Triglyceride buster

16. June 2009 William Davis (24)
Two weeks ago, Daniel started with a triglyceride level of 3100 mg/dl, a dangerous level that had potential to damage his pancreas. The inflammatory injury incurred could leave him with type I diabetes and inability to digest foods, since the insulin-producing capacity and the enzyme producing capacity of the pancreas are lost.

Daniel added 3600 mg of omega-3s per day. Within 10 days, his triglycerides dropped nearly 2000 mg to just over 1100 mg/dl--still too high, but an incredible start.

The power of omega-3 fatty acids from fish oil to reduce triglycerides is illustrated most graphically by people with a condition called "familial hypertriglyceridemia" that is responsible for triglyceride levels of 500, 1000, even several thousand milligrams. That's what Daniel has. Given appropriate doses of omega-3s, triglycerides drop hundreds, even thousands, of milligrams.

No question: Omega-3 fatty acids from fish oil are the best tool available for reduction of triglycerides. The effect is dose-dependent, i.e., the more you take, the greater the triglyceride reduction.

How omega-3s exerts this effect is unclear, though there is evidence to suggest that omega-3s suppress several nuclear receptors involved in triglyceride (VLDL) production and increase the expression or activity of the enzyme lipoprotein lipase, an enzyme that clears triglycerides from the blood.

I am continually surprised at the number of people with high triglycerides who are still treated with a fibrate drug, like Tricor, or a statin drug, when fish oil--widely available, essentially free of side-effects, with a proven cardiovascular risk-reducing track record--should clearly be the first choice by a long stretch.

Among its many benefits, omega-3 fatty acids from fish oil also:

Reduce matrix metalloproteinases (MMP)--Two fractions of MMPs, MMP-2 and MMP-9, are inflammatory enzymes present in atherosclerotic plaque that are suspected to trigger plaque "rupture." Omega-3s have been shown to reduce both forms of MMP.

Block uptake of lipids in the artery wall--Suggested by a study in mice.

Modify postprandial responses--In the first few hours after eating (the "postprandial" period), a flood of digestive byproducts of a meal are present in the bloodstream. While research exploring postprandial effects is still in its infancy, it is clear that omega-3 fatty acids have the capacity to favorably modify postprandial patterns. One common surrogate measure for postprandial abnormalities is intermediate-density lipoprotein, or IDL, that we obtain in fasting blood through lipoprotein panels like NMR and VAP. With sufficient omega-3s alone, IDL is completely eliminated.

Unfortunately, most of my colleagues, if they even think to use omega-3s, choose to use the prescription form, Lovaza. Indeed, several representatives from AstraZeneca, the pharmaceutical outfit now distributing this miserably overpriced product, frequently barge their way into my office poking fun at our use of nutritional supplements instead of the prescription Lovaza. "But insurance covers it in most cases!" they plead. "And your patients will know that they're getting the real product, not some fake. And they'll have to take fewer capsules!"

I never use Lovaza to reduce triglycerides, even in familial hypertriglyceridemia--the FDA-approved indication for Lovaza--and have not yet seen any failures, only successes.
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Comments (24) -

  • Sifter

    6/16/2009 3:43:12 PM |

    I am extremely skeptical of drug company boasts, but I do wonder if they have a point here.... since supplements are not regulated at all, how DO you know you're getting the right omega-3 and the right dosage? they could give you sugar and arsenic... how could you know?

  • mike V

    6/16/2009 4:06:00 PM |

    Hi Doc:
    Two questions please:

    1  It's well known that cutting carbohydrates also lowers trigs. significantly.
    Do you consider increasing omega 3s your primary attack?

    2 In this case is controlling omega 6/omega 3 ratio an issue, as it is in controlling inflammation?

    Thanks

    Mike V

  • Anonymous

    6/16/2009 5:06:06 PM |

    "But insurance covers it in most cases!"

    I wonder how much of the rise in health care costs can be attributed to this mentality? Why use a cheap, effective, non-patentable alternative when you can get something more expensive "for free" through your insurance? I think insurance coverage has had the unintended effect of causing health care to cost more and more since there's been ready money from insurers to cover the costs.

  • Frank Hagan

    6/16/2009 5:37:15 PM |

    Interesting ... I lowered by triglycerides from 344 to 106 mg/l in 6 weeks, but I'm not sure what the mechanism actually was.  I had been taking 1500mg of niacin per day for quite a while with little effect, but started a low carb diet (<30 grams of carbs per day) and taking 1600 mg of EPA in fish oil per day.  Within 6 weeks my test results showed the decrease.  

    I've heard both low carb diets and fish oil help lower triglycerides.  I'm hesitant to change anything ... thinking perhaps that its a "magical mix" of approaches that is working.

  • Venkat

    6/16/2009 9:03:13 PM |

    Thanks for the article Dr. By the way, does the fish oil increase Uric acid in (certain) individuals?

    In my case, I noticed that when I started on fish oil capsules, Uric acid jumped from 5.5 to 8.0 and hence the concern.

    Thanks

    Venkat

  • Anonymous

    6/16/2009 9:56:39 PM |

    We face similar ridicule from specialists. They not only get upset with us for managing our own patients (cardiology wants referrals for high cholesterol, psychiatry wants us to refer to them our average depressed patient, GI wants referrals for initial GERD) but they also very quickly dismiss our efforts to manage patients using generic medications and Vitamin D. We are family physicians. We MANAGE patients.

    A rheumatologist stopped by our office the other day to meet our providers.

    I witnessed his introduction to each provider (so I heard the same speech 5 times) and each time, the second or third sentence began with a list of 2-3 new drugs that the FDA just approved for treatment of XYZ condition, which he is already incorporating into his practice.

    After allowing him the courtesy to make his case, two of our providers questioned his experience with Vit D. His tone turned sour (as did the conversation) and he very quickly rushed through D (commenting that the results of managing D are "mixed" and "the jury is still out on that").

    He specifically asked how we manage patients who fail bisphosphonate therapy, to which one doc replied, "I haven't written for a bisphosphonate in almost 18 months, so I can't say that I've had any patients recently that fail a therapy I haven't put them on. I manage their osteo_____ by cranking up their D level. It's great! I've seen several patients with T-scores that increase 6-8%! Patients go from losing bone to making bone! We didn’t just slow their bone degeneration; we actually made new bone! With the bisphosphonates, you're preventing a natural process from occurring, plus the half life of at least 10 years doesn't sit well with most patients."

    To which the specialist replied, "oh sure. Which is why each patient must go on a drug holiday after 5 years."

    DRUG HOLIDAY? I'd never heard such a term.

    My doc went onto discuss how his patients have been very successfully treated for many types of arthritis without the use of prescription drugs.

    The conversation got especially tense when the specialist questioned how a patient could be “ethically” treated for osteo____ without the use of FDA approved pharmaceuticals.

    Needless to say, the specialist concluded with a comment about how we could stand around and argue medicine all day but he would appreciate more referrals from us.

    Yikes.

    (He also mentioned on more than one occasion how he can see our patients same day. A same day rheumatology referral? I'm struggling to picture a rheumatology referral that would require same day access.....

    He is also only 1 of 2 rheumatologists within 50 miles....and he has same day access and has been in the area for more than 2 years? Leads me to believe that maybe those services are becoming less needed due to D. Just a thought.)

    -JL

  • Ricardo.

    6/17/2009 12:15:33 AM |

    Low carb, low glycemic index, also help reduce tryglicerides:

    http://jn.nutrition.org/cgi/reprint/131/10/2772S.pdf
    http://jcem.endojournals.org/cgi/reprint/85/9/3085.pdf
    http://www.ebmonline.org/cgi/reprint/225/3/178.pdf

  • Anonymous

    6/17/2009 1:01:35 AM |

    That is such a typical specialist reaction to the hormone D issue.  I experience this frequently.

    BTW, Lovaza is marketed by GSK, not AZ.

  • Anonymous

    6/17/2009 1:04:09 AM |

    In the migraine world, the concept of a "drug holiday" is pretty common. It isn't fun - you avoid all meds but it helps avoid rebound or medication overuse headaches.

  • Dr. William Davis

    6/17/2009 2:23:26 AM |

    JL--
    Thanks for your great story! Tell us more.


    Anonymous--

    GSK, AZ--Can you tell the difference? I certainly cannot.

    Their representatives are the same smiling-to-your-face, can-I-please-my-supervisor-and-make-my-bonus? sorts of people after one thing: their own career advancement--whether or not health is served.

  • Richard A.

    6/17/2009 5:38:42 AM |

    Here is an interesting letter to congress from a former drug rep--

    http://aging.senate.gov/events/hr190sa.pdf

  • Nameless

    6/17/2009 3:47:46 PM |

    I ran across a forum for drug reps, while randomly searching for info on a specific drug --

    http://www.cafepharma.com/boards/forumdisplay.php?f=3

    Their practices are scary and they basically come across, for lack of a better term, as evil. Sell their drug, whatever it takes.

  • Anonymous

    6/18/2009 2:32:27 PM |

    I really appreciate this blog but seriously, some times it just scares me into a semi-anxiety attack.
    ( Oh where oh where is my valium, LOL)
    TY Dr. Davis and all who provide such great information.  Keep up the good work!

  • homertobias

    6/18/2009 3:35:00 PM |

    Yes, and everyone wants the free samples.....So the beat goes on.  Doctors are well aware of the tactics that are being used. Most feel that perhaps their colleagues may fall for drug rep tactics.  Doctors underestimate their own vulnerability.  These days the most a drug rep can provide is a free take out lunch for the staff, free pens or a cup of coffee. Most docs don't realize that some drug reps and most of their supervisors make more money than the doctors do!  No wonder lovaza is so expensive.

  • Anonymous

    9/11/2009 2:11:40 AM |

    My trigs roller coastered between 300 and 650.  I was on extreme diets, statins, and Lovaza.  Nothing touched it.  My cardiologist blamed it on genes and said there's nothing much more we can do.  The LAST time I visted him, we argued about it to the point he finally agreed to run a series of blood tests.  Hypothyroidism...  I've been on thyroid medicine for about 5 months and the last two cholesterol screens came back normal in ALL aspects!
    Rich

  • trinkwasser

    10/2/2009 12:03:29 PM |

    Result! Send him to read this blog!

    Yes there are stories of woeful undertreatment of thyroid. My current doctors are very proactive on it - a pleasant change - and report finding problems quite often, increasing with age and female gender but present in others as well.

    This should be a relatively low incidence area - high selenium soil content and iodine from seafood - but there is a large (active) elderly population which might slant the numbers the other way - but they don't have comparative information from other areas to check due to diagnostic bias.

  • dave

    10/28/2009 4:02:26 PM |

    i have high triglycerides too.  i learned a lot from this website:
    http://loweryourtriglycerides.blogspot.com/

  • LarryAJ

    1/17/2010 7:33:26 PM |

    Thanks Dr. Davis for your blog and efforts to make people healthy. I think you will find this blog (if you haven't seen it) by Dr. Mike Eades very interesting as it fits right in with your "Triglyceride buster" blog.

    Four patients who changed my life. (blog by Dr. Eades)

  • Anonymous

    3/19/2010 4:12:51 PM |

    Things are looking up.  This was posted on the CafePharma Board yesterday.
    "Not to burst your bubble, but there are 120,000 reps out of work. Don't bother. Even people with GREAT credentials are finding nothing. Companies will continue to cut back. Access is harder than ever. The only reps that do well with getting even 2 minutes of time have some HOT sample with excellent formulary coverage. Device reps bust their ass and work from 6 am to 7 pm, 5 and even 6 days a week. I am hospital and leave at 6 am to 8 am and come home at 6 pm, on the road from 2 to 5 hours a day. It takes me 30 phone calls/emails to get ONE apppointment and when I show up, I better provide something valuable to the HCP or they will NEVER see me again. Hence, I spend my weekends studying and preparing for work. If I was under age 40, I would go back to school for a tech or nursing degree."

  • Donald

    6/27/2010 5:13:15 PM |

    Being a nurse, I never thought I would see this day. Actual doctors (Dr. Davis and others) promoting alternative therapies that are really not alternative but wholistic in nature. I am just beginning my own journey with self directed preventive care and cannot say enough about the fantastic information available. Looking forward to seeing how this develops. So far my weight has dropped 35 pounds, triglycerides reduced from 323  to 151 and this is just the beginning.

  • Anonymous

    7/2/2010 5:43:43 PM |

    Well I have heard plenty of stories about Omega-3's I have looked into them all including Lovaza and found that only one stands up to the test that truly helps triglycerides to be lowered. OceanBlueProfessional.com has their Omega-3 2100 product that has such a high potency of omega-3 if you take the suggested dosage it really works I take it every day and recommend it to everyone I know.

  • Generic Cialis

    9/23/2010 8:51:39 PM |

    My father has a high level of Triglyceride, and we are all worried about him, I know he takes Omega-3 but I believe he should increase the dose.

  • buy jeans

    11/2/2010 7:43:19 PM |

    I am continually surprised at the number of people with high triglycerides who are still treated with a fibrate drug, like Tricor, or a statin drug, when fish oil--widely available, essentially free of side-effects, with a proven cardiovascular risk-reducing track record--should clearly be the first choice by a long stretch.

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