High Triglycerides: What Causes Them, Healthy Levels and How to Lower Them
Written by Naurah Gaspard, DNP, FNP-C, FNP-BC · Medically reviewed by Cherlie Joseph, MSN, FNP-BC · Updated November 2026
Triglycerides are a type of fat in your blood, and a fasting level of 150 mg/dL or higher is considered high. The most common causes are insulin resistance, extra weight, sugary drinks and refined carbs, alcohol, and uncontrolled diabetes. Cutting sugar and alcohol, losing even 5% to 10% of body weight and staying active can lower triglycerides quickly, and medicine is added when levels stay high or your heart risk calls for it.
In this guide
What triglycerides are and what the numbers mean
When you eat more calories than you burn right away, especially from sugar, refined starches and alcohol, your liver turns the extra into triglycerides and stores them in fat cells for later energy. Some is normal. Problems start when levels stay high, because the particles that carry triglycerides also carry cholesterol into artery walls.
| Fasting triglycerides | Category | What it usually means |
|---|---|---|
| Under 150 mg/dL | Normal | Healthy range |
| 150 to 199 mg/dL | Borderline high | A nudge to look at diet, alcohol, weight and blood sugar |
| 200 to 499 mg/dL | High | Adds to heart risk; check for diabetes, thyroid and medication causes |
| 500 mg/dL and above | Very high | Pancreatitis risk climbs, especially above 1,000; needs prompt treatment |
Triglycerides jump after a meal, so a high non-fasting result is often rechecked fasting (no food for 9 to 12 hours, water is fine). Ask your provider before your next lab draw whether you should fast.
Common causes of high triglycerides
- Insulin resistance, prediabetes and type 2 diabetes. High blood sugar and insulin push the liver to make more triglycerides. This is the most common driver we see.
- Extra weight, especially around the waist.
- Diet: sweet tea, soda, juice, white bread, rice and pastries.
- Alcohol, even moderate amounts in some people.
- Underactive thyroid, kidney disease and fatty liver disease.
- Medicines, including some beta blockers, thiazide diuretics, oral estrogen, steroids such as prednisone, isotretinoin and some HIV and antipsychotic medicines. Do not stop a prescription on your own; ask whether an alternative makes sense.
- Genetics. Some families make or clear triglycerides differently, and very high levels often run in families.
Already on a triglyceride or cholesterol medicine?
$79 refill review by a nurse practitioner licensed in your state. Adults 18+ in FL, NM, OR and WA.
Request a medication refill →Why high triglycerides matter
Moderately high triglycerides add to your risk of heart attack and stroke, and they often travel with low HDL, belly fat, high blood pressure and high blood sugar, a cluster known as metabolic syndrome. Very high triglycerides, usually above 500 and especially above 1,000 mg/dL, can trigger acute pancreatitis, a painful and sometimes dangerous inflammation of the pancreas.
The 2026 ACC/AHA dyslipidemia guideline recommends starting with lifestyle changes and a statin when triglycerides stay high and heart risk is elevated, and adding a triglyceride-lowering medicine to prevent pancreatitis when levels reach 1,000 mg/dL or higher.
How to lower triglycerides
Triglycerides respond to lifestyle changes faster than almost any other lab, often within weeks.
- Cut liquid sugar first. Replacing soda, sweet tea and juice with water or unsweetened drinks is the single biggest change for many people.
- Trade refined carbs for fiber-rich ones: beans, lentils, oats, vegetables and whole fruit instead of white rice, white bread and sweets.
- Limit or stop alcohol. If your level is above 500 mg/dL, avoid it completely.
- Lose 5% to 10% of your body weight if you have extra. That alone can lower triglycerides substantially.
- Move most days. About 150 minutes a week of brisk walking or similar activity helps.
- Eat fatty fish like salmon, sardines or mackerel twice a week.
- Treat the cause: getting diabetes or thyroid levels under control often brings triglycerides down with it.
Medicines your provider may discuss:
- Statins are first-line when heart risk is elevated; they lower triglycerides modestly and LDL substantially.
- Icosapent ethyl (Vascepa) is a prescription omega-3 that is FDA approved, alongside a statin, to lower heart attack and stroke risk in adults with triglycerides of 150 mg/dL or higher who have heart disease or diabetes plus other risk factors.
- Fibrates such as fenofibrate are mainly used for very high triglycerides to protect the pancreas.
- Prescription omega-3 acid ethyl esters are approved for levels of 500 mg/dL or higher.
Over-the-counter fish oil is not the same as prescription omega-3. Supplements are not reviewed by the FDA for purity or dose, and they have not been shown to prevent heart attacks the way icosapent ethyl was in its major trial. Generic prices are usually low, but brand prices change, so check the manufacturer's site or your pharmacy.
When to recheck and how we can help
Most people recheck a lipid panel about 6 to 12 weeks after starting a new medicine or making major diet changes. At OurTopClinic, a nurse practitioner licensed in your state can review your results, order follow-up labs, look for causes like prediabetes or an underactive thyroid, and renew non-controlled medicines like statins and fenofibrate when it is appropriate. A refill always depends on your provider's review.
Get in-person care or call 911 if you have:
- Severe pain in the upper belly that spreads to your back, with nausea or vomiting (possible pancreatitis)
- Chest pain or pressure, or shortness of breath
- Sudden weakness, numbness, facial drooping or trouble speaking
- Vomiting that will not stop or signs of dehydration
Frequently asked questions
What is a dangerous triglyceride level?
Levels of 500 mg/dL or higher are considered very high, and levels above 1,000 mg/dL carry a real risk of pancreatitis. Anyone with results in this range should talk with a provider promptly.
How fast can I lower my triglycerides?
Many people see a meaningful drop within 2 to 6 weeks after cutting sugary drinks and alcohol, eating fewer refined carbs and becoming more active. Medicines can lower levels further within weeks.
Does fish oil lower triglycerides?
Omega-3 fats can lower triglycerides, but over-the-counter fish oil varies in quality and dose. Prescription omega-3s are dosed and tested, and only icosapent ethyl has been shown to lower heart attack and stroke risk in its main trial. Ask your provider before starting a supplement.
Sources
- MedlinePlus: Triglycerides
- ACC/AHA 2026 dyslipidemia guideline summary (2 Minute Medicine)
- MedlinePlus: Icosapent ethyl
Keep reading
- High Cholesterol Explained: LDL, HDL and the New 2026 Targets
- Insulin Resistance: Signs, Causes, Tests and How to Reverse It
- Can You Reverse Prediabetes?
- Browse all conditions and treatments A to Z
Already on a triglyceride or cholesterol medicine?
$79 refill review by a nurse practitioner licensed in your state. Adults 18+ in FL, NM, OR and WA.
Request a medication refill →
Naurah Gaspard, DNP, FNP-C, FNP-BC
Board-certified family nurse practitioner licensed in Florida, New Mexico, Oregon and Washington, caring for adults online at OurTopClinic. Meet our providers.
This article is for general education and is not a substitute for medical advice. Treatment, including any prescription, is decided by a licensed provider after reviewing your health history. OurTopClinic is not for emergencies; if you have a medical emergency, call 911. OurTopClinic serves adults located in Florida, New Mexico, Oregon and Washington. Learn more at ourtopclinic.com.
