How to reduce high triglyceride levels

This blog is the 3rd in a series of 5 on the topic of metabolic syndrome risk factors.

Having elevated fasted blood levels of triglycerides is a risk factor for metabolic syndrome due to its association with cardiovascular disease. Triglycerides are the most common type of fat found circulating in our blood. Like cholesterol it is also insoluble in blood and is transported as part of lipoprotein complexes - mainly VLDLs (very low density lipoproteins), but also LDLs (low density lipoproteins). In our previous blog we explored how cholesterol plays an important role in the production of various substances including many hormones. Triglycerides store excess calories and provide our bodies with energy when required. 

Triglycerides are found in our diet and levels in our blood increase following a meal. Levels should, however, return to a baseline level fairly quickly which is why triglyceride levels measured in a blood lipid panel are measured in a fasted state. If these levels are persistently elevated it is a sign of metabolic dysfunction and a risk factor for diseases such as cardiovascular disease (heart attacks and stroke).

Fasted triglyceride levels above 1.69 mmol/L are the threshold as a risk factor for metabolic syndrome, however the optimal levels for triglycerides we should aim for are actually below 1.1mmol/L.

Mild-to-moderately elevated levels of triglycerides are very common (approximately 10% in the adult population), which closely parallels the prevalence of obesity and type 2 diabetes. High triglycerides increase your risk of atherosclerosis (hardening and/or thickening of arteries). It is important to note that when we measure LDL-C and triglyceride levels we are measuring most of the atherogenic particles to determine risk for developing disease. Apolipoprotein B (apoB) test measures all of the atherogenic particles and is the gold standard test.

Elevated triglyceride levels are caused by excess consumption of carbohydrates, fat and alcohol, diabetes, insulin resistance, hypothyroidism, and mitochondrial dysfunction and are often a sign of other conditions such as metabolic syndrome which increases your risk of heart disease and stroke. Very high triglyceride levels can also induce inflammation of the pancreas - pancreatitis.

Certain drugs and pollutants such as certain pesticides may also elevate triglyceride levels. Rarely, high triglycerides may have a genetic component. 

So what can we do to reduce our triglyceride levels and therefore our risk of developing metabolic syndrome?

Changing lifestyle factors by making healthy lifestyle choices is the most important tool in treating high levels of triglycerides. When these fail to reduce triglyceride levels to an optimal level your doctor may need to prescribe drugs in addition to your lifestyle changes. 

Lifestyle factors to reduce triglycerides: 

Avoiding or minimising alcohol - apart from its high sugar and calorie content, alcohol consumption has a particularly potent effect on triglycerides. Avoiding alcohol in any form and quantity can reduce elevated triglyceride levels by up to 80%.

Getting regular exercise - is a cornerstone of a healthy lifestyle. Getting at least 30 minutes day of aerobic exercise on most days of the week has numerous health effects including lowering triglyceride levels by 10 to 20%. 

A healthy balanced diet - particularly by reducing calorie intake is key to reducing elevated triglyceride levels as excess calories are converted to triglycerides and stored as fat. More specifically, saturated fats (found in red and processed meats) and trans fats (fried foods, commercially packaged snacks, margarine) should be  avoided and replaced with monounsaturated and polyunsaturated fats (extra virgin olive oil, fish rich in omega-3-fatty acids). Also, avoiding refined carbohydrates (sugar, white pasta, white bread) and replacing them with a diet rich in fibre and low-glycemic index carbohydrates.

Weight loss  - you can expect to lose 0.1mmol/L per kg of body weight lost. 

Drugs to reduce triglycerides:

If healthy lifestyle changes are not sufficient to reduce triglycerides to optimal levels, there are several medications which may be considered. LDL-lowering drugs such a statins, PCSK9 inhibitors and ezetimitibe (many times used in combination with statins). There are also specific triglyceride-lowering drugs which include fibrates, niacin and prescription-grade omega-3 fatty acids and have a more profound effect on reducing elevated triglycerides. 

 If you would like to test your personal risk factors for developing chronic diseases of ageing, find out more about the Longevity Annual health check and download the longevity doctor guide to healthy living.