The Trouble with Triglycerides

Manage high triglycerides with tips from the pros.
By Gina Shaw
WebMD Feature
Reviewed by Brunilda Nazario, MD

You’ve probably heard of triglycerides, and you’ve probably also heard that consistently high blood levels of triglycerides can be  a bad thing.

But what are triglycerides, exactly? Why would your doctor shake his head if your cholesterol report says that your triglycerides are high? And what do they have to do with diabetes and a group of worrisome symptoms called the “metabolic syndrome?”

What Are Triglycerides?
Simply put, triglycerides are fat. That is, they’re the major form in which our bodies store fat. Fat tissue is made up of cells that fill up with triglycerides.

So triglycerides are bad, right? Well, not normally. In fact, we couldn’t live without triglycerides. “They’re the main way evolution gave us to store energy,” says Mitchell Lazar, MD, PhD, director of the Institute for Diabetes, Obesity and Metabolism at the University of Pennsylvania.

“Up until 100 years ago or so, food wasn’t nearly as plentiful as it is now, and we burned a lot more calories in physical labor. So it was very important to have the ability to store fuel in an efficient way,” Lazar says. “Per pound, you get twice as much energy from your stores of fat as you do from the other two substances we can burn for energy -- proteins and sugars.”

But now there’s a lot more food around, we eat a lot more of it, and we don’t get as much physical activity as we once did. So, most of us are storing significantly more fat than we need -- in the form of triglycerides.

Damage and Diabetes
What’s the problem with having high triglycerides? If triglycerides are fat, and fat is energy, aren’t we just storing more energy? Unfortunately, our bodies often can’t store that extra energy efficiently -- and sometimes those extra fat cells can attract other cells that cause problems for your health.

“For one thing, fat cells tend to attract inflammatory cells,” Lazar says. “Certain inflammatory cells, called cytokines, compromise the body’s ability to deal with sugar and increase your risk of developing diabetes.”

Fat, in the form of triglycerides, also tends to spill over into other tissues, like the liver and the muscle. “This seems to predispose these other tissues to not being able to handle sugar properly and thus, again, increases your risk of becoming diabetic,” Lazar says.

Meet the Metabolic Syndrome
High triglycerides are often associated with a group of other conditions that together are called the “metabolic syndrome” -- a group of risk factors for heart disease and type 2 diabetes. These include:

• Obesity, especially excessive fat tissue in and around the abdomen
• High blood pressure
• Increased blood sugars (pre-diabetes or impaired glucose tolerance )
• High levels of inflammatory proteins in the blood

High triglycerides can also mean low levels of high-density lipoproteins (HDL) -- the “good” cholesterol.”  “We don’t know how HDL protects you from things like heart disease and diabetes, but we know it does,” Ginsburg says. “And high triglycerides mean lower HDL.”

At the same time, they can form a sort of “‘combination package” with low-density lipoproteins —LDL, or the “bad” cholesterol — leading to more plaque formation in the arteries of your heart and further elevating your risk of heart disease.

Know Your Levels
What should your triglyceride levels be? Normal triglycerides are 150 or below. Any level that is consistently higher than that is considered to be a problem:

• Borderline High: 150 - 199
• High: 200 - 499
• Very High: 500

So what can you do if your triglycerides are hitting the heights? One answer is extremely simple and, for many people, extremely challenging: losing weight through diet and exercise.

“If everybody lost 10% of their body weight and started exercising for half an hour, three or four times a week, it would take care of almost half the problem,” says Henry N. Ginsberg, M.D., Irving Professor of Medicine and Director of the Irving Institute for Clinical and Translational Research at Columbia University Medical Center in New York. “Yes, there is a genetic predisposition involved, but whatever the genetics are, it’s made much worse by being overweight.”

What should you eat? Well, in some ways what doesn’t matter as much as how much.

“I don’t care if you’re eating 100% protein or 100% carbohydrates, if you eat more than you burn, you’re going to make triglycerides,” Ginsberg says. “But if you’re eating 100% fat, the body doesn’t even have to work that hard to do it.”

A diet low in saturated fats, cholesterol, and simple carbohydrates is recommended when trying to reduce high triglycerides. If you’re not sure what simple carbohydrates are, think of “white” foods such as:

• White rice
• White bread
• Regular potatoes
• Pasta

“These get digested and turned into sugar so quickly that you might as well drink soda,” Ginsburg says. “What you want, instead, are carbs that take awhile to absorb -- which means fiber.” Try these foods instead:

• Brown rice
• Whole grain bread
• Sweet potatoes
• Whole wheat pasta

If your cholesterol and triglyceride levels are very high, your doctor may also prescribe medication to help bring them down. At very high levels, triglycerides can be so bad that a person can develop other problems such as pancreatitis, and these drugs are absolutely beneficial in these cases, Lazar says.

“To prevent diabetes and the metabolic syndrome, I think it’s probably most important to think about it in terms of calories. Your goal should be to eat only as much fuel as you’re going to burn.”