Understanding High Triglycerides: Causes, Symptoms, and Effective Management

Triglycerides are a type of lipid, or fat, found in your blood. They are the most common type of fat in the body and serve as a major energy source. Structurally, a triglyceride molecule is composed of three fatty acids linked together by a molecule called glycerol. (65)

After you eat (especially carbohydrate-rich foods), your body converts any calories it doesn't need immediately into triglycerides. These triglycerides are stored in fat cells and released later for energy between meals. The liver also produces smaller amounts of triglycerides and helps to regulate their levels in the bloodstream. (65)

High levels of triglycerides in the blood, a condition known as hypertriglyceridemia, affects one-quarter of American adults and is a risk factor for atherosclerotic cardiovascular disease (ASCVD). Monitoring and managing triglyceride levels is essential in preventive healthcare, as ASCVD remains the leading cause of death worldwide.

[signup]

What Causes High Triglycerides?

Various factors can cause high triglycerides. The interplay of multiple risk factors often culminates in the development of disease.

Genetics

Familial hypertriglyceridemia is a hereditary condition where individuals inherit genes that predispose them to elevated triglycerides. Mutations in genes involved in lipid metabolism can impair the body's ability to regulate triglyceride levels effectively. Genetic variations in lipoprotein lipase (LPL), an enzyme that assists in triglyceride breakdown, and apolipoproteins, proteins that facilitate the transport and metabolism of lipid complexes, are often implicated in familial hypertriglyceridemia and result in impaired lipid clearance and elevated triglyceride levels in the blood.

Diet & Lifestyle

Consuming a diet high in carbohydrates, particularly simple sugars and refined grains, can lead to increased triglyceride levels. Additionally, diets rich in unhealthy fats, such as trans fats and saturated fats, can contribute to hypertriglyceridemia. (44)

A sedentary lifestyle increases the risk of hypertriglyceridemia by promoting weight gain and obesity, which are linked to elevated triglyceride levels. Physical inactivity contributes to insulin resistance, increasing the liver's production of triglyceride-rich very low-density lipoprotein (VLDL) particles. It also reduces the activity of LPL and lowers levels of high-density lipoprotein (HDL) cholesterol, which helps transport triglycerides to the liver for excretion. Collectively, these factors impair the body's ability to manage and clear triglycerides, resulting in higher blood levels.

Studies show that alcohol, especially when consumed in excess, can cause hypertriglyceridemia both after eating and in the fasting state by increasing the liver's synthesis of large VLDL particles. When alcohol is consumed with a fat-rich meal, particularly one high in saturated fat, it significantly amplifies the triglyceride peak after eating. (66)

Medical Conditions

Several medical conditions are associated with elevated triglyceride levels. These include:

Postmenopausal women are at a higher risk of developing hypertriglyceridemia. Estrogen supports hepatic (liver) lipid metabolism. The characteristic drop in estrogen levels during menopause can lead to higher cholesterol and triglyceride levels.

Medications

Medications can contribute to hypertriglyceridemia as well. Drugs with elevated triglyceride levels as a known side effect include:

Corticosteroids
Antipsychotics
Blood pressure medications, including beta-blockers and thiazide diuretics
Antiretroviral medicines used to treat HIV
Medications used to treat certain types of cancers, such as cyclophosphamide and tamoxifen

What Foods Cause High Triglycerides?

High glycemic diets high in refined carbohydrates, sugars, and unhealthy fats raise triglyceride levels (68).

Refined Carbohydrates and Simple Sugars:

White bread, pasta, and rice
Breakfast cereals
Candy
Pastries
Ice cream
Soda
Fruit juice (45, 58)

Saturated Fats:

Beef
Pork
Butter
Cheese
Cream
Lard
Tallow
Coconut (53)

Trans Fats:

Fried foods
Baked goods
Packaged snack foods
Margarine (59)

What Do High Triglycerides Mean?

Hypertriglyceridemia is diagnosed when fasting triglycerides are higher than 150 mg/dL. Hypertriglyceridemia is classified based on the degree of triglyceride elevation:

Normal: less than 150 mg/dL
Borderline High: 150-199 mg/dL
High: 200-499 mg/dL
Very High: 500 mg/dL or higher

Hypertriglyceridemia is usually asymptomatic until triglyceride levels are greater than 1,000-2,000 mg/dL. If symptoms occur, they may include:

Abdominal pain
Xanthomas: raised, yellow, waxy-appearing skin lesions caused by lipid buildup under the skin on the palms, elbows, knees, trunk, buttocks, thighs, and eyelids
Corneal arcus: a blue, white, or gray ring around the colored portion of the eyes (61)

The primary health concerns related to hypertriglyceridemia are acute pancreatitis and ASCVD:

Acute pancreatitis is a sudden onset of inflammation in the pancreas and the leading cause of gastrointestinal-related hospitalizations in the United States. Mild cases may resolve over several days, but severe cases require medical attention to prevent serious complications, including infection, shock, and even death.
ASCVD refers to a range of conditions caused by the buildup of atherosclerotic plaques in the arteries, including coronary artery disease (CAD) and peripheral artery disease (PAD). It significantly increases the risk of severe cardiovascular events such as heart attacks and strokes, and it remains the leading cause of morbidity and mortality worldwide.

Testing-Related Biomarkers

Triglycerides can be measured with a basic lipid panel. For accurate results, the patient must fast (no food or drink except water) for 10 to 12 hours before the blood draw. In addition to triglycerides, a lipid panel also includes the following markers:

Order a lipid panel through Rupa Health with one of the following tests:

Cholesterol and Lipids Panel by Ayumetrix
Lipid Panel Basic by Boston Heart Diagnostics
Lipid Panel by Access Med Labs

Given the interconnected nature of hypertriglyceridemia with cardiometabolic dysfunction, additional labs are integral to understanding and managing the broader metabolic and cardiovascular implications of hypertriglyceridemia. These include:

Blood sugar assessments, including fasting glucose, fasting insulin, and hemoglobin A1c (HbA1c)
Cardiovascular disease risk assessments, which may include lipoprotein number and size, oxidized LDL, apolipoprotein B (ApoB), lipoprotein(a), and high-sensitivity C-reactive protein (hs-CRP)
A comprehensive metabolic panel (CMP) includes 14 markers related to blood sugar, electrolyte balance, kidney health, and liver function

How to Reduce High Triglycerides

Lowering triglycerides has been associated with decreased cardiovascular morbidity and mortality in high-risk patients. Lifestyle modifications are recommended before pharmacologic therapy in treating hypertriglyceridemia.

Dietary Modifications

Eating a heart-healthy diet, such as the Mediterranean diet, has been shown to reduce triglyceride levels by up to a whopping 60%. The Mediterranean diet focuses on consuming whole foods that contain fiber, antioxidants, lean protein, and unsaturated fats. In addition to its triglyceride-lowering effects, the Mediterranean diet is also correlated to reduced ASCVD risk, improved liver disease, and balanced blood sugar.

If patients decide against subscribing to a Mediterranean approach to eating, they should be counseled on reducing their intake of processed foods, refined carbohydrates, added sugars, saturated fats, and trans fats. These should be replaced with vegetables, legumes, fatty fish, and whole grains. (68)

Patients should also be counseled on moderating alcohol intake. The American College of Cardiology outlines the following alcohol guidelines for patients with hypertriglyceridemia:

Triglycerides < 500 mg/dL: Do not exceed two drinks per day for men and one drink per day for women. Patients should choose alcoholic beverages with lower alcohol content, such as wine or beer, over beverages with higher alcohol content.
Triglycerides 500 mg/dL or higher: Abstain from alcohol completely

Weight Loss

Patients who are overweight or obese should be given a goal to lose 5-10% of their total body weight, which can result in an average 10-20% reduction of triglycerides. In some cases, weight loss has been reported to result in triglyceride reductions as high as 70%. (68)

While there is not a single universally accepted dietary protocol that is best for losing weight in all people, the following diets have research to support their ability to support weight loss and triglyceride reduction:

Higher-fat, lower-carbohydrate
Carbohydrate-restricted (20% or less of calories from carbohydrates)
Higher-protein (at least 25% of energy from protein)
Intermittent fasting

‍Combining diet and exercise is generally more effective for weight loss than relying on either approach alone. Resistance training decreases triglycerides by about 6%, and aerobic training decreases triglycerides by about 11% (68). To reduce ASCVD risk, the American Heart Association recommends:

At least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise per week
Moderate-to-high-intensity strength training at least two days per week (18)

Treat Underlying Medical Conditions

Patients should be screened for secondary causes of hypertriglyceridemia and treated appropriately.

The following Rupa Health Magazine articles discuss comprehensive treatment approaches for some of the medical conditions that can result in high triglycerides:

Medications and Supplements

Triglyceride-lowering medications and supplements are associated with a reduced risk of major cardiovascular events. These should be considered for patients with triglyceride levels greater than 1,000 mg/dL or those who fail to reach triglyceride and cholesterol treatment goals despite adopting appropriate lifestyle habits (49).

The following have been shown effective in lowering triglycerides:

Fibrate Medications: Fibrates reduce the liver's production of VLDL and increase HDL-cholesterol levels, both of which can result in triglyceride reductions. They can reduce triglyceride levels by 30-50%.
Statin Medications: Statins work by inhibiting an enzyme required for the body to make cholesterol. Compared to fibrates, statins have a less dramatic effect on triglyceride levels (10-30% reduction) but are indicated in patients with high ASCVD risk and LDL cholesterol.
Omega-3s: Over-the-counter or prescription omega-3 fatty acids derived from fish oil can reduce triglycerides up to 35% when given in oral doses of 2-4 grams daily.
Nicotinic Acid: Nicotinic acid is a form of vitamin B3 (niacin). 500-2,000 mg of niacin daily can reduce triglycerides between 20-50%.

[signup]

Key Takeaways

Hypertriglyceridemia, marked by elevated triglyceride levels (> 150 mg/dL) in the blood, poses a significant risk for cardiovascular diseases.
Regular measurement of triglycerides through lipid panels is a vital component of preventive health screening, enabling early detection and timely intervention.
Effective management of high triglyceride levels involves a multifaceted approach, including dietary changes, increased physical activity, weight management, and, when necessary, medications and supplements.
Addressing these factors early on can significantly enhance cardiovascular health and reduce the risk of cardiovascular-related morbidity and mortality.

Understanding High Triglycerides: Causes, Symptoms, and Effective Management