The Silent Causes of High Triglycerides No One Told You

So, you've just got your blood test back

and you've been told that your

triglyceride level is high. And the very

first thought a lot of people have is,

"Right, well, I need to cut back on the

amount of fat I'm eating. You know,

triglycerides are fat in the blood, so

the fat that I eat must be causing it."

Well, that's not really the case. The

biology here is a lot more interesting

than that. And if you go straight to

cutting fat, you might miss the actual

cause entirely. So, here's what we're

going to cover in this video today. The

first thing we're going to cover is what

triglycerides actually are. Then I'm

going to talk about this big myth around

fat, this big lie we've all been told

for years and years. Then we're going to

go through five specific drivers, five

reasons your triglycerides might be

high. And some of these will actually

surprise you.

After that, we're going to talk about

what this actually means for your

long-term health and how much risk we're

actually talking about. And then we're

going to talk about what you can

actually do about it, what moves the

needle, and then these specific habits

that really introduce to your daily

life. So, what are triglycerides? Well,

triglycerides are basically just fat

floating around in your blood. That's

it. Your body uses them as fuel 24/7.

They're basically just stored energy

that gets released when you actually

need it. It's completely necessary and,

you know, a completely normal part of

physiology. Now, the problem isn't

having them. The problem is having too

many of them sitting in your blood

persistently over time. Because that

tells you something is going wrong with

how your body is managing energy. Now,

think of it like a delivery system. Your

body is constantly moving energy around

your body. And triglycerides are the

packets that energy travels in. Now,

when everything's working properly,

those packets get picked up and used.

When things go wrong, they start to pile

up in the blood and start causing damage

to the walls of your blood vessels very

quietly over years and decades.

And the reason this matters is that your

blood is flowing through every single

organ in your body, including your

heart, your brain, your kidneys, your

liver.

So, when something is persistently wrong

with what's in it, the effects

eventually show up literally everywhere.

And here's where that big myth around

fat starts to fall apart. So, people

assume I ate fat, there's fat in my

blood, so those two things must be

connected. And yes, right after a meal,

right after you eat something, fat from

that food does briefly circulate in the

blood. That is completely normal.

But fasting triglycerides, the one on

your blood test, those mainly reflect

what your liver is producing. And your

liver makes triglycerides primarily out

of excess sugar and carbohydrates, not

dietary fats. It takes the sugar that

you eat, it converts it into fat, and

then it releases it into the

bloodstream. So, the olive oil that you

had with your dinner last night probably

isn't the problem.

The issue, and this is really important,

the issue for most people is the liver

working overtime on too much sugar and

too many refined carbohydrates. So,

let's go through these five main drivers

then. These are the five reasons your

triglycerides might be high. And

understanding which ones apply to you

really is the key to actually fixing it.

So, the biggest driver for most people

is sugar, particularly added sugar and

refined carbohydrates, things like

sugary drinks or sweets or any sort of

dessert or white bread or pastries,

white pasta. You know, these eaten

regularly in large quantities can

actually cause a high triglyceride

level. The thing is, the type of sugar

found in fruit juice and fizzy drinks

and table sugar is particularly

efficient at being converted into fat by

the liver. So, a large glass of orange

juice or a kind of Coke or Sprite, you

know, isn't just sugar that you're

burning off. A significant proportion of

it actually gets turned into fat in the

blood.

And there is solid research showing that

cutting sugar, cutting carbohydrates,

lowers your triglycerides by quite a

large amount. And liquid sugar in

particular seems to have a

disproportionately large effect. Now,

the second driver is something called

insulin resistance. Now, if you've

watched any of my videos, you will know

that I talk about this pretty much all

the time. So, insulin is a hormone that

your body releases when you eat. Its job

is to manage your blood sugar and tell

your fat cells to hold onto their fat

rather than releasing it.

Now, when insulin stops working

properly, which happens gradually with

weight gain or inactivity or poor diet,

your fat cells start leaking fat into

the bloodstream constantly. The liver

then gets overwhelmed, it produces more

fat in the blood, and the whole system

really struggles to clear it.

Now, this is why people who carry a lot

of weight around their middle so often

have raised triglycerides. Now, driver

number three is alcohol and inactivity,

actually two points here. So, alcohol is

one that people consistently

underestimate. What it does is it pushes

the liver towards making more fat and

then releasing more of it into the

blood. And in some people, this effect

is actually quite dramatic, even at what

most people would consider sort of mild

to moderate drinking.

And then we've got inactivity. So, your

muscles, when they're working, actively

help to clear fat from the blood.

When you're sedentary, which to be

honest most people seem to be these

days, you know, we commute to work, we

have desk jobs, we have automated

delivery systems, all all sort of stuff.

When you're sedentary, that clearance

slows right down. And then sitting

underneath all of this is excess weight

around your middle, visceral fat, which

surrounds your organs, which drives the

whole cycle forward. Now, driver number

four is all about your thyroid gland and

medication. So, there are some medical

causes that we need to be aware of here.

One of them is an underactive thyroid.

So, your thyroid is a small gland in

your neck that just literally controls

your metabolism, you know, how fast your

body burns energy, how hot or cold you

feel, things like that. Now, when your

thyroid gland isn't producing enough

hormone, your body literally struggles

to clear fat from the blood properly. It

is a very common and frequently missed

cause of raised triglycerides, and it's

a really simple blood test to rule this

out.

Another one here is medication. So, some

very commonly prescribed drugs can raise

your triglycerides as a side effect. And

this is something that doesn't get told

to patients anywhere near enough, in my

opinion, at least, anyway.

So, we've got beta blockers, which are

used for things like blood pressure and

heart conditions. So, these are drugs

like atenolol and metoprolol and

bisoprolol and propranolol. These can

raise your triglycerides, not commonly,

but it is a side effect.

The other class is thiazide diuretics,

another type of blood pressure

medication, things like

bendroflumethiazide in the UK and

hydrochlorothiazide in the US. And then

we've got a class of drugs called

steroids, so things like prednisolone

that we use for inflammation and

autoimmune conditions. We've also got

some antipsychotic medications and also

something called isotretinoin, used for

severe acne. Now, if you're on any of

these medications and your triglycerides

are high and your doctor hasn't really

connected the dots yet,

then this is really a conversation worth

having as soon as possible. And then

finally, we've got genetics as our fifth

driver, and this is one that I want to

talk about from experience actually. You

know, this is really easy to read about

in a textbook or in a research article,

but it's quite hard to fully understand

and visualize until you actually see it.

Now, I remember the first time I took

blood from a patient with a condition

called familial hypertriglyceridemia,

which is basically an inherited

condition where the body can't clear fat

from the blood properly. Now, when I

drew his blood into the vacutainer into

the tube, you expect to see dark red

blood from the vein that you always see,

but instead, the blood actually looked

like butter, like somebody had mixed

butter into the blood.

It was pale. It was really thick. It was

the most unusual thing I'd ever seen in

a blood bottle. And this is because his

triglycerides were so high that the fat

was literally visible in the sample. And

that image has stayed with me ever

since. And most people with genetic

tendencies towards high triglycerides

won't be anywhere near that extreme.

That was a really extreme case, but some

people, you know, are just simply born

with a tendency to run higher levels

regardless of what they eat or how much

they exercise.

Lifestyle changes, which is really what

this video is about, you know, these

help, but they won't fully solve the

problem on their own. Now, if you're

eating a lot better and you're

exercising more and your lifestyle has

massively improved and your levels are

still high, then that's worth raising

with your doctor rather than just

blaming yourself because there is a

chance that you could have one of these

genetic conditions. Okay, so we've

talked about what drives your

triglycerides up. What I want to do now

is talk about why you should even care.

Why does any of this even matter? But

first, what I want you to do is try and

think about your great-grandparents or

great-great-grandparents, you know, four

or five or six generations ago.

What their day would have looked like.

Well, for most people back then, they

would have been getting up early and

moving constantly throughout the day.

There would have been no sitting at a

desk for 8 hours, no driving to work or

driving to the shops, no escalators or

lifts or any of that sort of stuff.

Physical work was just part of life.

They had to do it to survive. And what

they were eating was just whatever was

grown locally. You know, whatever was

available, like veg and meat and eggs

and fish. There was no supermarket full

of ultra-processed foods or, you know,

free juices or fizzy drinks or anything

like that. None of that existed back

then. All there was was whole foods.

Refined sugar was expensive and

incredibly rare. And if we could go back

and measure their triglycerides, which

obviously we can't, they almost

certainly would have been low. Not

because of genetics, not because they

were trying to keep them low, just

because the conditions that drive

triglycerides up simply weren't around

at that time. The food wasn't there. The

inactivity wasn't there. The excess that

we have these days wasn't there. And now

fast forward to today and almost

everything has flipped. We sit for most

of the day. We move very little and

sugar is basically in everything now.

And triglycerides have followed that

trend. So, when I say high triglycerides

are a modern lifestyle problem, I mean

that very literally. This is a condition

that would have been genuinely rare for

most of human history. That is the same

for things like insulin resistance and

high blood pressure and other chronic

conditions that just weren't around 100

years ago. Now, high triglycerides on

their own are not going to kill you

tomorrow. For most people, you've got a

lot of time to fix this. What they do is

actually quietly increase your risk of

serious conditions over years and

decades. And that's actually what makes

them worth paying attention to now while

you can do something about it.

The clearest risk, obviously, is

cardiovascular disease, heart attacks

and strokes, things like that. A big

study published in The Lancet looking at

over 300,000 people found that people

with high triglycerides have a

significantly increased risk of heart

attack. And importantly, that

relationship held up even after

accounting for other risk factors. So,

it's not just that people with high

triglycerides tend to have other

problems. The triglycerides themselves

appear to be part of the story. Elevated

triglycerides are also very closely

linked to something called metabolic

syndrome, which is a cluster of

conditions I talk about quite often,

including high blood sugar, high blood

pressure, excess weight around the

middle, and an abnormal cholesterol as

well. Having metabolic syndrome roughly

doubles your risk of heart attack and

increases your risk of type 2 diabetes

by about five times. Five times the

risk. And triglycerides are one of the

five markers used to diagnose it. And

then we've got a condition called

pancreatitis, inflammation of the

pancreas just here, which at very high

triglyceride levels becomes a real risk.

It can be life-threatening. It is very,

very serious and incredibly painful. We

see it quite often in the emergency

department. And it's actually the

condition that my patient had, the one

that I talked about earlier, whose blood

literally looked like lard or butter.

And here's what I find really motivating

about all of this, everything we've

talked about so far.

A study published in JAMA Cardiology

showed that simply addressing the

lifestyle factors that drive

triglycerides up, so your diet, your

activity, your weight,

this produces really meaningful

reductions in your cardiovascular risk.

Unless you've got a genetic condition,

which your doctor can diagnose with a

simple blood test, you don't need a drug

or an expensive supplement. Just a few

consistent habits, done over months and

years, really does reduce your risk of

disease and death. And that's what I

want to focus on for the rest of this

video. So, the first question that

people have is, does the fat that you

eat actually matter?

The honest answer is sometimes, but

probably less than you actually think.

And it really depends on what kind of

fat you're eating. If you're eating a

lot of heavily processed fried food, and

if you're eating in a really big calorie

surplus, then yes, it becomes relevant

at that point. But natural fats, like

olive oil or nuts or avocado or oily

fish, these actually tend to improve

your triglycerides when they replace the

sugar and refined carbs that a lot of

people eat.

The research on the Mediterranean diet

is pretty consistent on this. Swapping

sugary snacks and white bread for things

that include olive oil and nuts and

seeds and fish that we just talked

about, moves things in the right

direction. The problem with this old

low-fat advice, which a lot of people

still follow, is that when you take fat

out of food, it usually gets replaced

with sugar and refined carbs to make it

taste good.

And for triglycerides specifically, that

swap makes things a lot worse, not

better. Cutting out liquid sugar is

probably the best thing that most people

can do. Things like fizzy drinks or

fruit juice or really sugary smoothies

or sweet coffees, things with lots of

syrups and cream, that sort of thing.

What happens is that these deliver a

large amount of sugar to the liver very

quickly and removing these can make a

really noticeable difference within

weeks. Losing weight around your middle

as well, if you have excess weight to

lose, can be a really powerful driver

here. This is mentioned in the research

all the time. Another really powerful

thing, obviously, is exercise,

particularly regular low aerobic

exercise like walking after meals or a

gentle cycle or walking up and down the

stairs a few times a day.

What this does is it helps your muscles

to clear fat from the blood more

efficiently and improves how well your

body manages your blood sugar. This is

one of the most direct things you can

do. Another thing is building your meals

around protein and vegetables and fiber

rather than refined carbs because what

this does is reduces how much sugar hits

your liver across the entire day. As we

know, because we've talked about it lots

in this video, sugar is really important

for your triglyceride level. If you

drink alcohol, then cutting back even

just moderately is absolutely worth it

because the effect on your triglycerides

is often larger than most people expect.

Another one is oily fish, so things like

salmon or sardines or mackerel. Try and

get at least two portions a week in if

you can.

The omega-3 fats in these sorts of foods

have really, really good evidence behind

them for lowering your triglycerides and

your cholesterol.

And for people with really high levels,

probably because of a genetic condition,

there are medications that are

absolutely worth it, but this is a

conversation you have to have with your

GP. If you've got your blood test

results back, it's so important that you

get a doctor to go through them with you

and explain each one of them. The key

point here is don't look at your

triglyceride level in isolation. It

tells you much more when you look at it

alongside your good cholesterol, your

HDL, your waist measurement, your blood

sugar level, your liver function as

well. The ratio of your triglycerides to

your HDL level in particular is really

worth discussing with your GP. It's a

really useful marker for how well your

body is managing blood sugar and insulin

overall. So, the takeaway for this video

is this. If your triglycerides are high,

then asking how much fat am I eating is

probably the wrong first question.

Better questions are, how much sugar am

I eating? How much refined carbs am I

eating? How much am I exercising? Am I

carrying excess weight around my middle?

How much alcohol am I drinking? Has my

thyroid been checked? And am I on any

medication that could be causing any of

this? And these are conversations to

have with your doctor. Because for most

people, high triglycerides are not a fat

problem. They are a modern lifestyle

problem. And there are loads and loads

of videos across this channel that will

absolutely help you with that.