High Triglycerides

Cause

The most common causes of high triglycerides are obesity and poorly controlled diabetes. If you are overweight and are not active, you may have high triglycerides, especially if you eat a lot of carbohydrate or sugary foods or drink a lot of alcohol. Binge drinking of alcohol can cause dangerous spikes in triglyceride levels that can trigger inflammation of the pancreas (pancreatitis).

Other causes of high triglycerides include hypothyroidism, kidney disease, and certain inherited lipid disorders.

Estrogen therapy, which may be used for menopause symptoms, may also raise triglyceride levels. Certain medicines may also raise triglycerides. These medicines include:

• Tamoxifen.
• Steroids.
• Beta-blockers.
• Diuretics.
• Birth control pills.

High triglycerides rarely occur on their own. They are usually associated with other conditions.

High triglycerides are a part of metabolic syndrome, a group of medical problems that increase your risk of heart attack, stroke, and diabetes. Metabolic syndrome includes:

• High triglycerides.
• Low HDL ("good") cholesterol.
• High blood pressure.
• High blood sugar.
• Too much fat, especially around the waist.

Symptoms

High triglycerides by themselves do not cause symptoms. If your high triglycerides are caused by a genetic condition, you may have visible fatty deposits under the skin called xanthomas.

In rare cases, people who have very high triglyceride levels may develop inflammation of the pancreas (pancreatitis), which can cause sudden, severe abdominal (belly) pain, loss of appetite, nausea and vomiting, and fever.

Triglycerides are categorized as follows:^{footnote 1}

Triglyceride levels

Normal	Less than 150 milligrams per deciliter (mg/dL)
Borderline-high	150 to 199 mg/dL
High	200 to 499 mg/dL
Very high	500 mg/dL or higher

If you have high triglycerides, you may also have high cholesterol. In many cases, people don't know that they have high triglycerides until they have a blood test called a lipoprotein analysis to check their cholesterol levels.

If your triglyceride levels are high, your doctor will also check for and treat other associated conditions that may be linked to high triglycerides. These conditions include diabetes, hypothyroidism, kidney disease, and metabolic syndrome.

Treatment Overview

You can use diet and lifestyle changes to lower triglyceride levels.

Diet and lifestyle changes include:

• Losing weight and staying at a healthy weight.
• Limiting fat and sugars.
• Being more active.
• Limiting alcohol.

You may also take medicines to lower triglyceride levels. Medicines may be used if you have risk factors for coronary artery disease (CAD).

Initial treatment

Diet and lifestyle changes are the first steps you will take to lower triglyceride levels.

Diet and lifestyle changes include:

• Losing weight and staying at a healthy weight.
• Limiting the amount of carbohydrate and unhealthy fat that you eat.
• Being more active.
• Limiting alcohol.
• Not smoking.
• Keeping blood sugar in a target range if you have diabetes.

Eat a heart-healthy diet that is rich in fruits, vegetables, whole grains, fish, lean meats, and low-fat or nonfat dairy foods. Limit saturated fat and avoid trans fat. Limit sodium and sugar.

Eating fish may lower triglyceride levels. Eating at least 2 servings of fish each week is part of a heart-healthy diet. Oily fish, which contain omega-3 fatty acids, are best for your heart. These fish include salmon, mackerel, lake trout, herring, and sardines.

Fish oil supplements can also lower triglycerides. But doctors do not agree about whether these supplements can help protect your heart. If you have very high triglycerides, your doctor may recommend you take fish oil to try to prevent pancreatitis.

To reduce carbohydrate in your diet, you may want to learn about the amount of carbohydrate in various foods.

Alcohol has a particularly strong effect on triglycerides. Regular, excessive use of alcohol or even a one-time drinking binge can cause a significant increase in triglycerides. Binge drinking can cause a spike in your triglycerides that may trigger pancreatitis. Your doctor will want you either to stop or to limit the amount of alcohol you drink.

Before you increase your activity, check with your doctor to be sure it is safe. You may also want to talk with a dietitian to design a nutrition program that is right for you.

Your doctor will also look for anything else that might be causing your high triglycerides, such as hypothyroidism, poorly controlled diabetes, kidney disease, or medicines. Your doctor may adjust or stop any medicines that might raise your triglyceride level.

Ongoing treatment

If your triglycerides are still high after you make lifestyle changes, you may need to take medicine as well. Whether your doctor prescribes medicine for high triglycerides depends on more than just your triglyceride number. Your doctor will also look at your cholesterol levels and other risk factors (things that increase your risk) for heart disease before prescribing a medicine for high triglycerides.

If you have high cholesterol and other risk factors for heart disease, you may need a combination of medicines that target the different types of cholesterol. The medicines that you might take are:

• Fibrates.
• Nicotinic acid (niacin).
• Omega-3 fatty acids (fish oil).
• Statins.

Statins are used to lower LDL (bad) cholesterol. Statins may also lower triglycerides. If you have both high LDL cholesterol and high triglycerides, your doctor may first prescribe statins to lower your LDL and later prescribe a medicine to lower your triglycerides.

If your triglycerides are very high even after lifestyle changes, your doctor may first use medicine to lower your triglycerides to prevent damage to your pancreas.

Fibrates (fibric acid derivatives) should be used with caution by people who are also taking statins. There is a greater risk for a life-threatening muscle problem called rhabdomyolysis, which can lead to kidney failure. So it is important that your kidneys and liver are healthy before you take this combination of medicines. If you have any muscle problems or pain, report it immediately to your doctor.

Home Treatment

Diet and lifestyle changes can help lower your triglycerides. For example:

• Lose weight and stay at a healthy weight. Triglycerides are stored as fat in your tissues and muscles.
• Eat fewer calories. Excess calories are converted to triglycerides.
• Limit high-calorie foods and carbohydrate, especially high-sugar foods such as cookies, soda, and fruit juices.
• Limit unhealthy fats in your diet, especially saturated fat and trans fats.
• Choose a heart-healthy eating plan.
• Limit alcohol, which has a strong effect on triglycerides.
• Be active on most days of the week. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week.
• Stop smoking. See the topic Quitting Smoking for information on how to quit.