Triglycerides are the main type of fat in your blood. Triglyceride is a general term for a type of lipid-containing three fatty acids (tri) bound to a glycerol. Most importantly, triglycerides are used by the body as energy and are stored in adipocytes (fat cells that compose adipose tissue).
Most of the time, when you go to the doctor for a lipids test, they are worried about higher LDL or lower HDL levels. These are classically linked to cardiovascular disease risk. However, triglycerides also play a causal role in heart disease.[ref]
People are starting to take note of triglyceride levels as a marker of metabolic syndrome. The defining factors for metabolic syndrome include abdominal obesity, high blood pressure, high blood sugar, low HDL, and high triglycerides.
The immediate response to ‘why do I have high triglycerides’ is to blame the diet and assume you are eating donuts and drinking lots of soda. While diet does play a role (of course), your genetic variants are also very important in basal triglyceride levels.
Digging deeper into triglycerides
Triglycerides – three fatty acids and glycerol – can contain either saturated or unsaturated fatty acids. Most triglycerides contain different types of fatty acids in them.
Saturated fats are carbon-hydrogen chains that have single bonds between the carbons. Unsaturated fats have either one double bond (monounsaturated) or multiple double bonds (polyunsaturated). The double bonds cause a bend in the molecule, keeping it from packing together as tightly. Thus polyunsaturated fats are usually liquids and saturated fats can be solids at room temperature.
Triglycerides from food cannot be directly absorbed. Instead, they are emulsified by lipase, an enzyme secreted by the pancreas, to break down fats. In the enterocytes ( an intestinal cell that absorbs) of the small intestines, the fatty acids from triglycerides are packaged into chylomicrons (like a glob of fat). Picture how oil clumps together into droplets when you try to stir it into water.
Chylomicrons contain mostly triglycerides, along with a smaller percentage of cholesterol, phospholipids, and proteins. They are secreted into the lymphatic system first, so they don’t initially go through the liver’s first amino acids and sugars.
Testing triglyceride levels:
Testing of triglyceride levels is usually done in a fasted state because the blood levels of triglycerides can rise quite a bit after eating.
Plasma triglyceride tests measure the very low-density lipoproteins (VLDL) and chylomicrons.
Triglyceride level ranges[ref]:
- Normal: Less than 150 mg/dl
- Borderline high: 150-199 mg/dl
- High: 200 – 499 mg/dl
- Very high: 500 and up
To convert mg/dl triglyceride levels into mmol/L, multiply by .01129.
In studies, hypertriglyceridemia is usually defined as being higher than 150 mg/dl or higher than 2 mmol/L (175mg/dl). About 25% of adults in the US meet this criterion.[ref][ref] Other studies call levels from 150-999 mg/dl mild to moderate hypertriglyceridemia. Levels over 1,000 mg/dl are severe and can cause pancreatitis.[ref]
High triglycerides are linked to atherosclerosis and stroke. Is this a big increase in risk? That is a hard question to quantify since every study seems to have different endpoints and biases.
Here are some study results:
- High fasting triglycerides have links to a 24% increase in the risk of mortality from cardiovascular disease.[ref]
- All-cause mortality also increases as triglyceride levels increase.[ref – open access]
- One study states that slightly elevated triglyceride levels in people with metabolic syndrome or prediabetes are more likely to cause atherosclerosis than the really high levels found in people with genetic mutations.[ref – open access]
- Other studies point to elevated non-fasting triglyceride levels being linked to an increased risk of heart attack and death.[ref]
Fructose and high triglycerides:
Several studies show that high fructose intake increases triglycerides. As a result, this may lead you to assume that drinking the periodic soda is causing your high triglycerides…
Animal studies pretty clearly show that fructose increases triglyceride levels. In rats, replacing water with fructose water increases blood pressure, liver fat, and triglycerides pretty significantly.[ref][ref]
Human studies on fructose and triglycerides show similar trends but much less dramatic results.
A study using normal-weight adults looked at the difference between consuming 150g/d of fructose or 150 g/day of glucose for four weeks. They did this by substituting fructose or glucose for other calories in the diet, so overall calories weren’t affected. After four weeks, there was no increase in visceral fat, muscle fat, or liver fat and no changes to blood pressure. The only change after four weeks was that triglycerides in the fructose group went up by 35 mg/dl (still in the normal range, though). There was no change in triglycerides in the glucose group.[ref]
Studies in humans where fructose is added on top of their regular caloric intake show a more considerable increase in triglyceride. One study that added fructose for a 35% increase in calories showed triglyceride levels rising 75%.[ref] But it is hard to differentiate between suddenly adding that many calories vs. those calories being from fructose.[ref]
A meta-analysis concluded there is no difference in triglyceride levels from fructose vs. sucrose vs. glucose.[ref]
Triglycerides, leptin, and obesity:
Leptin is the hormone that signals to the brain that you are full and don’t need to eat. In people who are overweight or obese, there is usually a high level of leptin, but that signal isn’t being received in the brain (leptin resistance). The question is ‘why?’… For example, one theory is that elevated triglyceride levels interact with leptin in the brain, causing leptin resistance.
Triglyceride levels rise when you are in a state of starvation as your body activates fat from adipose tissue. A recent study recently looked at the connection between triglyceride levels and leptin resistance. The study found that triglycerides cross the blood-brain barrier and can induce leptin resistance.[ref – open access]
Theoretically, it makes sense that high triglycerides would block the leptin signal in times of starvation, driving people to need more food. But in our modern epidemic of metabolic syndrome and high triglyceride levels, this is causing leptin resistance and increasing the desire to eat even when overweight.
HDL and triglyceride levels:
High triglyceride levels usually correspond to lower HDL levels. Certainly, this is part of what makes research on cardiovascular disease risk and triglycerides difficult — is it the low HDL or high triglycerides that cause the increase in risk?[ref – open access]
Triglycerides Genotype Report
If you have high triglycerides, carrying some of the variants (above) that raise your triglyceride levels is part of the problem. The other half of the equation is diet and lifestyle.
Reducing Triglycerides through Dietary Changes:
Some research indicates that high fructose corn syrup increases triglyceride levels, while other research shows that increased calories (whether from high fructose corn syrup, sugar, etc.) increase trigs. Either way, cutting out the soda and switching to unsweetened drinks may help to lower triglyceride levels.
Even more noteworthy, a (small) study showed that the ketogenic diet, which is a low carbohydrate diet, reduced triglyceride levels fairly significantly.[ref]
The Mediterranean diet, consisting of plenty of fresh fruits, vegetables, and fish, reduced triglycerides (a little) in a clinical trial.[ref]
5 Natural Supplements that impact triglycerides:
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Ariza, María-José, et al. “Additive Effects of LPL, APOA5 and APOE Variant Combinations on Triglyceride Levels and Hypertriglyceridemia: Results of the ICARIA Genetic Sub-Study.” BMC Medical Genetics, vol. 11, Apr. 2010, p. 66. PubMed Central, https://doi.org/10.1186/1471-2350-11-66.
Balkan, Jale, et al. “The Effect of Betaine Treatment on Triglyceride Levels and Oxidative Stress in the Liver of Ethanol-Treated Guinea Pigs.” Experimental and Toxicologic Pathology: Official Journal of the Gesellschaft Fur Toxikologische Pathologie, vol. 55, no. 6, July 2004, pp. 505–09. PubMed, https://doi.org/10.1078/0940-2993-00347.
Dron, Jacqueline S., and Robert A. Hegele. “Genetics of Triglycerides and the Risk of Atherosclerosis.” Current Atherosclerosis Reports, vol. 19, no. 7, 2017, p. 31. PubMed Central, https://doi.org/10.1007/s11883-017-0667-9.
Dullaart, R. P. F., et al. “Plasma Phospholipid Transfer Protein Activity Is Inversely Associated with Betaine in Diabetic and Non-Diabetic Subjects.” Lipids in Health and Disease, vol. 15, no. 1, Aug. 2016, p. 143. PubMed Central, https://doi.org/10.1186/s12944-016-0313-5.
Dupas, Julie, et al. “Metabolic Syndrome and Hypertension Resulting from Fructose Enriched Diet in Wistar Rats.” BioMed Research International, vol. 2017, 2017, p. 2494067. PubMed Central, https://doi.org/10.1155/2017/2494067.
Eberly, Lynn E., et al. “Relation of Triglyceride Levels, Fasting and Nonfasting, to Fatal and Nonfatal Coronary Heart Disease.” Archives of Internal Medicine, vol. 163, no. 9, May 2003, pp. 1077–83. PubMed, https://doi.org/10.1001/archinte.163.9.1077.
Kozian, D. H., et al. “Glucokinase-Activating GCKR Polymorphisms Increase Plasma Levels of Triglycerides and Free Fatty Acids, but Do Not Elevate Cardiovascular Risk in the Ludwigshafen Risk and Cardiovascular Health Study.” Hormone and Metabolic Research = Hormon- Und Stoffwechselforschung = Hormones Et Metabolisme, vol. 42, no. 7, June 2010, pp. 502–06. PubMed, https://doi.org/10.1055/s-0030-1249637.
Lê, Kim-Anne, et al. “Fructose Overconsumption Causes Dyslipidemia and Ectopic Lipid Deposition in Healthy Subjects with and without a Family History of Type 2 Diabetes.” The American Journal of Clinical Nutrition, vol. 89, no. 6, June 2009, pp. 1760–65. PubMed, https://doi.org/10.3945/ajcn.2008.27336.
Liao, Yi-Chu, et al. “Multiple Genetic Determinants of Plasma Lipid Levels in Caribbean Hispanics.” Clinical Biochemistry, vol. 41, no. 4–5, Mar. 2008, pp. 306–12. PubMed Central, https://doi.org/10.1016/j.clinbiochem.2007.11.011.
Liu, Zhi-Kai, et al. “Associations of Polymorphisms in the Apolipoprotein A1/C3/A4/A5 Gene Cluster with Familial Combined Hyperlipidaemia in Hong Kong Chinese.” Atherosclerosis, vol. 208, no. 2, Feb. 2010, pp. 427–32. PubMed, https://doi.org/10.1016/j.atherosclerosis.2009.08.013.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases, 2012. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK547852/.
Masuda, Daisaku, and Shizuya Yamashita. “Postprandial Hyperlipidemia and Remnant Lipoproteins.” Journal of Atherosclerosis and Thrombosis, vol. 24, no. 2, Feb. 2017, pp. 95–109. PubMed Central, https://doi.org/10.5551/jat.RV16003.
Menzel, H. J., et al. “A Variant Primary Structure of Apolipoprotein C-II in Individuals of African Descent.” Journal of Clinical Investigation, vol. 77, no. 2, Feb. 1986, pp. 595–601. PubMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC423392/.
Morjane, Imane, et al. “Association of c.56C > G (Rs3135506) Apolipoprotein A5 Gene Polymorphism with Coronary Artery Disease in Moroccan Subjects: A Case-Control Study and an Updated Meta-Analysis.” Cardiology Research and Practice, vol. 2020, Aug. 2020, p. e5981971. www.hindawi.com, https://doi.org/10.1155/2020/5981971.
NM_000483.5(APOC2):C.122A>C (p.Lys41Thr) AND Apolipoprotein c-Ii Variant – ClinVar – NCBI. https://www.ncbi.nlm.nih.gov/clinvar/RCV000002697.2/. Accessed 19 Oct. 2022.
NM_000483.5(APOC2):C.229A>C (p.Lys77Gln) AND APOLIPOPROTEIN C-II (AFRICAN) – ClinVar – NCBI. https://www.ncbi.nlm.nih.gov/clinvar/RCV000002682.2/. Accessed 19 Oct. 2022.
Nordestgaard, Børge G., et al. “Nonfasting Triglycerides and Risk of Myocardial Infarction, Ischemic Heart Disease, and Death in Men and Women.” JAMA, vol. 298, no. 3, July 2007, pp. 299–308. PubMed, https://doi.org/10.1001/jama.298.3.299.
Orho-Melander, Marju, et al. “Common Missense Variant in the Glucokinase Regulatory Protein Gene Is Associated With Increased Plasma Triglyceride and C-Reactive Protein but Lower Fasting Glucose Concentrations.” Diabetes, vol. 57, no. 11, Nov. 2008, pp. 3112–21. PubMed Central, https://doi.org/10.2337/db08-0516.
Shahid, Saleem Ullah, et al. “Common Variants in the Genes of Triglyceride and HDL-C Metabolism Lack Association with Coronary Artery Disease in the Pakistani Subjects.” Lipids in Health and Disease, vol. 16, Jan. 2017, p. 24. PubMed Central, https://doi.org/10.1186/s12944-017-0419-4.
“Should You Worry about High Triglycerides?” Harvard Health, 1 Feb. 2006, https://www.health.harvard.edu/heart-health/should-you-worry-about-high-triglycerides.
VCV000004402.8 – ClinVar – NCBI. https://www.ncbi.nlm.nih.gov/clinvar/variation/4402/. Accessed 19 Oct. 2022.
VCV000157542.2 – ClinVar – NCBI. https://www.ncbi.nlm.nih.gov/clinvar/variation/157542/. Accessed 19 Oct. 2022.
Wang, Jian, et al. “Polygenic Determinants of Severe Hypertriglyceridemia.” Human Molecular Genetics, vol. 17, no. 18, Sept. 2008, pp. 2894–99. PubMed, https://doi.org/10.1093/hmg/ddn188.
Wang, Lijun, et al. “Betaine Supplement Alleviates Hepatic Triglyceride Accumulation of Apolipoprotein E Deficient Mice via Reducing Methylation of Peroxisomal Proliferator-Activated Receptor Alpha Promoter.” Lipids in Health and Disease, vol. 12, Mar. 2013, p. 34. PubMed Central, https://doi.org/10.1186/1476-511X-12-34.
Zeman, Miroslav, et al. “Niacin in the Treatment of Hyperlipidemias in Light of New Clinical Trials: Has Niacin Lost Its Place?” Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, vol. 21, July 2015, pp. 2156–62. PubMed Central, https://doi.org/10.12659/MSM.893619.