Porter Health

Understanding Triglycerides

The Most Common Fat in Your Blood

What Are Triglycerides?

Triglycerides are the most common type of fat in your body. They come from the food you eat (especially calories from fat, sugar, and alcohol) and are also made by your liver. Your body stores triglycerides in fat cells for energy between meals.

How Triglycerides Work:

You eat food

Your body converts extra calories (especially from sugar, refined carbs, and alcohol) into triglycerides.

Triglycerides enter your bloodstream

They're packaged in particles (like VLDL) and travel through your blood to fat cells.

Stored for later energy

When you need energy between meals, hormones release triglycerides from fat cells.

The Problem: When you eat more calories than you burn, triglycerides build up in your blood. High triglycerides increase your risk of heart disease, stroke, pancreatitis, and fatty liver disease.

What Should My Triglyceride Level Be?

Triglycerides are measured in mg/dL after an 8-hour fast (or non-fasting for screening). Lower is better:

Normal

< 150 mg/dL

This is the healthy range. Maintain it with a healthy diet, regular exercise, and maintaining a healthy weight.

Borderline High

150-199 mg/dL

You're at increased cardiovascular risk. Lifestyle changes can bring levels back to normal.

What to do:

Reduce sugar and refined carbs
Increase exercise and physical activity
Lose weight if overweight
Limit or avoid alcohol

High

200-499 mg/dL

Significantly elevated cardiovascular risk. You need aggressive lifestyle changes and possibly medication.

What to do:

Work with your doctor on a treatment plan
Consider omega-3 fish oil or prescription medications
Evaluate for metabolic syndrome or diabetes
Implement intensive dietary changes

Very High (Emergency!)

≥ 500 mg/dL

Immediate medical attention needed! Risk of acute pancreatitis (life-threatening inflammation of the pancreas).

Urgent Actions:

Contact your doctor immediately
Start medication to rapidly lower triglycerides (fibrates, omega-3)
Eliminate alcohol completely
Severely restrict fat intake temporarily (very low-fat diet)

New Optimal Target:

Some experts now recommend a target of < 100 mg/dL for optimal cardiovascular health, especially if you have diabetes or metabolic syndrome.

What Causes High Triglycerides?

High triglycerides are usually caused by lifestyle factors, but can also result from medical conditions:

Excess Calories

Eating more than you burn - especially from sugar and carbs

High Sugar Intake

Sugary drinks, sweets, refined carbs (white bread, pastries)

Alcohol

Even moderate drinking can significantly raise triglycerides

Obesity

Excess body weight, especially belly fat

Physical Inactivity

Sedentary lifestyle

Type 2 Diabetes

Poor blood sugar control

Metabolic Syndrome

Combination of high BP, high blood sugar, obesity, low HDL

Kidney Disease

Impaired triglyceride clearance

Hypothyroidism

Underactive thyroid gland

Medications

Beta blockers, thiazide diuretics, estrogen, tamoxifen, steroids

Genetic Conditions

Familial hypertriglyceridemia (rare)

Pregnancy

Temporary elevation during pregnancy

How to Lower Triglycerides Through Lifestyle

Great News: Triglycerides respond very well to lifestyle changes!

Unlike cholesterol (which is partly genetic), triglycerides are largely controlled by what you eat and how active you are. Many people can normalize triglycerides with lifestyle changes alone.

1. Lose Weight (Most Effective!)

Effect: Can lower triglycerides by 20-30% with 5-10% weight loss

Even modest weight loss dramatically lowers triglycerides. Losing just 10-20 lbs can cut triglycerides in half.

2. Drastically Cut Sugar and Refined Carbs

Effect: Can lower triglycerides by 20-50%

Eliminate or Minimize:

Sugary drinks (soda, juice, sweet tea, energy drinks)
Sweets and desserts (candy, cookies, cake, ice cream)
White bread, white rice, pastries
High-sugar breakfast cereals
Processed snacks (chips, crackers)

Replace With:

Whole grains (brown rice, quinoa, oats)
Non-starchy vegetables
Lean protein (chicken, fish, beans)
Healthy fats (nuts, avocado, olive oil)

3. Eliminate or Severely Limit Alcohol

Effect: Can lower triglycerides by 25-50% (if alcohol is a contributor)

Alcohol is a major trigger for high triglycerides. Even moderate drinking (1-2 drinks daily) can significantly elevate levels.

If your triglycerides are high, eliminate alcohol completely until they normalize.

4. Exercise Regularly

Effect: Can lower triglycerides by 20-30%

Exercise Goals:

150 minutes per week moderate activity (brisk walking, cycling)
Or 75 minutes per week vigorous activity (running, HIIT)
Even 10-minute walks after meals help lower triglycerides

5. Eat Omega-3 Fatty Acids

Effect: Can lower triglycerides by 15-30%

Best Sources:

Fatty fish: Salmon, mackerel, sardines, herring (2-3 servings per week)
Walnuts, flaxseeds, chia seeds
Omega-3 fish oil supplements (1-2 grams EPA+DHA daily)

6. Increase Fiber Intake

Effect: Can lower triglycerides by 10-15%

Aim for 25-35 grams of fiber daily from:

Vegetables and fruits
Beans, lentils, chickpeas
Whole grains (oats, barley, quinoa)
Nuts and seeds

Medications for High Triglycerides

If lifestyle changes alone don't lower triglycerides enough, medications can help:

Prescription Omega-3 Fatty Acids (Icosapent Ethyl, Lovaza)

Effect: Lower triglycerides by 20-30% (high-dose EPA: 2-4 grams daily)

Best for: Triglycerides 200-499 mg/dL or persistent elevation despite statin therapy

Icosapent ethyl (Vascepa) 4g daily has been proven to reduce cardiovascular events in high-risk patients.

Fibrates (Fenofibrate, Gemfibrozil)

Effect: Lower triglycerides by 30-50%, raise HDL by 10-20%

Best for: Very high triglycerides (≥ 500 mg/dL) to prevent pancreatitis

Caution: Can interact with statins (increased muscle pain risk). Use fenofibrate (safer) instead of gemfibrozil with statins.

Statins

Effect: Lower triglycerides by 10-30% (mainly lower LDL)

Best for: High LDL and moderately high triglycerides (150-500 mg/dL)

High-intensity statins provide the most triglyceride-lowering benefit.

Niacin (Vitamin B3)

Effect: Lower triglycerides by 20-40%, raise HDL by 15-35%

Rarely used: Side effects (flushing, itching, liver toxicity) and lack of cardiovascular benefit

When to Start Medication:

Triglycerides ≥ 500 mg/dL: Start medication immediately (fibrates or omega-3) to prevent pancreatitis
Triglycerides 200-499 mg/dL: Try lifestyle changes for 2-3 months, then consider medication
Triglycerides 150-199 mg/dL: Focus on lifestyle; medication usually not needed

Questions to Keep in Mind as You Discuss Triglycerides with Your Porter Health Coach or a Member of Your Medical Care Team

Use this checklist to guide your conversation about triglyceride management:

What is my current triglyceride level? Is it fasting or non-fasting?

What is my target triglyceride level based on my overall cardiovascular risk?

Do I have metabolic syndrome or insulin resistance?

Which lifestyle changes would have the biggest impact on my triglycerides?

Should I eliminate alcohol completely to lower my triglycerides?

Do I need medication, or can I try lifestyle changes first?

Should I take prescription omega-3 fish oil (icosapent ethyl/Vascepa)?

If my triglycerides are very high (≥ 500), am I at risk for pancreatitis?

How often should I have my triglycerides rechecked?

Key Takeaways

Triglycerides are fats in your blood from food and made by your liver

Target: < 150 mg/dL normal, < 100 mg/dL optimal for cardiovascular health

Very high triglycerides (≥ 500 mg/dL) risk acute pancreatitis - seek immediate care

High triglycerides respond extremely well to lifestyle changes (20-50% reduction)

Cut sugar and refined carbs - biggest impact on triglycerides

Eliminate alcohol if triglycerides are elevated

Weight loss of 10-20 lbs can cut triglycerides in half

Omega-3 fatty acids (food or supplements) lower triglycerides by 15-30%

Prescription omega-3 (icosapent ethyl 4g daily) reduces cardiovascular events

Fibrates lower triglycerides by 30-50% - used for very high levels

References:

Based on the 2026 ACC/AHA Guideline on the Management of Dyslipidemia and the Endocrine Society Clinical Practice Guideline for the Management of Hypertriglyceridemia. This guide translates the latest clinical guidelines into patient-friendly language to help you understand and manage triglycerides.

Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. J Am Coll Cardiol. 2026. doi:10.1016/j.jacc.2025.11.016

Berglund L, Brunzell JD, Goldberg AC, et al. Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97(9):2969-2989. doi:10.1210/jc.2011-3213