What Are Triglycerides, and Why Do They Matter?

When you get a cholesterol panel back, triglycerides are the fourth number — and the one people understand least. They aren't really cholesterol at all. Here's what they are, what your number means, and why they're more a window into your overall health than a villain in their own right.

What are triglycerides?

Triglycerides are your body's main way of shuttling and storing extra calories. They're fatty particles, and despite riding along on your cholesterol panel, only about 20% of a triglyceride particle is actually cholesterol. When you take in more calories than you burn — especially from sugar and refined carbs — your body packages the excess as triglycerides to store for later. That's what makes them the most nutrition-sensitive number on the entire panel.

What is a normal triglyceride level?

Below 150 mg/dL. But triglycerides live on a completely different scale from LDL and HDL. The lowest I've ever seen in a patient on no medication was 27; the highest, over 3,000. Because the range is so wide, a 30-point swing in triglycerides is fairly minor, whereas a 30-point move in LDL would be a big deal. So don't over-react to modest TG ups and downs.

Why don't triglycerides add up with HDL and LDL?

Because they're mostly fat, not cholesterol. You can't just add HDL + LDL + triglycerides to get your total cholesterol number. Since cholesterol represents only about 20% of a triglyceride particle, and the formula counts only the cholesterol portion, you have to divide the TG number by five. Here is how the values are related:

Total Cholesterol = HDL + LDL + (TGs ÷ 5)

In most cholesterol testing algorithms, this formula is actually re-arranged and used to calculate LDL instead. The lab measures total cholesterol, HDL and TGs and the equation becomes:

LDL = Total Cholesterol – HDL – (TG's ÷ 5)

When triglycerides are very high (over 400) this formula starts to fall apart making the standard LDL calculation unreliable — at that point your LDL has to be measured directly.

Are high triglycerides dangerous?

For most people they're more of a warning light than a direct cause of heart disease — an indicator of poor metabolic health rather than a primary driver of plaque. There's one important exception: very high levels, especially over 1,000 mg/dL, are often genetically driven and can trigger pancreatitis, a painful and serious inflammation of the pancreas. People with TGs in that range are usually put on medication specifically to prevent this condition.

What causes high triglycerides?

Mostly diet — and specifically sugar and refined carbs. The chain works like this: simple, processed carbs are digested and absorbed quickly, which spikes blood sugar, which spikes insulin. Insulin not only stimulates the enzyme in the liver that produces LDL, it's also central to managing excess calories. Excess calories show up as TGs in our bloodstream which insulin then helps store within our fat depots and liver. Anything that reduces our tissue's sensitivity to insulin will keep TGs elevated. So excess weight, inactivity – as well as recurrent exposure to insulin-spiking foods – will do it.

Alcohol will do it too, but though a different mechanism. Alcohol interferes with our liver's ability to store and use fat, by diverting its attention to metabolizing the ethanol (a toxin) first.

Add genetics and end up with some eye-popping TG numbers in some people.

How do you lower triglycerides?

Because they are so driven by what you eat, triglycerides are often the easiest number to move... with what you eat. Cut back on sugar, refined "white" carbs, and alcohol; lose weight if you have it to lose; and move most days. Lean on high-fiber whole-food carbs which are digested slowly and don't spike insulin, and unsaturated fats (olive oil, nuts, seeds, fish) which have been shown to help lower TG levels. In fact, Vascepa (a branded omega-3 prescription drug) is used to lower high TGs.

The best news? Many people can see their triglycerides fall dramatically within a few weeks of eating differently! In my own practice, unless TGs are so high that the patient is at imminent risk for pancreatitis, I never start with drugs for elevated triglyceride levels. I always start with diet. And my need to prescribe drugs for TG lowering is miniscule as a result.

Of all the numbers on your cholesterol panel, triglycerides respond the fastest to real food — which is exactly what Step One Foods is built on: complex carbohydrates and unsaturated fats to help with TGs as well as LDL. Add in plant sterols and antioxidants and you get a powerful dietary intervention regardless of what cholesterol particle you are trying to improve.

One caveat here – unlike LDL, which can be reduced significantly with only minor dietary adjustments (as our clinical trial demonstrated), triglycerides require a more comprehensive dietary overhaul. Step One Foods can help, but you will need to look at the totality of your simple carbohydrate, alcohol and calorie intake if your goal is a dramatic triglyceride reduction.

For more on these topics, see what your cholesterol numbers really mean and how to lower LDL.

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