To Your Health

Does fish oil work as well as Tricor to reduce triglycerides associated with diabetes?

Q. I have type 2 diabetes and the high triglyceride level that often goes with it. My doctor had first recommended dietary changes, but I didn't stay with the diet, so they did not work. Then he prescribed Tricor but recently took me off Tricor and put me on fish oil. Why might he make that change, and does fish oil work as well as Tricor to reduce triglycerides?

A. There is strong scientific evidence from human and animal research that omega-3 fatty acids from fish oil supplements (eicosapentaenoic and docosahexaenoic acids, usually abbreviated EPA and DHA) reduce blood triglyceride levels by as much as 40%. This is comparable to the results found with prescription medications such as Tricor. Although benefits are found with EPA/DHA doses as small as 2 grams per day, the best results are found with doses of 4 grams per day, which requires taking five capsules or more daily. This amount will reliably produce a fishy "burp" that is more unpleasant to some people than others. If it threatens to keep you from continuing to take the fish oil supplement, try taking the capsules at bedtime. You will still burp the fishy taste but will probably sleep right on through it.

You obviously have an astute physician who is aware of the advantage of fish oil over Tricor. Both can lower triglyceride level, and both can raise HDL ("good") cholesterol levels. The bonus from fish oil is that the DHA in fish oil can also help keep your blood sugar under control, something that Tricor does not do. All by itself, normalizing blood sugar goes a long way toward normalizing triglyceride level. Combining the anti-diabetic activity of DHA and the triglyceride lowering action of EPA seems to be a winning combination.

Ordinarily, combining nutritional supplements with drug therapy is beneficial or at least has no effect on outcome. Such is not the case with omega-3 fatty acids and Tricor. More research is needed, but at present it appears that Tricor affects the balance of the omega-3 and omega-6 fatty acids, which already tends to be unbalanced toward too much omega-6 and too little omega-3. If a choice between the two therapies is necessary, the omega-3 fatty acid supplement, with a two-pronged approach to the problem, seems to have the advantage.

In addition to lowering triglyceride and blood sugar levels, omega-3 fatty acid supplements provide a variety of beneficial "side effects." Several studies report that omega-3 fatty acids may reduce the risk of developing breast, colon, or prostate cancer; have anti-inflammatory effects that will benefit those who suffer with asthma, Crohn's disease, rheumatoid arthritis, psoriasis, and other inflammatory conditions; and may help with depression and anger management. This broad spectrum of beneficial activity, with so many conditions being affected by omega-3 fatty acids, indicates that for far too long we have ignored the effects of the quality of fat in our diets and concentrated only on the effect of the amount of fat. While it may be necessary because of reduced physical activity to modify our calorie intake, and with it fat intake, we should be careful to maintain an adequate amount and sensible balance of the important essential fatty acids.

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