What dietary changes can help reduce triglycerides?

Dietary Strategies to Reduce Triglycerides

The most effective dietary interventions for lowering triglycerides are weight loss (5-10% body weight reduction), eliminating added sugars and alcohol, restricting saturated fats while emphasizing omega-3 fatty acids from fatty fish, and replacing refined carbohydrates with fiber-rich whole grains—collectively these can reduce triglycerides by 20-50%. 1

Weight Loss: The Single Most Powerful Intervention

• A 5-10% reduction in body weight produces a 20% decrease in triglycerides, making weight loss the most effective lifestyle intervention 2
• In some patients, weight loss alone can reduce triglyceride levels by up to 50-70% 2, 3
• For every kilogram of weight lost, triglyceride levels decrease by approximately 1.5-1.9 mg/dL 1
• Visceral adiposity (belly fat) is particularly important to target, as it directly contributes to elevated triglycerides through reduced fatty acid oxidation 1

Sugar and Carbohydrate Management

Restrict added sugars to less than 6% of total daily calories (approximately 100 calories/day for women, 150 calories/day for men), as sugar intake directly increases hepatic triglyceride production 1, 2

• Eliminate all sugar-sweetened beverages completely 1
• Simple sugars (monosaccharides and disaccharides) increase triglycerides more than complex carbohydrates 1
• Higher versus lower dietary sugar intake increases triglycerides by approximately 10 mg/dL, independent of body weight effects 1
• Replace refined grains (white bread, white rice, pasta) with fiber-rich whole grains (brown rice, whole grain cereals and bread) to maintain adequate fiber intake while reducing carbohydrate-induced triglyceride elevation 1

Carbohydrate Dose-Response Effect

• Very-low-carbohydrate diets (3-30% of energy) decrease triglycerides by 24 mg/dL 1
• Low-carbohydrate diets (30-40% of energy) decrease triglycerides by 16 mg/dL 1
• Moderately-low-carbohydrate diets (40-45% of energy) decrease triglycerides by 9 mg/dL 1
• Low-carbohydrate diets are more effective at lowering triglycerides than low-fat diets 2

Alcohol: Complete Elimination for Severe Cases

• Alcohol consumption of just 1 ounce per day increases triglycerides by 5-10% compared to non-drinkers 2
• Alcohol impairs chylomicron hydrolysis and increases triglyceride-rich VLDL production 2
• The effects of alcohol are synergistically exaggerated when coupled with meals high in saturated fat 2
• For severe hypertriglyceridemia (≥500 mg/dL), complete abstinence from alcohol is mandatory to prevent hypertriglyceridemic pancreatitis 1, 2
• For moderate hypertriglyceridemia (<500 mg/dL), restrict alcohol but do not exceed 2 drinks/day for men or 1 drink/day for women 1

Fat Quality and Quantity: Strategic Replacement

Total Fat Intake by Triglyceride Level

• For mild-moderate hypertriglyceridemia (<500 mg/dL): limit total fat to 30-35% of total daily calories 1, 2
• For severe hypertriglyceridemia (500-999 mg/dL): restrict fat to 20-25% of total calories 1, 2
• For very severe hypertriglyceridemia (≥1,000 mg/dL): implement very low-fat diet (10-15% of calories) 1, 2
• In extreme cases, consider fat restriction to <5% of total calories until triglycerides fall below 1,000 mg/dL 2

Type of Fat Matters More Than Total Amount

Eliminate trans fatty acids completely, as they increase triglycerides and atherogenic lipoproteins; each 1% replacement of trans fats with monounsaturated or polyunsaturated fat lowers triglycerides by 1% 1

Restrict saturated fats to <7% of total energy intake 1, 2:

• For every 1% of energy from saturated fat replaced by polyunsaturated fat (PUFA), triglycerides decrease by 0.4 mg/dL 1
• When saturated fat is replaced by monounsaturated fat (MUFA), triglycerides decrease by 0.2 mg/dL 1
• Replacing saturated fat with refined carbohydrates increases triglycerides by 1.9 mg/dL per 1% energy substitution 2

Omega-3 Fatty Acids from Fish: The Triglyceride-Lowering Powerhouse

Consume at least 2 servings (8+ ounces) per week of fatty fish rich in EPA and DHA 1, 2

Best Fish Sources (per 3.5-oz serving) 1:

• Highest omega-3 content (1.8-2.1g): Anchovy (canned), Atlantic herring (kippered), Atlantic salmon (farmed or wild), sardines in tomato sauce
• High omega-3 content (1.0-1.4g): Salmon (coho, sockeye, pink/red canned), rainbow trout (farmed), sardines in oil
• Moderate omega-3 content (0.5-0.9g): White tuna (canned in water), halibut, crabs, lobster, shrimp

Mechanism and Efficacy

• Marine-derived omega-3 fatty acids (EPA and DHA) reduce triglycerides by 20-50% at doses of 2-4g/day 1
• Omega-3s decrease VLDL triglyceride secretion by preferentially shunting into phospholipid synthesis and enhancing peroxisomal β-oxidation 1
• Effects are seen within 2-3 days of starting high-dose omega-3 intake 3
• Omega-3 fatty acids prevent carbohydrate-induced hypertriglyceridemia, reducing triglycerides from 194 to 75 mg/dL even on high-carbohydrate diets 3

Critical Distinction: Marine vs. Plant-Based Omega-3s

Plant-based omega-3s (α-linolenic acid from flaxseed, walnuts, canola oil) have NOT demonstrated consistent triglyceride reduction due to very low conversion rates to the active compounds EPA and DHA 1

• If omega-3 PUFAs are used for triglyceride lowering, they should be exclusively marine-derived EPA and/or DHA 1

Fiber: The Carbohydrate Modifier

Increase soluble fiber to >10g/day (ideally 25-30g/day total fiber) 1, 2

• Dietary fiber attenuates the triglyceride-raising effect of dietary carbohydrates 1
• Emphasize vegetables (2.5 cups/day), legumes (beans, lentils, chickpeas), and fiber-rich whole grains 1
• For severe hypertriglyceridemia, limit fruits to 3-4 servings/day and avoid high glycemic index fruits (pineapples, mangoes, watermelon, ripe bananas) 1

Protein: The Underappreciated Macronutrient

Replacing 10% of calories from carbohydrates with protein lowers triglycerides by 16 mg/dL 1

• Emphasize plant-based proteins (legumes, tofu) instead of red meat 1
• Choose lean fish, poultry, and very lean meats 1
• Higher-protein diets (17-25% of energy) produce greater triglyceride reduction than standard protein intake 1

Mediterranean-Style Dietary Pattern

Implementing a Mediterranean-style diet can reduce triglycerides by 20-50% when combined with other interventions 1

This pattern emphasizes:

• Abundant vegetables, fruits, whole grains, and legumes 4
• Olive oil as the primary fat source (rich in monounsaturated fats) 1
• Regular fish consumption (especially fatty fish) 4
• Low-fat dairy products 1
• Minimal red meat and processed foods 4

Practical Implementation Algorithm by Triglyceride Level

For Triglycerides <500 mg/dL 1:

• Target 5-10% weight loss if overweight
• Restrict added sugars to <6% of calories
• Limit total fat to 30-35% of calories
• Restrict alcohol (≤2 drinks/day men, ≤1 drink/day women)
• Consume 2+ servings/week fatty fish
• Emphasize fiber-rich whole grains (6 servings/day)

For Triglycerides 500-999 mg/dL 1:

• All of the above, plus:
• Restrict added sugars to <5% of calories
• Limit total fat to 20-25% of calories
• Abstain completely from alcohol
• Limit fruits to 3-4 servings/day (avoid high glycemic index)
• Emphasize lean fish over fatty fish when fat must be restricted

For Triglycerides ≥1,000 mg/dL 1, 2:

• Eliminate all added sugars completely
• Restrict total fat to 10-15% of calories (or <5% until below 1,000 mg/dL)
• Complete alcohol abstinence
• Very limited fruit intake
• Emphasize lean protein sources
• This requires medical supervision and likely pharmacotherapy

Common Pitfalls to Avoid

• Don't replace saturated fat with refined carbohydrates, as this increases triglycerides by approximately 1.9 mg/dL per 1% energy substitution 2
• Don't rely on plant-based omega-3s (flaxseed, walnuts) for triglyceride lowering—they lack consistent efficacy 1
• Don't use over-the-counter fish oil supplements interchangeably with prescription omega-3s for severe hypertriglyceridemia—prescription formulations ensure consistent quality and dosing 2, 5
• Don't ignore secondary causes: uncontrolled diabetes, hypothyroidism, and certain medications can drive triglycerides higher than dietary factors alone 2
• Don't attempt dietary management alone for triglycerides ≥500 mg/dL—pharmacologic therapy is mandatory to prevent acute pancreatitis 2