Key takeaways

  • Managing very high triglycerides requires combining strict dietary changes with medication, where reducing fat intake and avoiding added sugars help prevent serious complications like acute pancreatitis.
  • Several medications, both prescription and over-the counter options, can effectively lower triglycerides. Examples include fibrates, omega-3 fatty acids, and niacin. Your healthcare professional can determine the best choice based on the underlying cause of elevation.
  • Triglyceride levels typically begin improving within days to weeks of starting treatment. But maintaining reductions of 20% or more requires consistent lifestyle modifications and medication adherence for at least 6 months.

High triglycerides can occur for a number of reasons. Generally, it’s an overlap between genetic and lifestyle factors, and sometimes other medical conditions or medications.

Hypertriglyceridemia is diagnosed using a fasting cholesterol panel, as it’s more reactive to food than other types of cholesterol. Classification of triglyceride levels is typically done as follows:

  • Normal: <150 milligrams per deciliter (mg/dL)
  • Borderline: 150 to 199 mg/dL
  • High: 200 to 499 mg/dL
  • Very high: >500 mg/dL

Triglycerides are often used to calculate low-density lipoprotein (LDL) levels on a cholesterol panel. If they’re above 400 mg/dL, alternative methods of determining LDL cholesterol must be used. Triglycerides are considered extremely high at levels over 1,000 or 1,500 mg/dL.

Very high triglycerides can increase the risk of cardiovascular disease, fatty liver disease, and metabolic syndrome, but they also put you at an increased risk for acute pancreatitis.

Acute pancreatitis causes the pancreas to become very inflamed, causing severe pain and often requiring hospitalization.

The first step in managing very high triglyceride levels is determining why they’re elevated.

Your healthcare professional will ask questions about family history and lifestyle. Sometimes this means additional testing to rule out underlying health concerns.

It’s also important to make immediate lifestyle changes such as stopping any alcohol use, eating a low fat diet, avoiding added sugars, and exercising regularly. For many people, losing weight can be helpful too.

There are several classes of medications that can treat very high triglycerides.

Fibrates, such as fenofibrate or gemfibrozil, are one class of first-line medications for managing very high triglycerides. They are expected to reduce triglycerides by 20% to 50%.

Niacin is a B vitamin that can also reduce triglycerides by 20% to 50%. It comes in both immediate-release and slow-release forms. The slow-release form is less likely to cause facial flushing.

Omega-3 fatty acids are available as both over-the-counter and prescription-strength medications. Similar to fibrates and niacin, omega-3s can lower triglycerides by 20% to 50%.

Statins are frequently used to treat high cholesterol and may also lower triglycerides by 15% to 30%.

Lomitapide is a prescription medication that healthcare professionals use to treat very high triglycerides related to a specific genetic condition. It may lower triglycerides by 30% to 70%.

Diet is extremely important for very high triglycerides. In fact, it is one of the most important treatments for this condition.

For people with very high triglycerides, a strict low fat diet (around 25 per day or 10% to 15% of total daily calories) is vital to decreasing the risk of complications of very high triglycerides, such as acute pancreatitis.

It is also important to reduce sugar intake, such as limiting refined carbohydrates and simple sugars. Whole grains, fruits, and vegetables are fine and should make up the majority of carbohydrate intake.

With strict dietary changes, exercise, and medication, triglycerides can start to decrease within a few days to a couple of weeks. More significant changes are seen over 6 to 12 weeks.

Long-term changes take consistency over several months (at least 6). Sustained weight loss of 5% to 10% of body weight can reduce triglycerides by around 20% in some people.

To keep triglycerides from rising again, it’s important to maintain a low sugar, low fat diet and stay physically active. Minimizing or eliminating alcohol can help keep triglycerides lower, too.

Eating plenty of omega-3 fatty acids, such as those in fish, can help manage triglycerides long term. It’s important to follow the advice of your healthcare professional, including taking all medications as prescribed.

Dr. Foglesong Stabile is a board certified Family Medicine Physician with a secondary specialty in Obesity Medicine. She practices rural full-scope Family Medicine with Obstetrics at Deer Park Family Care Clinic in Washington.