Your Triglycerides Are High. Now What?
You just got your lab results back and your triglycerides are flagged high. Before you panic, let's walk through the questions I think about as a dietitian when I see elevated triglycerides, and what you can actually do about it.
First, understand that triglycerides are the most common type of fat in your blood. When you eat, your body converts calories it doesn't need right away into triglycerides and stores them in fat cells. Between meals, hormones release triglycerides for energy. They’re a little different from cholesterol because triglycerides store energy and cholesterol is used to build cells and make hormones.
Normal triglycerides are below 150 mg/dL, moderately high is 150 to 499 mg/dL, and anything 500 mg/dL or higher is considered severely high, and these levels can affect risk for cardiovascular disease and pancreatitis — and it’s better to try to prevent issues before any serious conditions arise.
There are many things that can explain why you might have high triglycerides even if you presumably eat well:
You forgot to fast. Fasting gives a clearer baseline. Triglyceride levels are sensitive to what you eat or drink (alcohol) before the blood draw. So if you had a big meal the night before, that elevated number might not tell the full story.
Your medications or something in your medical history could be driving your levels up. Medications like beta-blockers, thiazide diuretics, oral estrogens (including some birth control pills and hormone replacement therapy), corticosteroids, certain antipsychotics, retinoids like isotretinoin, and some immunosuppressants can drive your levels up. Underlying conditions like PCOS, diabetes, hypothyroidism, chronic kidney disease, obesity, and metabolic syndrome can also be factors.
But once we rule out these factors, then we look at your diet.
This is where I spend most of my time as a dietitian, because lifestyle modification is helpful for managing elevated triglycerides.
The biggest dietary drivers of high triglycerides are:
Excess refined carbohydrates and added sugars (think sweetened beverages, white bread, pastries, candy). This is not to say you need to eliminate every refined carb or added sugar, but perhaps decrease intake.
Excessive alcohol intake
A caloric surplus, especially from saturated fats and refined or simple carbohydrate foods
What Can You Do About It?
The good news is that triglycerides are one of the most lifestyle-responsive lipid markers.
Step 1: Rule out and address secondary causes (medications, medical conditions) with your provider.
Step 2 (or both at the same time): Prioritize lifestyle changes, because they work! In terms of your diet:
Reduce refined carbohydrates (“simple” carbohydrates, carbohydrate foods where fiber was removed) and added sugars (to less than 25 grams per day). Added sugar is now listed separately on the nutrition label. This does not include sugar naturally in grains, starches, dairy and fruit.
Include omega-3-rich foods regularly
Limit alcohol
Eat carbohydrates with fiber and/or protein/unsaturated fats when possible
Prepackaged snacks are helpful when thinking about lowering triglycerides to help out during the busy day. Buy the individual sized option to keep portions in check.
Skinnypop Popcorn
Harvest Snaps Green Pea Snaps
Reduced Fat Triscuits ~10 crackers + Laughing Cow Cheese Light
Unsweetened Applesauce Packets
The Only Bean Crunchy Roasted Edamame
The Good Bean Crunchy Chickpea Snacks
Seaweed Snacks
Trail Mix
Made Good Granola Bites
That’s It Fruit Bar
Then, of course, lifestyle changes in other areas, such as with sleep or physical activity matter more than people realize.
Physical activity: At least 150 minutes per week of moderate-intensity exercise or 75 minutes of vigorous-intensity is associated with improved triglyceride and HDL cholesterol levels. Both aerobic exercise and resistance training are beneficial, and combining the two may amplify the results.
Stress: Persistently high levels of psychological stress have been associated with less favorable HDL cholesterol and triglyceride levels. Stress management strategies, including mindfulness, cognitive behavioral techniques, yoga, and tai chi, all show preliminary cardiovascular benefits.
Sleep: Poor sleep quality and short sleep duration are linked to metabolic syndrome, which includes elevated triglycerides. Prioritizing consistent, restorative sleep supports healthier lipid levels.
The Bottom Line
High triglycerides are common, very treatable, and worth addressing. As a dietitian, I see meaningful improvements when people make targeted dietary changes, get moving, and take a whole-person approach to their health. You don't have to overhaul everything at once. Start with one or two changes and build from there.
If triglycerides remain elevated despite lifestyle changes, talk with your provider about medication options.
Of course, your provider and dietitian should always collaborate to give you a better scope of care. If you’re in New York or New Jersey, I’m happy to work with you and your primary care physician to help you reach your health goals. For more information, book an appointment with me.