Pharmacokinetics And Drug Interactions
Omega-3 ethyl esters and fatty acids are absorbed by the GI tract similar to other dietary lipids. It is worth noting that omega-3-free fatty acids are directly absorbed by the small intestine and are not dependent on pancreatic lipases for absorption. Thus, absorption of omega-3-fatty acids is not decreased in patients with pancreatic insufficiency and therefore may be preferred in patients with pancreatic disease. Additionally, the bioavailability of omega-3-fatty acids with a low fat diet was greater than omega-3-ethyl esters while there was little difference between these different formulations with a high fat diet .
Drug interactions have not been seen with omega-3-fatty acids .
Best Medication For High Triglycerides
Triglycerides are the types of fat in the blood, which can increase the chances of having cardiovascular diseases. If you eat too much and take more calories than you need, the body transforms redundant calories into triglycerides.
The level of the triglycerides can be determined with a simple blood test. The blood test will include the cholesterol level as well. The difference between triglycerides and cholesterol is that triglycerides supply the body with energy and cholesterol is responsible for particular hormones and cells.
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What Is The Best Treatment For Hypertriglyceridemia
Hypertriglyceridemia treatment includes:
- Managing underlying causes of your high triglycerides.
You may need one or more of these approaches. Your provider will recommend the best treatment plan for you.
Lifestyle changes to lower your triglycerides
In general, treatment begins with lifestyle changes. Guidelines include:
Managing underlying causes of hypertriglyceridemia
Your healthcare provider will work with you to manage underlying causes. The goal is to make adjustments thatll help your triglycerides return to a normal level. You may need new medications to manage a medical condition. Or you may need changes to your current drug regimen. Ask your provider if you have questions or concerns about your treatment plan.
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What Are The Symptoms Of Hypertriglyceridemia
Most people with hypertriglyceridemia have no symptoms. People with severe hyperglyceridemia may develop xanthomas. These are skin bumps that form when lipids build up under your skin. The xanthomas usually appear around your eyelids. But they may also appear on your knees, elbows or palms of your hands.
A Warm Cup Of Cayenne Pepper Solution
Cayenne pepper, known for adding spicy heat to your foods, also helps lower triglycerides naturally. It contains an alkaloid compound, capsaicin, that helps reduce triglycerides and LDL cholesterol in obese individuals.
- Add a ½ to 1 teaspoon of cayenne pepper to 1 cup of hot water. Drink this solution twice daily for a few weeks.
- Another option is to take cayenne supplements. Consult your doctor for the proper dosage and its suitability for your case.
Note:
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Ask Your Doctor About Natural Supplements
Several natural supplements could have the potential to lower blood triglycerides. Always speak with your doctor before starting any supplements, as they can interact with other medications.
Note especially that the Food and Drug Administration does not regulate supplements in the same way as it regulates pharmaceuticals, and supplement quality can vary widely.
Below are a few of the main supplements that have been studied:
- Fish oil. Well known for its potent effects on heart health, fish oil is rich in omega-3 fatty acids, which have been shown to decrease triglycerides and several other risk factors for heart disease (
Summary
Several supplements have been studied for their ability to lower triglyceride levels, including fish oil, fenugreek, garlic extract, guggul, and curcumin.
The Best Herbs To Help Lower Cholesterol
While cholesterol is a necessary component in the body, too much of a certain type can lead to potential health problems. However, certain herbs, such as turmeric and rosemary, could help lower cholesterol. That said, more research is necessary to determine their effect on cholesterol.
Cholesterol is a necessary building component for cells. The liver creates this waxy substance and spreads it throughout the body through blood.
Genetics and lifestyle can influence how much cholesterol the liver produces. When it produces too much, it can lead to blockage, which can cause a heart attack or stroke.
However, not all cholesterol is bad. Health experts split it into two types :
- Low-density lipoprotein cholesterol: Individuals often call this bad cholesterol. LDL can contribute to blocked arteries when levels are high.
- High-density lipoprotein cholesterol: People often call this good cholesterol. HDL helps remove LDL cholesterol from the blood.
When testing cholesterol numbers, doctors often also look at levels of triglycerides. These fats store excess energy from a persons diet and can contribute to excess LDL cholesterol levels.
Several treatments, including medication and lifestyle changes, can help lower LDL cholesterol.
People may consume artichoke as part of a nutritious diet, such as the Mediterranean diet. Several studies over the years have looked at how artichoke affects cholesterol levels.
Some evidence suggests it may have cholesterol lowering effects.
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Lowering Triglycerides Without Medication
Unless your triglycerides are extremely high, lifestyle changes are the best place to start. These simple steps can significantly lower triglyceride levels.
- Beware of bad fats. Cutting back on saturated fat and trans fats can lower triglycerides.
- Go for good carbs. Easily digested carbohydrates give triglycerides a definite boost. Eating whole grains and cutting back on soda can help control triglycerides.
- Check your alcohol use. In some people, alcohol dramatically boosts triglycerides. The only way to know if this is true for you is to avoid alcohol for a few weeks and have your triglycerides tested again.
- Go fish. Omega-3 fats in salmon, tuna, sardines, and other fatty fish can lower triglycerides. Having fish twice a week is fine.
- Aim for a healthy weight. If you are overweight, losing just 5% to 10% of your weight can help drive down triglycerides.
- Get moving. Exercise lowers triglycerides and boosts heart-healthy HDL cholesterol.
- Stop smoking. It isnt good for triglyceride levels or for anything else.
About the Author
Gregory Curfman, MD, Assistant Professor of Medicine, Former Editor-in-Chief, Harvard Health Publishing
What Causes High Triglycerides
Aside from consuming a high-fat and/or high-carb diet, other lifestyle factors can contribute to high triglycerides, specifically excess weight, lack of exercise, drinking too much alcohol and smoking. Dr. Malaney adds that it can also be a side effect of certain medications, such as some birth control pills, beta blockers, antipsychotics medications, and corticosteroids.
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Is It Possible To Lower Triglycerides Naturally
Similar to cholesterol, triglycerides come from the food we eat and our liver. When levels are normal, triglycerides are used for energy. The problems arise when levels are high, explains Dr. Nissen. When we make more triglycerides than we use, the rest are stored as fat. Thats why many people who are overweight or have type 2 diabetes have high levels.
Poor diabetes control is a major factor in causing high triglyceride levels, Dr. Nissen says. He stresses the importance of watching your carbohydrate consumption. Eating a low-carb diet and getting plenty of exercise are often effective in lowering triglyceride levels.
Supplements And Medications To Lower Triglycerides
Some diabetes medications, Actos , for example, will also lower triglycerides, says Shurmur. However, this drug may cause or worsen congestive heart failure, warns the FDA.
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How Long Does It Take To Lower Triglycerides
Depending on whats causing your high triglyceride levels, you may be able to lower them in just a few days. A night out drinking or eating foods high in sugar can cause a spike in your triglyceride levels. Limiting alcohol and sugar intake can bring your levels back to normal within a few days.
If you have consistently high triglycerides, it may take a few months for them to return to a healthy range. How fast they lower depends on the lifestyle changes, diet, and medications youre taking.
How To Lower Triglycerides
Your doctor will determine if you need treatment to lowering triglycerides by talking with you about your current diet and lifestyle, and evaluating your triglyceride level, your LDL cholesterol level, and your potential risk factors for coronary heart disease.
Here are some of the reasons your doctor might discuss medications to lower triglycerides with you:
- You have metabolic syndrome. This condition includes a combination of abdominal obesity, high triglycerides, and high blood pressure. If you have metabolic syndrome and tried diet and lifestyle changes for three months without success, triglyceride-lowering medications may be needed.
- Previous medication lowered your total cholesterol but not your triglycerides. If your cholesterol is well controlled, but your triglyceride level is still too high, at or above 200 mg/dL, triglyceride-lowering medications may help.
- You have very high triglycerides. If your triglyceride level is at or higher than 500 mg/dL, you may need to start medications to lower triglycerides even before reaching lower cholesterol levels.
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Mechanisms Accounting For The Niacin Induced Lipid Effects
TRIGLYCERIDES
Early studies demonstrated that niacin inhibited the release of free fatty acids from cultured adipocytes and decreased circulating free fatty acid levels . The ability of niacin to inhibit adipose tissue lipolysis is mediated by the activation of GPR109A , a G protein-coupled receptor that is highly expressed in adipose tissue . It was initially thought that the decrease in plasma TGs induced by niacin therapy was due to niacin inhibiting lipolysis in adipose tissue resulting in a decrease in the transport of fatty acids to the liver leading to the decreased availability of fatty acids for hepatic TG synthesis. However, studies have shown that while niacin acutely decreases plasma free fatty acid levels this inhibition is not sustained . Additionally, studies in mice lacking GPR109A have shown that niacin does not inhibit lipolysis but still decreases plasma TG and LDL-C levels . Moreover, studies in humans using GPR109A agonists lowered plasma free fatty acid levels but did not cause the expected effects on plasma TGs and LDL-C . Thus, the effects of niacin on adipose tissue lipolysis are no longer thought to mediate the niacin induced decrease in plasma TG levels.
LOW DENSITY LIPOPROTEIN
The decrease in plasma LDL-C with niacin therapy is thought to be secondary to a reduction in VLDL and LDL formation and secretion by the liver .
HIGH DENSITY LIPOPROTEIN
LIPOPROTEIN
How Are Triglycerides Measured
Your doctor may give you a common test called a lipid panel. It checks for different types of cholesterol, including the levels of the “good” kind and the “bad” kind. The American Heart Association recommends that everyone 21 and older get a lipid panel at least every 5 years.
The levels are checked after an overnight fast. Fat from a recent meal can muddy the picture.
These tests are important because you rarely have any symptoms when your triglycerides are high, unlike with many other conditions.
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Follow A Lower Carb Diet
Much like added sugar, extra calories from carbs in your diet are converted into triglycerides and stored in fat cells.
Not surprisingly, low carb diets have been linked to lower blood triglyceride levels .
A review of 12 randomized controlled trials found that people following reduced carb diets typically saw a reduction in triglyceride levels at 6, 12, and 24 months. Across these studies, triglyceride levels decreased the most 6 months after starting a reduced calorie diet .
A 2020 review compared low fat and low carb diets. Researchers found that 612 months after starting their relative diets, those on the low carb diet had greater decreases in triglyceride levels than those on a low fat diet .
Summary
Following a low carb diet can lead to a significant reduction in blood triglyceride levels, at least in the short term, when compared with a low fat diet.
Goals And Rules Of Lipid
More than 1/3 of diabetic patients have atherogenic dyslipidemia, which further increases the risk of atherosclerotic CVD . As shown in the AHEAD study, the presence of dyslipidemia in patients with type 2 diabetes significantly increased the risk of ASCVD and coronary artery disease . In patients with diabetes and coexistence of lipid disorders, it is recommended to reduce low density lipoprotein cholesterol levels to< 1.8 mmol/l and to achieve at least a reduction of 50% of the baseline value .
Fig. 2
Recommendations by Polish Lipid Association 2021 on treatment of lipid disorders in patients with diabetes . LDL-C low-density lipoprotein cholesterol, HDL-C high-density lipoprotein cholesterol, Lp lipoprotein a, hsCRP high-sensitivity C-reactive protein, eGFR estimated glomerular filtration rate
In the case of lipid disorders in diabetic patients, practitioners should follow the principle: “the lower, the better”, but also to strive for the earlier, the better as soon as possible and maintain it as long as possible, preferably throughout the patients lifetime the longer, the better. Such an approach will significantly reduce the risk of CVD in these patients . The paradigm of the lower, the better has been confirmed in hundreds of trials and meta-analyses, therefore we would like to explain the importance of the two additional rules.
Paradigm II: the earlier, the better
Paradigm III: the longer, the better
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Moderate Hypertriglyceridemia Prevention Of Cardiovascular Disease
In the era of statin therapy, it is uncertain whether lowering TG levels in patients on statin therapy will further reduce cardiovascular events. As discussed in detail in the sections on individual drugs, the studies carried out so far have not shown that adding niacin or fibrates to statin therapy is beneficial with regards to cardiovascular disease. As also discussed, the available studies have major limitations because many of the patients in these outcome studies did not have substantial elevations in TGs and therefore the issue is an open question that requires additional studies. Notably, the REDUCE-IT trial, which tested the effect of high dose EPA in patients with elevated TG levels and the JELIS trial which tested the effect of EPA 1.8 grams per day in patients with high cholesterol levels demonstrated a reduction in cardiovascular events. However, in both of these trials the decrease in cardiovascular events was considerably greater than one would expect based on the reduction in TG levels suggesting that the decrease in cardiovascular events was not solely due to lowering TG levels and that other effects of EPA likely played a role.
How To Lower Triglycerides Fast Without Medications
Unlike many illnesses, much of the treatment centered around how to lower triglycerides actually has a lot to do with lifestyle factors like diet and physical activity. In fact, moderate to slightly high levels of triglycerides may be managed in this way alone, without the use of prescription medications. Since what raises triglycerides in the first place is often the foods that we eat, it is not a wonder that a mere change in ingestibles can provide long term benefits in the form of lower triglycerides levels. And, the long term management of the amounts of these fats circulating in the blood can often be well managed with a diet to lower triglycerides combined with an increase in moderate exercise.
Fats are also best left alone as much as possible for anyone trying to stave off ever rising levels of the manufactured blood fats. As such, fried foods and those that contain trans fat or saturated fat should be eliminated from diets entirely. Not only does this decrease the likelihood that triglycerides will remain on the rise, a low fat diet also contributes to a reduced risk of obesity. Being overweight or obese is a major contributing factor to the increase of triglycerides in the blood, and adhering to a low fat diet can reduce this risk dramatically.
References:
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Address Underlying Health Issues
Remember, although triglycerides can be high due to bad lifestyle and dietary choices, they can also be high due to an underlying health condition. The most important thing is to work with your doctor to find out whats causing your high triglyceride levels and to treat any underlying conditions!
For example, triglycerides can be high due to liver disease, infections, underactive thyroid , autoimmune disease, or some genetic disorders just to name a few .
In these cases, simply changing your diet or lifestyle wont help address the underlying issue and may actually be harmful!
In addition, high triglyceride levels can be dangerous for your body. If necessary, your doctor will prescribe triglyceride-lowering medication.
Thats why, if your triglycerides are elevated, you should discuss the lifestyle and dietary changes listed below with your doctor. None of these strategies should ever be done in place of what your doctor recommends or prescribes!