By Dr. Steven Long, DO, MHA, CPT
Beyond Health | Precision Medicine for High-Performance Living
Triglycerides are often dismissed as “just another cholesterol number” on a standard lipid panel. But in reality, triglycerides are one of the most sensitive indicators of insulin resistance and metabolic dysfunction.
As insulin resistance worsens, triglycerides tend to rise—and the triglyceride-to-HDL ratio emerges as a powerful, evidence-based marker of cardiometabolic risk. Understanding why this happens helps us move beyond a narrow cholesterol focus toward a true picture of metabolic health.
Why Triglycerides Rise in Insulin Resistance
Insulin is more than a glucose hormone—it is a master regulator of lipid metabolism.
When cells become resistant to insulin, several things happen in the liver and adipose tissue that drive triglyceride elevation:
- Increased lipolysis in adipose tissue
- Insulin normally suppresses hormone-sensitive lipase, which breaks down stored fat.
- In insulin resistance, this suppression is blunted → more free fatty acids (FFAs) spill into the bloodstream.
- Hepatic overproduction of VLDL particles
- The liver takes up excess FFAs and repackages them as triglycerides in VLDL (very low-density lipoproteins).
- This leads to hypertriglyceridemia, even before glucose abnormalities appear.
- Impaired clearance of triglycerides
- Lipoprotein lipase (LPL) normally hydrolyzes triglycerides for uptake into muscle and fat.
- Insulin resistance reduces LPL activity, slowing clearance.
The result: elevated circulating triglycerides, often the first lipid abnormality to appear with worsening insulin resistance (Ginsberg & MacCallum, 2009).
The Triglyceride:HDL Ratio
The triglyceride-to-HDL cholesterol ratio (TG:HDL) is a simple but powerful marker of insulin resistance and cardiovascular risk.
- High TG and low HDL are hallmarks of insulin resistance.
- Ratios >3.5 in men and >2.5 in women (using mg/dL values) are strongly associated with metabolic syndrome, small dense LDL particles, and increased atherogenic risk (McLaughlin et al., 2005).
- The TG:HDL ratio correlates closely with insulin resistance measured by the “gold standard” euglycemic clamp technique (McLaughlin et al., 2003).
At Beyond Health, we often use TG:HDL ratio alongside fasting insulin and CGM data to get a comprehensive view of metabolic health.
Why It Matters for Long-Term Health
Elevated triglycerides aren’t just a lab abnormality—they reflect ongoing metabolic strain. Persistently high TG and low HDL are associated with:
- Increased risk of atherosclerotic cardiovascular disease (ASCVD)
- Development of non-alcoholic fatty liver disease (NAFLD)
- Worsening insulin resistance and eventual type 2 diabetes
- Higher systemic inflammation
This explains why guidelines now increasingly highlight triglycerides as more than an afterthought—they are a window into insulin action and metabolic flexibility.
Beyond Health’s Perspective
At Beyond Health, we don’t view triglycerides as a passive byproduct of diet alone. We see them as an active biomarker of insulin signaling, hepatic metabolism, and adipose health.
That’s why our interventions focus not just on lowering triglycerides, but on addressing the root causes of insulin resistance:
- Nutrition: Reducing refined carbohydrates, improving omega-3 intake, emphasizing protein and fiber.
- Exercise: Zone 2 training improves fat oxidation; resistance training improves insulin sensitivity and triglyceride clearance.
- Sleep and Stress: Chronic stress and poor sleep elevate FFAs and worsen insulin resistance.
- Advanced labs: TG:HDL ratio, ApoB, and fasting insulin help us individualize care beyond standard cholesterol numbers.
The goal is not just “lower triglycerides”—it’s restoring metabolic flexibility and resilience.
References
- Ginsberg, H. N., & MacCallum, P. R. (2009). The obesity, metabolic syndrome, and type 2 diabetes mellitus pandemic: Part I. Increased cardiovascular disease risk and the importance of atherogenic dyslipidemia in persons with the metabolic syndrome and type 2 diabetes mellitus. Journal of the CardioMetabolic Syndrome, 4(2), 113–119.
- McLaughlin, T., et al. (2003). Use of metabolic markers to identify overweight individuals who are insulin resistant. Annals of Internal Medicine, 139(10), 802–809.
- McLaughlin, T., et al. (2005). Triglyceride/HDL cholesterol ratio identifies insulin resistance in overweight individuals. Metabolism, 54(11), 1528–1533.
