Very High Triglycerides

I am in the Rapamycin study at U of Washington. I am at 4 mg per week but I have 3 times normal level of triglycerides despite 1000 mg metformin a day. I wonder if acarbose might be better?

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I don’t think either of those has much effect on triglycerides. Statins, not metformin are usually prescribed for lowering lipids. Niacin if you can tolerate it will also lower your lipids.
Personal experience. Lower your BMI to 22.5 or less. Take niacin or one of the statin drugs

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Hi John, welcome to the forums.

Did you measure your triglycerides prior to starting rapamycin? You might try taking a break from rapamycin for a month and retesting to see what your baseline is (if you didn’t test prior to starting rapamycin).

Here are what I find are the top treatments / suggestions for high triglycerides:

Note - its interesting that gemfibrozil, mentioned below, is also something that Brian Kennedy’s lab is looking at as a longevity drug - see this presentation: Best rapamycin seminars? - #2 by RapAdmin

High triglycerides treatment options

If lifestyle modifications fail to lower triglyceride levels, your physician may give you one of the following four prescriptions:

1. Statins

“Statins, such as Atorvastatin or Rosuvastatin, are medications typically used to treat high cholesterol levels, as well as other risks for cardiovascular disease,” Dr. Malaney says. She further explains that these drugs work by decreasing the liver’s production of cholesterol, and at certain doses can decrease triglyceride levels by 50 percent. “And with these newer, more potent statins, both LDL (“bad” cholesterol) targets and triglyceride targets can be reached,” Dr. Thomas adds.

Even more encouraging: According to a December 2018 scientific statement released by the American Heart Association, side effects from statins tend to be rare, and their benefits outweigh any possible risks.

RELATED: Read more about the side effects of statins

2. Niacin

Also known as vitamin B3, niacin can decrease triglycerides by blocking the release of free fatty acids from fat while increasing the clearance of triglycerides from the blood, Dr. Malaney explains. “In addition, it can boost levels of HDL (“good”) cholesterol and lower levels of LDL (“bad”) cholesterol, so it’s commonly used for adults who have both heart disease and high cholesterol,” she says.

Dr. Thomas states that patients tend to prefer statins over niacin since statins are more tolerable. “And niacin has no demonstrable benefit over a statin,” she says.

3. Omega-3 fatty acids

Fish oil tablets—2 grams per day—have been shown to decrease triglyceride levels by up to 30 percent, Dr. Malaney says. “These pills work by inhibiting the release of triglycerides from the liver and by stimulating the enzyme that clears triglycerides from the blood,” she continues. Dr. Malaney further adds that prescription fish oil preparations, such as Lovaza, contain more active fatty acids than most non-prescription supplements.

4. Fibrates

Medications, such as Fenofibrate and Gemfibrozil, can lower triglyceride levels similarly to fish oil tablets. “Fibrates reduce the liver’s production of VLDL (the particle that circulates in the blood carrying triglycerides) while speeding up the removal of triglycerides from the blood,” Dr. Malaney explains. However, she warns that this medicine should not be prescribed for patients with severe kidney or liver disease.

From: 4 high triglycerides treatment options to prevent heart disease

Other sources of info on this:

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JohnC, The vitamin derivative pantethine may be worth a try. I take one 450 mg capsule in the morning and one in the evening. It lowers all of my bad cholesterol numbers (including triglycerides) nicely. However, at 3 times normal triglycerides a statin like Crestor would likely be much more effective for you.

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I have a lot of time for pantethine which is not rate limited compared to b5 itself. I always take it when drinking to speed up the metabolism of acetaldehyde, but it is known to extend bleeding and may not be good for some people as a result.