How to lower triglycerides

What does it mean when you have high triglycerides? How do you lower your triglycerides?

If you’ve been told that you have high triglycerides — a type of fat (lipid) found in the bloodstream — you’re not alone. One report suggests that nearly one-third of Americans have elevated triglycerides.1

Higher than normal triglyceride levels are a problem because they’re associated with increased risk of metabolic dysfunction, heart attacks, and strokes.2

Although many people focus on the risks associated with high low-density lipoprotein (LDL) cholesterol, high triglycerides may be even more predictive of future heart events.3

The good news is, you can use the advice in this guide to work with your healthcare provider to reduce your triglycerides naturally. You can also consider discussing medications or supplements to lower your triglycerides if needed.

Here’s what you need to know about reducing your triglycerides.

 

Action plan to lower triglycerides

  1. Eat a low-carbohydrate diet.
  2. Minimize sugars, refined carbs, and alcohol.
  3. Maintain a healthy weight.
  4. Perform high-intensity exercise if you can do so safely.
  5. If the above four interventions don’t adequately control your triglyceride levels, discuss omega-three fatty acids or other medications and supplements with your healthcare provider.
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1. What are triglycerides?

Glowing blue generic virus cell 3d render illustration

Triglycerides are fats in your bloodstream that the body either immediately burns for energy or stores in fat cells for future use.

Although they get a bad rap, from an evolutionary perspective, triglycerides were necessary for survival.

In times of plenty, triglycerides move food energy into fat stores. In times of famine or carbohydrate scarcity, we burn triglycerides for energy.

Overeating fat can increase your blood triglyceride levels. But that’s not the only way to raise your triglycerides. Even if you avoid eating fat, overeating carbs forces the liver to convert the excess energy into triglycerides for storage in your fat cells.

Instead of storing excess triglycerides, it’s healthier to burn them for energy. Fortunately, as you reduce the carbs you eat, your body switches from burning glucose for energy to burning fat in the form of triglycerides.

Your body will do this when you’re fasting or eating a low-carb or keto diet. Or, if you are physically active your body will turn to triglycerides when it runs out of stored carbs.


 

2. What causes elevated triglycerides?

A person measuring waist, Side view

Summary

Eating too many calories, especially sugars, refined carbohydrates, and alcohol, are the most common causes of increased triglycerides. Genetic abnormalities can also raise triglyceride levels and may require more aggressive treatment.

There are two leading causes of high triglycerides. The first, and by far the most common cause, is metabolic. The second is genetic.

Metabolic causes

Metabolic syndrome, type 2 diabetes, and obesity are all associated with elevated triglycerides.4

Since most of the data are observational, it’s not clear if these medical conditions cause elevated triglycerides — or if they share common root causes.

Why are metabolic conditions often linked to heightened triglycerides? High triglycerides seen in metabolic conditions are likely due to a common underlying link to the body’s resistance to the hormone insulin.5

Today, many have access to a constant food supply — unlike during ancestral times. This steady supply of food can lead to overeating — especially when those calories come from inexpensive, convenient, and tasty ultra-processed foods high in sugar and fat.

Overconsuming calories, especially sugar and carbs, overwhelms the body’s ability to store energy — leading to insulin resistance, elevated triglyceride levels, and an increased risk of heart disease and pancreatitis.6

Many in medicine believe a low-fat diet is the first step toward lowering triglycerides. This is in part because of national guidelines which frequently don’t recognize other safe and effective nutritional approaches.7

Earlier thinking was that limiting the amount of fat people eat would reduce the fat circulating in their blood.

But the body is more complicated than that. Any caloric excess — including refined carbohydrates and “healthy” carbs such as whole grains, fruits, and legumes — is converted to triglycerides and stored as fat.8

With readily available calories and carbs, our Western diet is the perfect catalyst for elevated triglycerides.

What counts as high triglycerides?

Most experts define normal triglycerides to be less than 150 mg/dL (1.7mmol/L) with very high levels being above 500 mg/dL (5.6 mmol/L) and severe elevation being above 1,000 mg/dL (11mmol/L).10

Other causes

Other conditions, such as hypothyroidism, certain kidney diseases, and pregnancy, can lead to elevated triglycerides.

Certain medications can also cause elevated levels, including steroids, estrogens, beta-blockers, and diuretics.

Genetic abnormalities can cause elevated triglycerides. This includes complex diseases such as lipoprotein lipase deficiency, apolipoprotein C-II deficiency, familial hypertriglyceridemia, familial combined hyperlipidemia, and familial chylomicronemia syndrome.11

When the root cause is genetic, triglyceride levels can be markedly elevated compared to hypertriglyceridemia related to metabolic diseases. The degree of elevation with genetic causes usually means the treatment will involve medications.12


 

3. Changing your diet to lower triglycerides

Tasty and healthy salmon steak with green peas, broccoli and tomatoes on a gray plate. Diet food on a dark background with copy space. Top view. Flat lay

Summary

Any diet that generates sustained weight loss is effective when attempting to lower triglycerides. However, a low-carb or keto diet is particularly effective.

Limiting sugars, refined carbs, and alcohol is crucial to get the best results.

Diets higher in fiber and fish may also help to lower triglycerides. Those with severely elevated levels may respond better to low-fat diets, but this is not a universal finding.

When attempting to lower triglyceride levels, many find success through altering their eating habits. Here are the dietary approaches worth trying, according to science.

1. Eat low-carb or keto

Dozens of studies show eating a very low-carb or ketogenic diet lowers fasting triglycerides.13

For many doctors, this evidence seems confusing. Physicians have been taught for decades, like many of us, that a low-fat diet is best for improving cholesterol and other blood lipids. But the supporting data for low-carb diets are difficult to deny.

As the evidence continues to grow, medical groups, such as the Endocrine Society, now recommend reducing carbohydrates as the initial dietary approach for correcting high fasting triglycerides.14

Comparisons between low-carb and low-fat diets consistently show that low carb is better for reducing triglycerides. This evidence is valid both when there is similar weight loss between groups and when the amount of weight lost differs.15

This does not mean a low-carb diet is the only way to lower triglycerides. But it does mean that low carb is an effective way — if not the most effective way — to reduce them.

The evidence also shows that, when trying to lower triglycerides, the overall makeup of a diet may matter more than a specific dietary component.

Some doctors, for example, believe that eating more saturated fat always increases triglycerides. But patients don’t eat fat in isolation. They eat it as part of an overall diet.

Two studies report that a low-carb diet with increased amounts of saturated fat is linked to lowered triglycerides.16

However, we have to be careful about defining “low carb” and “low fat.” For example, one study which defined low-carb as 40% of energy from carbs (not a true measure of “low carb”) found no significant reduction in triglycerides.17

Low-carb diets appear to be the most effective eating pattern for lowering triglycerides, as long as carbs are kept consistently low (probably less than 10% of energy from carbs or less than 50 grams per day).18

Popular low-carb meals

2. Limit sugar, refined carbohydrates, and too much alcohol

sugar cubes

Do you have to eat a keto diet to lower triglycerides? Not necessarily. Reducing sugars, refined carbohydrates, and alcohol may be enough to lower your levels.

As we mentioned, any caloric excess can increase triglycerides. However, the most likely sources of extra calories are excess sugar, refined carbs, and alcohol.19

One reason carbs and sugars commonly increase triglycerides may be that carbs and sugars are two of the most commonly overconsumed foods. However, another reason could be that fructose (a component of sugar) and alcohol are more likely to cause fatty liver, which can raise triglycerides.20

One study reports that simply replacing sugar-sweetened beverages with water reduced triglycerides.21

And another reports that decreasing alcohol consumption lowered fasting triglycerides.22

Other factors, such as baseline obesity and insulin resistance, may make it more likely that eating carbs would cause an individual’s triglycerides to rise.23

If you’re overweight or have insulin resistance, the evidence shows it’s important to reduce carbs. However, the data suggests that most people with high triglycerides — even people with normal weight — would benefit from reducing sugar, refined carbs, and alcohol.

3. Some people may respond best to a low-fat diet

For those with severely elevated triglycerides (defined as greater than 1,000 mg/dL or 11.2 mmol/L), there is a case for low-fat diets being equally good — if not better than — low carb in some situations.

One study finds that those with triglycerides below 400 mg/dL (4.5 mmol/L) respond best to low-carb diets, but those with triglycerides greater than 400 mg/dL (4.5 mmol/L) respond best to low-fat diets.24

However, case reports document a decrease in severely elevated triglycerides with low-carb, high-fat diets.25

It’s important to understand the cause of elevated triglycerides, as that may impact the proposed dietary treatment. If someone has a genetic cause, such as familial chylomicronemia or lipoprotein lipase deficiency, a low-fat diet may be more effective.26

Aside from these extreme examples, there is no evidence to support a low-fat diet as being better than a low-carb diet for reducing elevated triglycerides.

4. Eat to lose weight

Losing just 6.6 pounds (3 kilos) can result in an average of 15 mg/dL decrease in triglycerides.27

In the LookAHEAD trial, a randomized trial studying a calorie-reduced low-fat diet, the average reduction in triglycerides was only 12 mg/dL (0.13 mmol/L).28

However, decreases were more significant for participants who lost more weight. For instance, the few who lost more than 15% of their body weight in the LookAHEAD trial had an average triglyceride reduction of 70 mg/dL (0.8 mmol/L). Conversely, the 25% of participants who did not lose weight showed no reduction in their triglyceride levels.29

5. Fiber

Woman washing broccoli in the kitchen sink

Fiber can also lower triglycerides. But the way fiber affects you may have more to do with your diet’s underlying carbohydrate content.

One randomized trial reports that, for participants eating high-carb diets, lowering fiber intake raised triglycerides 45%. Adding back fiber brought triglyceride levels back to baseline.30

A weaker observational study finds an apparent relationship between higher fiber intake and lower triglyceride levels.31 But in a study structured like this, it’s difficult to control for overall diet quality. High-carb diets that are also high in fiber are likely better than high-carb diets low in fiber in several ways.

An interventional trial of a fiber supplement does not show improvements in participants’ triglyceride levels.32 This suggests that the effects associated with fiber may have more to do with overall diet quality than the presence of fiber itself.

The take-home lesson is that you should avoid refined carbs and sugars. If you are going to eat a high-carb diet, you should make sure it’s also high in fiber.

6. Eat more fish

Eating fish and taking omega-three fatty acid supplements can both significantly decrease triglycerides.

One randomized trial reports those who ate 270 grams of salmon twice each week reduced triglycerides by an average of 28 mg/dL (0.32 mmol/L)33

You can add this triglyceride-reducing effect to the many other potential health benefits of eating fish.

See below in the supplements section for information on omega-three supplements and their impact on triglyceride levels.


 

4. Exercising to lower triglycerides

Exercising at home with a puppy

Summary

Although any physical activity can provide health benefits, high-intensity exercise, and resistance training to fatigue are best for lowering triglycerides.

While nutrition probably has the most significant impact on triglycerides, exercise can also lower your levels. But not all forms of exercise produce equally promising results.

When it comes to lowering triglycerides, higher intensity exercise is best.34

There are different ways to define high-intensity exercise. The most common is achieving greater than 85% of your maximum heart rate. However, a more useful definition may be a level of exercise where you can no longer have a conversation or a level you can maintain for only a few minutes.

Resistance training, involving a moderate amount of weight and high repetitions, can also help with triglyceride levels. Lifting extra heavy weight fewer times produces less of a significant effect.35

Does this mean lower intensity exercise doesn’t provide health benefits? Of course not. As we detail in our in-depth exercise guide, physical activity of any kind has multiple health benefits.

Even if you can’t get to the point where exercise impacts your triglycerides, don’t let that discourage you. Carry on to maintain your muscles, strengthen your bones, and build your fitness one step at a time.


 

5. Taking supplements to lower triglycerides

Pills

The data show that diet and exercise are practical approaches for lowering triglycerides. However, for some people, lifestyle changes may not be enough. In that case, it may be worth discussing supplements with your healthcare provider.

Disclaimer:. Any medication or supplement may have unintended side effects or interactions with other medications. The following is for the purpose of general knowledge and is not meant to be medical advice. You should always consult your personal healthcare provider before starting, stopping, or changing the dose of any supplement of medication.

Here’s a list of possible choices.36

  • Niacin: 2,000 to 3,000 mg per day37
  • Berberine: 500 mg twice daily38
  • Fish oil: Eicosapentaenoic acid (EPA) 2 to 4 grams per day (Docosahexaenoic acid, or DHA, does not seem to have much of an effect.)39
  • Curcumin: 80 to 100 mg daily40
  • Fenugreek: 10 grams per day41

 

6. Taking medications to lower triglycerides

Old man taking pills

Summary

Many different supplements and medications can reduce triglyceride levels. Fish oil doses of 3 to 4 grams (EPA only) may be the best choice to reduce cardiovascular events and the risk of dying.

However, most medications and even supplements can come with significant side effects. Always ask your doctor before starting any new supplements or medications.

In addition to supplements, several studies show certain medications may reduce triglycerides. Recommendations to take medications focus on reducing the risk of pancreatitis as well as heart disease.

The evidence to support the idea that lowering triglycerides with medications can provide cardiac protection is mixed. Many isolated studies show no benefits, but a meta-analysis of multiple studies suggests minor benefits.42

Ask your doctor if any of these medications may be right for you:

Statins — The most commonly prescribed class of cholesterol-lowering drugs has a mild triglyceride-lowering effect ranging from 10% reduction at low doses to 30% at higher doses.43

Fibrates — Drugs such as gemfibrozil can lower triglycerides by 30-50%.44 These drugs should be used with caution when taken along with statins or warfarin due to drug interactions. Those with a history of gallstone disease should not take fibrates.

Although fibrates do lower triglycerides, it is not clear that they reduce cardiac events or the risk of death.

Prescription niacin — Niacin can reduce triglycerides by up to 30%.45 Niacin may cause liver disease, and may worsen insulin resistance or blood sugar control in those with type 2 diabetes. Those with peptic ulcer disease should not take niacin.

Although niacin does lower triglycerides, it is not clear that it reduces cardiac events or death risk.

Omega 3 fatty acids — These are available over the counter (as a supplement) and by a doctor’s prescription. The prescription version tends to come in higher doses and pure EPA form.

Studies of different omega 3 doses demonstrate a 20 to 50% reduction in triglycerides.46 Most studies report a dose of 3 to 4 grams as the most effective therapy.47

A major trial in 2019 reports people taking 4 grams of the fish oil EPA (in the form of icosapent ethyl) had a 21% reduction in triglycerides (from 216 mg/dL to 170 mg/dL) at five years.

More importantly, there was also a 5% reduction in cardiovascular events and a 0.9% reduction in death.48


 

7. Risk of elevated triglycerides

Doctor using stethoscope while examining patient

Summary

High triglyceride levels increase the risk of coronary artery disease and pancreatitis.

Elevated triglycerides can cause two main health concerns: an increased risk of heart disease and an increased risk of pancreatitis (an acute, severe inflammation of the pancreas).

Increased risk of heart disease

Medical science consistently demonstrates that people with higher triglycerides have a higher risk of heart disease. That is not surprising since high triglycerides are also correlated with other cardiac risk factors such as insulin resistance, metabolic syndrome, and more atherogenic small LDL particles.49

Observational studies demonstrate the risk of a heart attack triples (from 1% to 3% over ten years) for those with triglycerides above 265 mg/dL (3.0 mmol/L) compared to those with lower levels.50

Another study reports an increased risk for statin-treated patients when their triglycerides were above 175 mg/dL (2 mmol/L).51

Studies comparing the impact of elevated triglycerides on cardiovascular risk suggest it may be equally or more important than high LDL cholesterol.

One study shows genetic mutations that lower triglycerides have an equal benefit for reducing heart disease risk as those that lower LDL.52

Other studies report elevated triglycerides and triglyceride-to-high-density lipoprotein (HDL) cholesterol ratio are associated with smaller LDL particles and a more advanced coronary disease, whereas elevated LDL cholesterol show no significant correlation.53

Most recently, an evaluation of the PREDIMED trial demonstrates that triglycerides above 150 mg/dL (1.69 mmol/L) and remnant cholesterol (particles that contain a high amount of triglycerides such as VLDL and intermediate density lipoprotein (IDL)) have greater predictive power for heart disease risk than does LDL.54

However, the data on drug therapy for triglycerides don’t demonstrate consistent benefits. A meta-analysis of randomized trials, the highest-rated level of evidence, shows that lowering triglycerides with medications can reduce the risk of heart disease. But not all studies agree.55

In fact, many trials show no improvement in the risk of heart disease or death.

Could triglyceride-lowering lifestyles have a greater impact than medications?

Theoretically, lifestyle interventions could have a more significant impact since they target the underlying cause of elevated triglycerides, which medications can’t address. But comparative trials have not been done.

Increased risk of pancreatitis

Severely elevated triglycerides is the third most common risk factor for pancreatitis but causes only around 4% of all cases. Gallstones and alcoholism are much more common, comprising approximately 70% of all cases.56

Individuals with triglycerides above 1,000 mg/dL (11.2 mmol/L) have a 5% chance of developing pancreatitis, and that increases to 10 to 20% for levels above 2,000 mg/dL (22.5 mmol/L). For reference, the general population risk of pancreatitis is just 0.5%.57


 

8. Summary

High triglyceride levels are a concerning medical condition associated with an increased risk of heart disease and pancreatitis. They’re also common when obesity, insulin resistance, and other metabolic disorders are present.

Fortunately, you can do something about them. By eating a low-carb diet, avoiding sugar and excessive alcohol, and doing high-intensity exercise, you can play an active role in lowering your triglycerides.

 

Cholesterol videos

 

  1. Circulation 2002: Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report [overview article; ungraded]

  2. Circulation 2011: Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association [overview article; ungraded]

  3. Journal of the American College of Cardiology 2020: Remnant Cholesterol, Not LDL Cholesterol, Is Associated With Incident Cardiovascular Disease
    [observational study, weak evidence]

  4. European Heart Journal 2011: ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) [overview article; ungraded]

    Circulation 2011: Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association [overview article; ungraded]

  5. Insulin is a hormone that asks our cells to take up more energy. When the cells of our body have too much energy they become resistant to insulin. We commonly think of insulin resistance as leading to high blood sugars; however, insulin resistance leads to elevated triglycerides years if not decades before there are issues seen in our blood sugar.

  6. Journal of Clinical Investigation 1996: Human fatty acid synthesis is stimulated by a eucaloric low fat, high carbohydrate diet [nonrandomized study, weak evidence]

    Journal of Nutrition 2001: Effect of dietary carbohydrate on triglyceride metabolism in humans [overview article; ungraded]

    European Heart Journal 2018 Unmet need for primary prevention in individuals with hypertriglyceridaemia not eligible for statin therapy according to European Society of Cardiology/European Atherosclerosis Society guidelines: a contemporary population-based study [observational study, weak evidence]

    Journal of Clinical Gastroenterology 2014: Issues in hypertriglyceridemic pancreatitis: an update [overview article; ungraded]

  7. Circulation 2002: Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report [overview article; ungraded]

  8. Journal of Clinical Investigation 1996: Human fatty acid synthesis is stimulated by a eucaloric low fat, high carbohydrate diet [nonrandomized study, weak evidence]

  9. Journal of Endocrinology and Metabolism 2012: Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline [overview article; ungraded]

    Journal of the American College of Cardiology 2018: 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
    [overview article; ungraded]

  10. Journal of Endocrinology and Metabolism 2012: Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline [overview article; ungraded]

    Journal of the American College of Cardiology 2018: 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
    [overview article; ungraded]

  11. Frontiers in Endocrinology 2020: Genetics of Hypertriglyceridemia
    [overview article; ungraded]

    Endocrinology reviews 2015: Hypertriglyceridemia in the genomic era: a new paradigm [overview article; ungraded]

  12. Journal of Endocrinology and Metabolism 2012: Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline [overview article; ungraded]

  13. This finding is supported by high-quality evidence, which is summarized by three meta-analyses of randomized trials:

    PLoS One 2020: The effects of low-carbohydrate diets on cardiovascular risk factors: A meta-analysis [systematic review of randomized trials; strong evidence]

    Nutrition Reviews 2019: Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis [systematic review of randomized trials; strong evidence]

    European Journal of Clinical Nutrition 2018: The interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials [systematic review of randomized trials; strong evidence]

  14. Journal of Endocrinology and Metabolism 2012: Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline [overview article; ungraded]

  15. The following clinical trial finds that even when individuals had similar weight loss, a low-carb diet (14% of total calories from carbs), on average, reduced triglycerides more than a low-fat diet.

    Diabete Care 2014: A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial [randomized trial; moderate evidence]

    And the following three randomized controlled trials all report that low-carb diets consistently reduce triglycerides better than low-fat diets.

    Lipids 2009: Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet
    [randomized trial; moderate evidence]

    American Journal of Clinical Nutrition 2009: Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo [randomized trial; moderate evidence]

    NEJM 2003: A low-carbohydrate as compared with a low-fat diet in severe obesity [randomized trial; moderate evidence]

  16. American Journal of clinical Nutrition 2019: Changes in blood lipid concentrations associated with changes in intake of dietary saturated fat in the context of a healthy low-carbohydrate weight-loss diet: a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial
    [randomized trial; moderate evidence]

    American Journal of Clinical Nutrition 2006: Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia
    [randomized trial; moderate evidence]

  17. Journal of Nutrition 2004: Individual serum triglyceride responses to high-fat and low-fat diets differ in men with modest and severe hypertriglyceridemia
    [randomized trial; moderate evidence]

    Similarly, the following study of low carb versus low fat shows much more triglyceride reduction for low carb when it started participants at 20 grams per day. As the study continued, the investigators allowed participants to increase their carb intake. The triglyceride difference between the two groups eventually disappeared at two years, as participants added more carbs.

    Annals of Internal Medicine 2010: Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial
    [randomized trial; moderate evidence]

  18. We don’t have clear data to suggest where the “cut off” point is for maximal triglyceride-lowering effect. Therefore, the numbers we suggest are an estimate based on the data presented in this guide. [anecdotal report; very weak evidence]

  19. The following reviews show the consistent relationship between carbohydrate intake and elevated triglycerides:

    Journal of Nutrition 2001: Effect of dietary carbohydrate on triglyceride metabolism in humans
    [overview article; ungraded]

    American Journal of Clinical Nutrition 2000 Carbohydrate-induced hypertriacylglycerolemia: historical perspective and review of biological mechanisms
    [overview article; ungraded]

    The following observational studies reported that triglycerides increased with higher amounts of alcohol intake:

    Alcohol and Alcholism 2012: Association of alcohol consumption with lipid profile in hypertensive men
    [observational study, weak evidence]

    Alcohol and Alcholism 2011: Severe hypertriglyceridemia influenced by alcohol (SHIBA)
    [observational study, weak evidence]

    And two trials demonstrate higher alcohol intake led to increased triglycerides.

    Alcohol and Alcoholism 1990: Effects of a moderate dose of alcohol on blood lipids and lipoproteins postprandially and in the fasting state
    [randomized trial; moderate evidence]

    Athersclerosis 1998: Changes in postprandial lipoproteins of low and high density caused by moderate alcohol consumption with dinner
    [nonrandomized study, weak evidence]

  20. Biomedical Reports 2014: Triglyceride is strongly associated with nonalcoholic fatty liver disease among markers of hyperlipidemia and diabetes
    [nonrandomized study, weak evidence]

    Journal of Hepatology 2018:
    Fructose and sugar: A major mediator of non-alcoholic fatty liver disease
    [overview article; ungraded]

    Alcohol Research 2017: Alcoholic Liver Disease: Pathogenesis and Current Management
    [overview article; ungraded]

    Comprehensive Physiology 2017: Triglyceride Metabolism in the Liver
    [overview article; ungraded]

  21. Journal of Nutrition 2014: Substituting water for sugar-sweetened beverages reduces circulating triglycerides and the prevalence of metabolic syndrome in obese but not in overweight Mexican women in a randomized controlled trial
    [randomized trial; moderate evidence]

  22. Athersclerosis 1998: A controlled trial of the effects of pattern of alcohol intake on serum lipid levels in regular drinkers
    [randomized trial; moderate evidence]

  23. Journal of Cardiopulmonary Rehabilitation 1999: Lifestyle modification program in management of patients with coronary artery disease: the clinical experience in a tertiary care hospital
    [randomized trial; moderate evidence]

    Diabetes Care 1989: Persistence of hypertriglyceridemic effect of low-fat high-carbohydrate diets in NIDDM patients
    [randomized trial; moderate evidence]

  24. Journal of Nutrition 2004: Individual serum triglyceride responses to high-fat and low-fat diets differ in men with modest and severe hypertriglyceridemia
    [randomized trial; moderate evidence]

  25. Annals of Nutrition and Metabolism 2010: Successful treatment of severe hypertriglyceridemia with a formula diet rich in omega-3 fatty acids and medium-chain triglycerides
    [nonrandomized study, weak evidence]

    Current Opinions in Endocrinology, Diabetes, and Obesity 2020: Reversal of severe hypertriglyceridemia with intermittent fasting and a very-low-carbohydrate ketogenic diet: a case series
    [anecdotal report; very weak evidence]

  26. Journal of Clinical Epidemiology 2018:
    Familial chylomicronemia syndrome: Bringing to life dietary recommendations throughout the life span
    [overview article; ungraded]

  27. Circulation 2014: 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society
    [randomized trial; moderate evidence]

  28. NEJM 2013: Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes [randomized trial; moderate evidence]

  29. In the same study, 19% of the participants lost between 5% and 10% of their weight, with an average triglyceride reduction of 25 mg/dL (0.28 mmol/L).

    Diabetes Care 2011: Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes
    [randomized trial; moderate evidence]

  30. American Journal of Clinical Nutrition 1979: Effect of high- and low-fiber diets on plasma lipids and insulin [randomized trial; moderate evidence]

  31. Current Developments in Nutrition 2018: Dietary Fiber Is Independently Related to Blood Triglycerides Among Adults with Overweight and Obesity
    [nonrandomized study, weak evidence]

  32. Nutrition Journal 2011: The role of soluble fiber intake in patients under highly effective lipid-lowering therapy [randomized trial; moderate evidence]

  33. Nutrition Research 2016: Twice weekly intake of farmed Atlantic salmon (Salmo salar) positively influences lipoprotein concentration and particle size in overweight men and women
    [randomized trial; moderate evidence]

  34. The following study reported a significant decrease in triglycerides only with higher-intensity exercise and not with lower-intensity activity. It’s unclear if this is related to the number of calories burned or an exercise threshold to activate lipoprotein lipase.

    Journal of Applied Physiology 1998:
    Effects of four different single exercise sessions on lipids, lipoproteins, and lipoprotein lipase
    [randomized trial; moderate evidence]

    Other studies show similar results.

    NEJM 2002: Effects of the amount and intensity of exercise on plasma lipoproteins [randomized trial; moderate evidence]

    Sports Medicine 2014: Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations [overview article; ungraded]

  35. Diabetology and Metabolic Syndrome 2010: Low and moderate, rather than high intensity strength exercise induces benefit regarding plasma lipid profile
    [randomized trial; moderate evidence]

  36. These presented doses are estimates of what may be most effective. Since researchers have not studied these supplements as rigorously as prescription medications, we don’t know the best dose ranges with evidence-based certainty.

  37. The following study shows an approximately 25% triglyceride reduction with niacin:JAMA 2000: Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: the ADMIT study: A randomized trial. Arterial Disease Multiple Intervention Trial [randomized trial; moderate evidence]

    However, given its potential for side effects, adverse effects on blood sugar, and some trials reporting no cardiovascular benefits, the role of niacin in cardiac prevention has been questioned. It appears that specific populations may still benefit, but probably not the entire population.

    JAMA 2004: New Perspectives on the Use of Niacin in the Treatment of Lipid Disorders [overview article; ungraded]

    Journal of Clinical Lipidology 2017: Niacin and heart disease prevention: Engraving its tombstone is a mistake [overview article; ungraded]

  38. The following review reports reductions of 25 to 55 mg/dL:Journal of Evidence Based Complementary and Alternative Medicine 2017: Efficacy of Berberine Alone and in Combination for the Treatment of Hyperlipidemia: A Systematic Review
    [overview article; ungraded]

  39. Circulation 2019: Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association [overview article; ungraded]

  40. This study reports a small but significant reduction in triglycerides:Nutrition Journal 2012: Diverse effects of a low dose supplement of lipidated curcumin in healthy middle aged people
    [randomized trial; moderate evidence]

  41. Fenugreek is an herb that’s been used in alternative medicine for centuries. The following study reported supplementing 10 grams of powdered fenugreek seed for eight weeks led to improved triglycerides and insulin sensitivity.International Journal Vitamin and Nutrition Research 2014: Effect of Fenugreek Seeds on Serum Metabolic Factors and Adiponectin Levels in Type 2 Diabetic Patients [randomized trial; moderate evidence]

  42. Lancet 2005: Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial
    [randomized trial; moderate evidence]

    Circulation 2019: Association Between Triglyceride Lowering and Reduction of Cardiovascular Risk Across Multiple Lipid-Lowering Therapeutic Classes: A Systematic Review and Meta-Regression Analysis of Randomized Controlled Trials
    [systematic review of randomized trials; strong evidence]

  43. European Heart Journal 2011: Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management [overview article; ungraded]

    Best Practice and Research, Clinical Endocrinology and Metabolism 2014: Treatment options for hypertriglyceridemia: from risk reduction to pancreatitis [overview article; ungraded]

  44. NEJM 1999: Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group [randomized trial; moderate evidence]

    Best Practice and Research, Clinical Endocrinology and Metabolism 2014: Treatment options for hypertriglyceridemia: from risk reduction to pancreatitis [overview article; ungraded]

  45. JAMA 2004: New Perspectives on the Use of Niacin in the Treatment of Lipid Disorders [overview article; ungraded]

    Journal of Clinical Lipidology 2017: Niacin and heart disease prevention: Engraving its tombstone is a mistake [overview article; ungraded]

  46. Best Practice and Research, Clinical Endocrinology and Metabolism 2014: Treatment options for hypertriglyceridemia: from risk reduction to pancreatitis [overview article; ungraded]

  47. Nutrition Reviews 2010: Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid dose-dependently reduce fasting serum triglycerides [overview article; ungraded]

  48. NEJM 2019: Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia [randomized trial; moderate evidence]

  49. European Heart Journal 2011: ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) [overview article; ungraded]

    Circulation 2011: Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association [overview article; ungraded]

  50. European Heart Journal 2018: Unmet need for primary prevention in individuals with hypertriglyceridaemia not eligible for statin therapy according to European Society of Cardiology/European Atherosclerosis Society guidelines: a contemporary population-based study [observational study, weak evidence]

  51. Journal of the American College of Cardiology 2015: Fasting triglycerides predict recurrent ischemic events in patients with acute coronary syndrome treated with statins [randomized trial; moderate evidence]

  52. JAMA 2019: Association of Triglyceride-Lowering LPL Variants and LDL-C-Lowering LDLR Variants With Risk of Coronary Heart Disease [observational study, weak evidence]

  53. Clinics 2008: High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease [observational study, weak evidence]

    Diabetes Care 2000: Ratio of triglycerides to HDL cholesterol is an indicator of LDL particle size in patients with type 2 diabetes and normal HDL cholesterol levels [observational study, weak evidence]

  54. Journal of the American College of Cardiology 2020: Remnant Cholesterol, Not LDL Cholesterol, Is Associated With Incident Cardiovascular Disease [observational study, weak evidence]

  55. Circulation 2019: Association Between Triglyceride Lowering and Reduction of Cardiovascular Risk Across Multiple Lipid-Lowering Therapeutic Classes: A Systematic Review and Meta-Regression Analysis of Randomized Controlled Trials
    [systematic review of randomized trials; strong evidence]

    Lancet 2005: Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial [randomized trial; moderate evidence]

    Circulation 2004: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins [randomized trial; moderate evidence]

    NEJM 2001: Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease [randomized trial; moderate evidence]

  56. World Journal of Clinical Cases 2019: Evaluation and management of acute pancreatitis [overview article; ungraded]

  57. Journal of Clinical Gastroenterology 2014: Issues in hypertriglyceridemic pancreatitis: an update [overview article; ungraded]