High triglycerides: Wheat elimination or gemfibrozil?

April posted this question about high triglycerides. High triglycerides are very confusing to many people, often even ignored by many of my colleagues. Because she got such lousy advice from her doctor and because the solutions are really SO simple, I thought I’d relate her story with the advice that really works.

I had blood work done last week after experiencing some edema in my feet and legs. My non-fasting triglycerides were 600 mg/dl and the doctor wants to put me on gemfibrozil and do a HbA1c to rule out diabetes. I want to try Wheat Belly first before taking the meds. Is that reasonable?

He told me I need to start the medicine right away or I am at risk of pancreatitis. I am about 100 pounds overweight, so I obviously need to make some dietary changes. This is kind of scary stuff to me. I was told other than the triglycerides my cholesterol was ‘OK.’ My vitamin D was also very low at 13 ng/ml so I was given a prescription of D3 (50,000 I.U.) for 12 weeks. I just really don’t want to start a medication like the gemfibrozil without at least giving diet a chance.

April likely has “Familial Hypertriglyceridemia,” a genetically-determined abnormality in which she is unable to clear triglycerides formed from diet. We know several things based on the facts provided by April:

1) Potential for pancreatitis really shows itself at around a triglyceride of 1000 mg/dl. This is very bad: Not only is it very painful, but it can do irreversible damage to the pancreas, both endocrine (killing off beta cells that produce insulin) and exocrine (killing off the cells that produce digestive enzymes like pancreatic lipase and trypsin). But a low-grade, imperceptible degree of beta cell damage can occur at triglyceride levels below 1000 mg/dl, sufficient to impair insulin responses and bring the prospect of irreversible type 2 diabetes closer.

2) While fats and oils are, by definition, triglycerides, a much larger contributor to blood triglycerides is the process of de novo lipogenesis: liver conversion of sugars and carbohydrates to triglyceride-containing lipoproteins. You can see this with extended monitoring of blood triglycerides: After a meal of mixed composition (fats/oils, proteins, carbohydrates, fibers), there is a modest initial rise in triglycerides at 2-4 hours, followed by a much larger rise 6-8 hours, the time lag represented by liver de novo lipogenesis from carbohydrates. High triglycerides are therefore largely caused by grains and sugars.

3) High triglycerides can be made worse by insulin resistance/pre-diabetes/diabetes. On this issue, April’s doctor was correct: Look for diabetes: Fasting glucose and HbA1c (reflecting the last 90 days of blood sugars) will almost certainly be high, given the excess weight. Conventional answer: prescribe metformin and a low-fat diet. My answer: Go berserk on diet to reduce both blood sugar (and HbA1c) and triglycerides: NO grains, NO sugars; don’t worry about fat but have MORE of it.

4) Gemfibrozil? This is a drug from the fibrate class, but similar to statin drugs in side-effects. It can reduce triglycerides 100-200 mg/dl, rarely more, so it’s not a complete answer. And it has little benefit beyond this.

5) Fish oil–If there is an agent that reduces triglycerides, it’s the omega-3 fatty acids from fish oil, EPA and DHA. However, higher doses are required, e.g., 3600 mg EPA + DHA per day, divided into two doses. Omega-3 fatty acids activate the enzyme, lipoprotein lipase, that is responsible for clearing triglyceride-containing lipoproteins from the bloodstream. Ideally, this should come in the form of liquid triglyceride fish oil, such as that from Ascenta NutraSea or Nordic Naturals, not the stuff from big box retailers that comes in capsules as the less well-absorbed ethyl ester form. It should certain NOT be the prescription form, Lovaza, as this is a big ripoff, plain and simple. (It represents a loophole in FDA regulations in that a company who can spend the money to gain FDA approval for a health indication can take something in the public domain and give it the veneer of a “drug” while charging drug-like prices for it–typical monthly cost: $300–provided physicians can be persuaded to prescribe it. There is NO analysis showing superiority over, say, Sam’s Club fish oil for $18.99 for triple-strength capsules with 900 mg omega-3s.) And it should not be krill oil, a trivial source of EPA + DHA, nor linolenic acid from flaxseed or chia. (These are fine foods, but not for reducing triglycerides.)

6) Correct vitamin D deficiency–At 13 ng/ml, April is woefully deficient. While correcting vitamin D deficiency does not reduce triglycerides per se, it can improve insulin responses and indirectly reduce triglycerides. The dose of D3 or cholecalciferol–the HUMAN form–is likely to be something like 10,000 units per day, the dose required to raise her 25-hydroxy vitamin D level to 60-70 ng/ml. (The prescription form is usually D2 or ergocalciferol, the MUSHROOM form, that is inferior in effect and duration. I don’t believe any mushrooms read this blog. There is a prescription D3, but it is not usually prescribed.)

This approach is uniformly effective. While gemfibrozil reduces triglycerides but achieves little else, the above approach also:

–Achieves weight loss–especially from visceral fat stores
–Reduces blood sugar–often sufficient to reverse diabetes
–Reduces hypertension
–Reduces appetite–since you lose the gliadin-derived opiates that stimulate appetite
–Reduces inflammation–because you lose the gliadin-induced abnormal intestinal permeability
–Improves gallbladder function–because you lose the lectin of wheat that blocks cholecystokinin, the hormone that stimulates the gallbladder
–Improves bowel flora–since the disruptive effects of gliadin, wheat germ agglutinin, and amylopectin A are removed.
–Improves a long list of other individual wheat-related phenomena

Target triglyceride level? I aim for 60 mg/dl or less, the level that we KNOW is associated with complete relief from abnormal triglyceride-related phenomena.

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Comments & Feedback...

  1. Kat

    In about 2005 i had fasting triglycerides of 658. The docs freaked, but i just smiled at them. Within 9 months i had that number down to 178 – all with a change of diet. (The doc made me really angry when he saw the 178 – didn’t look at the previous test – and said, “Oh! We have to get those triglycerides down.” I nearly slapped him! I’d dropped them by over 450 points and he didn’t even realize it.)

    I was already eating gluten-free in those days (not the nearly grain-free that i am now), but i was still consuming a lot of things with high fructose corn syrup (HFCS) in them. I love Pepsi, and lots of sauces and candy bars (they are gluten-free!) and very sweet things. In that 9 months i cut out 100% of anything with HFCS. I was and am very proud that i dropped my triglycerides that way. I had a test run just a couple of months ago again – fasting triglycerides 148. My total cholesterol is “high” – but still under 300, and that does not concern me at all. As long as it stays under 300 i don’t see an issue with it.

    I still miss sugar a lot. I’ve been 99% sugar-free since January now (not meaning i have 1% a day, but that about every 5-6 weeks i’ve had something with sugar). I do still use stevia. I know Dr. Davis advocates Splenda, but i have had severe toxic reactions to that one when i’ve had tiny amounts by accident; if i were to take a full dose of it, i think it would kill me. I must be a real sugar-addict because i really miss it and could revert tomorrow back to where i was in 2005, but i believe that the choice i am making to avoid grains and sugar means a healthier life for me tomorrow and next month and next year, etc.

  2. kwakinmi

    I’m a 62-year-old female with 35 pounds to lose (again!) My cholesterol levels have always been excellent. My most recent lipid panel, though, came back not so great:
    272 mg/dl cholesterol (last year: 188)
    59 mg/dl HDL (was 65)
    200 mg/dl LDL (was 111)
    4.6 Chol/HDL ratio (was 2.9)

    My triglcerides are not too bad, at 65 mg/dl (previously 59).

    I was just one week into following a Wheat Belly food plan (with 6.6 pounds lost!) when I had this blood work done. I’ve no desire to take statins and I believe these numbers will turn around. (I also wonder if the elevation may be due to taking glucosamine chondroitin supplements, since there’s anecdotal evidence this raises cholesterol in some people. I stopped taking these after receiving my lab results.)

    So here’s my question: Is it common for LDL cholesterol levels to temporarily rise immediately upon adopting a low carb / higher healthy fats diet?

    Thanks in advance for any insight.

    • derp

      Short answer: Yes, it will take some time. But LDL-C is a useless lab value. Get the LDL particle count.

  3. Deb Brandt

    How long does it take to see the triglyceride and A1c numbers to decrease? I suspect it is probably directly related to how high they are. Mine were just slightly elevated and I went wheat free last December and have lost 30 #s, feel awesome and my numbers were down in May and stopped my Lipitor but my Triglycerides were still at 88 and my A1c was 5.8
    Thanks for all you have done!

  4. In situations like April’s it’s often the case hyperglycemia, hypertension, hypertriglyceridemia, and insulin resistance are related to magnesium deficiency. Improving magnesium intake also has a beneficial impact on the body’s ability to absorb and utilize vitamin D3.
    Magnesium intake decreases Type 2 diabetes risk through the improvement of insulin resistance and inflammation so will fit in well with the protocol Dr Davis has outlined.
    We don’t know what April’s blood pressure is but if it’s verging on pre-hypertension then consider adding potassium as well.

    • Neicee

      Mr. Ted Hutchinson, I find your comments with links on many sites. I have to tell you that one of the links you left over at http://www.dietdoctor.com on potassium really helped me. I kept getting heart palpitations and was taking magnesium (probably not as much as I do now) but adding a higher dosage of potassium leveled out the heat palps and I feel much better. So many thanks and I think you’re a great asset to those of us using Bing or Google to try and learn about supplements.
      And, thank you Dr. Davis for putting through the message again, of how and why we need to keep our triglycerides in check is so important. I’ve kept mine at 55-60 over a year. And, my husband has kept his lower, even having a beer or two a week after golf. Drat!

      • L.S.

        Hi Neice,

        I’ve noticed a strong heartbeat with palpitations at times, especially at night when laying on the couch and switching positions my heart will palpitate at times. Can you provide me with the direct link to which you refer to please. Thank you.

        • Neicee

          A year ago or so, I visited my primary physician due to those little ticks at times. Not out of control or off beats, just a steady, harder than usual, heartbeat for a few minutes. I was referred to an endo and they said my heart appeared to be fine. But, after a gazillion dollars in tests they felt it was due to high calcium loss. So, naturally it must be hyper parathyroid issues. I was scheduled for surgery in a matter of days but the surgeon (God bless him) said no. His guess was that it was osteoporosis. And, it was. However the little off beats kept showing up now and then. I doubled my Vit D3, magnesium and started researching the need for potassium. Added some liquid kelp tablets too. It worked out better when I paid more attention to the potassium. I’m due for blood tests within the next couple of months and hope everything is better.

          • Neicee

            L.S. I remember now where I saw the article. Was flipping through Dr. Malcolm Kendrick’s site. Believe I simply used the search there and it came up showing Ted Hutchinson and a link to a great article about potassium.

      • Marv D.


        I’d like to briefly share my heart palp experience (a lot of extra and irregular heartbeats), it may be helpful. Had them usually overnight too, stopping quietly after the morning routine began. I started Magnesium Supp (3 x 1250mg Mag Malate = 425mg Mag per day) and they went away for months (even over a cruise with every “trigger” in excess!). They came back in August so I started a spreadsheet log with a row for every day of the year and a simple checkmark and remarks if I had palps that night.

        I did not expect what I saw a month into logging: they were coming every 4th night, accompanied by frequent urination and a 3-5 pound lower-than-expected morning weight.

        Since this sure looked like a level of something peaking and causing a problem, I stopped the Magnesium on 9/18/13 and haven’t had another palp since. There is certainly a careful balance required between magnesium, calcium, potassium, salt, all the electrolytes. I was probably poisoning myself, even at the RDA of magnesium, by affecting the balance even though it initially helped. Almonds are high in magnesium too, and I’m eating a ton of them (and loving it!).

        Try a log if your palps are irregular. Hope this is helpful.
        –Marv (1-1/2 yrs wheat-free; never going back! I am a new man.)

        • Nobelly

          Marv – that is very interesting. Obviously the magnesium had a diuretic effect on you causing dehydration and possible electolyte imbalance. It speaks to why we should not take any supplements unless we are sure we are deficient.

          • Marv D.

            Nobelly? (Love that name!)

            It could be that, but I think it’s more that the electrolytes have to be balanced. Like taking calcium if you take magnesium – just taking one may deplete the other; still researching. The consensus is that in America we’re all deficient in magnesium to start with. Supplements are to prevent deficiency, no? – you don’t wait until you’re deficient to take them. In any case I’m fine now and I appreciate the info :)
            –Marv (54 and now officially not a single health complaint, all hail Dr. D!)

        • Yes, somewhere on this blog, Dr. Davis cautions about supplementing with calcium (I think he recommends no m ore than 600 mg/day) as it is associated with increased risk of heart attacks.

    • April

      My blood pressure was 128/78 I believe. The doctor did not say anything about it, but it is higher than it used to be. My A1c ended up being 5.8 and a retest when fasting showed triglycerides of 260 with the rest of the lipid profile being normal. Total cholesterol was 178. So I have chosen diet and am working on cutting out sugar and am reading Dr. Davis’s book. Hopefully after cutting wheat, grains, and sugar things will look much better.

  5. Anne Rhodes

    I know that Dr. Davis recommends Magnesium supplement, specifically, Magnesium Malate. But I have also read that Magnesium Glycinate is recommended. Dr. Davis, what is the difference? And does it matter which form you take?

    Anne Rhodes

  6. Mark.

    Of course, alcohol and fructose get converted to triglycerides so eliminating them can’t hurt either — although in this case that might not make a telling difference.

  7. Patt Satterfield

    I have been wheat free for almost 7 months, thanks to my niece, Debi Williams. My A1C has dropped from 13 to 7, lost about 30 pounds, only taking 18 units of insulin per day instead of 45 to 50,MY tris was 95 instead of 150, and my cholesterol was 119 from 200.. Before starting this lifestyle I could not walk very far because of arthritis and neuropathy in my feet. Regularly, I go to walk at some of the parks with my grandkids. I can walk almost 2 miles without having to rest 4 or 5 times. Wheat belly is saving my life. The doc says if I keep up the good work on my A1c,HHe may take me off my insulin! whhooo- hoo! Thanks.

    • derp

      Add the high-fat component to your low-carbohydrate, wheat-free lifestyle: go ketogenic. This should bring down your fasting glucose much faster.

  8. This is a great post that many people will find helpful. We’ll share it with our network as well. Thanks for continuing to provide such insightful and useful information.

  9. Denise

    Dr Davis,

    I ordered the Nordic Natural EPA you had suggested. I am only taking one pill a day and having a though time will diaherra. I do take a probiotic in the a.m. As well. Any suggestions on how to take the EPA without the side effects?

    Thank you.

    • Barbara in New Jersey

      Are you taking it with a full meal?
      Perhaps stop taking this for a day or so to see if the diarrhea stops.

      • Denise


        Yes, I am taking with breakfast. I am going to stay off it until Saturday and try again to see what happens. :)

  10. Karen

    My Vitamin D count is low by about 1/2 what it should be and when I try to take supplements my joints kill me while I am on these. What would you suggest for me to try since this makes it impossible for me to walk when my knees hurt so bad while I am taking it. The same happens to me when I get anything with MSG or artificial sweetners as well. I also had cancer in February took no chemo or radiation and had the same thing happen when I took metformin for my sugar (it also made me constipated for almost 2 weeks did not have BM) an when they tried me on a drug like tomoxifin for the cancer. I had LVSI and finally I decided I hurt so bad that I opted to do nothing. I have always been extremely allergic to most pain meds as well for many years. Basically I can take Morphine and tylenol and that is it.

    Any guidance on the D would be helpful to me as I want to increase my levels but it just does not seem to work without killing my joints.

    • Drae

      Karen, I would check to make sure your supplements are wheat/gluten free. I’ve been shocked to discover how many supplements and vitamins contain wheat. Make sure to check any and all prescriptions for wheat/gluten as well as it is often used as a binder (Tylenol is GF). MSG should be avoided for a number of reasons, including that it can be derived from wheat, and in many people can cause the same reactions that wheat causes.

      As for sweeteners, I’ve discovered that HFCS and other artificial sweeteners affect my joints, so now I avoid them completely. When I do have sweets, the more natural sweeteners of real sugar, honey, maple syrup and agave don’t have the same impact. However, sugars can cause bad gut flora to multiply, in addition to its relation to insulin resistance, so it’s best to eliminate it completely.

      Hope this helps, and good luck!

      • > When I do have sweets, the more natural sweeteners of real sugar,
        > honey, maple syrup and agave don’t have the same impact.

        “Natural” buys these simple saccharides little or nothing. In addition to the gut flora and insulin provoking issues, they also all contain fructose (some more than others), and fructose has a long rap sheet of crimes even glucose doesn’t commit.

        … and that’s if they’re real honey, maple syrup and agave. These products are commonly adulterated in today’s packaged retail market
        (google “honey laundering”).

        Label assurances are meaningless. If you’re lucky, the bee spit or raw fruit sugar has been replaced by reasonably pure cane syrup. If you’re not, it could bring any number of contaminants, random chemicals, bacteria, heavy metals.

        Anyone who insists on eating honey, maple syrup and agave needs to buy from a trusted local supplier.

        Unfortunately, these sugars are being “cut” due to supply and demand. I’m concerned that if demand rises for safe alternatives, and supply can’t keep up, crooks will cut them with real sugars or other random, potentially hazardous fillers.

        • Drae

          Boundless – thanks for the information! I do buy locally produced honey and locally produced vegan honey made from apples – and I would love to hear your take on it.

          I’ve come a long way reigning in my sweet tooth, and I’m hoping when I complete a Whole 30 that I’ll finally have it completely whipped. Again, thanks for the info and I look forward to seeing any information you can share about apple derived honey.

          • > any information you can share about
            > apple derived honey.

            I’m not familiar with it specifically, but having lately run the numbers on apples, and this being the internet, I can of course opine. :)

            Apple carbs are largely sugars, and that sugar is surprisingly high in fructose (70%, which is higher than HFCS, and 60% of the sugars are free fructose, just like HFCS). Apart from avoiding possible GMO issues from the corn, my guess is that apple-based honey might as well be HFCS. I presume you have seen:

            Using a local supplier, you probably are avoiding adulteration. But consuming simple saccharides, particularly fructose, has so many metabolic hazards that the adulteration risks are really secondary.

            We lucky at this moment in time to have multiple reasonable alternative sweeteners. I see zero reason to consume real sugars, other than as unavoidable deminimus amounts occurring naturally in veggies and small portions of low-fructose fruits.

  11. Anna

    Hello! I am not at all sure where to ask this, so I hope someone here will help. I bought Wheat Belly, and I am very interested in going “wheat free” for my health (pre-diabetes, overweight, acid reflux, you name it). However, I have a BIG stumbling block. I am allergic to all nuts. All of them, in any form: peanuts, tree-nuts, and coconut. As well as peas and lentils (I was told they’re in the nut family, don’t know if thats true, but I know they make me very ill). What is the best alternative that’s not nut based? I know “gluten free” stuff is a no no, and I have read several things on here that make it seem like oats, quinoa, and barley are also out. What can I have instead? (PS: I actually like oats, quinoa, and barley, so if those are okay let me know!)

    Thank you so much.


    • Tony

      Hi Ana,
      Check out this post by Dr. Davis, I’m sure it’ll be helpful:

      With your list of issues I’d pretty much stick to “enjoy unlimited” section as a starting point.

      You don’t really have to have nuts if you can’t handle them. Basically the idea is to cut carbs down to under 50g per day and replace them with vegetables, healthy fats: avocados, healthy oils, and meats and eggs.

      All of the stuff listed in your PS is not okay. FYI barley actually has gluten.

      • Barbara in New Jersey


        Since you have so many food sensitivities, you also might want to make sure you keep yourself hydrated and take the supplements Dr. Davis recommends, especially the probiotics.

        Many people have reported that they gradually become less sensitive to the foods you mention the longer they are grain and sugar free.

    • Drae

      Anna – there are a number of great paleo recipe sites out there and all of them will have numerous recipes you can enjoy – just google! It can take a little time to get adjusted to this new way of cooking, but once you do, you’ll find it easier to navigate as you start seeing food in a new light. Good luck!

  12. Anna

    Thank you both for the information! I guess I specifically meant as a flour substitute, since most of the baking recipes I’ve seen require nut flours. I’ll check out the link Tony sent. Barbara, I will definitely stay hydrated and check out those supplements, but as for the nut allergy, its straight up an anaphylaxis reaction, not just a sensitivity, so I don’t expect to ever be able to have them even in small doses.

    Thanks again, both of you!

    • Tony

      Hi Anna, I hope this works out for you, sounds like you need change.

      I have to say I’ve been doing this since the beginning of the year and I still haven’t baked a single thing, and frankly, I don’t feel like I missed anything. :-)

      I started out as 25lbs overweight and pre-diabetic. Now I’m 25lbs lighter with normal blood sugar, lower BP, and better lipids, so for me it was definitely worth it.

      Good luck.

  13. Dawn

    If you suffer from gluten related disorders, there is a free online event that is to take place next week. Each day, 3-4 interviews with leading experts on this topic will be available for a 24 hour period. I used to suffer from multiple migraines each month and since going gluten free a little over a year ago, I rarely get headaches!

    If interested, click on this link to go to the registration page. There is no cost to attend! https://gg110.infusionsoft.com/go/tgs/dfralick/