Hypertriglyceridemia is a high level of triglycerides in the blood, and 30% of Americans have a triglyceride level over 150 mg/dL. Hypertriglyceridemia is commonly associated with other lipid abnormalities and can be secondary to a high fat diet, excessive alcohol use, some medications and some medical conditions such as obesity, diabetes and hypothyroidism.
Primary hypertriglyceridemia is due to a genetic defect. Hypertriglyceridemia can be due to the metabolic syndrome, which is a combination of (1) hypertriglyceridemia, (2) abdominal obesity, (3) insulin resistance, (4) low HDL and (5) hypertension.
The main risk of a high triglyceride (over 1,000 mg/dL.) is pancreatitis. At this time the main reason to treat high triglycerides is to prevent pancreatitis. Reducing triglycerides and treating the metabolic syndrome reduces coronary events. It has not been proven that high triglycerides correlate with coronary disease and treating high triglycerides has not been proven to prevent coronary disease.
The following Therapeutic Lifestyle Changes (TLC) are suggested by the authors to try and reduce triglycerides below 200:
1. Eat a low saturated fat, carbohydrate controlled diet.
2. Reduce alcohol consumption.
3. Cessation of smoking.
4. Regular aerobic exercise.
5. Eat oily fish at least two times a week.
6. Stop any medications that increase triglycerides.
7. Treat diabetes and hypothyroidism.
High doses of omega-3 oil from fish and fish oil supplements are known to lower triglycerides. If TLC’s do not work, supplemtation of 2 to 4 g. fish oil should be tried, but fish oil can have the undesirable effect of raising LDL. People who have problems with “burping” from fish oil capsules can try freezing them, taking them at night, or taking them with food.
Niacin is the preferred treatment for patients with high triglycerides and low high-density lipoproteins (HDL). Niacin of the immediate acting type must be taken three times a day and has the side effect of flushing. Long acting niacin has the risk of toxicity to the liver. Extended release (ER) niacin is the preferred type of niacin and ER niacin can be taken only once a day and has a lower incidence of liver toxicity. ER niacin can lower triglycerides by as much as 25% and raise HDL as much as 30%.
Aspirin (325 mg.) can be taken 30 to 60 minutes ahead of time to reduce flushing from niacin. Niacin can increase blood glucose and should be used with caution in diabetes. People with stomach ulcers should not use Niacin. Niacin can increase blood uric acid and should be used with caution in gout.
CONCLUSION: There are a number of lifestyle changes that can improve the triglyceride blood levels. Fish oil and niacin can be of therapeutic use. Lowering the triglyceride levels prevents pancreatitis and lowers the risk factors for cardiovascular disease. Attempts should be made to reduce high LDL levels and elevate reduced HDL levels.
NOTE: Read about the beneficial effects of the Paleolithic diet.
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