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The risk of
ischemic heart disease with low-fat, high-carbohydrate diets |
by:
Michal R.
Pijak |
There is
convincing scientific evidence that type of fat have a more
important role in determining the risk of coronary heart
disease(CHD) than total amount of fat in the diet.(1) However,
because of misleading presentation of epidemiological data by
some authors(1), the readers might be left with the impression
that low-fat, high- carbohydrate diet is the best option for
patients with CHD risk.
In fact, high- carbohydrate diets, in the absence of weight loss, can lead
to both elevated triglyceride and reduced HDL cholesterol,
effects that may be associated with increased risk for CHD.(2)
Although these effects may be lessened with dietary fiber and
moderate physical activity, they appear to be worse among
individuals with insulin resistance.(3)
As reviewed by Kris-Etherton(4) adverse metabolic effects of low fat diet do
not occur with substitution of monounsaturated (MUFA) or
polyunsaturated (PUFA) fatty acids for saturated and trans-fatty
acids. This is also the case for individuals with diabetes, with
the added benefit of better glycaemic control.(5)
As predicted by metabolic studies, replacement of saturated fat, and even
more so trans fatty acids with either PUFA or MUFA was
associated with a larger reduction in risk of CHD than simple
reduction of total fat consumption.(6) With respect to weight
control, a moderate-fat diet can be as, or even more, effective
that lower-fat diet. (6)
References
1. Hu FB, Manson JE, Willet WC. Types of dietary fat and risk of coronary
heart disease: a critical review. J Am Coll Nutr 2001;20:5-19.
2. Fung MA, Frohlich JJ. Common problems in the management of
hypertriglyceridemia. CMAJ 2002;167:1261-6.
3. Jeppesen J, Schaaf P, Jones G, Zhou MY, Chen YD, Reaven GM. Effects of
low-fat, high-carbohydrate diets on risk factors for ischemic
heart disease in postmenopausal women. Am J Clin Nutr
1997;65:1027-33.
4. Kris-Etherton PM, Kris-Etherton PM, Binkoski AE, Zhao G, Coval SM,
Clemmer KF, et al. Dietary fat: assessing the evidence in
support of a moderate-fat diet; the benchmark based on
lipoprotein metabolism. Proc Nutr Soc 2002;61:287-98.
5. Rivellese AA, De Natale C, Lilli S. Type of dietary fat and insulin
resistance. Ann N Y Acad Sci 2002;967:329-35.
6. Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ et al.
AHA Dietary Guidelines: revision 2000: A statement for
healthcare professionals from the Nutrition Committee of the
American Heart Association. Circulation. 2000;102:2284-99.
About the author:
Dr. Michal R. Pijak is a consultant in rheumatology, allergy and
clinical immunology at the University Hospital in Bratislava,
Slovakia
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