Triglycerides still high

[dixieman]

Well yesterday I got the results of my labs... cd4's 1542, non-detectable viral load... cholesterol 200 but, for some reason my triglycerides are still up there even with fish oil and meds... #457... I exercise, eat right etc... but, for some reason I can not get them to go down... it seems theres not a magic formula to decrease this... any suggestions that have worked for you?

[John2038]

Excercising + healthy nutrition + omega 3/6/9 oils with high EPA+DHA + vitamin E did easily the trick for me: divided by 50% my triglycerides in just 2 weeks.

Try "eye q liquid" 3 spoon a day with food. I take in more flaxseed Oil 1000mg.

You may want to check your triglycerides level yourself, after wake-up, and check their level taking into account the food you just had eat the days before. Accutrend GCT allows you to check your cholesterol + triglycerides at home. The triglycerides test is quite expensive.

But eating green + fish + white meat is the best you can do for sure.
The next step is in the hand of your doc.

Best Luck
John

[dixieman]

Thanks John... I'll try out your suggestions. My doctor finally has made me an appointment to see an endrocologist... well see what this doctor suggest also. thanks, John

[sharkdiver]

Hypertriclyceridemia from medication is not so easily solved by diet and exercise. (believe me I eat very well and exercise quite a bit, but my Tri # is 3x as much as yours)....And depending on what medication you are taking, you may be limited by what kinds of lipid lowering meds you can take.

Hope you are able to get this under control

[aztecan]

Dixieman, you're not alone.

I have tried just about everything I and my doc can think of and, so far, the only way I have managed to drop my lipids is to cut out just about all food.

I did manage to lose weight that way, but its no way to live.

My next step, if the current regimen of Crestor and Tricor doesn't work, will be to switch out my PI with the Norvir boost and start something new, probably Isentress (Raltegravir).

I hope you find something that works for you.

HUGS,

Mark

[minismom]

Dixie,
I certainly understand the frustration and confusion.  Like Mark, we've tried everything we, and the lipid doctor, can think of and Mim's cholesterol and triglycerides are still super high.  She's on 1000mg of fish oil / day, eats enough fiber to clog a drainage pipe, eats sugar-free, lots of chicken and fish, nothing fried...and it doesn't seem to help.  We took her off of Susteva last year hoping that was the culprit.  It brought her numbers down some a few months later.  But, 4 months after that, they were back up again.  She's not on meds for it because of the negative effects they can have on her liver.

I'm sorry that you are having to go through this.  I truly hope that you are able to find a suitable solution soon.

Mum

[John2038]

Just few comments (reading)

• Medication may help to reduce lipid disorder (e.g. Gemfibrozol Lopid)
• Diet should include fibrate, niacin and omega-3 fatty acids
• Sport is helpful
• The total lipid profile test requires a 12-hour fast (no food or drink, except water).

In more, this article might be interesting for some, maybe

How effective are dietary interventions in lowering lipids in adults with dyslipidemia?

Diets lower in fat, higher in soy protein, or higher in fiber reduce serum total cholesterol, low-density lipoprotein (LDL), and triglycerides. More restrictive low-fat diets also lower high-density lipoprotein (HDL), while soy protein increases HDL. Average in LDL A decreases range from 6.96 to 25.14 mg/dL, depending on the particular intervention and participants' baseline characteristics (strength of recommendation [SOR]: C, based on meta-analyses of randomized controlled trials [RCTs] measuring intermediate endpoints). "portfolio diet" that includes cholesterol-lowering "functional foods" can reduce total cholesterol and LDL; a Mediterranean-type diet can lower LDL (SOR: C, based on fair-quality RCTs, measuring intermediate endpoints). We do not yet know whether the these diets will also help patients live longer and more healthy lives or just improve their lipid profiles.

CLINICAL COMMENTARY

Simple interventions, like reducing fast food and increasing fruit and vegetable intake, are a good starling place

Dietary modifications are necessary for the successful long-term treatment of lipid disorders, as well as many other chronic medical conditions. Patients are often encouraged when they learn they can reverse a disease process without taking a medication. We should take every opportunity to educate our patients and promote healthy lifestyles. Simple interventions, such as eating less fast food and more fresh fruits and vegetables, are often a good starting place.

Other simple interventions to reduce cholesterol levels are taking fiber supplements and substituting commercially available margarines with plant sterols for butter.

Dietary counseling or referral to a medical nutritionist should be part of our overall treatment plan for patients with lipid disorders. Regularly scheduled follow-up visits help promote adherence to therapeutic lifestyle changes and encourage a therapeutic alliance.

Rade N. Pejic, MD
Department of Family Medicine, Tulane University
School of Medicine, New Orleans, La

Evidence Summary

Dietary changes are recommended as first-line treatment for mild to moderate dyslipidemia. We examined evidence on 5 common dietary interventions for adults with dyslipidemia. The average effects on lipid levels are reported in the TABLE.

Low-fat

A meta-analysis of 37 mostly good-quality controlled trials evaluated the former National Cholesterol Education Program (NCEP) Step I and Step II diets in 11,586 participants. (1) The Step I diet restricted intake of total fat ([less than or equal to]30% of total calories), saturated fat ([less than or equal to]10% of total calories), and cholesterol ([less than or equal to]300 mg/d). Step II goals were lower for saturated fat (<7%) and cholesterol (<200 mg/d). Mean baseline lipid values (mg/dL) were total cholesterol, 233.57; LDL, 155.10; HDL, 47.95; and triglycerides, 147.91. Both of these low-fat diets significantly reduced total cholesterol, LDL, and triglycerides. The Step II diet also reduced HDL.

Soy

A meta-analysis of 23 good-quality controlled trials with 1381 participants reported that soy protein with naturally occurring isoflavones significantly reduced total cholesterol, LDL, and triglycerides while significantly increasing HDL. (2) The amount of soy isoflavone consumed varied across studies. One subgroup analysis showed that consumption of >80 mg/d was associated with a better effect on lipids. In subjects with baseline hypercholesterolemia (total cholesterol >240 mg/dL), greater reductions in total cholesterol, and greater increases in HDL were reported, with comparable changes in LDL and triglycerides.

Soluble fiber

A meta-analysis of 67 good-quality RCTs evaluated the effects of soluble dietary fiber in 2990 subjects (mean baseline lipid values [mg/dL]: total cholesterol, 240.9; LDL, 164.4). (3) Diets high in soluble fiber (average dose of 9.5 g/d) were associated with a statistically significant decrease in total cholesterol and LDL and no significant change in HDL or triglycerides. Type of fiber (oat, psyllium, or pectin) was not influential after controlling for initial lipid level.

"Portfolio" diet

A fair-quality randomized crossover study with 34 participants found that a "portfolio diet," which combines the fat intake of the NCEP Step II diet with cholesterol-lowering "functional foods" (including plant sterols, nuts, soluble fibers, and soy protein), markedly reduced total cholesterol and LDL. (4) Mean baseline lipid values (mg/dL) were: total cholesterol, 261.41; LDL, 174.40; HDL, 47.56; triglycerides, 199.28.

Mediterranean diet

A fair-quality RCT with 88 participants reported reduced LDL among subjects assigned to a Mediterranean-type diet. (5) Mean baseline lipid values (mg/dL) were total cholesterol, 255.22; LDL, 170.15; HDL, 58.01; triglycerides, 141.71.

Recommendations from others

The NCEP Adult Treatment Panel III and the American Heart Association recommend the Therapeutic Lifestyle Changes diet. (6,7) The first stage of this diet emphasizes reduction in dietary saturated fat and cholesterol at the levels of the former NCEP Step II diet ([less than or equal to] 7% of energy as saturated fat and [less than or equal to] 200 mg dietary cholesterol). If the LDL goal is not achieved, the second stage emphasizes the addition of functional foods and soluble fiber.

FAST TRACK

A diet lower in fat and higher in soy and fiber reduces serum total cholesterol, LDL cholesterol, and triglycerides

Source

I did manage to lose weight that way, but its no way to live.

I am wondering (assuming no drugs interactions) what a drug like xenical (orlistat) can do to contribute reducing/fixing this problem

[bocker3]

Hey Dixieman-

What meds are you taking?  Is it possible that a change in your regimen could help with the Trigs?  I've been on statins for at least 15 yrs -- had fairly high trigs back then (I forget the results -- but I think it was 300+).  The Zocor did wonders for all my lipids and trigs.  When I started on Sustiva and Truvada in 2005, my total chol went up a little bit (still always between 150-200), while my HDL was raised by about 10, but my trigs did not change -- consistently under 100 then.  In 2006 I had to had a PI and chose Reyataz because it is generally more lipid friendly -- even with the Norvir boost.  This resulted in my trigs going up about 2x.  Since then the trigs have only once been above 200, usually just over the reference range of 150, with my last result actually being 93.
So.....  maybe a med switch could be helpful if nothing else works.

I should point out that I do exercise about 5 times a week -- usually tennis, but could stand to lose a good 30 pounds.  My diet does include a good deal of meat (although I try to keep it as lean as possible), but also has a good deal of fruit and vegetables.  I also take fiber supplements twice a day.

I'm not saying that you would have the same experience as me with my regimen -- everyone's got their own biologic "quirks", but it's something else to consider.

Good luck,
Mike

[sharkdiver]

Speaking of biological quirks
    my LDL and HDL have remained in the lower range for over a year now. But even with taking Lopid my tri's are abdormal. But anyways
The dietary recommendation that has helped with the Tris is cutting out fried foods, sugar and alcohol and reducing carbohydrates. I would recommend that you see a medical  nutritionist that specializes in HIV, because for the most part they are up to date and can individualize a plan for you.

[dixieman]

I wanted to thank everyone for their suggestions... I have an appointment with an endrochronogist so I'll have more tests ran. My cd4's are too high to change meds...sharkdiver I'll change off of sugar and lower carbs... see if that works... I'm a 5%body fat, cholesterol and everything else is great... already exercise so I'll have to see what else is going on... yall have a great day!

[bocker3]

My cd4's are too high to change meds...

I don't understand this?  What does high CD4's have to do with changing meds?  Am I missing something?

Mike

[Miss Philicia]

I thought the same thing.

[mewithu]

I take Gemfibrozil 600 mg one tab twice a day and also lipitor 10 mg once daily
I have normal range now after a long time.

[dixieman]

Mike, to answer your question... I'm on atripila... everything is in check on my labs except for triglycerides... my cd4 count is 1,542 non-detectable... 64% .. so changing meds would not be an option... I've been dealing with hiv for 18 years... exercise seems to not work, the medication to lower the triglycerides is not working and the fish oil does not seem to help either... I'm going to see about cutting out carbs, and sugar to see if this will help as was suggested. thanks for yalls help

[bocker3]

OK -- I get it -- you could change, but you don't want to because things are going well.  I totally get that!  I've not heard that Atripla does much harm to trigs anyway (although, again -- we all have our own biological "quirks").  Thanks for clarifying.  I hope diet helps -- cutting carbs, especially sugar, just might do it.

Mike

[John2038]

Two studies in relation to the subject discussed here.

To summarize those 2 studies:

1) Reductions in triglyceride levels as a result of gemfibrozil treatment were significantly smaller in HIV-positive people (44.2% vs 59.3%, p<0.001), but when responses were analysed according to antiretroviral drug class, people taking non-nucleoside reverse transcriptase inhibitors (NNRTIs) showed a similar triglyceride reduction to that seen in HIV-negative people.

2) Though HIV patients are at higher risk for cardiovascular disease in part due to lipid abnormalities that can occur with the use of certain antiretroviral therapies, researchers now have evidence that cholesterol medications work very well in this population.

aidsmap

Poorer responses to lipid-lowering drugs in people with HIV
People with HIV had poorer responses to lipid-lowering drugs than the HIV-negative population, but these responses varied according to antiretroviral regimen and lipid-lowering drug, according to a major review of patients receiving treatment through California’s Kaiser Permanente managed care system in the San Francisco area. The findings were published in Annals of Internal Medicine.

The study is the largest and most rigorous comparison to date of the effects of lipid-lowering treatments in people with HIV and the general population.

Cholesterol and triglyceride levels may be altered in untreated people with HIV due to effects of HIV infection (lowered levels of `good` HDL cholesterol and elevated triglyceride levels) or effects of some antiretroviral drugs, particularly all the protease inhibitors apart from atazanavir (elevated levels of `bad` LDL cholesterol and triglycerides, normalisation of HDL cholesterol).

More

esciencenews

Largest study compares cholesterol treatment in HIV patients and patients without HIV
A new study in the online issue of Annals of Internal Medicine has found that cholesterol medications can work well among certain HIV patients at risk for cardiovascular disease. Though HIV patients are at higher risk for cardiovascular disease in part due to lipid abnormalities that can occur with the use of certain antiretroviral therapies, researchers now have evidence that cholesterol medications work very well in this population.

More

[guy02840]

I had the same issues with my triglycerides until recently. Aside from attempting to eat well and to work out, I heard of a study being done at Tufts about a Glaxo medication called Lovaza...it is pharmaceutical grade fish oil(Omega 3 and 6). My results have been amazing.....down in the normal range...you may want to try it. I know there are those that knock fish oil due to impuritites, but Lovaza has none as it is controlled by the FDA. So, it worked for me and hope you have the same results!

[Miss Philicia]

That part about Lovaza is very interesting, guy02840 -- thanks (and welcome to the AIDSmeds forums as well

[dixieman]

 guy02840, Thanks for the information... I've called my Doc... and have the prescription ready for pickup... Thanks, John

[pozjack]

I was having problems with that as well. I found that 1/3 of a cantalope a day works miracles. Unfortunately, they're quite expensive. My doc was about to give up on meds for it - too many bad side affects. One visit she gave me a script for time released niacin. She said 'this doesn't work well for most folks, but you're quirky enough.... let's give it a try.' Works great. I'm even on half the recommended dosage.

Good luck!

[mewithu]

I Take Gemfibrozil and lipitor and my results have been in the below normal range for quite some time now.

Good luck to you all and mention this to your docs.

Sincereley,
Jerry

[John2038]

Exercise linked to lower triglyceride levels on HAART
http://www.aidsmap.com/en/news/D945E58E-1E1F-4C53-9013-2A69BE690ABC.asp

[aztecan]

I know someone on Lovaza. I don't yet know how its working for him, but I have my fingers crossed that it knocks his troublesome lipids for a loop.

I have to test again on Monday. At this point, I don't hold out much hope for any positive change without changing my ARV therapy.

Who knows? I could be wrong. But I kinda doubt it.

HUGS,

Mark

[Miss Philicia]

fish oil is only for moderate issues... why note take something more aggressive.

[tendai]

i just wnated to say your CD4 count is awesome, didnt know it could get that high..

[aztecan]

Yep, the CD4s have been pretty good to date. 

As for the cholesterol;

Aside from the 6,000 mgs of fish oil I take, I have taken Vytorin, Niaspan, Pravachol with Zetia, Pravachol without Zetia, Pravachol with Tricor, and, now Crestor with Tricor. I can't take Lipitor because it is contraindicated with my PIs, but so are some of the others, specifically Zocor, a part of Vytorin.

The problem is the statins raise my CPKs too high and cause muscle damage.

But I have talked to several people who have switched to Isentress and that looks promising. I am not giving up, I just may have to take another avenue.

HUGS,

Mark

[John2038]

Have you try ispaghula husk  ?

Results in a study below showed that total cholesterol decreased by 15.8 percent and low-density lipoprotein (LDL) cholesterol decreased by 22.97 percent among patients taking ispaghula husk.

Triglycerides decreased by 20.89 percent and high-density lipoprotein (HDL) cholesterol increased by 10.69 percent in these patients.

http://www.docguide.com/news/content.nsf/news/8525697700573E1885256C860060D1E2

I take it some time (3.5 g) in the morning only just because it is high in fibre.

[Peter Staley]

Have you try ispaghula husk  ?

Results in a study below showed that total cholesterol decreased by 15.8 percent and low-density lipoprotein (LDL) cholesterol decreased by 22.97 percent among patients taking ispaghula husk.

Triglycerides decreased by 20.89 percent and high-density lipoprotein (HDL) cholesterol increased by 10.69 percent in these patients.

http://www.docguide.com/news/content.nsf/news/8525697700573E1885256C860060D1E2

I take it some time (3.5 g) in the morning only just because it is high in fibre.

A 60-patient study published in "Indian Heart Journal"?  Come on, John.  I think it's a little irresponsible to advise someone to take a supplement that hasn't been tested for interactions with anti-HIV meds, based on a puny study published in something far less than a internationally-respected journal.

[veritas]

Peter,

I think there were some studies done with HIV patients. Evidently, it helped with PI indused "runs".

http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102245876.html

http://en.wikipedia.org/wiki/Psyllium_seed_husks


veritas

[Peter Staley]

That's not an interactions study.

[John2038]

About herbal drugs interactions:

http://www.thebody.com/content/art47467.html

(written by the Canadian AIDS Treatment Information Exchange -CATIE)

About the ispaghula husk or psyllium husk:

Psyllium is the seed and husk of the plant Plantago isphagula. It is used to control diarrhea and constipation. Psyllium is the major component of many over-the-counter laxatives such as Metamucil. It absorbs water in the intestine, making stools firmer and more regular. People with HIV often use it to control drug-related diarrhea. One small study used psyllium fiber bars to treat HIV-positive people who were experiencing diarrhea as a side effect of protease inhibitors. Ninety-three per cent of people in the study found that psyllium improved their condition.

Psyllium, because it is a fibre, may also help lower cholesterol levels. No psyllium studies have looked specifically at the cholesterol problems associated with HIV treatments, although a study of diabetic men (who didn't require insulin) with high cholesterol levels showed that psyllium twice a day for eight weeks lowered cholesterol levels.

Psyllium can be purchased as ground seed and taken with water. It can also be purchased in nutrition bars. People taking psyllium should be sure to drink lots of water to prevent it from causing blockage in the intestine. Psyllium interferes with the absorption of other herbs or drugs because it slows the passage of food through the intestine. Wait an hour or two after other treatments before taking psyllium.

Source
http://www.thebody.com/content/art47532.html#

Please cross-check with your healthcare provider.

[John2038]

Response to Lipid-Lowering Therapy in Individuals with and without HIV Infection