend that everybody get at least 30 minutes of exercise at least five times a week. If you’re out of shape, start slowly. Begin with a quick walk three times a week and then build up from there.
  • Lose some weight – If you’re heavy, shed a few pounds and try to maintain an ideal body weight. Exercise will help, but you also need to focus on diet. The key is to eat fewer calories — whether they come from fats, carbs, or protein. Focus on a diet that’s high in fruits, vegetables, lean proteins, and low-fat dairy products. Cutting down on sugary foods — like sodas — could really help, too.
  • Choose better fats – Pay more attention to the fats you eat. Eat fewer foods with unhealthy fats (found in meat, butter, and cheese) and trans fats (in processed foods and margarines), as well as cholesterol. Boost your intake of healthy monounsaturated and polyunsaturated fats, which are found in olive oil, nuts, and some fish. Studies have found that the omega-3s in fatty fish — like tuna, salmon, mackerel, and sardines — are particularly good at lowering triglyceride levels. Because even healthy fats are high in calories, you still need to eat these foods in moderation.
  • Exercise regularly – Aim for at least 30 minutes of physical activity on most or all days of the week. Regular exercise can lower triglycerides and boost “good” cholesterol. Try to incorporate more physical activity into your daily tasks — for example, climb the stairs at work or take a walk during breaks.
  • Avoid sugar and refined carbohydrates – Simple carbohydrates, such as sugar and foods made with white flour or fructose, can increase triglycerides.
  • Choose healthier fats – Trade saturated fat found in meats for healthier fat found in plants, such as olive and canola oils. Instead of red meat, try fish high in omega-3 fatty acids — such as mackerel or salmon. Avoid trans fats or foods with hydrogenated oils or fats.
  • Limit how much alcohol you drink – Alcohol is high in calories and sugar and has a particularly potent effect on triglycerides. If you have severe hypertriglyceridemia, avoid drinking any alcohol.

Medication

If healthy lifestyle changes aren’t enough to control high triglycerides, your doctor might recommend:

  • Statins – These cholesterol-lowering medications may be recommended if you also have poor cholesterol numbers or a history of blocked arteries or diabetes. Examples of statins include atorvastatin calcium (Lipitor) and rosuvastatin calcium (Crestor).
  • Fibrates – Fibrate medications, such as fenofibrate (TriCor, Fenoglide, others) and gemfibrozil (Lopid), can lower your triglyceride levels. Fibrates aren’t used if you have severe kidney or liver disease.
  • Fish oil – Also known as omega-3 fatty acids, fish oil can help lower your triglycerides. Prescription fish oil preparations, such as Lovaza, contain more-active fatty acids than many nonprescription supplements. Fish oil taken at high levels can interfere with blood clotting, so talk to your doctor before taking any supplements.
  • Niacin – Niacin, sometimes called nicotinic acid, can lower your triglycerides and low-density lipoprotein (LDL) cholesterol — the “bad” cholesterol. Talk to your doctor before taking over-the-counter niacin because it can interact with other medications and cause significant side effects.

If your doctor prescribes medication to lower your triglycerides, take the medication as prescribed. And remember the significance of the healthy lifestyle changes you’ve made. Medications can help — but lifestyle matters, too.

How do foods affect triglyceride levels?

Eating foods high in simple sugars significantly contributes to high triglyceride levels. Follow these guidelines to limit simple sugars in your diet:

  • Substitute beverages like colas, fruit drinks, iced tea, lemonade, Hi-C and Kool-Aid with artificially sweetened beverages labeled “sugar-free” or “diet.”
  • Limit hard candies, chocolates, candy bars, and gummy bears.
  • Avoid adding table sugar and brown sugar to cereal, drinks or foods. Instead, use an artificial or herbal sweetener or nothing at all!
  • Choose sugar-free gum or mints instead of the regular versions.
  • Try light or low-sugar syrups on pancakes and waffles.
  • Spread breads and crackers with no-sugar-added jelly or preserves.
  • Snack on whole fruit instead of fruit roll-ups and other fruit-flavored treats.
  • When selecting cereals, choose those with no more than 8 grams of sugar per serving.
  • Try sugar-free gelatin, popsicles, yogurts, and puddings instead of the regular versions.
  • Be aware that desserts labeled “fat-free” usually contain more sugar than the full-fat varieties and the same number of calories.
  • Cut back on or avoid eating sweets and dessert foods, including cookies, cakes, pastries, pies, ice cream, frozen yogurt, sherbet, gelato, and flavored ices. All of these foods contain high levels of sugar.
  • Read the ingredients list on food labels, and limit foods that list any of the following words (all simple sugars) in the first few ingredients:
    • Sucrose
    • Glucose
    • Fructose
    • Corn syrup
    • Maltose
    • Honey
    • Molasses
    • High-fructose corn syrup

Natural sugars, when eaten in excess, can also raise your triglyceride level.

Follow these guidelines to help limit natural sugars

  • Use honey and molasses sparingly; they are both high in sugar.
  • Choose light yogurt (made with artificial sweeteners) instead of regular yogurt.
  • Choose whole fruit instead of fruit juice.
  • Limit dried fruits to ¼ cup per day. Dried fruits contain a more concentrated source of sugar than fresh fruits.
  • Choose canned fruit in its own juice and strain before eating. Avoid canned fruits packed in heavy syrup.
  • Limit your portion sizes of starchy vegetables to ½ cup. These include mashed potatoes, yams, beans, corn, and peas. Limit baked potatoes (with skin) to about 3 ounces.

Limit refined grains: products made with bleached, enriched or refined flour which contain very little or no dietary fiber.

  • Choose breads, crackers, and cereals that contain whole grain oats, barley, corn, rice or wheat as the first ingredient
  • Try whole-wheat pasta or brown rice.
  • Choose breads, crackers, rice, and pasta with 2 or more grams of dietary fiber per serving.
  • Select hot and cold cereals with 5 or more grams of dietary fiber per serving.
  • Use barley, bulgur, couscous, millet or wheat berries as a side dish.
  • Try whole wheat crackers with soup instead of saltines.

A key part of controlling triglycerides is making sure you limit your portion sizes of grain-based foods.

Examples of a single serving size of grain-based foods

  • 1 slice of bread
  • 2 slices of reduced-calorie bread
  • ½ hot dog or hamburger bun
  • ½ English muffin
  • ½ bagel (1 ounce)
  • 1 oz most cold cereals (¼ to 1 cup)
  • 2 graham crackers
  • ¾ matzoh cracker
  • 4 slices melba toast
  • 3 cups popped light popcorn
  • 2 to 6 baked whole-wheat crackers
  • ½ cup cooked cereal (including oatmeal, oat bran, cream of wheat)

Alcoholic beverages can significantly raise triglyceride levels. Beer, wine, spirits, mixed drinks, wine coolers and coffee drinks containing alcohol are all examples. Men should not have more than 2 drinks per day. Women should have no more than one drink per day.

One serving of alcohol is equal to: 1.5-ounce spirits, 3 ounces wine or 12 ounces beer. Keep in mind that these are general guidelines. If you have elevated triglyceride levels, you should avoid alcoholic beverages or have less than recommended in the above guidelines.

Including too much fat in your diet, especially saturated and trans fats can increase your triglyceride levels. However, cutting back too much on fats can result in eating too much sugar if you eat many reduced-fat foods. If you have high triglycerides, follow these dietary guidelines to reduce fat in your diet:

  • Limit your total fat intake to 30% to 35% of your total daily calories.
  • Limit saturated fat to 7% of your total daily calories.
  • Avoid foods high in trans-fats.
  • Limit your total cholesterol intake to 200 mg daily.
  • Choose monounsaturated and polyunsaturated fats (such as canola and olive oils) over other types of oils.
  • See your dietitian or clinician for more information to help you determine your daily fat limit.

More ways to help lower triglycerides

  • Lose weight if you are overweight. Reduce the number of calories you eat each day by controlling portion sizes.
  • Eat small, frequent meals and do not skip meals.
  • Avoid late-night snacking.
  • Participate in regular physical activity.

Omega-3 Fatty Acids

Foods that contain Omega-3 fatty acids have been found to be very powerful in lowering triglycerides.

To get more omega-3 fats in your diet, choose fatty fish for two or more meals each week. Examples of fatty fish are mackerel, salmon, sardines, tuna, herring, and trout. You can also choose plant-based forms of omega-3, such as soy foods, canola oil, flax seeds, and walnuts.

References

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