Common problems in the management of hypertriglyceridemia

Michelle A. Fung; Jiri J. Frohlich

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Low fat diet
Kristen N MacEachern

Posted on: 26 November 2002
Low Fat Diets Will Increase, Not Decrease Tryglycerides: Some Vegetable Alternatives
Dr. Joseph Mercola

Posted on: 26 November 2002

Posted on: (26 November 2002)
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Low fat diet
Kristen N MacEachern, Registered Dietitian
In response to your article about hypertriglyceridemia, I wonder where reference for a diet containing less than 10% of calories from fat is from. This would be a very low fat diet. I have read your stated reference #12, the Executive Summary of the Third Report of the National Cholesterol Education Program, Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. The recommendation th...
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In response to your article about hypertriglyceridemia, I wonder where reference for a diet containing less than 10% of calories from fat is from. This would be a very low fat diet. I have read your stated reference #12, the Executive Summary of the Third Report of the National Cholesterol Education Program, Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. The recommendation there is to consume 25-35% of calories from fat and goes on to break this down between the unsaturated and saturated fats. Assistance is appreciated so I may better counsel my patients on this matter.
Sincerely,
Kristen MacEachern RD
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Competing Interests: None declared.
Posted on: (26 November 2002)
Page navigation anchor for Low Fat Diets Will Increase, Not Decrease Tryglycerides: Some Vegetable Alternatives
Low Fat Diets Will Increase, Not Decrease Tryglycerides: Some Vegetable Alternatives
Dr. Joseph Mercola, Physician
Dr. Froelich and Frung provide a practical summary of the important issue of hypertryglyceridemia. This is an especially important clinical concern as the ratio of HDL/tryglycerides has been documented as one of the most important cardiovascular risk factors. (1)
However, they perpetuate the myth that “A very-low-fat diet (total fat intake <10% of total daily energy intake)” will be helpful in the management of this probl...
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Dr. Froelich and Frung provide a practical summary of the important issue of hypertryglyceridemia. This is an especially important clinical concern as the ratio of HDL/tryglycerides has been documented as one of the most important cardiovascular risk factors. (1)
However, they perpetuate the myth that “A very-low-fat diet (total fat intake <10% of total daily energy intake)” will be helpful in the management of this problem. (2)
Horn and Lichtenstein (3) extensively reviewed this approach a few years ago, and their full text article is available on line for review. Examination of their evidence would suggest that applying a low fat diet regimen will in fact produce the exact opposite effect, one’s tryglycerides will actually increase.
This is not surprising when one considers that insulin resistance may be one of the central driving forces of elevated tryglycerides. Insulin resistance may actually be the culprit behind much of the pathology observed in high tryglyceride states.(4-5)
Since there are only three macronutrient components in the diet available, a low-fat diet automatically assumes increases in the protein and carbohydrate fractions of the diet. Since most people eat a fixed amount of protein, the majority of the calories are shifted to carbohydrates. The problem results when the individual consumes high glycemic grains, rather than vegetables, as an alternative to fat. The grains are rapidly metabolized to simple sugars that are clearly associated with increases in tryglyceride elevation. (6)
An alternative therapeutic approach is to radically reduce all grain and simple sugar consumption. Unpublished data in our medical center over the past twenty years has shown consistently rapid resolution of hypertryglyceridemia in dozens of patients who presented this problem.
It is a simple, inexpensive, and non-toxic approach to substitute grains and sugars with low glycemic green leafy vegetables. It is certainly a reasonable alternative to the more expensive and potentially toxic pharmacologic options that are traditionally applied.
References
[1] Gotto AM Jr. Triglyceride: the forgotten risk factor. Circulation. 1998 Mar 24;97(11):1027-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9531247&dopt=Abstract
[2] Fung, M A, Frohlich JJ; Common problems in the management of hypertriglyceridemia CMAJ 2002 167: 1261-1266 http://www.cmaj.ca/cgi/content/full/167/11/1261
[3] Lichtenstein AH, Van Horn L. Very low fat diets. Circulation. 1998 Sep 1;98(9):935-9. http://circ.ahajournals.org/cgi/content/full/98/9/935
[4] Jonkers IJ, van de Ree MA, Smelt AH, et. Al. Insulin resistance but not hypertriglyceridemia per se is associated with endothelial dysfunction in chronic hypertriglyceridemia. Cardiovasc Res. 2002 Feb 1;53(2):496-501. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11827701&dopt=Abstract
[5] Schwarz JM, Linfoot P, Dare D; Hepatic de novo lipogenesis in normoinsulinemic and hyperinsulinemic subjects consuming high-fat, low-carbohydrate and low-fat, high-carbohydrate isoenergetic diets. American Journal of Clinical Nutrition, Vol. 77, No. 1, 43-50, January 2003
[6] Ostos MA, Recalde D, Baroukh N, et. Al. Fructose intake increases hyperlipidemia and modifies apolipoprotein expression in apolipoprotein AI-CIII-AIV transgenic mice. J Nutr. 2002 May;132(5):918-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11983814&dopt=Abstract
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Competing Interests: None declared.