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.¹ 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.² 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.³ 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.⁴ 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.⁵ 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.⁶

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%.⁷

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.

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.^8,9,10 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.¹¹ 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.^12,13 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.

Caution: Calcium supplements should be avoided by prostate cancer patients.

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.¹⁹ However, in another trial, calcium supplementation had no effect on TG levels.²⁰ 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.²¹Some,^22,23 but not all, trials^24,25 support these findings. It is not clear whether chromium supplementation affects TG levels in non-diabetics, but some evidence suggests that it does not.^{26,27,28,29,23}

Fenugreek has been shown to lower total and LDL cholesterol and triglyceride levels in people with high lipid levels in preliminary trials.³⁰ 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.³¹ A small randomized trial found similar results using 100 grams fenugreek seeds daily.³² 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.³³ Mild diarrhea and gas can accompany the first few days of fenugreek use, though it almost always fades as the person taking it adapts.

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.^34,35,36,37 In people with normal or low cholesterol or triglyceride levels, FOS or inulin produced little effect.^38,39,40

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.^41,42,43 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.^44,45,46 One negative trial has been criticized for using a steam distilled garlic “oil” that has no track record for this purpose,⁴⁷ 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.⁴⁸

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.

Although primarily used to lower high serum cholesterol, red yeast rice extract, high in monacolins, has been found to significantly lower serum triglyceride levels.⁷⁶ 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. ⁷⁷ Until further information is available, red yeast rice products other than Cholestin cannot be recommended.

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.⁷⁸ 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.⁷⁹ Creatine supplementation in this negative trial was lower—only five grams per day was taken for the last 11 weeks of the study.