Many of us are still confused about the difference between cholesterol and triglycerides. Some people even think they are the same thing, which is of course incorrect. However, a high level of triglycerides or a high level of cholesterol in the body is just as dangerous for health because both can lead to a heart problem. On the other hand, triglycerides and cholesterol serve very different functions for the body.
Like what has been explained by Benjamin Wedro M.D., a professor at the University of Wisconsin-Madison, triglycerides and cholesterol are separate types of lipids that circulate in the blood. While triglycerides store unused calories and provide energy for the body, cholesterol is used by the body to build cells and certain hormones. Because triglycerides and cholesterol can’t dissolve in blood, they circulate throughout the body with the help of proteins that transport lipids (lipoproteins).
Danya L. Dinwoodey, M.D., a cardiologist at Lahey Clinic, explains that when a person eat, his body will change the calories into triglycerides. Therefore, excessive calories will increase the level of triglycerides, leading to a condition called hypertriglyceridemia.
High cholesterol vs high triglycerides
In order to protect yourselves from the bad effects of high triglycerides, Pat F. Bass, MD, MPH, a professor and pediatrician at Louisiana State University Health Services Center-Shreveport, explains that ideally our triglycerides level must be lower than 150 mg/dL; or up to 199 mg/dL (borderline). The triglycerides level of more than 200 mg/dL is considered high, and more than 500 mg/dL is very dangerous.
Things that can increase the triglycerides level and must therefore be avoided are overweight, sedentary lifestyle, smoking, excessive alcohol consumption, and certain drugs. However, genetic condition can also contribute to hypertriglyceridemia.
Different genetic condition of every person, according to Robert S. Rosenson, MD, Director of Lipoprotein Disorders and Atherosclerosis at the University of Michigan, will lead to different effect among the patients. For example, one of his patients whose total cholesterol level was 175 with HDL of 25 has a high risk of cardiovascular diseases. Meanwhile, another patient with the total cholesterol level of 240 with HDL of 65 doesn’t have the same risk.
Both cholesterol and triglycerides can only be examined through a blood test. The test for measuring triglycerides is called lipid profile or lipid panel. This test can also measure the level of total cholesterol, LDL, and HDL.
- High Triglycerides Versus Bad Cholesterol: What You Need to Know
- Cholesterol: The good and the bad
- Should You Be Worried If Your Triglycerides Are Low?
- Should you worry about high triglycerides?
High Triglycerides Versus Bad Cholesterol: What You Need to Know
Although you may know what your total cholesterol level is and be aware of the difference between bad cholesterol and good cholesterol, you may not know that your triglyceride level is an equally important part of your blood lipids profile. In fact, high triglycerides are as dangerous as bad cholesterol when it comes to your risk for heart disease.
According to researchers at the Centers for Disease Control and Prevention (CDC), high triglycerides could be a problem for one-third of all Americans. A recent article published in the Archives of Internal Medicine revealed that one-third of adults in the United States have borderline high triglyceride levels, and one in five have high triglyceride levels. Though high triglyceride levels have increased dramatically over the past 30 years, only 1.3 percent of people with high triglycerides are taking medication approved to lower triglyceride levels. These findings suggest that triglyceride levels need to get more attention.
“The days when you only needed to know your total cholesterol level are gone,” says Danya L. Dinwoodey, MD, a cardiologist at the Lahey Clinic in Burlington, Mass. “Think of your triglyceride level as one part of the total fats in your blood. To get the whole picture, you need to break down the total fats into good cholesterol, bad cholesterol, and triglycerides.”
High Triglycerides and Cholesterol Levels
Triglycerides are the form in which most fats exist in the body, including in your blood. When you eat more fatty calories than you use, the fat — or lipid — levels in your blood go up. Your body also makes triglycerides from the carbohydrates you eat and may send triglycerides to fat cells where they are stored for energy. Optimally, your triglyceride level should be less than 150 mg/dL; borderline levels are up to 199 mg/dL, over 200 mg/dL is considered high, and over 500 mg/dL is very high.
Unlike triglycerides, not all cholesterol contributes to heart disease. High-density lipoprotein (HDL) cholesterol keeps cholesterol from building up inside your blood vessels and returns it to your liver. That’s why this kind of cholesterol is called the “good cholesterol.” Low-density lipoprotein (LDL) is the type of cholesterol that forms plaques inside blood vessels and is considered “bad cholesterol.”
“High triglyceride levels often go along with low HDL levels. This kind of blood lipid profile may be more likely to run in families and contributes to heart attacks and to strokes,” says Dr. Dinwoodey.
Related: Are Heart Attacks ‘All in the Family?’
You ideally want your total cholesterol to be below 200 mg/dL, but you also need to know the breakdown of your cholesterol levels:
- Your LDL cholesterol level should be between 70 and 130 mg/dL, with lower being better.
- Your HDL cholesterol level should be between 40 and 60 mg/dL, with higher being better.
Getting Control of High Triglycerides
The CDC researchers found that people with high triglyceride levels tended to be older and overweight, smoked more, and got less than 150 minutes of exercise per week. According to the American Heart Association, healthy lifestyle changes to counter those bad habits are the most important steps you can make to control high triglycerides, even more important than medication.
These choices include:
- Maintaining a healthy body weight
- Eating a healthy diet
- Getting regular exercise
- Quitting smoking and limiting alcohol
“Lifestyle modification is the best way to lower your bad cholesterol, increase your good cholesterol, and lower your triglyceride level,” says Dinwoodey. It’s not just about total cholesterol levels anymore. You need to know all your numbers and take the necessary actions to bring them in line.
Cholesterol: The good and the bad
Two types of lipoproteins carry cholesterol to and from cells. One is low-density lipoprotein, or LDL. The other is high-density lipoprotein, or HDL. The amount of each type of cholesterol in your blood can be measured by a blood test.
LDL (bad) cholesterol
LDL cholesterol is considered the “bad” cholesterol, because it contributes to fatty buildups in arteries (atherosclerosis). This condition narrows the arteries and increases the risk for heart attack, stroke and peripheral artery disease, or PAD.
HDL (good) cholesterol
HDL cholesterol can be thought of as the “good” cholesterol. (So, in the case of HDL cholesterol, higher levels are actually better.)
Experts believe that HDL acts as a scavenger, carrying LDL (bad) cholesterol away from the arteries and back to the liver, where the LDL is broken down and passed from the body. But HDL cholesterol does not completely eliminate LDL cholesterol. Only one-third to one-fourth of blood cholesterol is carried by HDL.
A healthy HDL cholesterol level may protect against heart attack and stroke. Studies show that low levels of HDL cholesterol increase the risk of heart disease.
Triglycerides are the most common type of fat in the body. They store excess energy from your diet.
A high triglyceride level combined with high LDL (bad) cholesterol or low HDL (good) cholesterol is linked with fatty buildups within the artery walls, which increases the risk of heart attack and stroke.
Watch an animation about cholesterol.
Watch an animation about atherosclerosis.
Should You Be Worried If Your Triglycerides Are Low?
A healthy diet
We know that an unhealthy diet can cause high triglycerides, while a healthy diet generally leads to low triglycerides.
One interesting note is that sometimes low triglyceride levels can occur with high LDL levels (which often indicate a higher heart disease risk). If low triglyceride levels lower heart disease risk, but high LDL levels increase it, what can cause this inconsistency?
There are two types of LDL particles that should be taken into account when calculating heart disease risk:
- LDL-A particles are larger, less dense, and lower your risk.
- LDL-B particles are smaller, denser, and increase your risk.
When you have low triglyceride levels but high LDL levels, it could indicate that you have a diet filled with healthy fats.
Healthy fats will not only cause an increase in good cholesterol (HDL) but can also change the type of the LDL particles in the blood. Therefore, those high LDL levels may not actually be a bad thing.
Instead, it is more likely that they are LDL particles that have become larger and less dense from the intake of healthy fat. Low triglycerides and high HDL levels in the blood will generally support this idea.
A very low-fat diet
Low-fat diets aren’t necessarily unhealthy. Research has shown that low-fat diets can be an effective way to lose weight. However, anything done on an extreme scale can be dangerous, and very low-fat diets are no exception to the rule.
People on low-fat diets who are consuming very little fat may have lower triglyceride levels. With fat being an essential part of human metabolism, it is important to consume at least some fat — preferably, the healthy kind.
Fasting is the abstinence of food and drink, and for some people it’s one of the ways in which they improve their health. Fasting can have many health benefits, from lowering blood sugar and lipid levels to aiding in weight loss.
In a small 2010 study, researchers found that in people who partook in alternate-day fasting (a type of intermittent fasting) over eight weeks, triglyceride levels were lowered by roughly 32 percent.
A longer period of fasting may produce more dramatic results. For those with already normal levels, this could potentially lead to very low triglyceride levels.
Instead of fasting for long periods of time, or fasting every other day, a shorter stint of intermittent fasting may be just as effective, without lowering your levels too much. This could mean fasting for 8 or 16 hours each day, rather than skipping food entirely for 24 hours.
Malnutrition occurs when the body is not getting enough of, or alternately too much of, certain nutrients. According to the World Health Organization, more than 2.3 billion adults in the United States experience malnutrition in some form.
Undernutrition can lead to deficiencies in important nutrients, including macronutrients such as lipids. Some symptoms of malnutrition include:
- weight loss, fat loss, and muscle mass loss
- hollow cheeks and eyes
- a protruding, or swollen, stomach
- dry and brittle hair, skin, or nails
- emotional symptoms, such as depression, anxiety, and irritability
If someone is experiencing severe undernutrition, their triglyceride levels may be well below the normal range. Undernutrition is best treated with increased food intake and, in some cases, supplementation of vitamins and minerals.
Malabsorption is a condition in which the small intestine is unable to properly absorb the nutrients from food. Causes of malabsorption may include damage to the digestive tract, diseases affecting the digestive tract, or even certain drugs. For people who experience malabsorption, the body may not be able to properly absorb carbohydrates, proteins, or fats.
There are many symptoms of malabsorption. However, fat malabsorption can lead to a condition called steatorrhea. Steatorrhea is a major indicator that your body isn’t absorbing fats properly. You may notice:
- pale and foul-smelling stools
- stools that are bulkier and float
- grease or fat in your stools
- drops of oil or fat in the water surrounding your stools
People who have trouble absorbing fats may have low triglyceride levels. Treatment for steatorrhea involves addressing underlying conditions that may be causing malabsorption with medication and lifestyle changes.
The thyroid gland plays a crucial role in regulating metabolism. In people with an overactive thyroid (hyperthyroidism), regular metabolic processes can be greatly affected. Some of the symptoms of hyperthyroidism include:
- an enlarged thyroid gland, called a goiter
- unintentional weight loss and appetite changes
- alterations in heart rate
- thinning of the skin and hair
- cognitive changes, such as increased anxiety or nervousness
One of the biggest indicators of hyperthyroidism is unintentional weight loss. Generally, this weight loss occurs regardless of food intake. This means that the body is always using up more energy than that person is consuming. People with hyperthyroidism may have low levels of triglycerides due to the increased use of these triglycerides for fuel.
Blood tests that measure levels of thyroxine and thyroid-stimulating hormone may be used to diagnose hyperthyroidism. It’s generally treated with medication and lifestyle changes.
According to a 2015 report from the Centers for Disease Control and Prevention, roughly “78.1 million Americans were already taking or are eligible for cholesterol-lowering medication.” Cholesterol medication, or lipid-lowering drugs, are one of the ways in which people can get their cholesterol levels under control.
There are many different types of lipid-lowering medications, including statins, PCSK9 inhibitors, and more. Statins, fibrates, and omega-3 fatty acid ethyl esters are three types of lipid-lowering drugs that are known to lower triglyceride levels.
If you’re concerned that your cholesterol-lowering drugs are causing your triglyceride levels to drop too low, consider speaking with a doctor to switch medications.
Beans and lentils are leading sources of cholesterol-crushing soluble fiber and research shows that noshing on them regularly can help send levels of LDL cholesterol (the “bad” kind) crashing down. Other sources of soluble fiber include oats, barley, flaxseed, chia seeds, and certain fruits such as apples and citrus.
It sounds counterintuitive but eating fat can help keep your cholesterol numbers in check—the right fats, that is. It’s now known that the long-chain omega-3 fatty acids found in fatty fish like salmon, sardines, and mackerel can help reduce triglyceride numbers, which manifests itself as a drop in VLDL levels and a big reason why these mega-healthy fats are considered especially good for your heart. It seems that these fats increase the delivery of triglycerides to the liver for removal from the body.
Crean also focuses on monounsaturated fat (MUFA) as another fat that is a cholesterol crusher. Research indicates that eating more MUFA at the expense of saturated fat can improve our HDL-to-LDL ratio for better heart health. Harvard researchers found that among nearly 130,000 people, those who replaced 5 percent of the daily calories they ate from saturated fat with calories from MUFA benefited from a 15 percent lower risk for heart disease. “Excellent sources of MUFA include olive oil, avocado, and nuts like almonds,” says Crean.
A review of research published in the journal Nutrients found that there is enough evidence to say that adding MUFA-rich hazelnuts to a diet can aid in slashing LDL cholesterol numbers. While another research review showed that eating MUFA-packed avocados can chip away at total cholesterol, LDL cholesterol, and triglyceride levels making the popular food especially ticker-friendly.
Here’s more science to take to heart: A higher consumption of anthocyanins, antioxidants found in fruits including blueberries, blackberries, dark grapes, and cherries, have been found to boost HDL cholesterol numbers while simultaneously trimming LDL numbers. It appears that anthocyanins reduce the activity of CETP, a protein that transfers cholesterol from HDL to LDL molecules, which is not what your heart wants.
- Plant Proteins
To keep heart disease at bay, consider implementing meatless Mondays. When researchers from Harvard T.H. Chan School of Public Health and Purdue University analyzed the diets of 1,800 individuals, they found that higher intakes of plant proteins such as tofu, beans, lentils, and seeds resulted in lower levels of both total and LDL (“bad”) cholesterol compared to diets that included more red meat. More generous intakes of red meat were linked to higher levels of triglycerides, which can drive up the amount of VLDL moving around in the body.
“As for eating more plant-based proteins in place of red meat, this benefit can be two fold,” says Crean. “Plant-based proteins are naturally lower in saturated fat and diets high in saturated fat like that found in red meat can increase LDL cholesterol.” She adds that eating more plant proteins also comes with the added benefit of being higher in fiber, which we know can help lower cholesterol. A Mediterranean-style diet that emphasizes plant-based foods with smaller allowances for meat than the typical American diet is a good place to start.
- Low Sugar
It’s OK to fuel your big rides with sugary gels and chews, but your overall diet should be light in added sugars. When you flood your system with simple sugar (glucose) some is used to generate energy, but Crean cautions that the excess is used to make triglycerides, which can raise your risk for heart disease and insulin resistance, a contributing factor to diabetes. The best way to lower your VLDL levels is to lower your triglycerides, and slashing the added sugar in your diet is a good first step.
Good news: You can ride your way to tackling your cholesterol head-on. An investigation in the American Heart Journal found that independent of diet, regular exercise can have beneficial effects on LDL and HDL numbers, LDL size (smaller, denser LDL particle size is more predictive of heart disease) and triglycerides. A big reason why regular sweat sessions can improve cholesterol numbers is because it keeps your body weight in check: Overweight people tend to have worse levels of cholesterol and triglycerides.
But be sure to work some intervals into your training program as research shows HIIT exercise can be especially helpful in improving cholesterol levels. Plus, consider picking up the dumbbells few times a week since resistance training, which improve our muscle-to-fat ratio, is also part of the workout equation to healthier cholesterol numbers in both men and women .
Should you worry about high triglycerides?
Updated: January 30, 2019Published: February, 2006
These blood fats can be one of the signs of metabolic syndrome, which increases the risk for having a heart attack or stroke.
Doctors are seeing lots of hungry patients these days, and it’s not because people don’t have enough to eat.
Before their appointments, patients are fasting for 9–12 hours because that’s the only way to get an accurate lipid profile, the blood test that generates measurements of total cholesterol, “good” HDL cholesterol, and triglycerides. Lipid profiles have become increasingly popular because of the emphasis on lowering “bad” LDL cholesterol, and your LDL level can be calculated from a lipid profile.
Doctors have a good handle on HDL. High concentrations are better than low ones. An HDL or higher is associated with a lower risk of heart disease. Levels of 40 and below (50 for women, because their HDL levels tend to run a little higher, on average) may mean you have a higher risk, depending on you LDL level.
Until recently, triglycerides tended to get less attention when looking at cardiovascular risk. There’s no question that extremely high levels (1,000 mg/dL or more) spell trouble and can lead to acute pancreatitis. But what about treating lower levels of triglycerides? Recent evidence suggests you should work to reduce triglyceride levels of they are higher than normal, especially if you have heart disease or have other risk factors such as diabetes, high blood pressure or smoking.
Less than 150*
500 or higher
*All values in milligrams per deciliter
Source: National Cholesterol Education Program.
A sign of metabolic syndrome
People with metabolic syndrome are several times more likely to have a heart attack or stroke. The risk of eventually developing diabetes is even greater.
A syndrome is, by definition, a group of signs and symptoms that occur together because of an underlying condition. For metabolic syndrome, that group includes abdominal obesity (as measured by waistline), high blood pressure, high blood sugar, low HDL cholesterol — and, yes, high triglyceride levels.
So as doctors have started to take metabolic syndrome more seriously, they’ve also started to pay more attention to triglyceride levels as one of its telltale signs.
Triglycerides go it alone
HDL and triglycerides are metabolically connected and are often inversely related: As triglycerides go up, HDL goes down — and vice versa. But that isn’t always so. People can have “isolated” high triglycerides without low HDL levels, and research is now showing that high triglycerides are an independent risk factor for cardiovascular disease, no matter what the HDL is.
What you can do
Many of the steps you should take to lower triglycerides are the same ones you should take to protect your heart and health overall.
If you’re overweight, shed a few pounds. Get regular aerobic exercise (the kind that increases your heart rate). Limit the saturated fats in meat and dairy products. Watch your alcohol intake, even moderate drinking ramps up triglyceride levels. And diet? High-carb/low-fat eating will increase your triglycerides and lower your HDL.
If you’re taking a statin to lower your LDL, one side benefit may be reduced triglyceride levels. Depending on the dose, statins can lower triglycerides by 20%–40%.
The omega-3 fats in fish and fish oil capsules are another triglyceride-lowering option. For a very high triglyceride level, your doctor can prescribe a high-dose omega-3 medication.
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Cholesterol levels should be measured at least once every five years in everyone over age 20. The screening test that is usually performed is a blood test called a lipid profile. Experts recommend that men ages 35 and older and women ages 45 and older be more frequently screened for lipid disorders. The lipoprotein profile includes:
- Total cholesterol
- LDL (low-density lipoprotein cholesterol, also called “bad” cholesterol)
- HDL (high-density lipoprotein cholesterol, also called “good” cholesterol)
- Triglycerides (fats carried in the blood from the food we eat. Excess calories, alcohol, or sugar in the body are converted into triglycerides and stored in fat cells throughout the body.)
Results of your blood test will come in the forms of numbers. Here is how to interpret your cholesterol numbers. The first thing you need to know is that the numbers by themselves are not enough to predict your risk of heart problems or to determine what you need to do to lower that risk. They are, instead, one part of a larger equation that includes your age, your blood pressure, your smoking status, and your use of blood pressure medicines. Your doctor will use this information to calculate your 10-year risk for serious heart problems. Then the two of you will develop a strategy for reducing that risk.
What are triglycerides?
Triglycerides are a type of fat. They are the most common type of fat in your body. They come from foods, especially butter, oils, and other fats you eat. Triglycerides also come from extra calories. These are the calories that you eat, but your body does not need right away. Your body changes these extra calories into triglycerides, and stores them in fat cells. When your body needs energy, it releases the triglycerides. Your VLDL cholesterol particles carry the triglycerides to your tissues.
Having a high level of triglycerides can raise your risk of heart diseases, such as coronary artery disease.
What causes high triglycerides?
Factors that can raise your triglyceride level include
- Regularly eating more calories that you burn off, especially if you eat a lot of sugar
- Being overweight of having obesity
- Cigarette smoking
- Excessive alcohol use
- Certain medicines
- Some genetic disorders
- Thyroid diseases
- Poorly controlled type 2 diabetes
- Liver or kidney diseases
How are high triglycerides diagnosed?
There is a blood test that measures your triglycerides, along with your cholesterol. Triglyceride levels are measured in milligrams per deciliter (mg/dL). The guidelines for triglyceride levels are
|Normal||Less than 150mg/dL|
|Borderline high||150 to 199 mg/dL|
|High||200 to 499 mg/dL|
|Very high||500 mg/dL and above|
Levels above 150mg/dl may raise your risk for heart disease. A triglyceride level of 150 mg/dL or higher is also a risk factor for metabolic syndrome.
What are the treatments for high triglycerides?
You may be able to lower your triglyceride levels with lifestyle changes:
- Controlling your weight
- Regular physical activity
- Not smoking
- Limiting sugar and refined foods
- Limiting alcohol
- Switching from saturated fats to healthier fats
Some people will also need to take cholesterol medicines to lower their triglycerides.