High triglycerides: what they mean

What triglycerides measure

Triglycerides are the most common type of fat in the body. They come from the food you eat and are also made by the liver from extra calories, especially sugar, refined carbohydrates and alcohol. The body stores them in fat cells and uses them for energy between meals. A lipid profile measures them along with cholesterol. Levels rise after eating, so a fasting test of 9 to 12 hours gives the clearest reading. To convert mg/dL to mmol/L, divide by 88.6.

Common causes

High triglycerides often come as part of a group of problems with weight, blood sugar and blood pressure, sometimes called metabolic syndrome. This pattern is common in South Asian adults, often with a low HDL. Genes also play a part, and some families have much higher levels. Doctors often find the cause in daily habits, and many people see their levels improve once the main cause is dealt with.

• Excess weight, especially around the waist
• Sugary drinks, sweets and large amounts of white rice, bread or refined flour
• Alcohol, even in moderate amounts for some people
• Poorly controlled diabetes or an underactive thyroid
• Kidney or liver disease, and some medicines such as steroids
• Eating shortly before a test that was meant to be fasting

Why HDL matters too

High triglycerides and low HDL often go together, and the combination is linked to insulin resistance, fatty liver and higher heart risk. An HDL under 40 mg/dL in men or under 50 mg/dL in women is considered low. When triglycerides are above about 400 mg/dL, the usual calculation for LDL becomes unreliable, so labs may measure LDL directly or report non-HDL cholesterol instead. Your doctor will often check blood sugar or HbA1c and liver tests too, because high triglycerides can be an early sign of diabetes.

What usually happens next

If your test was not fasting, the first step is often a repeat after a 9 to 12 hour fast. For mild to moderate rises, lifestyle changes usually work well: cutting sugary drinks, sweets and refined carbohydrates, limiting alcohol, losing weight if needed, regular exercise and eating oily fish. Triglycerides often respond faster to these changes than LDL does. Your doctor will also treat any cause such as high blood sugar. If levels stay very high, especially above 500 mg/dL, your doctor may suggest medicine to lower the risk of pancreatitis.

Questions to ask your doctor

• Was my test fasting, and should I repeat it after fasting?
• Could diabetes, thyroid, kidney or liver problems be raising my triglycerides?
• Is my level high enough to raise my risk of pancreatitis?
• Which diet changes would help me most?
• Do I need medicine, or should I try lifestyle changes first?