High Triglycerides — What to Do
What your triglyceride number means, why it matters for heart attack and pancreatitis risk, and the lifestyle and medical changes that actually move the needle.
The Short Answer
Triglycerides should ideally be under 1.7 mmol/L (fasting). Anything higher signals that your body is storing more fat in your bloodstream than it can clear. The four heaviest hitters — alcohol, refined carbs, insulin resistance, and visceral fat — are responsible for the vast majority of cases. The good news: triglycerides respond faster to lifestyle changes than any other lipid. Most people halve their level in 6-12 weeks with the right plan.
What Are Triglycerides?
Triglycerides are the body's main form of stored fat. Every spare calorie you eat that isn't burned for energy gets packaged as a triglyceride and stored in fat cells. They are made up of three fatty acid chains attached to a glycerol backbone — hence “tri” + “glyceride”.
Your bloodstream carries triglycerides in two main vehicles: chylomicrons (after meals, transporting dietary fat) and VLDL (made by the liver, transporting fat between meals). When either of these systems is overwhelmed — too much fat in, not enough cleared out — triglycerides build up in your blood.
Less than 1.1 mmol/L
No increased cardiovascular risk. Common in healthy, lean adults.
1.1 - 1.7 mmol/L
Within reference range. Maintain current lifestyle.
1.7 - 2.2 mmol/L
Lifestyle changes recommended. Often a sign of early metabolic syndrome.
2.3 - 5.6 mmol/L
Significant cardiovascular risk. Treatment indicated.
5.6 - 11.2 mmol/L
High pancreatitis risk. Aggressive treatment needed.
Above 11.3 mmol/L
Acute pancreatitis risk. Hospital review required.
What Causes High Triglycerides?
Most cases are driven by lifestyle. Genetics play a small role for the average person — but a much bigger one for the rare patient with familial hypertriglyceridaemia.
Excess alcohol intake
The single biggest reversible driver. Even 1-2 daily drinks can keep triglycerides 30-40% elevated. Beer and sweet wines are worst.
Refined carbohydrates and sugar
White bread, sugary drinks, sweets, and fruit juice cause sharp insulin spikes. The liver converts excess sugar directly into triglycerides.
Insulin resistance / type 2 diabetes
Insulin resistance impairs the breakdown of triglyceride-carrying particles (VLDL). Often the underlying cause when triglycerides exceed 4 mmol/L.
Obesity, especially central fat
Visceral fat releases free fatty acids into the portal vein, driving liver triglyceride production. A 5-10% weight loss often halves triglycerides.
Hypothyroidism
Low thyroid slows clearance of triglyceride-rich particles. Always check TSH if triglycerides are unexpectedly high in a healthy-looking person.
Chronic kidney disease
Reduced kidney function impairs lipoprotein metabolism. Common in nephrotic syndrome, where triglycerides can rise dramatically.
Pregnancy
Triglycerides rise 2-4 fold in normal pregnancy. Pre-existing hypertriglyceridaemia can become dangerous and precipitate pancreatitis.
Medications (steroids, beta-blockers, oestrogen)
Prednisolone, atenolol, isotretinoin (Roaccutane), tamoxifen, and oestrogen-containing contraceptives all raise triglycerides.
Familial hypertriglyceridaemia
Inherited condition where triglycerides run 5-15 mmol/L despite a healthy diet. Strong family history of pancreatitis or early heart attack.
Symptoms — Mostly Silent Until They Aren't
Triglycerides under 5 mmol/L typically cause no symptoms at all. The damage is silent — building plaque in arteries, depositing fat in the liver, accelerating insulin resistance. Symptoms only appear at very high levels.
Under 5 mmol/L — Silent
No symptoms. Detected only on blood test. The risk is to the cardiovascular system over years and decades. Fatty liver disease (steatosis) often present and visible on ultrasound.
5 - 11 mmol/L — Visible Signs Begin
Yellowish bumps (eruptive xanthomas) may appear on the elbows, knees, buttocks, or back. Lipaemia retinalis — whitish/cream colour in the retinal blood vessels visible at an eye exam. Fatigue, brain fog, and a sense of feeling unwell. Liver tests (ALT, GGT) often elevated.
Above 11 mmol/L — Pancreatitis Danger Zone
Severe upper abdominal pain radiating to the back, nausea, vomiting, fever — classic acute pancreatitis presentation. Blood looks milky or creamy when drawn. Mortality from triglyceride-induced pancreatitis is 5-15%. Hospital admission required.
When to See a Doctor
Within a week
- Triglycerides above 5 mmol/L on your fasting blood test
- Yellow bumps on skin (xanthomas)
- Triglycerides above 2.5 mmol/L plus established heart disease or diabetes
- Family history of pancreatitis or early heart attack (under age 55)
Routine GP review
- Triglycerides 1.7-3.0 mmol/L — for lifestyle plan and 6-week recheck
- High triglycerides plus fatty liver on ultrasound
- High triglycerides plus low HDL or high blood pressure (metabolic syndrome)
- Pre-pregnancy planning if you have a history of high triglycerides
Diagnostic Next Steps
Step 1: Repeat lipids fasting
If your initial test was non-fasting, repeat it after a 12-hour fast (water only). A non-fasting triglyceride above 2.0 mmol/L should always be repeated fasting before making decisions.
Step 2: Check the cardiovascular package
Full lipid panel (LDL, HDL, total cholesterol, non-HDL), HbA1c, fasting glucose, urea and electrolytes, liver function tests, TSH. These tests are bulk-billed under MBS items 66536, 66552, 66507, and 66719 when ordered together by your GP.
Step 3: Look for fatty liver
If your ALT and GGT are also raised, ask for an upper abdominal ultrasound (MBS item 55036). Non-alcoholic fatty liver disease (NAFLD) and high triglycerides almost always travel together — both driven by insulin resistance.
Step 4: Cardiovascular risk calculator
Use the Australian CVD Risk Calculator (NVDPA, available free at cvdcheck.org.au). It combines your age, sex, blood pressure, lipids, smoking, and diabetes status to estimate your 5-year risk of heart attack or stroke. Triglycerides are part of the non-HDL cholesterol used by the calculator.
How to Lower Triglycerides — The Plan That Works
Triglycerides are the most lifestyle-responsive lipid. Get the basics right and you can often avoid medication entirely. Here is the order of impact, biggest first:
Cut alcohol completely for 4 weeks
Then keep it under 4 standard drinks per week. Beer, sweet wine, and cocktails are the worst offenders. Expected drop: 20-50%.
Eliminate sugar-sweetened drinks
Soft drink, fruit juice, sweetened iced tea, energy drinks, and sweetened coffees are pure liquid triglyceride fuel. Switch to water, sparkling water, or black tea/coffee. Expected drop: 15-30%.
Cut refined carbohydrates
White bread, pasta, rice, pastries, and breakfast cereals. Replace with wholegrain, slow-release carbs (oats, brown rice, quinoa, legumes). Expected drop: 15-25%.
Lose 5-10% body weight
A 10 kg loss in someone weighing 100 kg can halve triglycerides. The weight comes off when alcohol and refined carbs go. Expected drop: 20-40% from weight loss alone.
High-dose fish oil (2-4 g EPA + DHA per day)
Standard 1 g capsules contain 300 mg EPA + DHA — you need 6-10 capsules. Or use a high-strength formulation. Take with a meal. Expected drop: 15-30%.
150-300 minutes/week of moderate exercise
Brisk walking, cycling, swimming. Resistance training 2x/week amplifies the effect. Exercise improves insulin sensitivity and lipid clearance. Expected drop: 10-20%.
Mediterranean-style eating pattern
Olive oil, oily fish, nuts, vegetables, legumes, wholegrains, moderate dairy, limited red meat. Best-evidenced diet for lowering triglycerides and cardiovascular events. Expected drop: 15-25%.
Medication if needed
If lifestyle change is not enough, fenofibrate (Lipidil) lowers triglycerides 30-50%. Statins help if cholesterol is also raised. Prescription omega-3 (icosapent ethyl) for very high levels. Always discuss with your GP.
Common Triglyceride Myths
Myth: “Eating fat raises triglycerides the most”
Counterintuitively, dietary fat is not the main driver. Excess carbohydrate (especially refined sugar and alcohol) raises triglycerides much more than dietary fat. Healthy fats from olive oil, nuts, and oily fish are part of the solution, not the problem.
Myth: “I am thin, so my triglycerides should be fine”
TOFI (Thin Outside, Fat Inside) is real. People with normal BMI but high visceral fat can have triglycerides above 5 mmol/L. Asian populations are particularly prone to this pattern. Body shape matters more than total weight.
Myth: “Statins lower triglycerides as well as cholesterol”
Statins lower LDL cholesterol primarily, with only a 10-20% effect on triglycerides. For triglyceride-specific lowering, fenofibrate is the standard agent. Many patients with mixed dyslipidaemia end up on both.
Myth: “Triglycerides only matter for heart disease”
False. Above 11 mmol/L they cause acute pancreatitis — a potentially fatal inflammation of the pancreas. They also drive non-alcoholic fatty liver disease (NAFLD), which is now the leading cause of liver transplant in many Western countries.
Myth: “Olive oil is a low-fat health food”
Olive oil is a high-fat health food. One tablespoon is 120 calories of pure fat. The benefit comes from replacing saturated fat with monounsaturated fat — not from olive oil being calorie-free. Use it generously but mindfully.
Related Reading
Track Your Triglycerides Over Time
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This guide draws on the National Heart Foundation of Australia / Cardiac Society of Australia and New Zealand (NHF/CSANZ) lipid management position statement, Royal College of Pathologists of Australasia reference ranges, and Therapeutic Guidelines. SmarterBlood is educational only and does not replace personalised advice from your GP or specialist.