2. Limit sugar, refined carbohydrates, and too much alcohol
Do you have to eat a keto diet to lower triglycerides? Not necessarily. Reducing sugars, refined carbohydrates, and alcohol may be enough to lower your levels.
As we mentioned, any caloric excess can increase triglycerides. However, the most likely sources of extra calories are excess sugar, refined carbs, and alcohol.
One reason carbs and sugars commonly increase triglycerides may be that carbs and sugars are two of the most commonly overconsumed foods. However, another reason could be that fructose (a component of sugar) and alcohol are more likely to cause fatty liver, which can raise triglycerides.
One study reports that simply replacing sugar-sweetened beverages with water reduced triglycerides.
And another reports that decreasing alcohol consumption lowered fasting triglycerides.
Other factors, such as baseline obesity and insulin resistance, may make it more likely that eating carbs would cause an individual's triglycerides to rise.
If you're overweight or have insulin resistance, the evidence shows it's important to reduce carbs. However, the data suggests that most people with high triglycerides - even people with normal weight - would benefit from reducing sugar, refined carbs, and alcohol.
3. Some people may respond best to a low-fat diet
For those with severely elevated triglycerides (defined as greater than 1,000 mg/dL or 11.2 mmol/L), there is a case for low-fat diets being equally good - if not better than - low carb in some situations.
One study finds that those with triglycerides below 400 mg/dL (4.5 mmol/L) respond best to low-carb diets, but those with triglycerides greater than 400 mg/dL (4.5 mmol/L) respond best to low-fat diets.
However, case reports document a decrease in severely elevated triglycerides with low-carb, high-fat diets.
It's important to understand the cause of elevated triglycerides, as that may impact the proposed dietary treatment. If someone has a genetic cause, such as familial chylomicronemia or lipoprotein lipase deficiency, a low-fat diet may be more effective.
Aside from these extreme examples, there is no evidence to support a low-fat diet as being better than a low-carb diet for reducing elevated triglycerides.
4. Eat to lose weight
Losing just 6.6 pounds (3 kilos) can result in an average of 15 mg/dL decrease in triglycerides.
In the LookAHEAD trial, a randomized trial studying a calorie-reduced low-fat diet, the average reduction in triglycerides was only 12 mg/dL (0.13 mmol/L).
However, decreases were more significant for participants who lost more weight. For instance, the few who lost more than 15% of their body weight in the LookAHEAD trial had an average triglyceride reduction of 70 mg/dL (0.8 mmol/L). Conversely, the 25% of participants who did not lose weight showed no reduction in their triglyceride levels.
5. Fiber
Fiber can also lower triglycerides. But the way fiber affects you may have more to do with your diet's underlying carbohydrate content.
One randomized trial reports that, for participants eating high-carb diets, lowering fiber intake raised triglycerides 45%. Adding back fiber brought triglyceride levels back to baseline.
A weaker observational study finds an apparent relationship between higher fiber intake and lower triglyceride levels. But in a study structured like this, it's difficult to control for overall diet quality. High-carb diets that are also high in fiber are likely better than high-carb diets low in fiber in several ways.
An interventional trial of a fiber supplement does not show improvements in participants' triglyceride levels. This suggests that the effects associated with fiber may have more to do with overall diet quality than the presence of fiber itself.
The take-home lesson is that you should avoid refined carbs and sugars. If you are going to eat a high-carb diet, you should make sure it's also high in fiber.
6. Eat more fish
Eating fish and taking omega-three fatty acid supplements can both significantly decrease triglycerides.
One randomized trial reports those who ate 270 grams of salmon twice each week reduced triglycerides by an average of 28 mg/dL (0.32 mmol/L)
You can add this triglyceride-reducing effect to the many other potential health benefits of eating fish.
See below in the supplements section for information on omega-three supplements and their impact on triglyceride levels.
4. Exercising to lower triglycerides
Summary
Although any physical activity can provide health benefits, high-intensity exercise, and resistance training to fatigue are best for lowering triglycerides.
While nutrition probably has the most significant impact on triglycerides, exercise can also lower your levels. But not all forms of exercise produce equally promising results.
When it comes to lowering triglycerides, higher intensity exercise is best.
There are different ways to define high-intensity exercise. The most common is achieving greater than 85% of your maximum heart rate. However, a more useful definition may be a level of exercise where you can no longer have a conversation or a level you can maintain for only a few minutes.
Resistance training, involving a moderate amount of weight and high repetitions, can also help with triglyceride levels. Lifting extra heavy weight fewer times produces less of a significant effect.
Does this mean lower intensity exercise doesn't provide health benefits? Of course not. As we detail in our in-depth exercise guide, physical activity of any kind has multiple health benefits.
Even if you can't get to the point where exercise impacts your triglycerides, don't let that discourage you. Carry on to maintain your muscles, strengthen your bones, and build your fitness one step at a time.
5. Taking supplements to lower triglycerides
The data show that diet and exercise are practical approaches for lowering triglycerides. However, for some people, lifestyle changes may not be enough. In that case, it may be worth discussing supplements with your healthcare provider.
Disclaimer:. Any medication or supplement may have unintended side effects or interactions with other medications. The following is for the purpose of general knowledge and is not meant to be medical advice. You should always consult your personal healthcare provider before starting, stopping, or changing the dose of any supplement of medication.
Here's a list of possible choices.
- Niacin: 2,000 to 3,000 mg per day
- Berberine: 500 mg twice daily
- Fish oil: Eicosapentaenoic acid (EPA) 2 to 4 grams per day (Docosahexaenoic acid, or DHA, does not seem to have much of an effect.)
- Curcumin: 80 to 100 mg daily
- Fenugreek: 10 grams per day
6. Taking medications to lower triglycerides
Summary
Many different supplements and medications can reduce triglyceride levels. Fish oil doses of 3 to 4 grams (EPA only) may be the best choice to reduce cardiovascular events and the risk of dying.
However, most medications and even supplements can come with significant side effects. Always ask your doctor before starting any new supplements or medications.
In addition to supplements, several studies show certain medications may reduce triglycerides. Recommendations to take medications focus on reducing the risk of pancreatitis as well as heart disease.
The evidence to support the idea that lowering triglycerides with medications can provide cardiac protection is mixed. Many isolated studies show no benefits, but a meta-analysis of multiple studies suggests minor benefits.
Ask your doctor if any of these medications may be right for you:
Statins - The most commonly prescribed class of cholesterol-lowering drugs has a mild triglyceride-lowering effect ranging from 10% reduction at low doses to 30% at higher doses.
Fibrates - Drugs such as gemfibrozil can lower triglycerides by 30-50%. These drugs should be used with caution when taken along with statins or warfarin due to drug interactions. Those with a history of gallstone disease should not take fibrates.
Although fibrates do lower triglycerides, it is not clear that they reduce cardiac events or the risk of death.
Prescription niacin - Niacin can reduce triglycerides by up to 30%. Niacin may cause liver disease, and may worsen insulin resistance or blood sugar control in those with type 2 diabetes. Those with peptic ulcer disease should not take niacin.
Although niacin does lower triglycerides, it is not clear that it reduces cardiac events or death risk.
Omega 3 fatty acids - These are available over the counter (as a supplement) and by a doctor's prescription. The prescription version tends to come in higher doses and pure EPA form.
Studies of different omega 3 doses demonstrate a 20 to 50% reduction in triglycerides. Most studies report a dose of 3 to 4 grams as the most effective therapy.
A major trial in 2019 reports people taking 4 grams of the fish oil EPA (in the form of icosapent ethyl) had a 21% reduction in triglycerides (from 216 mg/dL to 170 mg/dL) at five years.
More importantly, there was also a 5% reduction in cardiovascular events and a 0.9% reduction in death.
7. Risk of elevated triglycerides
Summary
High triglyceride levels increase the risk of coronary artery disease and pancreatitis.
Elevated triglycerides can cause two main health concerns: an increased risk of heart disease and an increased risk of pancreatitis (an acute, severe inflammation of the pancreas).
Increased risk of heart disease
Medical science consistently demonstrates that people with higher triglycerides have a higher risk of heart disease. That is not surprising since high triglycerides are also correlated with other cardiac risk factors such as insulin resistance, metabolic syndrome, and more atherogenic small LDL particles.
Observational studies demonstrate the risk of a heart attack triples (from 1% to 3% over ten years) for those with triglycerides above 265 mg/dL (3.0 mmol/L) compared to those with lower levels.
Another study reports an increased risk for statin-treated patients when their triglycerides were above 175 mg/dL (2 mmol/L).
Studies comparing the impact of elevated triglycerides on cardiovascular risk suggest it may be equally or more important than high LDL cholesterol.
One study shows genetic mutations that lower triglycerides have an equal benefit for reducing heart disease risk as those that lower LDL.
Other studies report elevated triglycerides and triglyceride-to-high-density lipoprotein (HDL) cholesterol ratio are associated with smaller LDL particles and a more advanced coronary disease, whereas elevated LDL cholesterol show no significant correlation.
Most recently, an evaluation of the PREDIMED trial demonstrates that triglycerides above 150 mg/dL (1.69 mmol/L) and remnant cholesterol (particles that contain a high amount of triglycerides such as VLDL and intermediate density lipoprotein (IDL)) have greater predictive power for heart disease risk than does LDL.
However, the data on drug therapy for triglycerides don't demonstrate consistent benefits. A meta-analysis of randomized trials, the highest-rated level of evidence, shows that lowering triglycerides with medications can reduce the risk of heart disease. But not all studies agree.
In fact, many trials show no improvement in the risk of heart disease or death.
Could triglyceride-lowering lifestyles have a greater impact than medications?
Theoretically, lifestyle interventions could have a more significant impact since they target the underlying cause of elevated triglycerides, which medications can't address. But comparative trials have not been done.
Increased risk of pancreatitis
Severely elevated triglycerides is the third most common risk factor for pancreatitis but causes only around 4% of all cases. Gallstones and alcoholism are much more common, comprising approximately 70% of all cases.
Individuals with triglycerides above 1,000 mg/dL (11.2 mmol/L) have a 5% chance of developing pancreatitis, and that increases to 10 to 20% for levels above 2,000 mg/dL (22.5 mmol/L). For reference, the general population risk of pancreatitis is just 0.5%.
8. Summary
High triglyceride levels are a concerning medical condition associated with an increased risk of heart disease and pancreatitis. They're also common when obesity, insulin resistance, and other metabolic disorders are present.
Fortunately, you can do something about them. By eating a low-carb diet, avoiding sugar and excessive alcohol, and doing high-intensity exercise, you can play an active role in lowering your triglycerides.