Very high triglyceride levels (defined as 500mg/dL or 5, 6 mmol/l) are associated with early onset of diseases such as angina pectoris or heart infarction, and should therefore be treated. In the United States very high triglyceride levels occur in about 3,8 million patients and can be caused by several genetic conditions such as familiar combined hyperlipidemia or because of other underlying conditions such as diabetes, hypothyroidism, liver- or kidney failure and other autoimmune diseases.
The vast majority of cases however, can be contributed to obesity and a sedentary lifestyle. Excess alcohol intake and certain medications (such as β-blockers, antipsychotic medications, estrogen and corticosteroids among others) can also contribute to the elevation in blood triglyceride.
Once the underlying conditions mentioned above has been excluded it’s recommended that patients initiate multifaceted lifestyle changes – most importantly weight reduction in combination with increased physical activity to improve their blood lipid profiles and decrease the risk of the medical conditions mentioned above. However, medical intervention in addition to lifestyle changes is often needed for successful treatment.
Reducing Triglycerides with Omega-3 Fatty Acids
Omega-3 fatty acids are available as dietary supplements or in some countries (USA included) as prescription medicine and are often delivered in one gram capsules. The content of the actual omega-3 fatty esters Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) vary widely between different supplement companies, so do not think that all capsules are made equal – always check the concentration of EPA and DHA in the capsules before you buy a fish oil supplement. The content of EPA and DHA in prescription based Omega-3 is generally much higher than in the dietary supplements.
One study from 2009 reviewed the research available to see if prescription Omega-3 could effectively decrease levels of blood triglycerides (1). The analysis included totally 84 adult patients with triglyceride levels of more the 500 mg/dl. The patients were given four prescription based 1 g capsules of Omega-3 fatty acids (each capsule containing 465 mg and 375 mg of EPA and DHA respectively). The results from the two studies are shown in the table below.
Conclusion: Four 1 g capsules can reduce triglyceride levels by up to 45 % while improving the whole blood lipid profile in mere weeks. The intervention was well tolerated and the study dropout was minimal – confirming that adverse effects from the fish oil intake were unusual.
The American Heart Association recommends fatty fish consumption twice weekly for sufficient Omega-3 fatty acid intake. Hover, the amount of EPA and DHA provided with this dietary intervention might not be enough to decrease triglycerides in certain patient groups. The study above shows that in addition to weight loss and an increased physical activity, an additional increase in Omega-3 fatty acid intake can dramatically improve the blood lipid profile in this patient group and is well tolerated. However, always make sure to check the exact content of EPA and DHA in your fish oil supplement as the dosage of one gram capsule of prescription based Omega-3 might be equivalent of as much as 4-5 capsules in the form of dietary supplement depending on the concentration.
Like you needed another reason to take your fish oils?
1. Sadovsky, R., & Kris-Etherton, P. (2009). Prescription omega-3-acid ethyl esters for the treatment of very high triglycerides. Postgraduate Medicine,121(4), 145-153.Svensk översättning på denna artikel kommer inom kort.
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