Triglycerides (TGs) are a group of fatty compounds that circulate in the bloodstream and are stored in the fat tissue. Individuals who have elevated blood levels of TGs (known as hypertriglyceridemia) appear to be at increased risk of developing heart disease.
People with diabetes often have elevated TG levels. Successfully controlling diabetes will, in some cases, lead to normalization of TG levels.
What are the symptoms of high triglycerides?
Very high triglycerides can cause pancreatitis, an enlarged liver and spleen, and fatty deposits in the skin called xanthomas. Otherwise, high triglycerides may not cause symptoms until and unless heart disease or other diseases of blood vessels develop.
Dietary changes that may be helpful for high triglycerides
While consuming moderate amounts of alcohol does not appear to affect TG levels, heavy drinking is believed to be an important cause of hypertriglyceridemia.1 Alcoholics with elevated TG levels should deal with the disease of alcoholism first.
Ingesting refined sugar increases TG levels, as well.2 3 People with elevated TGs should therefore reduce their intake of sugar, sweets, and other sugar-containing foods. There is also evidence that ingesting fructose in amounts that are found in a typical Western diet can raise TG levels, although not all studies agree on that point.4 It should be noted that most studies of fructose investigated the refined form, not the fructose that occurs naturally in some fruits.
In a study of heavy caffeine users (individuals who were consuming an average of 560 mg of caffeine per day from coffee and tea), changing to decaffeinated coffee and eliminating all other caffeinated products for two weeks resulted in a statistically significant 25% reduction in TG levels.5
Diets high in fiber have reduced TG levels in several clinical trials,6 but have had no effect in other clinical trials.7 Water-soluble fibers, such as pectin found in fruit, guar gum and other gums found in beans, and beta-glucan found in oats, may be particularly helpful in lowering triglycerides.
Consumption of a low-fat, high-carbohydrate diet reduced TGs in one study.8 However, in another study, populations that consumed a low-fat, high-carbohydrate diet had higher TG levels, compared with populations that consumed lower amounts of carbohydrates.9 Suddenly switching to a high-carbohydrate, low-fat diet will generally increase TGs temporarily, but making the switch gradually protects against this short-term problem.10
The blood level of TGs following a meal may be a more important indicator of coronary heart disease risk than the fasting level.11 12 However, a low-fat diet (55% carbohydrates, 23% fats, 22% proteins) that succeeded in normalizing other blood lipids, including fasting TG levels, failed to normalize post-meal TG levels in a group of people with hypertriglyceridemia.13 These results suggest that dietary reduction of fasting TGs, even if the diet controls other blood lipids, may not be enough to provide optimal protection against coronary heart disease. Many doctors recommend a diet low in saturated fat (meaning avoidance of red meat and all dairy except nonfat dairy) to reduce TGs and the risk of heart disease.14
Some,15 16 but not all,17 studies have found that increasing consumption of fish is associated with a lower risk of heart disease. Significant amounts of TG-lowering omega-3 fatty acids (EPA and DHA) can be found in the fish oil of salmon, herring, mackerel, sardines, anchovies, albacore tuna, and black cod. Many doctors recommend that people with elevated TGs increase their intake of these fatty fish.
Lifestyle changes that may be helpful for high triglycerides
Exercise lowers TG levels.18 People who have diabetes, heart disease, or are over the age of 40, should talk with a doctor before beginning an exercise program.
Smoking has been linked to elevated TG levels.19 As always, it makes sense for smokers to quit.
Obesity increases TG levels.20 Maintaining ideal body weight helps protect against elevated TG levels. Many doctors encourage people who have elevated TGs and who are overweight to lose the extra weight.
Nutritional supplements that may be helpful for high triglycerides
Many double-blind trials have demonstrated that fish oils (also called fish-oil concentrates) containing EPA and DHA (mentioned above) lower TG levels.21 The amount of fish oil used in much of the research was an amount that provided 3,000 mg per day of omega-3 fatty acids. To calculate how much omega-3 fatty acid is contained in a fish-oil supplement, add together the amounts of EPA and DHA. For example, a typical 1,000-mg capsule of fish oil provides 180 mg of EPA and 120 mg of DHA (total omega-3 fatty acids equals 300 mg). Ten of these capsules would contain 3,000 mg of omega-3 fatty acids. Other sources of omega-3 fatty acids, such as flaxseed oil, do not lower TGs. While flaxseed oil has other benefits, it should not be used for the purpose of reducing TGs.
Cod liver oil, another source of omega-3 fatty acids, has also been found to lower TGs.22 Cod-liver oil is less expensive than the fish-oil concentrates discussed previously. However, cod-liver oil also contains relatively large amounts of vitamin A and vitamin D; too much of either can cause side effects. In contrast, fish-oil concentrates have little or none of these vitamins. Individuals wishing to use cod liver oil as a substitute for a fish-oil concentrate should consult a doctor.
Omega-3 fatty acids from fish oil and cod liver oil have been reported to affect blood in many other ways that might lower the risk of heart disease.23 However, these supplements sometimes increase LDL cholesterol—the bad form of cholesterol. A doctor can check to see if fish oil has this effect on an individual. Research shows that when 900 mg of garlic extract is added to fish oil, the combination still dramatically lowers TG levels but no longer increases LDL cholesterol.24 Therefore, it appears that taking garlic supplements may be a way to avoid the increase in LDL cholesterol sometimes associated with taking fish oil. People who take fish oil may also need to take vitamin E to prevent the oil from undergoing potentially damaging oxidation in the body.25 It is not known how much vitamin E is needed to prevent such oxidation. The amount required would presumably depend on the amount of fish oil used. In one clinical trial, 300 IU of vitamin E per day prevented oxidation damage in individuals taking 6 grams of fish oil per day.26
Pantethine is a byproduct of pantothenic acid (vitamin B5). Several clinical trials have shown that 300 mg of pantethine taken three times per day will lower TG levels.27 28 29 Pantothenic acid, which is found in most B vitamins, does not have this effect.
The niacin form of vitamin B3 is used by doctors to lower cholesterol levels, but niacin also lowers TG levels.30 The amount of niacin needed to achieve worthwhile reductions in cholesterol and TG levels is several grams per day. Such quantities can cause side effects, including potential damage to the liver, and should not be taken without the supervision of a doctor. Some doctors recommend inositol hexaniacinate (a special form of vitamin B3) as an alternative to niacin. A typical amount recommended is 500 mg three times per day.31 32 This form of vitamin B3 does not typically cause a skin flush and is said to be safer for the liver than niacin. However, the alleged safety advantage of inositol hexaniacinate needs to be confirmed by additional clinical trials. Moreover, it is not clear whether inositol hexaniacinate is as effective as niacin at lowering cholesterol and TG levels.
In a preliminary trial, supplementation with 800 mg of calcium per day for one year resulted in a statistically significant 35% reduction in the average TG level among people with elevated cholesterol and triglycerides.33 However, in another trial, calcium supplementation had no effect on TG levels.34 One of the differences between these two trials was that more people in the former trial had initially elevated TG levels.
In a double-blind trial, 30 people with type 2 (non-insulin-dependent) diabetes received 200 mcg of chromium per day (as chromium picolinate) for two months and a placebo for an additional two months. The average TG level was significantly lower (by an average of 17.4%) during chromium supplementation than during the placebo period.35 Some,36 37 but not all, trials38 39 support these findings. It is not clear whether chromium supplementation affects TG levels in non-diabetics, but some evidence suggests that it does not.40 41 42 43 44
L-carnitine is another supplement that has lowered TGs in several clinical trials.45 46 However, the effect of carnitine is unpredictable, and some individuals have experienced an increase in triglyceride levels after receiving this supplement.47 Some doctors recommend 1–3 grams of carnitine per day, in the form known as L-carnitine.
Several double-blind trials have evaluated the efficacy of fructo-oligosaccharides (FOS) or inulin (a related compound) for lowering blood cholesterol and triglyceride levels. These trials have shown that in individuals with elevated total cholesterol or triglyceride levels, including people with type 2 diabetes, FOS or inulin (in amounts ranging from 8 to 20 grams daily) produced significant reductions in triglyceride levels; however, the effect on cholesterol levels was inconsistent.48 49 50 51 In people with normal or low cholesterol or triglyceride levels, FOS or inulin produced little effect.52 53 54
The effect of policosanol on serum triglycerides has been inconsistent, ranging from no effect up to as much as a 19% reduction.55 56 57 58 59 60 61 62 63 64 Several controlled studies have compared policosanol with cholesterol-lowering medications, such as statins, and have found policosanol similarly effective.65 66 67 68 69 70 71 Policosanol extracted from beeswax or other sources differs from the sugar-cane-derived preparation in the proportions of long-chain alcohols, and whether these types of policosanol are as effective as sugar-cane-derived policosanol is unknown.
A double-blind trial found that a supplement of 5 grams of creatine plus 1 gram of glucose taken four times per day for five days followed by twice a day for 51 days significantly lowered serum total triglycerides in both men and women.72 However, another double-blind trial found no change in any of these blood levels in trained athletes using creatine during a 12-week strength training program.73 Creatine supplementation in this negative trial was lower—only five grams per day was taken for the last 11 weeks of the study.
Are there any side effects or interactions with high triglycerides?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful for high triglycerides
Guggul, a mixture of ketonic steroids from the gum oleoresin of Commiphora mukul, is an approved treatment of hyperlipidemia in India and has been a mainstay of Ayurvedic herbal approaches to preventing atherosclerosis. Clinical trials indicate that guggul is effective in the treatment of high TGs; in one trial, serum TGs fell by 30.3%.74
However, these results have not been confirmed by large, controlled trials. The recommended daily intake of guggul is typically based on the amount of guggulsterones in the extract. The recommended amount of guggulsterones is 25 mg three times per day. Most extracts contain 5–10% guggulsterones. Guggul’s effect on TGs should be monitored for three to four months, and guggul may be taken long term if successful in lowering TGs.
Reports on many clinical trials of garlic performed until 1998 suggested that triglycerides were lowered by an average of 8–27% and cholesterol by 9–12% over a one- to four-month period.75 76 77 Most of these trials used 600–900 mg per day of a garlic supplement standardized to alliin content and allicin potential. More recently, however, three double-blind clinical trials have found garlic to have minimal success in lowering triglycerides and cholesterol.78 79 80 One negative trial has been criticized for using a steam distilled garlic “oil” that has no track record for this purpose,81 while the others used the same standardized garlic products as the previous positive clinical trials. Based on these findings, the use of garlic should not be considered a primary approach to lowering high triglycerides and cholesterol.82
Odor-controlled, enteric-coated garlic tablets standardized for allicin content can be taken in the amount of 900 mg daily (providing 5,000–6,000 mcg of allicin), divided into two or three daily portions.
In a double-blind trial, people with moderately high triglycerides took a tincture of Achillea wilhelmsii, an herb used in traditional Persian medicine.83 Participants in the trial used 15–20 drops of the tincture twice daily for six months. At the end of the trial, participants experienced significant reductions in triglycerides compared to those who took placebo. No adverse effects were reported.
Fenugreek has been shown to lower total and LDL cholesterol and triglyceride levels in people with high lipid levels in preliminary trials.84 Bread made with 50 grams defatted fenugreek powder was used twice daily in the trial. Similar results have been seen at half that amount in people with diabetes and elevated blood levels of various lipids.85 A small randomized trial found similar results using 100 grams fenugreek seeds daily.86 One small clinical trial found that either 25 grams or 50 grams per day of defatted fenugreek seed powder were effective in reducing triglycerides over a 20-day period.87 Mild diarrhea and gas can accompany the first few days of fenugreek use, though it almost always fades as the person taking it adapts.
Psyllium seeds and husks have shown a modest ability to lower blood triglyceride levels in some,88 89 but not all,90 clinical trials. Further research is needed to assess the effect of psyllium on triglyceride levels more closely, as much of the study so far has focused on lowering cholesterol levels.
Intake of three cups or less of green tea daily has been shown not to affect blood triglyceride levels.91 Intake of four or more cups per day has been correlated with lower triglyceride levels.92 Overall, the evidence is unclear on how much of an effect high levels of intake of green tea has on triglyceride levels.
Although primarily used to lower high serum cholesterol, red yeast rice extract, high in monacolins, has been found to significantly lower serum triglyceride levels.93 People in the trial took 1.2 grams (approximately 13.5 mg total monacolins) of a concentrated red yeast rice extract per day for two months. The sale of Cholestin has been banned in the United States, as a result of a lawsuit alleging patent infringement. Other red yeast rice products currently on the market differ from Cholestin in their chemical makeup. None contain the full complement of 10 monacolin compounds that are present in Cholestin, and some contain a potentially toxic fermentation product called citrinin. 94 Until further information is available, red yeast rice products other than Cholestin cannot be recommended.
Animal studies suggest the mushroom maitake may lower fat levels in the blood.95 However, this research is still preliminary and requires confirmation by controlled human trials.
Are there any side effects or interactions with high triglycerides?
Refer to the individual herb for information about any side effects or interactions.