Triglycerides are the most common type of fat in your blood and body: the fuel your body stores from calories it doesn't need right away. The surprise most people miss is that high triglycerides on a blood test usually don't come from the fat you can see on your plate. They come mostly from sugar, refined starches, alcohol and surplus calories, which your liver turns into fat. So the number is a messenger reporting on your metabolism. The real fix is to deal with what sent the message, not to silence it.
This article explains what triglycerides are, what a normal level looks like, why cutting dietary fat alone isn't enough, why lowering the number with a drug failed to protect the heart in a large recent trial, what actually brings triglycerides down, and when a high level becomes urgent.
🩸 What are triglycerides, and what is a normal triglyceride level?
According to the US National Heart, Lung, and Blood Institute (NHLBI), triglycerides are a type of fat that circulates in your blood. They are the most common type of fat in the body, and you need some of them to stay healthy. Any extra calories you don't burn right away are stored as triglycerides.
These are NHLBI's categories for adults (in milligrams per decilitre):
Healthy: below 150
Borderline high: 150 to 199
High: 200 to 499
Very high: 500 and above
The American Heart Association's 2011 scientific statement added a sharper figure: a fasting triglyceride level below 100 mg/dL is "optimal," which the statement described as a marker of metabolic health. The same statement was careful to say this is not a target for drug treatment, because there was not enough evidence that pushing triglycerides that low with medication helps. The optimal number is a sign of a good lifestyle, not a figure to chase with a pill.
High triglycerides are common. The same statement reported that nearly a third (31%) of US adults have levels above 150 mg/dL. Most of them feel nothing. Cleveland Clinic notes that most people with high triglycerides have no symptoms, which is why a blood test is usually the only way to find out.
🍞 Why isn't cutting fat from your diet enough to lower triglycerides?
The name suggests that the triglycerides in your blood are simply the fat you ate. The real picture is more complicated. Harvard Health explains that your liver converts carbohydrates into triglycerides, and that when you eat more calories than you need, the liver churns out extra triglycerides. Part of the number on your report is made inside your own body from starches and sugars, not just imported from your plate.
That is why official advice puts sugar and starch ahead of fat. The AHA's 2011 statement recommended keeping added sugar below 5–10% of daily calories and fructose below 50–100 grams a day. In 2021, the American College of Cardiology (ACC) published an expert consensus decision pathway on persistent hypertriglyceridemia. It advises people to "markedly limit" high-glycaemic-index foods, "especially fructose and starches," and it lists high-glycaemic-index foods and alcohol among the secondary causes to look for first. Cleveland Clinic puts it in one line: avoid refined carbohydrates and sugars.
What happens when low-carb and low-fat diets are tested head to head? A 2016 meta-analysis in the British Journal of Nutrition (Mansoor and colleagues) pooled 11 randomised trials with 1,369 participants. Compared with low-fat diets, low-carbohydrate diets lowered triglycerides by an extra 0.26 mmol/L (about 23 mg/dL by our conversion), raised HDL ("good") cholesterol by an extra 0.14 mmol/L (about 5 mg/dL), and produced about 2.2 kg more weight loss.
In fairness, here is the rest of the result. In the same analysis, LDL ("bad") cholesterol rose by 0.16 mmol/L (about 6 mg/dL by our conversion) on the low-carb diets compared with low-fat. The authors concluded that the benefits "must be weighed against the possible detrimental effects of increased LDL-cholesterol." We accept that caveat: if you cut carbohydrates, watch your LDL as well as your triglycerides. Our article on the two numbers your lipid panel leaves out, ApoB and Lp(a) explains why one number never tells the whole heart story.
❓ Do triglycerides cause heart disease, or are they just a marker?
This is the core idea of the article: the number is a messenger, not the culprit. The AHA statement says plainly that triglyceride "is not directly atherogenic, but represents an important biomarker" of cardiovascular risk. The link exists mainly because of the other cholesterol-carrying particles that travel with triglycerides and do contribute to clogged arteries.
A large trial tested this idea directly. In PROMINENT, presented and published in 2022, nearly 10,500 adults in 24 countries received either the drug pemafibrate or a placebo. Participants had type 2 diabetes, high triglycerides and low HDL, and almost all were taking a statin. The drug lowered triglycerides by 26% compared with placebo. Yet about 1 in 10 people in both groups had a cardiovascular event over roughly three years, with no meaningful difference between them. The number went down, but the risk did not.
Why? LDL cholesterol rose on the drug. The lead investigator said the results "cannot exclude the possibility that the observed increase in LDL-C and ApoB negated any benefit of triglyceride reduction." One commentator wrote that lowering triglycerides without lowering ApoB probably won't bring a meaningful cardiovascular benefit. This fits the new 2026 US dyslipidemia guideline, which keeps LDL cholesterol and non-HDL cholesterol as the main treatment targets even in people with high triglycerides, and starts with lifestyle change.
Does this mean lowering triglycerides with medication never helps? No. The ACC's 2021 pathway notes that icosapent ethyl, a pure prescription form of EPA, cut cardiovascular events by 25% in specific patient groups in the REDUCE-IT trial, with more atrial fibrillation and serious bleeding. It recommends the prescription form, not over-the-counter fish oil. Fibrates also remain important for protecting the pancreas when levels are very high. But these are decisions for your doctor, not for the pharmacy shelf. Our article Omega-3: why flaxseed isn't enough explains the different forms.
⏰ Do you need to fast before a triglyceride test?
Because the number carries news from the last few days, it does respond to what you've eaten recently, though less than most people think. In a joint consensus statement from the European Atherosclerosis Society and the European Federation of Clinical Chemistry and Laboratory Medicine (Nordestgaard and colleagues, 2016), the largest difference in triglycerides between a non-fasting test (1–6 hours after a usual meal) and a fasting one was just 26 mg/dL. A difference that size usually doesn't change the medical decision.
The statement therefore recommended non-fasting tests for most people and treated non-fasting triglycerides of 175 mg/dL or more as abnormal. It still preferred a fasting sample in specific situations, including triglycerides above 400 mg/dL and recovery from pancreatitis. Your doctor may ask you to fast for 10–12 hours, as Cleveland Clinic notes, so follow their instructions.
The practical lesson: if your result comes back high after a celebration night of sweets, rice and juice, neither ignore it nor panic. Repeat the test as your doctor advises, and ask yourself what the messenger has been trying to tell you about the last few weeks.
🇸🇦 What do we know about high triglycerides in Saudi Arabia?
A cross-sectional study at primary health care centres in Jeddah, carried out in 2016–2017 and published in Nutrients in 2020 (Enani and colleagues), included 1,385 adults with no prior diabetes diagnosis. It found high triglycerides (1.7 mmol/L or more, about 150 mg/dL) in 21.7% of them, and some form of dyslipidaemia in 62%.
In men, after adjusting for age, BMI and waist size, the study linked dyslipidaemia with drinking carbonated soft drinks five or more times a week (odds ratio 1.53), sleeping less than six hours a day (1.57) and smoking (1.41).
These figures need careful reading. The authors themselves wrote that the cross-sectional design "did not allow for inferences about cause and effect," and that diet and lifestyle data came from self-reported questionnaires. The sample was clinic attendees in one city, not the whole Kingdom, and the paper contains internally inconsistent figures on women's vegetable intake, so we have left those out. We also don't compare Jeddah's 21.7% directly with the US 31%, because the samples and methods differ. What we can say safely: high triglycerides are common among people visiting primary care in a major Saudi city, and many of them don't know it.
🥗 How to lower triglycerides: treat the sender, not the message
The good news is that triglycerides are among the most lifestyle-responsive numbers on a blood test. The AHA statement says intensive lifestyle change can lower them by 50% or more. It breaks that down roughly as follows: losing 5–10% of body weight is expected to cut triglycerides by about 20%, and cutting added sugar and fructose while eating more unsaturated fat may lower them by a further 10–20%.
Start with the loudest senders: added sugar in drinks and sweets; refined starches such as white bread and large servings of white rice; and juices, even ones labelled "natural." Then alcohol, which guidelines say to limit, and to stop completely when triglycerides are very high or after pancreatitis caused by triglycerides.
Don't strip all fat out; swap it. The ACC recommends a heart-healthy diet with a registered dietitian's guidance. Cleveland Clinic suggests eating more seafood, especially fish rich in omega-3s, and Harvard Health advises cutting back on saturated fat from meat. The aim is olive oil, avocado, nuts and fish in place of sugar and white flour, not large amounts of saturated fat.
Movement is part of the treatment. Regular physical activity appears in every source, along with enough sleep, stress management and quitting smoking, as NHLBI lists.
Finally, look for secondary causes with your doctor. The ACC's 2021 pathway calls for checking for uncontrolled diabetes, chronic kidney disease, obesity and metabolic syndrome, pregnancy, chronic inflammatory disease, and medicines such as beta-blockers, diuretics, steroids, oestrogens and tamoxifen. NHLBI adds liver and thyroid disease. Sometimes getting blood sugar under control or treating an underactive thyroid fixes the number when no diet would.
🚨 When are high triglycerides an emergency?
Most high readings are silent and can be managed calmly. Some situations can't wait. See your doctor promptly, or go to the emergency department, if any of these apply:
- Triglycerides of 500 mg/dL or more raise the risk of acute pancreatitis, according to NHLBI and Cleveland Clinic.
- Above 880 mg/dL, the European consensus recommends referral to a lipid specialist.
- Sudden, severe upper-abdominal pain that may spread to the back, with nausea or vomiting, especially if you know your triglycerides are high. This needs emergency care immediately.
- Small yellowish bumps under the skin around the eyelids, or on the knees, elbows or palms. Cleveland Clinic calls these xanthomas and links them to severe hypertriglyceridaemia.
- High triglycerides during pregnancy, or in anyone who has had pancreatitis before.
Our article Acute pancreatitis: what actually prevents the next attack explains why the cause must be dealt with after a first episode.
Important: this article is for health education only and does not replace medical advice. If you have a high result, or you live with diabetes, heart or kidney disease, or take lipid-lowering medicine, talk to your doctor before changing your diet or medication. Never stop a prescribed medicine on your own.
🥖 Where does Bakery 8 stand in all this?
We should be upfront, because we have a stake in this topic: no bread we bake lowers triglycerides, and we don't claim it does. What changes when you choose almond-flour, sugar-free bread is not the product itself but what it replaces in your day: white bread and sugar-sweetened sweets, which are exactly what the guidelines ask you to cut.
We'll also say it plainly: a low-carb diet can be done badly, with lots of processed meat, butter and saturated fat, and that is the pattern that can push LDL up, as the meta-analysis showed. The better version cuts sugar and refined starch while leaning on unsaturated fats, vegetables and good protein. And before you visit our store, visit your lab. Know your number first.
If you're looking for everyday swaps, our bread range includes samoli, cloud bread and toast made with almond flour and no added sugar. Our keto granola can replace sweetened breakfast cereal, and our sugar-free sweets are there for anyone who doesn't want to give up dessert entirely.
💬 Frequently asked questions about triglycerides
What is a normal triglyceride level?
According to the US National Heart, Lung, and Blood Institute, a healthy adult level is below 150 mg/dL. 150–199 is borderline high, 200–499 is high, and 500 or above is very high. The American Heart Association calls a fasting level below 100 mg/dL optimal, as a sign of good metabolic health rather than a drug target.
Does eating less fat lower triglycerides?
Not necessarily. Your liver makes triglycerides from carbohydrates and surplus calories, so guidelines focus on cutting added sugar, fructose, refined starches and alcohol, and on losing weight. In a meta-analysis of 11 trials, low-carb diets lowered triglycerides more than low-fat diets did, with a small rise in LDL cholesterol that is worth monitoring.
Do I need to fast before a triglyceride test?
Not always. A 2016 European consensus found the largest fasting-versus-non-fasting difference in triglycerides was 26 mg/dL. It recommended non-fasting tests for most people, treating 175 mg/dL or more as abnormal. Fasting is preferred above 400 mg/dL or after pancreatitis. Always follow your doctor's and laboratory's instructions.
Does lowering triglycerides with medication protect the heart?
Not automatically. In the PROMINENT trial of about 10,500 people with diabetes, pemafibrate lowered triglycerides by 26% without reducing heart attacks or strokes, while LDL cholesterol rose. Current guidelines therefore focus on LDL and non-HDL cholesterol, although certain prescription drugs can help specific groups, as decided by a doctor.
When do high triglycerides become dangerous?
At 500 mg/dL or more, the risk of acute pancreatitis rises, and above 880 mg/dL the European consensus recommends referral to a specialist. Sudden severe upper-abdominal pain spreading to the back, with vomiting, needs emergency care right away, especially if you know your triglycerides are high.
✅ The bottom line
Triglycerides are a number that talks about your metabolism: sugar, refined starch, alcohol, surplus calories, sleep and movement. Lowering the number with a drug alone did not protect the heart in a large trial, while dealing with its source brings it down sharply and improves your whole health picture. Know your number, discuss it with your doctor, and start with what goes on your plate every day. If you need bread and sweets that fit that change, Bakery 8 in Riyadh, Saudi Arabia bakes them with almond flour and no sugar: healthy and delicious.
📚 References
- National Heart, Lung, and Blood Institute (NHLBI). High Blood Triglycerides. nhlbi.nih.gov.
- Cleveland Clinic. Hypertriglyceridemia: Causes, Risk Factors and Treatment. my.clevelandclinic.org.
- Miller M, et al. Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2011 (summaries: ACC Journal Scan; ScienceDaily, 18 April 2011).
- Nordestgaard BG, Langsted A, Mora S, et al. Fasting Is Not Routinely Required for Determination of a Lipid Profile (EAS/EFLM consensus). Eur Heart J. 2016 (ACC "Ten Points to Remember").
- Virani SS, Morris PB, Agarwala A, et al. 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia. J Am Coll Cardiol. 2021.
- PROMINENT investigators (Das Pradhan A, et al.). Pemafibrate to reduce cardiovascular outcomes. N Engl J Med. 2022 (ACC summary, Nov 2022).
- Mansoor N, Vinknes KJ, Veierød MB, Retterstøl K. Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. Br J Nutr. 2016;115(3):466–479.
- Enani S, et al. The Association between Dyslipidemia, Dietary Habits and Other Lifestyle Indicators among Non-Diabetic Attendees of Primary Health Care Centers in Jeddah, Saudi Arabia. Nutrients. 2020;12(8):2441.
- Harvard Health Publishing. Understanding triglycerides. health.harvard.edu (updated July 2023).
- 2026 ACC/AHA/multisociety Guideline on the Management of Dyslipidemia. J Am Coll Cardiol. 2026 (hypertriglyceridemia section as summarised by Labcorp, a laboratory company, cited for the guideline's direction only).
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