Various molecules are counted and/or calculated when we do blood work. This article focuses on Triglycerides and how they contribute to heart disease risk. As you'll learn, they are a marker for many conditions so thoughtful assessment and strategic treatment strategies must be considered.
What are Triglycerides?
Next to cholesterol, triglycerides are the most important measurement in the lipid panel.
Triglycerides enter our blood from 2 sources:
- They are the end product of digesting and breaking down fat in food
- They are released from the liver
Another factor that influences their release is sugar and insulin metabolism. This is the reason someone with high triglycerides must be told to not only watch their fat intake, but also their sugar intake. In some cases, the person is eating all the right fats, and their high triglycerides are a result of poor sugar metabolism.
How Do High Triglycerides Impact Health?
Whereas LDL and HDL have a relatively clear mechanism to heart health, triglycerides are a bit different. Triglyceride levels are related to many other lipid and non-lipid risk factors, meaning many things alter their levels.
For the longest time, doctors emphasized lowering LDL-C and increasing HDL-C, with less focus on lowering triglycerides. Now, it’s clear that triglycerides are very important too. Triglycerides are an independent risk factor for cardiovascular disease . As mentioned above, they are closely linked with blood sugar dysregulation in addition to sub-optimal HDL and LDL profiles.
When a doctor sees high triglycerides, we investigate glucose metabolism, thyroid health, kidney function and possible alcohol intake. Having low triglycerides is usually okay, but pathologically low values can be due to malabsorption, low intake of dietary fats, or possible autoimmunity .
Conditions associated with High Triglyceride Levels 
- Metabolic syndrome
- Fatty liver
- Alcohol intake (both moderate in some people and alcohol dependence)
- Renal disease, especially uremia or glomerulonephritis
- Pregnancy (notably 3rd trimester where triglycerides may double)
- Paraproteinemias (myeloma, lymphoma, lymphocytic leukemia)
- Autoimmune disorders: systemic lupus erythematosus
- Several medications, including
- Estrogens, especially those taken orally
- Antihypertensives (non-cardioselective B-blockers, thiazides)
- Bile-acid-binding resins
- Antiretroviral regimens, especially for HIV infections
- Psychotropic medications: phenothiazides, second generation anti-psychotics
- Pancreatitis (is only a risk factor when triglycerides rise dramatically)
Getting Triglycerides Tested
Triglycerides are important to test because there aren’t many symptoms specific to high or low triglycerides. Luckily, they are commonly tested in routine lipid panels.
The National Cholesterol Education Program set guidelines for triglyceride levels :
- Normal levels: Less than 150 mg/dL
- Borderline high: 150 to 199 mg/dL
- High: 200 to 499 mg/dL
- Very high: 500 mg/dL or more
Moderate elevations (150 – 499 mg/dL) may identify those at risk for insulin resistance and elevated cardiovascular risk. Severely elevated (more than 1000 mg/dL) is considered a risk for pancreatitis .
The test is very accurate, however, triglycerides vary throughout the day, so it’s harder to base decisions off of them in isolation. A full assessment, looking at other blood parameters, and completing a physical examination will be required in order to determine how to treat elevated triglycerides.
Ways to reduce triglycerides
Some basic lifestyle factors have been shown in human research to have beneficial effects on lowering elevated triglycerides. In fact, the triglyceride response to diet and exercise, with accompanying weight loss, is about a 25% reduction .
These factors help reduce elevated triglycerides:
- Weight reduction (if necessary) 
- Aerobic exercise 
- Minimizing alcohol consumption 
- Mediterranean diet 
- Niacin 
- Omega 3-fatty acids (EPA, DHA); aim for 4 grams a day 
- Avoid excessive fructose 
- Dietary fat intake
- Moderate elevations in triglycerides: limit trans fats, some saturated fats, and vegetable based polyunsaturated fats 
- Severe elevations in triglycerides: fat intake may be restricted to 10-15% of total energy intake 
- There are several supplements and nutraceuticals used for lowering triglycerides but they must be prescribed on a case-by-case basis
See a Naturopath for Support
As you can see, elevated triglycerides must be assessed in conjunction with your other body systems and overall health. Triglycerides usually don’t elevate by themselves – there’s always something else going on simultaneously. A naturopath will be able to guide you through the various treatment options to best serve you.
About the Author
I'm Johann de Chickera, a Naturopathic Doctor, practicing in Ontario, Canada. My clinical practice relies on keeping up with the most up-to-date research and continued education. This blog serves as a way to provide others with a compilation of everything I've learned along the way. Please click here if you're local and want to see me in practice.