High triglycerides, what to do?

By Cristiano Antonino Last updated Jun 29, 2023

Part of the glyceride family together with monoglycerides and diglycerides, triglycerides are neutral esters of glycerol which – instead of the hydrogen atoms of the hydroxyl groups – are made up of three chains of fatty acids

They are found in the blood, but their concentration should not exceed 180 mg/dl: higher quantities of triglycerides expose the person to the risk of cardiovascular disease.

To detect them, a simple blood test is used, and their value allows the determination of bad cholesterol (LDL).

The formula is: LDL cholesterol = total cholesterol – HDL cholesterol – triglycerides/5

Anyone with too much triglycerides in their blood suffers from hypertriglyceridemia.

A condition which, if not identified and treated, exposes the person to numerous risks.

What are high triglycerides?

Having high triglycerides in the blood means suffering from hypertriglyceridemia.

An energy reserve for the body, triglycerides are lipids introduced into the blood through food and – to a small extent – produced by the liver.

They are the main component of adipose tissue.

However, it is essential that their concentration is kept under control.

Normal triglycerides < 150 mg/dl

Borderline triglycerides 150-199 mg/dl

High triglycerides 200-499 mg/dl

Very high triglycerides > 500 mg/dl

Triglycerides above 200 mg/dl expose you to a higher risk of atherosclerosis, cerebrovascular events, coronary artery disease and various other cardiovascular pathologies.

High triglycerides symptoms

Unless we are talking about very serious cases, high triglycerides do not cause symptoms.

Only if their value rises above 1000 mg/dl can the patient feel:

severe abdominal pain related to the occurrence of acute pancreatitis
xanthoma (yellowish plaques or nodules caused by deposits of fat-filled macrophages in the skin).

However, even when the person does not feel any symptoms, triglycerides work silently and increase the risk of cardiovascular disease, atherosclerosis and acute pancreatitis.

Hypertriglyceridemia exposes you to numerous and dangerous pathologies, but it is even more risky when it is associated with other risk factors:

low levels of good cholesterol (HDL) versus high levels of bad cholesterol (LDL)
diabetes
metabolic syndrome

Metabolic syndrome, in particular, is a condition that needs the utmost attention.

Characterized by hypertension, hypertriglyceridemia, hypercholesterolemia, abdominal obesity and fasting hyperglycemia, it significantly increases the risk of stroke, heart attack and other cardiovascular diseases.

High triglycerides, the causes

At the base of high triglycerides there is a lifestyle with incorrect habits.

Particularly risky are:

cigarette smoke
a high-fat diet
obesity or overweight
excessive sedentary lifestyle
alcohol abuse

However, the basis of hypertriglyceridemia can also be:

diabetes mellitus
the metabolic syndrome
severe kidney disease
an untreated state of insulin resistance
endocrinological diseases such as hypothyroidism
the use of drugs such as the contraceptive pill and thiazide diuretics
genetic diseases such as familial hypertriglyceridemia (which, however, affects only 1% of the population)

In most cases, high triglycerides are caused by an excessively caloric diet.

In the digestive process, intestinal cells capture dietary lipids and transform them into chylomicrons, whose function is precisely to transport the “new” triglycerides in the blood.

Production is also carried out by the liver, where, however, it starts from dietary amino acids and glucose and – for transport – produces VLDL.

The triglycerides are therefore brought into the blood, so that the tissue cells use the lipids as a source of energy (immediate or reserve).

When the person has a correct lifestyle, made up of a balanced diet and sufficient physical activity, the production of triglycerides and their transporters is in line with the needs of the tissue cells; when the diet is excessively fatty or a pathological condition is present, production exceeds the needs of the cells and triglycerides accumulate in the blood.

High triglycerides, the diagnosis

In general, high triglycerides are detected “randomly” during normal blood tests: the doctor will periodically prescribe the patient the measurement of total cholesterol, LDL and HDL cholesterol, blood sugar, triglycerides and many others standard parameters.

The exam must be carried out fasting for at least 12 hours and, the evening before, a light dinner must be eaten.

If these rules are not respected, it is possible that the examination detects a “false positive”.

Other good rules to follow are:

avoid excess food in the previous 4-5 days
avoid alcohol consumption in the previous 2-3 days
do not overdo it with physical activity in the 48 hours preceding the sampling

High triglycerides, therapy

The first therapy, for those suffering from high triglycerides, is lifestyle modification: it varies from patient to patient, and is aimed at a change – mainly – in eating habits.

And if all this is not enough, the doctor can prescribe drugs such as fibrates, fish oil, niacin and statins.

To be decisive is the cause of hypertriglyceridemia:

diet high in fat and calories: modification of diet
obesity/overweight: diet aimed at weight loss and educational plan to learn the basics of healthy eating
kidney disease: treatment for the cure of the same (if possible)
taking a medicine: stop taking it by discussing the best substitute with your general practitioner

The diet for high triglycerides

Most cases of hypertriglyceridemia are caused by an incorrect diet: very often it is sufficient to change one’s food style to bring the values back to normal.

Habitually consuming high-calorie foods and sugary/alcoholic drinks, even more in the face of little or no physical activity, causes an ineffective and inappropriate metabolic response.

It’s not just a matter of fat: if you consume a lot of sugar, blood sugar rises causing hyperglycemia and therefore hyperinsulinemia.

The metabolization of nutrients is impaired, these are converted into fatty acids and the number of triglycerides in the blood rises.

The same happens if you consume a lot of alcohol: its insulin stimulus is similar to that of simple carbohydrates and also leads to an increase in triglycerides.

The eating habits (and not only) that prevent the rise of triglycerides are therefore:

follow a balanced diet, keeping body weight under control
reduce or avoid alcohol consumption
not smoking
do regular physical activity
consume fish three times a week, preferring mackerel, sardines, trout, herring and salmon due to their omega-3 content
limit the consumption of meat, especially the red one
consume plenty of fruits and vegetables, rich in antioxidants
prefer whole grains to plain ones
limit the consumption of saturated fats (especially contained in dairy products)
prefer monounsaturated fatty acids (contained in olive oil and dried fruit)
avoid hydrogenated fats (present in snacks, snacks and packaged baked goods)

Finally, there are foods capable of counteracting the increase in triglycerides, due to the high content of essential omega-3 fatty acids, alpha linoleic acid, eicosapentaenoic acid and docosahexaenoic acid.

These are oily fish, fish oils and vegetable oils.

Medicines for high triglycerides

If changing your eating habits is not enough to reduce the number of triglycerides in the blood, you can use some prescription drugs:

fish oil: thanks to the omega-3 content, it lowers triglycerides and blood sugar, protects the heart and has an anti-inflammatory and antioxidant action
Fibrates: these are the most effective drugs for those suffering from hypertriglyceridemia
niacin: reduces triglycerides but also bad cholesterol, increasing the good one
statins: mainly used to reduce LDL cholesterol, they are also effective in case of high triglycerides

By adopting a correct lifestyle, acting on nutrition and physical activity, the chances that triglycerides in the blood will decrease are very high.

However, the answer is not the same for everyone: each patient reacts differently to changes and therapies.

Therefore, hypertriglyceridemia should always be monitored by your doctor so that the cardiovascular risk is lowered.

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