High Triglycerides: Causes, Symptoms and How to Lower Them
Medically reviewed by Sabeen Munib M.D.Triglycerides are high at 200 mg/dL or more, borderline at 150 to 199, and very high at 500 or more, the level where pancreatitis becomes a concern. Most people have no symptoms. The most common causes are insulin resistance, extra weight, sugar and refined carbs, and alcohol, and lifestyle changes often bring the number down within weeks.
What level of triglycerides is high?
Triglycerides are the most common type of fat in the blood. Your body makes them from extra calories, especially from sugar, refined starches and alcohol, and stores them for energy. They are measured on a standard cholesterol test (lipid panel) in mg/dL:
- Normal: below 150 mg/dL
- Borderline high: 150 to 199 mg/dL
- High: 200 to 499 mg/dL
- Very high: 500 mg/dL or higher
For children and teens the targets are lower: below 75 mg/dL up to age 9 and below 90 mg/dL from ages 10 to 19.
Why very high triglycerides are urgent
At 500 mg/dL and above, and especially above 1,000, triglycerides can cause pancreatitis, a painful and sometimes dangerous swelling of the pancreas. At this level the first goal is to bring the number down quickly to protect the pancreas. Below 500, the main concern is long-term heart and blood vessel risk.
What causes high triglycerides?
High triglycerides usually come from a mix of habits, other health conditions, medicines and genes. Finding the cause matters, because treating it often brings the number down.
Lifestyle causes
- Eating more calories than you burn, especially from sugary drinks, sweets, white bread, white rice and other refined starches
- Drinking alcohol, even moderate amounts in some people
- Extra weight, especially around the waist
- Low physical activity
- Smoking
Medical causes
- Insulin resistance, prediabetes and type 2 diabetes, especially when blood sugar is not well controlled
- An underactive thyroid (hypothyroidism)
- Kidney disease, including conditions that cause protein in the urine
- Fatty liver disease
- Pregnancy, when triglycerides naturally rise
Medicines that can raise triglycerides
- Estrogen taken by mouth, including some birth control pills and hormone therapy
- Steroids such as prednisone
- Some blood pressure medicines, such as certain diuretics and beta blockers
- Isotretinoin and other retinoid medicines
- Some medicines for mental health conditions, HIV and organ transplants
- Tamoxifen
Do not stop a prescribed medicine on your own. If one of yours may be playing a role, your doctor can weigh whether a change makes sense.
Genetics
Some families make or clear triglycerides differently. Inherited conditions can cause high triglycerides alone or together with high LDL cholesterol. A rare genetic condition can push triglycerides above 1,000 even in children. A strong family history of high triglycerides, early heart disease or pancreatitis is worth mentioning to your doctor.
What are the symptoms of high triglycerides?
Most people with high triglycerides have no symptoms at all. It is usually found on routine blood work. When levels are very high, some people notice:
- Small yellow or reddish bumps on the skin, often on the buttocks, elbows or knees (eruptive xanthomas)
- Belly pain, nausea or vomiting, which can be signs of pancreatitis
Severe pain in the upper belly that spreads to the back, especially with vomiting or fever, needs care the same day. Go to the emergency room.
How are high triglycerides linked to prediabetes and fatty liver?
High triglycerides often travel with insulin resistance. When insulin does not work well, the liver makes more triglycerides and the body clears them more slowly. This is why the same person often has several of these at once:
- Triglycerides of 150 mg/dL or higher
- Low HDL (good) cholesterol
- A larger waist
- Higher blood pressure
- Higher fasting blood sugar or an A1C in the prediabetes range
Having three or more of these is called metabolic syndrome, and it raises the risk of type 2 diabetes and heart disease. Fat can also build up in the liver, a condition now called metabolic dysfunction-associated steatotic liver disease (MASLD), often still known as fatty liver. It is usually silent too, and is often first suspected from blood tests or an ultrasound.
The good news is that these share the same fixes. The changes that lower triglycerides also tend to improve blood sugar and liver fat.
Read about the prediabetes A1C range and how to bring it down
How do you lower triglycerides?
Triglycerides respond to lifestyle change faster than most lab numbers, often within weeks. The changes that help most:
Diet changes for high triglycerides
- Cut sugary drinks, including soda, juice, sweet tea and specialty coffee drinks. This is often the single biggest change.
- Eat fewer sweets and refined starches such as white bread, white rice, pastries and chips.
- Choose whole grains, beans, vegetables and fruit in place of refined carbohydrates.
- Eat fatty fish such as salmon, sardines or trout about twice a week.
- Use olive oil, nuts and avocado in place of butter and fatty meats.
- Watch portions. Extra calories of any kind are turned into triglycerides.
Alcohol
Alcohol raises triglycerides in many people. Cutting back helps. If your triglycerides are 500 or higher, or you have had pancreatitis, avoiding alcohol completely is usually advised.
Weight and activity
- If you carry extra weight, losing 5% to 10% of your body weight can lower triglycerides. For someone who weighs 200 pounds, that is 10 to 20 pounds.
- Aim for at least 150 minutes a week of moderate activity, such as brisk walking or cycling.
- Even a single session of exercise can lower triglycerides for a short time, so regular movement adds up.
Very high triglycerides
When triglycerides are 500 or higher, a very low-fat diet, no alcohol and close follow-up are often needed until the level comes down. Medicine is more likely to be part of the plan.
Get help with a nutrition and weight management plan at The Pur Health
What medicines treat high triglycerides?
Lifestyle change comes first. Medicine may be discussed when triglycerides stay high, when they are very high, or when your overall heart risk is high. Options Dr. Munib may discuss include:
- A statin, when your overall heart risk calls for one. Statins lower LDL and also lower triglycerides.
- A fibrate, such as fenofibrate, mainly for very high triglycerides to lower pancreatitis risk
- A prescription omega-3 medicine, such as icosapent ethyl, in selected adults
- Treating the cause, such as better blood sugar control, thyroid treatment, or reviewing a medicine that raises triglycerides
Over-the-counter fish oil capsules are not the same as prescription omega-3 medicines. Talk with your doctor before taking supplements for triglycerides. Which option fits depends on your numbers, other health conditions and other medicines.
How often should triglycerides be checked?
- Adults with normal results: as part of a routine cholesterol test, usually every 4 to 6 years if your risk is low
- If your triglycerides are borderline or high: often every 3 to 12 months while you make changes
- After starting or changing medicine: usually within 4 to 12 weeks
A non-fasting test is fine for most people. If your triglycerides come back at 400 or higher, your doctor may repeat the test after a 9 to 12 hour fast to get a clearer number.
How Dr. Munib approaches high triglycerides
Dr. Munib first looks for the reason your triglycerides are high. She may check:
- Your full lipid panel, and a fasting repeat if needed
- A1C or fasting glucose for prediabetes or diabetes
- Thyroid, kidney and liver tests
- Your medicines and alcohol intake
- Your weight, waist and blood pressure, and your family history
The plan depends on what she finds. For many people it starts with food, alcohol and activity changes and a recheck in a few months. For others it may include treating blood sugar or thyroid problems, a weight-loss plan, or a medicine discussion. Very high triglycerides get faster follow-up.
Learn how Dr. Munib manages cholesterol, diabetes and other chronic conditions
Get help with high triglycerides in Irvine
If your lab report shows triglycerides of 150 or higher, Dr. Munib can review your results and build a plan with you at our office at 114 Pacifica, Suite 280, Irvine. We are in-network with most PPO plans. Cash-pay visits are $190 for new patients and $150 for returning patients, and labs are billed separately. Call (949) 647-5234 or book online.