• Triglycerides are how your body packages surplus energy. A raised level says something about how you’re handling that surplus.
• The particles they travel in, are around four times more damaging to your arteries than LDL, particle for particle.
• In the UK, the aim is a fasting level below 1.7 mmol/L.
• The rise clusters around the menopause transition itself, rather than tracking gently with age.
• Carbohydrates and alcohol raise triglycerides more than dietary fat does.
• Oral HRT raises triglycerides. Patches and gels don’t, and may lower them.
• Omega-3 fats, soluble fibre, structured exercise and selected herbs all have evidence of benefit behind them.

Most women who get a cholesterol result look at two things. The total number, and whether the doctor seemed worried about it. There’s usually a third figure on that page that nobody mentions.

That figure is your triglycerides. It changes more than cholesterol does around menopause, and it responds faster to what you eat. Yet it gets a fraction of the attention.

This post explains what triglycerides are, why they matter more than you’ve been told, why they climb in your forties and fifties, and what actually brings them down.

So a triglyceride reading is a picture of how your body is handling surplus energy. It says less about the fat on your plate than most people assume.

Fat you eat does get packaged this way. But carbohydrate and alcohol have a larger effect on the number, which surprises almost everybody.

Triglycerides don’t block an artery on their own. What matters is the particle they travel in.

Your liver sends triglycerides out inside large particles. As those particles deliver their fat to your muscles and fat cells, they shrink. What’s left behind is called a remnant, and remnants are small enough to lodge in an artery wall.

The finding that changes the picture

Researchers used genetic data from UK Biobank to compare remnant particles with LDL, the so-called bad cholesterol. Remnants turned out to be around four times more damaging to arteries than LDL, particle for particle.

In a related analysis, each 1 mmol/L rise in remnant cholesterol carried nearly double the heart risk of the same rise in LDL.

So the number that nobody discusses is the marker for the particles doing the most harm. That’s worth knowing before anyone tells you your triglycerides are only mildly up.

In the UK, the aim is a fasting triglyceride level below 1.7 mmol/L.

Above 4.5 mmol/L, the standard heart risk calculators may underestimate your risk. Above 10 mmol/L, your GP would consider referral, because very high levels can inflame the pancreas.

You no longer need to fast for a routine lipid test, unless your triglycerides are already very high. So if you’ve been putting off a blood test because of the early start, that reason has gone.

Most women I see are nowhere near the top range. They’re somewhere between 1.7 and 3, which tends to get a shrug and no follow-up from the doctor. But, that middle ground is where your food has the ability to make a difference.

Levels rise across the menopausal transition, and not simply because you’re another year older.

In a UK sample of nearly 10,000 women, postmenopausal women had higher triglycerides than premenopausal women. That held true even after researchers accounted for age.

The timing is the interesting part. Researchers followed 298 women aged 48 to 55 across several years. The women who crossed into postmenopause during the study showed a rise across all their blood markers, triglycerides included. Those whose menopausal status didn’t change showed smaller changes.

So this clusters around the transition itself. As oestrogen falls, your body handles fat and glucose differently, and the number on the test result reflects that.

It isn’t a slow drift you can blame on your age. It’s a change with a cause, and causes can be worked with.

Oral oestrogen and transdermal oestrogen do different things to your triglycerides. They can even do opposite things, and it’s worth understanding why.

Why the route changes the result

A tablet is swallowed, absorbed from your gut, and passes through your liver before it reaches the rest of you. Your liver responds to that arriving oestrogen by making more triglycerides.

A patch or a gel goes through your skin and straight into your bloodstream. Your liver never sees that first surge, so it doesn’t respond in the same way.

What the trials show

Researchers pooled eight randomised trials in 885 postmenopausal women, comparing the two routes directly. Oral oestrogen raised triglycerides by about 0.22 mmol/L compared with transdermal. It also raised HDL, the protective cholesterol, which is a point in its favour.

An earlier randomised trial made the contrast sharper. Oral oestrogen raised triglycerides by around 21%. Transdermal oestradiol lowered them by around 9%. Same hormone, opposite directions.

HRT is prescribed medication, and I don’t advise on it. But the research suggests it can make a real difference to triglyceride levels, and for some women that’s worth knowing about.

You might also like my post:  How Gut Health Affects Insulin Resistance

An underactive thyroid

UK guidance lists an underactive thyroid among the causes to rule out when blood fats are high. It’s an easy test, and it’s the kind of thing that gets missed when everyone assumes the answer is diet.

Alcohol

This is the one most women underestimate.

Alcohol appears in that same guidance as a common cause of raised blood fats, alongside uncontrolled diabetes and liver disease.

A few glasses of wine across a week may seem harmless. But, it affects triglycerides more than most people realise.

Insulin resistance

When your cells respond less well to insulin, your liver makes more triglycerides. That’s part of why your levels often climb alongside weight around the middle, and why it goes together with blood sugar levels.

It also explains why the things that help your blood sugar tend to help your triglycerides too.

Swapping one sugar for another does very little. Researchers pooled 38 trials and looked at replacing sucrose or fructose with starch, calorie for calorie. Triglycerides didn’t change.

Cutting the total amount is what works. Across 10 trials, a lower fructose diet lowered triglycerides, along with waist measurement, blood pressure and blood sugar.

The effect was larger in people over 50. So the useful question isn’t which sugar. It’s how much, and the group that responded best are women in menopause.

Fructose is handled almost entirely by your liver, which is exactly where triglycerides are made. That’s the link, and it’s why sweet drinks matter more than their calories suggest.

Protein and fibre at every meal. Both slow the rise in blood sugar after eating. That means less surplus for your liver to package away.

Fewer sweet drinks. Fruit juice, squash and sweetened coffees deliver fructose quickly and without fibre. They’re the easiest place to make a change.

A clear look at alcohol. Not necessarily avoiding altogether. But fewer days drinking, using smaller glasses, and a run of alcohol-free nights each week.

None of this is exciting, and that’s rather the point. These are the simple changes that can make the difference.

You might also like to read my post:  How to Lower Cholesterol Naturally with Food as Medicine

Here the evidence needs reading carefully, because two things often get muddled up.

In that Finnish study, the women’s usual level of physical activity didn’t prevent the rise that came with the menopausal transition. Your ordinary walking, gardening and shopping won’t keep this number down on its own.

But deliberate training is a different matter. Researchers pooled 39 trials in over 2,000 postmenopausal women. Exercise training lowered triglycerides by around 0.4 mmol/L, alongside smaller waists, lower blood pressure and better blood sugar.

What worked best

Combining cardio with resistance work outperformed either on its own. Resistance training alone also lowered triglycerides, and lowered total and LDL cholesterol as well.

So the message isn’t move more. It’s train, with some purpose, twice or three times a week, and include something that makes your muscles work against resistance.

Omega-3 fat has the best nutritional evidence here, and there’s a pooled analysis in postmenopausal women specifically.

Across those trials, omega-3s lowered triglycerides by around 0.2 mmol/L. The fall was larger in women whose triglycerides were already above 1.7 mmol/L, and larger again at doses of a gram a day or more. So, it’s a modest change rather than a dramatic one.

In the same analysis, LDL cholesterol rose slightly, by about 0.1 mmol/L. Which is worth knowing about, and weighing up against the fall in triglycerides.

Oily fish twice a week is where I’d start. Sardines, mackerel, salmon and herring all count, and tinned is fine.

Not all soluble fibre does the same job. Researchers compared 16 different types across 46 trials. Galactomannans came out top for lowering both triglycerides and LDL. Beta-glucans and psyllium did more for insulin instead.

Galactomannan is the sticky fibre found in fenugreek and guar gum. Those trials were in people with type 2 diabetes, so the picture in women who aren’t diabetic is less clear. Still, the direction is useful to know about.

Oats, beans, lentils, apples and flaxseed all bring soluble fibre to the table. Fenugreek seeds can go into a curry, or be soaked overnight and added to a salad. Sesame seeds and tahini help here too, since pooled trials found sesame lowers triglycerides. I cover them in my post on sesame seeds for menopause.

You might also like my post: How to Lower Cholesterol Naturally 

Berberine, and what it actually is

Berberine isn’t a herb, it’s a single compound, extracted from medicinal plants like barberry and goldenseal, then concentrated and sold on its own. That makes berberine a nutraceutical rather than a herbal medicine. Nutraceuticals are plant-derived phytochemicals sold as dietary supplements. Berberine is different to the herbs from which it is derived because it is an isolated compound at a concentrated dose, and as such has powerful effects.

The evidence is stronger than most people expect. Pooled across 50 studies, berberine lowered triglycerides by 0.35 mmol/L. A second review of 46 trials found a fall of 0.5 mmol/L, alongside better insulin measures. So, that’s a larger change than omega-3s produced.

Both reviews were in people with type 2 diabetes, so they don’t map exactly onto a woman in perimenopause. Berberine works by improving insulin sensitivity, though, which is why I’d expect the same effect where insulin resistance is part of the picture.

Berberine is easily available of the shelf, and that’s where the trouble can start. People buy it because a friend found it helpful, or because they read about it somewhere, and they start taking it without knowing what it does and how powerful it can be.

Among other things, berberine acts on your blood sugar levels, and also on liver enzymes that clear medication out of your body. It’s the clearing of medications that means there is the potential for interactions.

So if you take any prescribed medication, ask a medical herbalist before you start it. We’re trained to know what’s safe alongside what, and berberine is one where that can be important.

Garlic

The pooled trials of aged garlic didn’t find a change in triglycerides overall, although blood pressure and LDL both came down. The one group where triglycerides did fall was the group who already had heart disease.

So if you are wondering if this food is for you, remeber this. A trial gives one preparation, at one dose, to everybody, taking the tested product. That’s not how a practitioner works. A group average doesn’t tell you what happened to each woman in it.

Garlic earns its place in a heart-supporting diet, and for the most part I’d keep it there. Unless there is a specific reason not to.

Matching it to the picture

Which of these fits you depends on your whole picture, not on the triglyceride number alone. Insulin resistance with weight around the middle points one way. A liver under pressure from alcohol points another.

The real caution with all of them is prescribed medication, and that’s worth checking with a medical herbalist who knows your case.

You might also like my post:  Daily Low Dose Aspirin: Is it Still a Good Idea?

They also respond faster to changes you make than cholesterol, and the things that move your results are ordinary. Having less sugar, fewer alcphol drinks, more protein and soluble fibre, oily fish twice a week, and exercise that includes some resistance work.

If your result came back above 1.7 or over and nobody told you what to do about it, I can personalise a plan for you to help improve that result.