Originally posted by Dr. Davis on 2013-10-14
on the Wheat Belly Blog,
sourced from and currently found at: Infinite Health Blog.
PCM forum Index
of WB Blog articles.
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
–Achieves weight loss–especially from
visceral fat stores
–Reduces blood sugar–often sufficient to reverse diabetes
–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.