What are triglycerides?
Triglycerides are fats from the food we eat that are carried in the blood. Most of the fats we eat, including butter, margarines and oils, are in triglyceride form. Excess calories, alcohol or sugar in the body turn into triglycerides and are stored in fat cells throughout the body.
How are triglycerides different from cholesterol?
Triglycerides and cholesterol are both fatty substances known as lipids. But, triglycerides are fats; cholesterol is not. Cholesterol is a waxy, odorless substance made by the liver that is an essential part of cell walls and nerves.
Cholesterol also plays an important role in body functions such as digestion and hormone production. In addition to being produced by the body, cholesterol comes from animal foods that we eat.
Pure cholesterol cannot mix with or dissolve in the blood. Therefore, the liver packages cholesterol with triglycerides and proteins in carriers called lipoproteins. The lipoproteins move this fatty mixture to areas throughout the body. An elevated triglyceride level increases the risk of heart disease.
When are triglyceride levels measured?
Triglyceride levels are usually measured whenever you have a blood test called a Lipid Profile. Everyone over age 20 should have their cholesterol checked at least every 5 years. Your healthcare provider can check your cholesterol and triglyceride levels by taking a sample of blood, which is sent to a lab for testing. The Lipid Profile shows your triglyceride level, total cholesterol level, HDL cholesterol (high-density lipoprotein or “good” cholesterol) and LDL (low-density lipoprotein or “bad” cholesterol) levels.
Blood triglyceride levels are normally high after you eat. Therefore, you should wait 12 hours after eating or drinking before you have your triglyceride levels tested. Many other factors affect blood triglyceride levels, including alcohol, diet, menstrual cycle, time of day and recent exercise.
What are the guidelines for triglyceride levels?
The national guidelines for fasting triglyceride levels in healthy adults are:
- Normal: Under 150 mg/dl
- Borderline High: 151–200 mg/dl
- High: 201–499 mg/dl
- Very High: 500 mg/dl or higher
Levels higher than 200 mg/dL are associated with an increase in the risk of heart attack, stroke and death.
How can triglyceride levels be lowered?
If your triglyceride levels are high, the next step is for your doctor to check for potential causes. Certain medications, thyroid function issues, poorly controlled diabetes, liver or kidney disease can all cause triglyceride levels to be higher than normal.
The first steps in treatment to lower triglyceride levels include eating a healthy diet, achieving and maintaining a healthy weight, and aerobic exercise on a regular basis.
To lower your triglyceride levels, your diet should be:
- low in fats
- low in sugars
- low in simple carbohydrates (the white stuff….potatoes, pasta, bread); and
- low in alcohol
If you have high triglycerides and low HDL or high LDL levels, you may need to take medication along with making lifestyle changes. If your triglyceride levels are in the very high range (over 500 mg/dL) you are at risk to develop other medical problems, so you will most likely need to take medication.
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 a artifical 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:
- Corn syrup
- 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.
Diet and exercise are not always enough to lower high triglyceride levels. If this is the case, you may need to take medication.
Statins are the first-line medications for patients with high triglycerides. While these medications are known for their cholesterol-lowering properties, they also work quite well at lowering triglyceride levels. They are also known to reduce the risk of heart attack, stroke and other major cardiac events.
You may need to take more than one medication. There are several second-line medications your doctor may prescribe. One is omega-3 fatty acids. Your doctor may recommend taking between 2,000 mg (2 grams) and 4,000 mg (4 grams) of DHA + EPA (the key omega-3 fatty acids) each day. In large trials, omega-3 fatty acid supplements have been shown to reduce cardiac risks. 1,2
Niacin is also used to help lower triglyceride levels. When niacin is taken in large amounts, it acts like a drug. It is used to lower levels of both triglycerides and LDL (bad) cholesterol. Niacin therapy can also raise HDL (good) cholesterol levels. Studies show that niacin alone helps reduce the risk of heart attack, stroke and death. However, we still do not have trial data showing that adding niacin to treatment with statins has a greater impact on the risk of heart attack, stroke and death. There is some evidence that the combination does offer greater benefits than niacin alone.3 Our physicians at Cleveland Clinic often prescribe niacin in combination with statins to help reduce triglyceride and more importantly, help to lower LDL levels to reach lipid goals.
Researchers in a recent trial known as ACCORD studied patients with diabetes who were taking a statin and a medication called fenofibric acid (also known as TriCor and Trilipix) to lower triglyceride levels. Although the patients’ triglyceride levels went down, the study did not establish an overall benefit for those taking the medication. This was especially true among the women in the trial. The medication did seem to decrease the risk of cardiovascular events among a subset of men, particularly those with triglyceride levels higher than 220 mg/dL and very low HDL levels. Therefore, the medication may benefit men with high triglyceride and low HDL levels.4
These studies clearly show that the way in which a person lowers triglyceride levels makes a difference, and simply lowering the levels is not always enough to reduce the risk of cardiac events. Instead, an overall effort to reduce the risks of cardiovascular events is best.
You should discuss the risks and benefits of any triglyceride-lowering therapy with your primary care physician, or see a specialist in Cleveland Clinic’s Preventive Cardiology department to help understand and evaluate your treatment options.
- GISSI PREVENZIONE INVESTIGATORS. Dietary supplementation with n3 polyunsaturated fatty acids and vitamin E after myocardial infarctation: results of the GISSI Prevenzione trial. Lancet 1999; 354:447-455. www.ncbi.nlm.nih.gov/pubmed/10465168
- THIES F, GARRY JM, YAQOOD P, RERKASEM K, WILLIAMS J,SHEARMAN CP. Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomized controlled trial. Lancet 2003; 361: 477-485. www.ncbi.nlm.nih.gov/pubmed/12583947
- Brown BG, Zhao, XQ, Chait, A, et.al. Simvastatin and Niacin, Antioxidant Vitamins, or the Combination for the Prevention of Coronary Disease. New Engl J Med 2001; Volume 345:1583-1592. content.nejm.org/cgi/content/short/345/22/1583
- The ACCORD Study Group. Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus. New Engl J Med 2010; 362 (18)1748. content.nejm.org/cgi/content/abstract/362/17/1563
Talk to your healthcare provider or registered dietitian for more information.
For more information on implementing a low cholesterol diet, contact:
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