How to lower triglycerides

The table compiles effect sizes from guidelines, meta-analyses and trials in one place. Percent figures and absolute changes come from different study designs, so compare within a column rather than across.

Two cautions. Effects are usually larger when triglycerides start high: icosapent ethyl lowered triglycerides by 33% when they started at 500 mg/dL or more but by 22% at 200 to 499 mg/dL [1]. And changes add up: weight loss, less sugar and alcohol and more exercise together do more than any one alone [1].

In a meta-analysis of 42 experimental studies, 30 g of alcohol a day raised triglycerides by 5.69 mg/dL on average [5]. That is the average across mostly healthy volunteers. The National Lipid Association recommends restricting alcohol for everyone with raised triglycerides [6], and the 2026 US guideline lists alcohol excess among the first causes to correct [7]. With very high triglycerides, people are advised to avoid alcohol altogether [7].

If alcohol is part of your week, comparing a test after an alcohol-free stretch with your usual result shows how much it contributes for you.

The European consensus diet goals for high triglycerides are to avoid highly refined carbohydrate foods, eat seafood, especially fatty fish, eat more fiber-rich fruit, vegetables and whole grains, avoid excess alcohol and swap animal fat for mono- and polyunsaturated fats from plant oils and nuts [8]. The National Lipid Association adds limits on added sugars and refined starches [6].

Foods to limit: sugar-sweetened drinks, sweets and desserts, white bread and other refined starches, and alcohol. Higher sugar intakes raised triglycerides by about 10 mg/dL (0.11 mmol/L)0.11 mmol/L (10 mg/dL) in trials [9].

Foods to favor: fatty fish such as salmon, sardines and mackerel; vegetables, legumes and whole grains; olive oil, nuts and seeds.

Low-carbohydrate eating lowered triglycerides by 23 mg/dL (0.26 mmol/L)0.26 mmol/L (23 mg/dL) more than low-fat diets over 6 months or more, but raised LDL cholesterol by 6 mg/dL (0.16 mmol/L)0.16 mmol/L (6 mg/dL) more [10]. Watch ApoB and LDL if you choose it.

At 1,000 mg/dL or more the rules flip: a very low-fat diet is needed to cut chylomicron production [7]. NLA guidance limits fat to 10 to 15% of calories when triglycerides are very high [1].

AumniVIDA protocols that score these patterns: the Mediterranean pattern, glucose stability, keto and low-carb and time-restricted eating.

A 20% drop in triglycerides comes with a 5 to 10% loss of body weight, according to the guideline summaries [1]. For someone at 250 mg/dL (2.8 mmol/L)2.8 mmol/L (250 mg/dL), that is roughly 50 mg/dL.

In sedentary adults with three or more metabolic syndrome features, aerobic training lowered triglycerides by about 15 to 16 mg/dL (0.17 to 0.18 mmol/L)0.17 to 0.18 mmol/L (about 15 to 16 mg/dL), and training intensity explained part of the variation [2]. When trials compared diet, exercise and both, exercise alone lowered triglycerides but not LDL cholesterol, while diet plus exercise did best [11].

The National Lipid Association recommends daily physical activity for everyone with raised triglycerides [6]. The Zone 2 base building protocol is one way to build regular aerobic volume.

The American Heart Association concludes that prescription omega-3, EPA plus DHA or EPA only, at 4 g a day lowers very high triglycerides by 30% or more and is safe alone or with a statin [3]. Icosapent ethyl, a pure EPA drug, lowered triglycerides by 33% compared with placebo at 500 to 2,000 mg/dL and by 22% at 200 to 499 mg/dL [1]. EPA plus DHA products can raise LDL cholesterol when triglycerides are very high, while EPA-only did not [3].

Supplements are a different product. One analysis found that over-the-counter fish oils contained on average 68% of the EPA and DHA on the label [1].

For heart outcomes, the trials disagree: icosapent ethyl reduced events in REDUCE-IT [12], while an EPA plus DHA drug did not in STRENGTH [13]. The 2026 US guideline review warns against extending REDUCE-IT to supplements [7].

• Statins: 15.1% to 31.3% lower triglycerides in people starting at 177 mg/dL (2.0 mmol/L)2.0 mmol/L (177 mg/dL) or more [14]. They also cut ApoB, which is what lowers heart risk [4].
• Fibrates: pemafibrate lowered triglycerides by 26.2% [15]. Across trials, fibrates reduced major cardiovascular events by 10% without lowering deaths [16]. Fenofibrate is preferred over gemfibrozil with a statin because gemfibrozil raises the risk of muscle problems [7].
• Prescription omega-3: see above.
• Ezetimibe: a small 5 to 10% effect [1].
• ApoC-III drugs: olezarsen lowered triglycerides by 58 to 61 percentage points more than placebo in moderate hypertriglyceridemia [17] and cut pancreatitis in severe disease [18].

These are prescription decisions that depend on heart risk, pancreatitis risk and other medicines; talk them through with your clinician.

Chylomicrons and VLDL circulate for 4 to 13 hours in people with raised triglycerides, compared with 2.5 to 3.5 days for LDL [8]. That short life lets triglycerides fall quickly when production falls.

What the studies measured:

• Prescription omega-3 trials reported effects at 6 to 16 weeks [1].
• Pemafibrate's 26% drop was measured at 4 months [15]; olezarsen's at 6 months [17].
• In a cohort of 41,210 adults with triglycerides of 500 mg/dL or more, 79% were below 500 mg/dL after about 90 days of follow-up [1].

A sensible plan is to make changes and retest after several weeks, under the same conditions as before. US guidance rechecks lipids 4 to 12 weeks after starting or changing a statin [19]. A very high nonfasting value after a very fatty meal is usually followed by lower ones [20], so a large drop between two tests can partly reflect what was eaten before the first.