Triglycerides are a type of lipid in your bloodstream. Like high cholesterol, which often occurs alongside elevated triglyceride levels, hypertriglyceridemia can play a role in increasing your risk for atherosclerosis, which puts you at risk for heart attack or stroke. And extremely high levels of triglycerides can put you at risk for pancreatitis, an inflammation of the pancreas, according to the American College of Cardiology. While the food you eat can have a major impact on your triglyceride levels, lesser-known factors, such as how much you sleep, how much alcohol you drink, and even your stress level, can also affect it. There’s not enough evidence to call these direct causes of high triglycerides, says Andrew Freeman, MD, a cardiologist at National Jewish Health in Denver, but they are contributing players. “When you have high triglycerides, there tend to be other lifestyle factors going on,” says Dr. Freeman. “Poor diet and exercise, stress, and not sleeping well all take a toll on cardiovascular health, but they are seldom recognized.” The good news is that no matter the cause, doctors can work with you to normalize your levels, says Douglas Jacoby, MD, a cardiologist with Penn Medicine in Philadelphia. Here are 6 surprising reasons your triglycerides may be high — and what you can do about it.
1. Genes
As with cholesterol, abnormally high triglycerides can be inherited — a condition called familial hypertriglyceridemia. Many people have elevated triglycerides and no family history of the condition, meaning it’s caused by other factors, such as diet or lifestyle habits, but there are some for whom high triglycerides are likely caused by a combination of genetic defects and environmental factors, according to the U.S. National Library of Medicine. Looking at your triglyceride numbers will provide strong clues if the condition is caused by genetics, says Dr. Jacoby. “Sometimes there is a mutation in one or more genes that affects certain pathways that ultimately drive triglycerides very high,” he explains. According to Kaiser Permanente, triglyceride levels above 200 in adults or 100 in children are a possible sign of familial hypertriglyceridemia. And the numbers can go as high as 4,000 mg/dL, says Jacoby, which can increase the risk for pancreatitis, or inflammation of the pancreas. Individuals with familial hypertriglyceridemia are typically treated with lifestyle interventions, such as a diet (preferably one planned with the guidance of a certified dietitian) and other measures, and, if necessary, medications, such as prescription omega-3 fatty acids. “I recommend these patients stick to an extremely low-fat diet,” says Jacoby.
2. Medication
Certain immunosuppressants as well as some antiviral, cardiovascular, antipsychotic, and hormone medications can drive up triglyceride levels anywhere from 5 to 200 percent, , according to Endotext. “We look through a patient’s medications for those that may be possibly contributing to their elevated levels,” says Jacoby. Although it’s unclear if this drug-induced increase poses harm long term, your doctor may consider changing your medication or, if that’s not possible, monitoring your lipid levels during treatment.
3. Simple Carbohydrates and Sugar
A poor diet is by far the most common cause of high triglyceride levels, says Freeman. “I consider high triglycerides as a marker that someone may not be eating as well as they should,” he says. Excess calories and sugar are turned into triglycerides before being stored as fat, notes Cleveland Clinic. A study published in May 2019 in the journal The BMJ found that consuming more than four servings of ultraprocessed foods per day increased the risk of mortality from all causes by 62 percent. “These foods, which includes refined grains and added sugar, will also raise triglycerides,” he says. Freeman advises his patients on how to transition to a low-fat, whole-foods, plant-based diet.
4. Alcohol
According to Mayo Clinic, alcohol adds extra calories, carbohydrates, and sugar to your diet, which can have a particularly negative effect on triglycerides. And it can increase low-density lipoprotein (LDL, or “bad”) cholesterol and impair the breakdown of fats, according to a review published in August 2013 in the journal Current Opinion in Lipidology. “We ask patients to cut down on alcohol intake, and if levels are very high, we will recommend no alcohol for a while,” Jacoby says.
5. Sleep
Freeman recommends that patients sleep at least 7 hours per night, which is in line with the advice from the Centers for Disease Control and Prevention. There are a number of metabolic and cardiovascular consequences of clocking less. Consistent lack of sleep is associated with not only high blood pressure, but also type 2 diabetes and obesity— two conditions that have been linked to high triglycerides. Sleep disorders, including obstructive sleep apnea — marked by disruptive, brief pauses in breathing throughout the night — have also been associated with unfavorable lipid levels, such as elevated triglycerides and LDL cholesterol; this may be the reason sleep apnea also increases the risk for cardiovascular disease, according to a study published in August 2018 in the journal Respirology. Interestingly, sleeping more than 10 hours per night has also been found to contribute to metabolic syndrome, including elevated triglycerides for both men and women, according to a study published in June 2018 in the journal BMC Public Health. Sleeping too long may be a marker of poor sleep quality and is linked to fatigue and less physical activity, impacting blood lipid levels.
6. Stress
The American Heart Association is careful to point out that it’s still not clear if stress is a cause of heart disease, but it is apparent that stress drives us to do not-so-healthy things, such as consuming alcohol and eating sugar- and carbohydrate-rich foods that, in turn, increase triglyceride levels. And, according to Endotext, chronic stress also contributes to inflammation, which works on triglycerides in a couple of ways: one, by stymieing the body’s ability to clear these fats from the blood and two, by increasing the liver’s production of very low-density lipoprotein (VLDL) particles, which carry triglycerides to your tissues via the bloodstream. (Like LDL, VLDL is considered a “bad” cholesterol because it can contribute to the buildup of plaque in your arteries and increase your risk of cardiovascular disease, according to the U.S. National Library of Medicine.) For stress relief, Freeman recommends practicing mindful stress reduction, such as meditation or yoga, 30 minutes per day, connecting with your social support network, and engaging in 30 minutes of physical activity — that ideally gets you out of breath — every day.
