• Triglycerides, High; Hypertriglyceridemia
Principal Proposed Treatments:
• Fish Oil; Niacin
Other Proposed Treatments
• Achillea wilhelmsii; Chromium; Combined Vitamin C and Vitamin E; Creatine; Fenugreek; Flax Oil; Pantethine; Soy; Walnut Oil
Triglycerides belong to a group of fat-related substances called lipids. An increase in levels of certain lipids—a condition called “hyperlipidemia”—contributes to heart disease.
To test for hyperlipidemia, physicians rely on blood tests called lipid profiles that measure triglycerides as well as two types of the lipid cholesterol: low-density lipoprotein (LDL) or “bad” cholesterol, and high-density lipoprotein (HDL) or good cholesterol.
In many people with hyperlipidemia, elevation of LDL predominates. Drugs in the statin family work particularly well at treating this form of hyperlipidemia. (For information on natural treatments for this condition, see the High Cholesterol article.)
In some people with hyperlipidemia, however, high triglyceride levels are the primary problem. These people are just as much at risk for heart disease as people with elevated LDL cholesterol. Furthermore, if triglyceride levels get high enough, the pancreas may become inflamed, causing a dangerous condition called pancreatitis. Skin lesions called xanthomas may occur as well.
Common causes of elevated triglyceride levels include genetic predisposition, diabetes, excessive alcohol intake, and various medications (including estrogen , tamoxifen, glucocorticoids , thiazide diuretics , and some beta-blockers ).
People with high triglycerides may not respond well to statin drugs. Instead, they may need to use high-dose niacin or drugs in the fibrate family . Exercise (with or without weight loss) may also lower triglycerides. Diet, except when weight loss occurs, may not help, as a low-fat, high-carbohydrate diet can actually raise triglyceride levels.
Principal Proposed Natural Treatments
Fish oil has shown distinct promise for treating hypertriglyceridemia. More than 2,000 people have participated in well-designed studies of fish oil for reducing triglyceride levels. 1 Most studies ran from about 7 to 10 weeks.
It appears that fish oil supplements can reduce triglycerides by about 25% to 30%. Although not all studies have been positive, in a detailed review of 47 randomized trials, researchers concluded that fish oil is capable of significantly reducing triglyceride levels with no change in total cholesterol levels and only slight increases in HDL (“good”) cholesterol and LDL (“bad”) cholesterol. 35 However, it should be noted that in some studies, use of fish oil has markedly raised LDL cholesterol, which might offset some of the benefit.
For more information, see the full High Cholesterol article.
Fish oil has been studied for reducing triglyceride levels specifically in people with diabetes , and it appears to do so safely and effectively. 3 Furthermore, in people using statin drugs to control lipid levels, the addition of fish oil or its isolated component DHA appears to improve results. 4, 34
Fish oil is a source of omega-3 fatty acids , healthy fats that the body needs as much as it needs vitamins. The most important omega-3 fatty acids found in fish oil are named EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). According to some, but not all, studies, EPA may be more important than DHA for reducing triglyceride levels. 5-10, 32
In addition, a slightly modified form of fish oil (ethyl-omega-3 fatty acids) has been approved by the FDA as a treatment for hypertriglyceridemia (high triglycerides). 33 This specially processed product, sold under the trade name Omacor, is widely advertised as more effective than ordinary fish oil. However, it should be noted that Omacor has undergone relatively little study itself; the physician prescribing information notes only two small trials to support its effectiveness for this use. This is far less evidence than usually required for drug approval, and also substantially less than the body of evidence supporting standard fish oil as a treatment for high triglycerides.
For more information, including dosage and safety issues, see the full Fish Oil article.
Other Proposed Natural Treatments
Numerous studies indicate that soy can reduce total and LDL cholesterol, especially when it replaces animal protein in the diet, and on this basis it has been approved for a “heart healthy” label by the FDA. Soy also appears to modestly improve triglyceride levels. 11
However, chromium does not appear to be effective for reducing triglyceride levels in people without diabetes. 20,22-25
The supplement flax oil contains omega-3 fatty acids similar but not identical to those found in fish oil. It has been proposed as an alternative to fish oil, because it does not cause fishy burps. However, evidence suggests that flax oil is not as effective as fish oil for reducing triglycerides. 1
Walnut oil has shown some promise for reducing triglycerides. 31
Most natural treatments used to reduce cholesterol have the potential to reduce triglyceride levels as well. For more information on these many options, see the full High Cholesterol article.
1. Harris WS. N-3 fatty acids and serum lipoproteins: human studies. Am J Clin Nutr . 1997;65(Suppl 5):S1645-S1654.
2. van Dam M, Stalenhoef AF, Wittekoek J, et al. Efficacy of concentrated n-3 fatty acids in hypertriglyceridaemia: a comparison with gemfibrozil. Clin Drug Invest . 2001;21:175-181.
3. Montori VM, Farmer A, Wollan PC, et al. Fish oil supplementation in type 2 diabetes: a quantitative systematic review. Diabetes Care . 2000;23:1407-1415.
4. Durrington PN, Bhatnagar D, Mackness MI, et al. An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia. Heart . 2001;85:544-548.
5. Mori TA, Burke V, Puddey IB, et al. Purified eicosapentaenoic and docosahexaenoic acids have differential effects on serum lipids and lipoproteins, LDL particle size, glucose, and insulin in mildly hyperlipidemic men. Am J Clin Nutr . 2000;71:1085-1094.
6. Rambjor GS, Walen AI, Windsor SL. Eicosapentaenoic acid is primarily responsible for hypotriglyceridemic effect of fish oil in humans. Lipids . 1996;31(Suppl):S45-S49.
7. Agren JJ, Hanninen O, Julkunen A, et al. Fish diet, fish oil and docosahexaenoic acid rich oil lower fasting and postprandial plasma lipid levels. Eur J Clin Nutr . 1996;50:765-771.
8. Childs MT, King IB, Knopp RH. Divergent lipoprotein responses to fish oils with various ratios of eicosapentaenoic acid and docosahexaenoic acid. Am J Clin Nutr . 1990;52:632-639.
9. Davidson MH, Maki KC, Kalkowski J, et al. Effects of docosahexaenoic acid on serum lipoproteins in patients with combined hyperlipidemia: a randomized, double-blind, placebo-controlled trial. J Am Coll Nutr . 1997;16:236-243.
10. Leigh-Firbank EC, Minihane AM, Minihane AM, et al. Eicosapentaenoic acid and docosahexaenoic acid from fish oils: differential associations with lipid responses. Br J Nutr . 2002;87:435-445.
11. Anderson JW, Johnstone BM, Cook-Newell ME. Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med . 1995;333:276-281.
12. Gaddi A, Descovich GC, Noseda G, et al. Controlled evaluation of pantethine, a natural hypolipidemic compound, in patients with different forms of hyperlipoproteinemia. Atherosclerosis . 1984;50:73-83.
13. Angelico M, Pinto G, Ciaccheri C, et al. Improvement in serum lipid profile in hyperlipoproteinaemic patients after treatment with pantethine: a crossover, double-blind trial versus placebo. Curr Ther Res . 1983;33:1091-1097.
14. Bertolini S, Donati C, Elicio N, et al. Lipoprotein changes induced by pantethine in hyperlipoproteinemic patients: adults and children. Int J Clin Pharmacol Ther Toxicol . 1986;24:630-637.
15. Rubba R, Postiglione A, De Simone B, et al. Comparative evaluation of the lipid-lowering effects of fenofibrate and pantethine in type II hyperlipoproteinemia. Curr Ther Res . 1985;38:719-727.
16. Da Col PG, Cattin L, Fonda M, et al. Pantethine in the treatment of hypercholesterolemia: a randomized double-blind trial versus tiadenol. Curr Ther Res . 1984;36:314-322.
17. Abraham AS, Brooks BA, Eylath U. The effects of chromium supplementation on serum glucose and lipids in patients with and without non-insulin-dependent diabetes. Metabolism . 1992;41:768-771.
18. Lee NA, Reasner CA. Beneficial effect of chromium supplementation on serum triglyceride levels in NIDDM. Diabetes Care . 1994;17:1449-1452.
19. Rabinowitz MB, Gonick HC, Levin SR, Davidson MB. Effects of chromium and yeast supplements on carbohydrate and lipid metabolism in diabetic men. Diabetes Care . 1983;6:319-327.
20. Thomas VL, Gropper SS. Effect of chromium nicotinic acid supplementation on selected cardiovascular disease risk factors. Biol Trace Elem Res . 1996;55:297-305.
21. Uusitupa MI, Kumpulainen JT, Voutilainen E, et al. Effect of inorganic chromium supplementation on glucose tolerance, insulin response, and serum lipids in noninsulin-dependent diabetics. Am J Clin Nutr . 1983;38:404-410.
22. Press RI, Geller J, Evans GW. The effect of chromium picolinate on serum cholesterol in apolipoprotein fractions in human subjects. West J Med . 1990;152:41-45.
23. Offenbacher EG, Pi-Sunyer FX. Beneficial effect of chromium-rich yeast on glucose tolerance and blood lipids in elderly subjects. Diabetes . 1980;29:919-925.
24. Offenbacher EG, Rinko CJ, Pi-Sunyer FX. The effects of inorganic chromium and brewer’s yeast on glucose tolerance, plasma lipids, and plasma chromium in elderly subjects. Am J Clin Nutr . 1985;42:454-461.
25. Roeback JR Jr, Hla KM, Chambless LE, Fletcher RH. Effects of chromium supplementation on serum high-density lipoprotein cholesterol levels in men taking beta-blockers. A randomized, controlled trial. Ann Intern Med . 1991;115:917-924.
26. Wilson BE, Gondy A. Effects of chromium supplementation on fasting insulin levels and lipid parameters in healthy, non-obese young subjects. Diabetes Res Clin Pract . 1995;28:179-184.
27. Gupta A, Gupta R, Lal B. Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double-blind, placebo-controlled study. J Assoc Physicians India . 2001;49:1057-1061.
28. Earnest CP, Almada AL, Mitchell TL. High-performance capillary electrophoresis-pure creatine monohydrate reduces blood lipids in men and women. Clin Sci (Colch). 1996;91:113-118.
29. Asgary S, Naderi GH, Sarrafzadegan N, et al. Antihypertensive and antihyperlipidemic effects of Achillea wilhelmsii. Drugs Exp Clin Res . 2000;26:89-93.
30. Babu JR, Sundravel S, Arumugam G, et al. Salubrious effect of vitamin C and vitamin E on tamoxifen-treated women in breast cancer with reference to plasma lipid and lipoprotein levels. Cancer Lett . 2000;151:1-5.
31. Zibaeenezhad MJ, Rezaiezadeh M, Mowla A, et al. Antihypertriglyceridemic effect of walnut oil. Angiology . 2003;54:411-4.
32. Schwellenbach LJ, Olson KL, McConnell KJ, et al. The triglyceride-lowering effects of a modest dose of docosahexaenoic acid alone versus in combination with low-dose eicosapentaenoic acid in patients with coronary artery disease and elevated triglycerides. J Am Coll Nutr . 2006;25:480-5.
33. McKenney JM, Sica D. Prescription omega-3 fatty acids for the treatment of hypertriglyceridemia. Am J Health Syst Pharm . 2007;64:595-605.
34. Meyer BJ, Hammervold T, Rustan AC, et al. Dose-dependent effects of docosahexaenoic acid supplementation on blood lipids in statin-treated hyperlipidaemic subjects. Lipids . 2007;42:109-15.
35. Eslick GD, Howe PR, Smith C, et al. Benefits of fish oil supplementation in hyperlipidemia: a systematic review and meta-analysis. Int J Cardiol. 2008 Sep 5.
Last reviewed July 2012 by EBSCO CAM Review Board
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