What Are Triglycerides?

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Patients usually seek medical attention regarding their cardiac risk when lab tests show their total cholesterol, triglycerides, or blood sugar levels to be high. Most people know a bit about cholesterol (enough to be often frightened by mere mention of the word) and blood sugar. However, most people are left wondering, “what are triglycerides?”.

Triglycerides are the most common type of fat found in your body. They come primarily from the carbohydrates – the calorie sources − that you eat. Triglycerides are carried in the bloodstream and distributed to tissues for energy. When you consume an excess of calories from carbohydrates, sugar, and even alcohol; your body stores those triglycerides as fat when their metabolism is insufficient. Abnormally elevated levels of triglycerides in the blood are indicative of an increased risk of inflammation, atherosclerosis, and diabetes.

Healthy Triglyceride Levels

Triglycerides have a close relationship with HDL cholesterol, a protective form of cholesterol produced by your body. HDL plays an important role in removing the oxidized LDL cholesterol particles that are involved in inflammation and arterial disease. When your doctor does a blood test, one of the important things he or she checks is the triglyceride-to-HDL ratio. A ratio takes into account the respective levels of two items in proportion to one another. The triglyceride/HDL ratio reflects how much pro-inflammatory triglyceride particles are being balanced out by protective HDL cholesterol particles. A low ratio between triglycerides and HDL is best because it indicates less risk of inflammation and cardiovascular disease. The best triglyceride/HDL ratio is 1 to 1 or 1:1 which can be “bottom-lined” and expressed simply as “1”. This essentially means you have equal parts of triglyceride and HDL – an exceptional balance.

When it comes to HDL – a higher level is better. However, HDL levels rarely go above 100mg/dL, and if they do, it usually indicates something dysfunctional. Healthy triglyceride levels are in the 50-150 range and HDL in the 50 to 75 zone. A ratio less than 2 is ideal, and less than 3 is still satisfactory.

I get a little concerned with triglyceride/HDL ratios over 3, and more concerned when the ratio is 5:1, which, unfortunately, is very common. Over the years, I’ve seen some seriously imbalanced ratios, such as a 300 triglyceride level, with an HDL of only 30 (a ratio of 10:1, or 10). As expected, this high triglyceride/HDL ratio was a reflection of serious arterial inflammation and disease. Commonly, I would see patients with metabolic syndrome and diabetes who had dangerously high ratios of 7:1 to 10:1 (or 7-10).

Triglycerides and the Metabolic Syndrome-Diabetes Connection

Also known as insulin resistance, metabolic syndrome is a condition that increases the risk of coronary artery disease, stroke, and diabetes. Some 20-25 million Americans are insulin resistant. This sneaky pre-diabetic condition does not generate overt symptoms. However, underneath the radar of detection, the cells of the body are no longer responding normally to insulin, the hormone produced by the pancreas that brings blood sugar (glucose) and triglycerides into the cells to be used for energy. When this process starts failing, the pancreas compensates by releasing more insulin. Unfortunately, the cell membranes no longer respond appropriately to those insulin surges, and the insulin becomes ineffective. Eventually, glucose and triglycerides are unable to permeate the cell membrane to enter the cells efficiently, and they start building up in the circulation. The end result is higher blood sugar and triglyceride levels in the blood, as well as the development of diabetes – which has a serious association with arterial inflammation and cardiovascular disease.

You likely have metabolic syndrome if you have the following:

  • A Triglyceride level over 180mg/dL
  • HDL under 40 (men) and 50 (women)
  • A large waist circumference: over 35 inches in a woman and 40 in a man
  • Elevated fasting blood sugar (FBS): over 100 mg/dl
  • Elevated blood pressure of 130/85 or greater

In clinical practice, I often saw dangerously high triglyceride/HDL ratios in overweight women. A high triglyceride level is much more dangerous for women than it is for men. If you are a diabetic, overweight woman with high triglycerides, your risk of developing heart disease is actually 200 times greater than someone without these factors! A typical case like this might be someone following a strict low-fat diet, thinking that it will help them lose weight. As I have written before, many low-fat foods contain sweeteners and carbohydrates that ramp up the triglyceride level, as well as the body weight. The low-fat diet has turned out to be dietary folly.

Could the Paleo Diet Be a “Metabolic Syndrome Diet”?

What to Do About High Triglycerides

If you have high triglycerides and a poor triglyceride/HDL ratio, here’s my advice:

Switch to eating the PAMM diet. This is a style of eating that I developed based upon the unprocessed, vibrant, nutrient packed staples of traditional Mediterranean and Asian diets. The PAMM diet consists of 40-45 percent carbohydrates from fruits, vegetables, and whole grains (my favorites are gluten-free, non-genetically engineered quinoa, amaranth, and buckwheat); 20-25 percent protein from eggs, poultry, and beans; and 35 to 40 percent healthy fats from fish (such as wild salmon), nuts, avocado, and extra-virgin olive oil.

Keep your carb intake to a minimum. You need to be smart and disciplined when it comes to carbohydrates because they fuel heightened triglycerides. Stay far away from the typical refined carbohydrates that many people overeat, such as rice, pasta, potatoes, corn, carrots, peas, bread, crackers, cookies, cakes, and bagels. And as always, avoid sugar and sweets as much as possible because they fan the flames of inflammation in addition to increasing triglycerides. Remember, sugar consumption is the number one risk factor for developing heart disease – NOT cholesterol.

Cut down on alcohol.

Physical activity is a must. Keep it simple and enjoyable, but make sure it gets done. Try to walk a mile a day and as briskly as you can.

Consider three nutritional supplements that can be quite helpful:

1. Omega-3 fatty acids – are best sourced from fish or squid oil which have been proven to reduce triglycerides and raise HDL. I recommend taking 2 grams daily.

High Triglycerides? Bring them Down with Omega-3 Fatty Acids

2. Bergamonte extract – is a lesser known substance derived from an orange that grows in the Calabria area of Italy; it has the same properties with the added ability to lower blood sugar.

3. Magnesium – can bring down the triglyceride level, a direct effect I’ve observed in my patients many times. This important mineral is involved in some 300 enzymatic processes in the body, including an enzyme called lipoprotein lipase. The enzyme breaks down circulating triglycerides into fatty acids for tissue use and helps form beneficial HDL cholesterol. Take about 400-600 milligrams daily in divided doses. It is best to start with a level of 100 or 200 milligrams and increase your doses over time. I like the magnesium glycinate or citrate forms of magnesium. An additional benefit of magnesium is that it can often naturally relieve constipation.

Triglycerides are big players when it comes to heart health and the inflammatory process in the body. Arm yourself with this knowledge and employ changes in lifestyle, diet, and exercise to help you get your healthy triglyceride levels (and keep them).


© 2014, 2016 HeartMD Institute. All rights reserved.

Leave a Reply


  1. Richard I. Ellis

    on November 20, 2014 at 6:30 pm

    I am really interested in your new formula for PQQ additive for TELEMERES health. I am using your Omega Q Plus with Resveratrol for a long time am due to re-order again. QUESTION: Can an order be mixed like 3 Omega Q Plus with 2 of the Telemerse formula and how well ro these two work together? Aiming for 120 years, Hi, Hi. Do have good luck with Omega Q Plus in stopping numnes in my ankels when sitting. Stoped this cold. Thank you for you time.


    on November 21, 2014 at 2:26 am




  3. Debbie Hicks

    on November 21, 2014 at 6:12 am

    After reading your triglyceride/HDL ratio recommendation I have a few questions.
    My recent physical results show my triglycerides at 44 mg/dl and my HDL at 98
    mg/dl which yields a ratio of approximately .45, which would certainly be below
    the ideal of 2, that you recommend. However, my cholesterol reads at 245, which
    is high, as is my LDL reading of 138, so am confused how to interpret the good and
    not so good numbers.

    I eat very much along the PAM/Paleo diet, get regular exercise, and am in pretty decent
    shape for my age. However, there is a family history of high blood pressure, which I also
    have, but seem to be able to control with biofeedback, if I’m diligent, and exercise.

    I would very much like to know what you have to say about this.

  4. Chris

    on November 22, 2014 at 5:25 pm

    One point caught my eye. My HDL has ranged from high 60’s to a high of 122 (since 2010, over 100), now 114. Triglycerides from 50s to over 100, with care below 100 since 2010, now 74. Should I be worried about something. My Ca heart scan results are bad, PET scan shows good flow.

  5. Richard Kurylski, PhD

    on December 4, 2014 at 10:16 pm

    Dr Sinatra, my triglycerides / HDL ratio is perfect 55/80, but unfortunately I have been asking the same question for 3 months now and no answer yet, namely how can I lower NT proBNP, which is over 300. I suffer from a serious aortical stenosis and a heavily calcified aortic valve. A have been trying to avoid an operation for 2.5 years. I feel fine, with no shortage of breath but after 5 minutes of a very brisk walking I feel pain on the left-hand side close to my armpit. I supplement with CoQ10 -150 mg, magnesium -600mg, L-Carnitine 850 mg .L-Arginine 500mg, Niacin -250mg only because I get very hot flashes 2 hours after taking it with a meal, vit D3 5000 iu and vit K2 (MK7 and MK4) 300-400 mg. Thank you

  6. Michael

    on December 4, 2014 at 11:30 pm

    If one does have calcium deposits in the arterial walls, past experience has told me to step up my vitamin D3 to get a blood concentration of between 60 to 80 ng/ml of 2,5-hydroxy-D3 (I suggest starting with 5000 IU vitamin D3 daily but will vary with each person because some people absorb D3 better than others), at least 90 micrograms of vitamin K2 (MQ-7) and make sure you are taking about 400 to 600 mg of chelated magnesium in the form of either glycinate, citrate, taurate or malate. These extremely vital 3 components are the vital missing links to getting your calcium transferred to your bone rather than to your arterial walls. After doing this for about 6 months, I found that most all the calcium deposits in the arterial walls were gone!

  7. Mary Ann

    on December 8, 2014 at 4:25 pm

    Omega-3 fatty acids (best sourced from fish or squid oil) ~
    Being highly allergic to all shellfish, I avoid fish or squid oil.
    What source would you recommend for those with shellfish allergies???

  8. Patti

    on February 14, 2015 at 5:21 pm

    How would you interpret my 0.62 triglyceride (73) to HDL (117) ratio. My diet consists of healthy fats, fresh veggies, minimal grains, and no wheat. I walk for exercise.

  9. S W

    on April 7, 2016 at 6:05 pm

    My HDL is 112, TG 51. You’re saying that means something dysfunctional, but my mother, who is 78, also has HDL over 80 and no heart disease. What does high HDL mean?

  10. Nick Duncan

    on April 8, 2016 at 3:06 am

    My triglyceride level is 67 and hdl level is 87 giving a ratio of less than 1. Is this bad?

  11. Clay

    on May 4, 2016 at 11:11 pm

    No, that’s good. The lower better. My TG/HDL ration is .37 because my TG is 40 and my HDL is 107

  12. Clay

    on May 4, 2016 at 11:11 pm

    That’s excellent. Be happy.

  13. Clay

    on May 4, 2016 at 11:13 pm

    By ideal they mean 2 or LOWER. You don’t want to go up to 2 if you’re already below. The reason they don’t even mention fractions is because the typical American will never get ratios that good.

  14. sadat

    on September 6, 2016 at 9:28 am

    hi,,my clostrol is 230….. trig is 94,,,,,,,,,,,,,

  15. samantha

    on December 29, 2016 at 2:42 pm

    My triglycerides went from 142 to 520 fasting.-Last test was in May, to now Dec.
    I just got my biometrics done today- my triglycerides have ranged from 71 to 160 in the past 4 years- 71,123 ,160,142.
    My LDL has been 140, 102,121,154.
    Today, my triglycerides went from 142 to 520 fasting.-Last test was in May, to now Dec, which is in less than 7 months and I lost 12 lbs.
    My LDL was off the charts..my BMI is 28.1 so I am not considered very dangerously obese.
    How serious is this?
    How do I get it under control and how did it go up so much in such a short period of time?

  16. Joseph B.

    on October 14, 2018 at 2:49 pm

    My last blood test showed a TRIG reading of 36 (L), where 44-200 mg/do seems to be the area of no concern. Is this a concern ? I have a BMI of 22, just turned 54 and watch what I eat. Staying mostly away from bread, potatoes and pasta, lots of fruit, leafy greens and vegetables. Most meats are white and I almost always feel great and have lots of energy. I don’t REALLY want to bring that level up I don’t think. I know that I need more healthy fats and working on that.

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