Lowering triglycerides: what works and what your blood shows

Lowering triglycerides works fastest in practice through three things: less alcohol, fewer sugary drinks and losing weight around the abdomen. Of all the values on a lipid panel, this one responds to change fastest, often within a few weeks.

That makes it a rewarding value to work on.

There is one catch that hands many people a misleading result: triglycerides rise sharply after a meal. Drawn non-fasting, the number here says very little.

When are triglycerides too high?

The limit applied in the metabolic syndrome criteria is 1.7 mmol/l. Above that the value counts as a risk factor. The further above it sits, the more attention it deserves, and very high values call for separate assessment.

The unit is the stumbling block here.

Many English-language pages quote 150 as the limit, and that is the same limit in mg/dl. A Dutch report prints 1.7. So always read your own triglyceride value against the unit printed after it.

Very high triglycerides are themselves a cause of pancreatitis. That is why values far above the limit are assessed separately from the cholesterol story, as also covered in elevated lipase.

Why do triglycerides rise?

Because your liver makes them from whatever energy is left over. Excess carbohydrate, and fructose and alcohol in particular, is converted in your liver into fat and released into your blood as triglycerides. So this value hangs far more directly on your diet than your LDL cholesterol does.

Alcohol is the strongest single factor.

A sensitive liver can respond to a few glasses a day with a clear rise. Sugary soft drinks work through the same route, because fructose is processed in the liver rather than in your muscles.

Reduced insulin sensitivity amplifies the whole thing, because your body then clears fat from the blood less well. That mechanism is set out in insulin resistance.

What lowers triglycerides fastest?

Less alcohol, fewer liquid sugars and weight loss, in that order of speed. People who stop drinking daily often see this value move within two to four weeks. That is exceptionally fast for a blood value.

Liquid calories are the second lever.

Soft drinks, fruit juice and sugar in coffee deliver fructose without satiety, and go straight to the same liver route. The Dutch Voedingscentrum recommends water and tea as default drinks and treats sugary drinks as the easiest place to cut.

Weight loss works more slowly but lasts longer. In the Diabetes Prevention Program, a modest lifestyle programme in 3,234 participants produced 58 percent fewer new diabetes cases, through changes that were not extreme (Knowler et al., 2002). The Dutch Hartstichting names regular movement and less saturated fat as fixed parts of the same package.

Why does HDL always belong with it?

Because the ratio between the two says more than either number alone. When insulin sensitivity falls, triglycerides rise while HDL drops, so they almost always move in opposite directions. Together they form two of the five metabolic syndrome criteria.

There is a useful sum using exactly those two numbers.

Divide your triglycerides by your HDL cholesterol, both in mmol/l. American research in people carrying excess weight found a result around 1.8 in SI units to be a usable simple marker for reduced insulin sensitivity, alongside a triglyceride value of 1.47 mmol/l (McLaughlin et al., 2003).

Say you have triglycerides of 2.2 mmol/l against an HDL of 0.9 mmol/l, which gives 2.4. Triglycerides of 1.2 against an HDL of 1.5 gives 0.8. Both people can carry the same total cholesterol, while the ratio tells a different story.

That is the whole point of this division.

Both numbers already sit on your report, so this sum costs nothing extra. Do not confuse it with your cholesterol/HDL ratio, which looks at cardiovascular risk rather than at insulin sensitivity. The five criteria together are in metabolic syndrome.

How do you get it measured properly?

Fasting, after eight to twelve hours without food, and without alcohol in the days before. Of all the values on a lipid panel this is the most sensitive to what you did the night before. A meal can lift your result well past the 1.7 mmol/l line with nothing actually wrong.

Two days without alcohol before the draw is a reasonable rule of thumb.

Measure triglycerides preferably alongside HDL and fasting glucose, because that gives you three of the five criteria in one draw. The GLP-1 baseline panel contains that combination, and a BIG-registered doctor assesses the result.

Always discuss a sharply raised value with your GP. They weigh in whether medication, thyroid or kidney problems are pushing the value up.

What I would look at myself

The speed at which this value responds. Where HbA1c needs eight to twelve weeks to move, triglycerides show within a month whether anything has changed. That makes it well suited to checking a change you have made.

What strikes me about this value is how often it gets drawn wrongly.

A non-fasting result with last night's drink still in it is not a measurement of your metabolism but of your evening. Draw it fasting, have HDL run alongside it, and work out that one division before worrying about an isolated number.

References

• McLaughlin T et al. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med. 2003. PMID 14623617
• Knowler WC et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002. PMID 11832527
• Hartstichting, information on cholesterol, movement and risk factors.
• Voedingscentrum, information on sugary drinks and alcohol.
• NHG guideline on cardiovascular risk management, interpretation of the lipid panel.

Every blood test result includes a professional assessment from a BIG-registered doctor. Discuss your result with your GP before changing anything about your treatment.