Key takeaways

  • The higher a person’s triglyceride levels, the more likely they are to experience acute pancreatitis. Very high triglycerides occur when triglyceride levels reach 500 milligrams per deciliter (mg/dl), but when they reach 1000 mg/dl or more, the risk of acute pancreatitis increases significantly.
  • Treatment for pancreatitis caused by very high triglycerides often requires hospitalization. It focuses on managing acute inflammation and rapidly lowering triglyceride levels through insulin therapy, plasmapheresis, or medications such as fibrates or omega-3 fatty acids.
  • Lifestyle modifications, such as a balanced diet low in simple carbohydrates and saturated fats, avoiding alcohol and tobacco, and staying physically active, can help manage triglyceride levels and reduce the risk of developing or recurrent pancreatitis.

The pancreas has two roles in lipid (fat) metabolism. It has an exocrine function that breaks down dietary fats and an endocrine function that regulates blood sugars.

If a person has very high triglycerides (hypertriglyceridemia), their body may sometimes convert the triglycerides into substances that can trigger pancreatitis, which is inflammation of the pancreas.

Although experts do not fully understand the relationship between very high triglyceride levels and pancreatitis, they theorize that triglyceride-rich lipoproteins, which carry triglycerides and cholesterol through the bloodstream, interact with the enzyme that breaks down fats in the pancreatic capillaries.

The body then breaks down triglycerides into free fatty acids and phospholipids, which then form a lipid called lysophosphatidylcholine (LPC).

Both free fatty acids and LPC can damage the pancreas, leading to pancreatitis.

Hypertriglyceridemia is the third leading cause of acute pancreatitis and is responsible for around 5% to 25% of cases.

The higher a person’s triglyceride levels, the higher the risk of pancreatitis. Doctors consider the following hypertriglyceridemia levels when determining severity:

  • mild hypertriglyceridemia: 150 to 199 milligrams per deciliter (mg/dL)
  • high hypertriglyceridemia: 200 to 499 mg/dL
  • very high hypertriglyceridemia: 500 mg/dL and above

For those with triglyceride levels of 1000 mg/dl or higher, the incidence of acute pancreatitis increases to about 10% of cases, and those with levels of 2000 mg/dl or higher account for about 20% of pancreatitis cases.

Typically, acute pancreatitis causes severe pain and swelling in the upper abdomen, which may also reach the back.

The pain may worsen when coughing, moving vigorously, or breathing deeply. Leaning forward or sitting upright may ease the pain.

Other symptoms may also include:

  • vomiting
  • nausea
  • low blood pressure
  • lightheadedness when first moving from a seated to standing position
  • raised body temperature

If a person has symptoms that could indicate pancreatitis, they should contact a doctor or another healthcare professional as soon as possible.

Healthcare professionals will treat acute pancreatitis due to very high triglycerides in a similar way to other causes, but they will need to lower triglyceride levels as a matter of urgency.

It may be necessary to stay in the hospital for treatment, which may include:

  • food restriction, as this can reduce triglyceride levels by around 50% within 24 hours
  • intravenous (IV) fluids
  • pain relief
  • treatment for other metabolic health conditions, such as diabetes

A healthcare team may also use the following medications to lower triglyceride levels:

  • fibrates, such as fenofibrate (Tricor, Antara, Lipofen) and gemfibrozil (Lopid)
  • omega-3 fatty acids, such as icosapent ethyl (Vascepa), omega-3-acid ethyl esters (Lovaza, Omacor), and omega-3-carboxylic acid (Epanova)
  • niacin (Niaspan)
  • statins, such as atorvastatin (Lipitor), rosuvastatin (Crestor), simvastatin (Zocor), pravastatin (Pravachol), and fluvastatin (Lescol)

A person can work with their healthcare team to determine the best way to reduce their personal risk of pancreatitis. However, lifestyle adaptations can also reduce risk.

Some strategies that may help include:

  • Avoid drinking alcohol (if applicable): Drinking alcohol causes 17% to 25% of acute pancreatitis cases. If a person also has very high triglycerides, the risk of acute pancreatitis increases even more. Consider avoiding alcohol altogether for better health.
  • Quit smoking (if applicable): Smoking is common in both acute and chronic pancreatitis. It can increase the risk of recurrent acute pancreatitis episodes, even when not combined with other risk factors like alcohol consumption.
  • Choose a healthy, balanced diet: During an acute pancreatitis episode, a person’s healthcare team will likely recommend they avoid food altogether. However, during recovery, they will typically focus on a low fat diet, including small, more frequent meals that will not irritate the pancreas.
  • Gallbladder removal (cholecystectomy): Removing the gallbladder may help prevent future complications, especially if a person has previously had gallstones.

People with gallstones and those with alcohol use disorder have the highest risk of acute pancreatitis. The third most common cause is very high triglycerides.

Some people have hereditary acute pancreatitis, and research has identified specific gene alterations that predispose people to the condition.

Additionally, people with cystic fibrosis or those who have cystic fibrosis in their genes have a higher risk of both acute and chronic pancreatitis.

While pancreatitis is a serious complication of very high triglycerides, managing triglyceride levels effectively can significantly lower the risk of the condition and its recurrence.

Focusing on a healthy, balanced diet, avoiding alcohol and smoking, and taking medications as instructed by a medical professional will help an individual manage their overall health and well-being.