High triglycerides: what the levels mean, causes, when they are dangerous and how to lower them

• age 18+, fasting: 0 – 150 mg/dL

Often reflects high carbohydrate or alcohol intake, weight changes, or insulin resistance.

Full reference table, citations and testing options: Triglycerides biomarker page.

1. A non-fasting sample, or alcohol in the 24–72 hours before the draw
2. Excess weight around the middle, a high-sugar or refined-carbohydrate diet, sugary drinks and fruit juice, inactivity and smoking
3. Insulin resistance, prediabetes and poorly controlled type 2 diabetes — the most common medical cause; triglycerides fall as glucose is controlled
4. Hypothyroidism, chronic kidney disease and nephrotic syndrome, fatty liver, Cushing's syndrome, lupus, HIV and lipodystrophy
5. Pregnancy — triglycerides double or triple by the third trimester
6. Medications — oral estrogens and tamoxifen, glucocorticoids, thiazides and beta-blockers, isotretinoin, cyclosporine, bile-acid sequestrants, protease inhibitors, second-generation antipsychotics (olanzapine, clozapine), L-asparaginase
7. Genetic disorders — familial hypertriglyceridemia and familial combined hyperlipidemia (200–1,000 mg/dL), and familial chylomicronemia syndrome, where levels run above 1,000 from childhood

• None at moderate levels — triglycerides are found on a lipid panel
• Severe upper abdominal pain radiating to the back, with nausea and vomiting, when very high levels cause pancreatitis
• Small yellow bumps on the skin of the back, buttocks, elbows and knees (eruptive xanthomas) and a milky appearance of the retinal vessels at very high levels
• Memory and concentration difficulty and abdominal fullness from an enlarged liver and spleen in chylomicronemia

• Repeat after a 9–12 hour fast, with no alcohol for 72 hours and normal eating in the days before — a single non-fasting value is not diagnostic
• Hemoglobin A1c or fasting glucose, TSH, creatinine and eGFR, a urine albumin-to-creatinine ratio and liver enzymes for the secondary causes
• Apolipoprotein B or non-HDL cholesterol — when triglycerides are high, calculated LDL is unreliable and these measure the atherogenic particles better
• A medication review for the drugs above, and an alcohol and diet history focused on sugar, refined carbohydrate and alcohol
• A 10-year cardiovascular risk estimate: at 150–499 mg/dL, triglycerides are a risk-enhancing factor that strengthens the case for lifestyle change and, with other risk, for statin therapy
• Above 500 mg/dL the priority becomes preventing pancreatitis — a very low-fat diet, no alcohol, glucose control and medication as directed by the clinician; a lipid specialist for levels above 1,000 or a suspected genetic disorder

Follow-up tests available at TestWell: TSH Test (Thyroid Stimulating Hormone) ($20.99), TSH with Reflex to Free T4 Test ($29.99), TSH + Free T4 Test ($27.99), Hemoglobin A1c Test ($18.99), Glucose Test ($14.99).