What are triglycerides?
Triglycerides are particles in the blood that transport fat. They come from excess sugar (refined carbohydrate) and fat intake in the diet and can also be made in the liver. Triglycerides are converted into energy in the body; for example, to fuel muscles. If a person doesn't use their muscles after eating, the excess triglycerides will be stored as fat or in the liver. High levels of triglycerides in the bloodstream are a risk factor for heart disease and stroke as well as obesity. High triglycerides are associated with more that a 70% increased risk of coronary heart disease. High triglycerides are especially significant risk factors for people with type 2 diabetes or metabolic syndrome.
Causes of high blood triglycerides include genetics, obesity, insulin resistance, type 2 diabetes, high-carbohydrate and/or high-fat diet, excessive alcohol consumption, sedentary lifestyle, hypothyroidism, renal disease, and medications such as beta- blockers, thiazide diuretics, glucocorticosteroids, anabolic steroids, and some HIV medications.
How to Lower Triglycerides Naturally: Mediterranean Diet
Eating a Mediterranean diet is not really dieting at all, but eating a variety of fresh foods that taste good and prevent obesity and its health consequences. The Mediterranean diet has been around for over 50 years, and its benefits continue to become apparent. The health benefits of the Mediterranean diet range from a lower risk of:
- heart disease,
- certain cancers,
- and stroke;
- lower blood pressure and LDL levels;
- improved brain function,
- eye health, and fertility;
- healthy body weight; and
- increased life span.
What is the optimal range for blood triglycerides?
A standard blood cholesterol panel includes triglycerides, along with HDL, LDL, and total cholesterol. An advanced lipid test will include measurement of other particles that carry fat, including VLDL. Triglycerides are associated with VLDL, which are highly associated with atherosclerosis ("hardening" of the arteries).
Optimally, levels of triglycerides should be less than 100 for prevention of vascular disease and optimal wellness. Standard laboratory ranges of triglyceride levels are shown below in a triglyceride level chart:
Triglyceride Level Ranges
|Triglyceride Level (mg/dL)
||Level of Risk
|101 to 150
|151 to 200
|201 to 300
||Very High Risk
Triglycerides can be extremely elevated in some people. When triglycerides are over 500, you can see actually the fats in the serum when a tube of blood is drawn. Triglycerides over 300 can be caused by poor dietary habits, but sometimes people can eat very well and still have high triglycerides because of genetics. People with very elevated levels of triglycerides have trouble transporting other lipid particles (specifically VLDLs) out of the circulation. Anyone with triglycerides over 200 should definitely be doing something to lower triglyceride levels. People with triglycerides greater than 200 especially benefit from weight loss and increasing physical activity. The good news is that triglycerides are very responsive to lifestyle changes such as eating better, drinking less alcohol, and exercising more.
Is it possible to lower triglycerides naturally without drugs?
Triglycerides can be lowered without drugs. For example, they can be lowered naturally through diet changes, decreasing consumption of alcohol or sugary beverages, by increasing physical activity, by losing weight, and other ways. As little as 5% to 10% reduction in body weight may lower triglycerides. The table below summarizes how much benefit different changes can effect.
Benefit of Lifestyle Modification to Lower Triglycerides
||Magnitude of Effect
|Reduce excessive body weight
|Reduce alcohol intake
|Reduce intake of simple sugars
|Reduce total amount of dietary carbohydrate
|Utilize supplements of omega-3 polyunsaturated fat
|Replace saturated fat with mono- or polyunsaturated fat
What dietary changes and foods help lower triglycerides?
A general dietary pattern to lower triglycerides is the Mediterranean diet. This diet is characterized by a low glycemic load, a high intake of healthy fats such as olive oil and fish oil, and low intake of processed meats, saturated fats, and trans fats. This dietary pattern is low in total carbohydrates. The carbohydrates that are consumed are largely low in glycemic load – that is, they are largely unprocessed.
To lower triglycerides, some foods should be avoided. Decreasing animal fats (specifically saturated fat) decreases triglycerides and LDL directly. Trans fats, which are identified on food labels as hydrogenated fats and oils, should also be avoided. Decreasing refined carbohydrate (specifically sugar, bread, and other processed foods made with flour and/or sugar) can also help lower triglycerides. These simple sugars are high in mono- and disaccharides, which raise triglyceride levels. Very low carbohydrate diets (less than 35g per day) are very efficient at lowering triglycerides. Fructose can also raise triglycerides; high fructose corn syrup should be avoided and fruit should be consumed in its whole form, not as juice. Reducing sugars is especially important when a person also has insulin resistance. Added sugars should be no more than 5% of the diet.
Other foods can be added to the diet to reduce triglycerides. Cold water fish, which are rich in omega-3 fatty acids, help lower triglycerides. Examples of omega-3 rich fish include salmon, sardines, mackerel, herring, tuna, and halibut. Other foods that help lower triglycerides include fiber-rich foods such as oats, flax meal, and beans. Olive oil, especially when substituted for animal fats like butter or lard, is another food that can help lower triglycerides.
What supplements help lower triglyceride levels?
Fish oil lowers triglycerides. The dose needed to reduce triglycerides is 1 to 4 grams of EPA/DHA per day. Four grams per day has been shown to reduce triglycerides by 25% to 30%. People with the highest triglycerides benefit most. It is worth noting that non-marine omega 3 fatty acids do not appear to lower triglycerides in the same way. The prescription form of synthetic omega-3 fatty acids, Lovasa, Vascepa, or Epanova are approved by the US Food and Drug Administration (FDA) for people with triglycerides over 500 mg/dL.
Niacin is another supplement for lowering triglycerides. Both regular and extended release nicotinic acid have been shown to reduce triglycerides by up to 40% (at a dose of 1500 mg per day). Niacin has the added benefit of increasing HDL and lowering LDL. The high doses of niacin needed to lower triglycerides can cause uncomfortable flushing in some people. To avoid this, niacin can be taken with baby aspirin, with food, or an extended release form of niacin/nicotinic acid (one in which the niacin is mixed with an edible wax such as carnauba wax). Inositol-hexanicotinate, marketed as No-flush niacin, is NOT the same thing and contains very little nicotinic acid.
Fibers, such as chia, flax, psyllium or bran, help lower triglycerides. Fibrates, a class of cholesterol-lowering drugs that have been used for decades, also have a triglyceride lowering effect, through the same general mechanisms.
Alpha lipoic acid, a dietary supplement antioxidant, also has triglyceride-lowering effects. Because alpha lipoic acid has other beneficial effects on overall cardiovascular and diabetes risk, this makes it a good option. Several studies have found that 600 mg of alpha lipoic acid helpful for high triglycerides.
There are other supplements with limited research supporting their benefit in hypertriglyceridemia. Recent research has shown that probiotics may play a role in lowering triglycerides. Two lactobacillus species have been studied and found to lower triglycerides. Some research suggests l-carnitine can benefit triglyceride lowering as well.
What other lifestyle strategies help lower triglycerides?
Lifestyle strategies are a way to lower triglycerides naturally. Weight loss has a positive effect on triglycerides. For every 5% to 10% weight reduction, triglycerides may be lowered by 20%. Another way to look at this: for every kilogram (2.2 lb) lost, triglycerides may be reduced by 2%.
Increasing physical activity lowers triglycerides. Aerobic activity of any kind, especially when done after a meal, uses up triglycerides that are in the blood ready to be used as fuel. This not only lowers triglycerides but also helps abdominal obesity. Exercise is most effective for lowering triglycerides when they are very elevated. If triglycerides are optimal (less than 100), exercise will not further lower the level.
All together, intensive lifestyle strategies can reduce triglycerides by 50% or more over a year. Lifestyle strategies can enable people to effectively reduce triglycerides without medicine or drugs, plus there are many other positive effects on other aspects of health and well-being. This is the recommended approach of the American Heart Association for anyone with triglycerides greater than optimal (greater than 100 mg/dL).
What is the relationship between triglycerides and alcohol?
There is a dose-dependent relationship between alcohol intake and triglyceride levels. The more a person drinks, the higher their triglycerides. It is estimated that for every 1 oz/day of regular alcohol consumption, triglycerides increase by 5% to 10%. Heavy alcohol use is associated with very high triglycerides. It can also be associated with pancreatitis because of difficulty metabolizing alcohol and fats together in the liver. For people with very high triglycerides (over 250 mg/dL) abstaining from alcohol entirely may be recommended. For people who have questions about whether their amount of drinking is healthy, a self-assessment and information is available.
Is it possible to lower triglycerides quickly?
It is entirely possible to lower triglycerides quickly. The quickest ways are to make lifestyle changes. A very low carbohydrate diet free from animal fats (a low-sugar, low glycemic load Mediterranean pattern) is most efficient. Exercise is also a quick way to lower triglycerides. Supplements can lower triglycerides over a period of several months.
Do triglyceride-lowering strategies help raise HDL?
Triglycerides are involved in the transport of fatty acids to muscles and tissues for energy. HDL particles are involved in the transport of excess fatty acids from the periphery back to the liver for elimination. Because of these competing roles, it is very difficult to increase HDL, the healthy good cholesterol, without first addressing triglycerides. HDL not only transports excess lipid to the liver for disposal, it transports cholesterol to organs such as the adrenals, ovaries, and testes for steroid hormone synthesis. Many of the strategies discussed here that lower triglycerides are also known to raise HDL.
Medically Reviewed on 8/8/2018
Medically reviewed by Joseph Palermo, DO; Board Certificate: Internal Medicine/Geriatric Medicine
Choi, I. D., et al. "Triglyceride-lowering Effects of Two Probiotics, Lactobacillus plantarum KY1032 and Lactobacillus curvatus HY7601, in a Rat Model of High-Fat Diet-induced Hypertriglyceridemia." Journal of Microbiology and Biotechnology 2015.
Jia, R., et al. "Effects of dietary α-lipoic acid, acetyl-l-carnitine, and sex on antioxidative ability, energy, and lipid metabolism in broilers." Poultry Science 93.11 (2014): 2809-2817.
Miller, M., et al. "Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association." Circulation 123.20 (2011): 2292-2333.
Mozaffarian, D. and R. Clarke. "Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils." European Journal of Clinical Nutrition Suppl 2 (2009): S22-S33.
Pashaj, A., et al. "α-Lipoic acid as a tryglyceride-lowering nutraceutical." Canadian Journal of Physiology and Pharmacology 93.12 (2015): 1029-1041.
Vrablink, M. and R. Ceska. "Treatment of hypertriglyceridemia: a review of current options." Physiological Research Suppl 3 (2015): S331-S340.