Low-fat diets raise triglycerides

19. May 2007 William Davis (4)
Martin, a hospital employee, knowing that I fuss a great deal with lipids and lipoproteins, showed me his lipid panel because the result triggered a "panic value" for triglycerides at 267 mg/dl. He asked if he should go on a serious low-fat diet.

I asked Martin what he had for breakfast: a whole wheat bagel with no-added-sugar jam. Lunch: a turkey sub on whole grain bread, no mayonnaise. Snacks: baked chips, pretzels ("a low-fat snack!").

In years past, if person developed high triglycerides levels, a very low-fat diet was prescribed. Someone would come to the hospital, for instance, with abdominal pain from pancreatitis (an inflamed pancreas)due to the damaging effects of triglyceride levels >1000 mg/dl. For this reason, many people still believe that all instances of elevated triglycerides should be treated with a reduction in fat intake.

This is absolutely wrong. While a fat restriction may reduce triglycerides in genetically-programmed responses when triglycerides are >1000 mg/dl, lesser levels of high triglycerides of, say 250 or 300 mg/dl, do not respond to dietary fat restrictions as a sole strategy.

Yes, a reduction in unhealthy fats (saturated, trans, polyunsaturated) helps. But a reduction in fats of all sorts is not necessary and can, in fact, worsen the problem. We learned this lesson years ago with the Ornish diet and similar ultra low-fat approaches. When you reduce fat intake significantly to <10% of calories, triglycerides go way up. In those days, it wasn't uncommon to see triglycerides skyrocket past 200 or 300 mg/dl on these diets.

Why are triglycerides important? Triglycerides are an ingredient in creating the lipoproteins VLDL, IDL, small LDL. Elevated triglycerides trigger a drop in HDL, a shift towards small, ineffective HDL, and contribute to heightened inflammation. Higher triglycerides also tend to go hand in hand with lipoproteins that persist for extended periods (12-24 hours or longer) in the blood after a meal.

Triglycerides respond very nicely to a dramatic reduction in processed carbohydrates, especially wheat and corn. Of course, wheat is the bulk of the problem, since it has grown to occupy an enormous role in many people's diet, not uncommonly eaten 3,4, or 5 times per day in various forms, as it has in Martin's diet. Eliminating all sources of high-fructose corn syrup is also helpful, since high-fructose corn syrup shoots triglycerides way up. (Recall that high-fructose corn syrup is everywhere: ketchup, beer, low-fat or non-fat salad dressings, breads, fruit drinks, sports drinks, breakfast cereals, etc.)

Curiously, it is a fat that also powerfully reduces triglycerides in the form of fish oil. In the Track Your Plaque program, fish oil, taken at truly effective doses of 4000 mg per day or more (to provide at least 1200 mg EPA+DHA), is our number one choice after reduction of processed carbohydrates for reduction of high triglycerides.
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Comments (4) -

  • Bruce K

    6/10/2008 7:42:00 PM |

    _I asked Martin what he had for breakfast: a whole wheat bagel with no-added-sugar jam. Lunch: a turkey sub on whole grain bread, no mayonnaise. Snacks: baked chips, pretzels ("a low-fat snack!")._

    What do you think of Joel Fuhrman's approach? He would not allow people to eat bagels, jam, bread, chips, and pretzels. The base of his diet is veggies (half raw, half-cooked), then fruits, beans, potatoes, raw nuts, and raw seeds. Grains are at the top of Fuhrman's food pyramid.

    http://www.nutritionforwellness.org/img/food_pyramid.gif

    Also, when he says "whole grains", he means unbroken grains like brown rice, oatmeal, etc. Not flours, or pastas, or breads made with flour. The only breads he would allow are things like sprouted grain breads, made without any flour.

    Most people who eat a low-fat diet eat bad foods. They don't eat high quality foods. Dr. Fuhrman claims to lower triglycerides and improve all other health markers, because he stricly limits foods like flour, fruit juice, vegetable oils, sugar, etc. Maybe a low-fat diet based on grains (esp flours) will raise the triglycerides, but a low-fat diet based on vegetables, fruits, beans, nuts, and seeds (Fuhrman's) wont.

    Fuhrman emphasizes nutrient-density far more than people like Dr. Dean Ornish. Whole grain flours are very perishable and quickly turn rancid. Weston Price pointed this out, but most people didn't bother to listen and still don't. Here's an article about how whole grain flours cause sterility if they are stored for as little as 15 days, while flour and bread that is fresh-ground doesn't. How many are eating fresh flour? I would say <1%, maybe zero.

    http://eap.mcgill.ca/Publications/EAP35.htm

  • Anonymous

    7/1/2009 11:14:32 AM |

    Just a small correction - Dr Fuhrman's diet is not really low fat like Ornish/McDougall, the only similarity to those diets is the predominance of plant based foods.

    It eliminates/restricts saturated fat and plant oils but he is VERY pro 'good' fat in it's natural packaging i.e. nuts, seeds, avocado and fish oil in some cases (he prefers DHA from algae due to mercury in fish for most people and esp pregnant/lactating/babies but for high doses still recommends high quality fish oil especially for autoimmune patients). Re the nuts/seeds/avocado - in his weight loss strategy he does limit them but a minimum level is compulsory on a daily basis and he actively encourages people to have them while maintaining ideal weight i.e. can go very high if very skinny, lower if overweight but cannot eliminate them.

  • buy jeans

    11/3/2010 6:41:31 PM |

    Yes, a reduction in unhealthy fats (saturated, trans, polyunsaturated) helps. But a reduction in fats of all sorts is not necessary and can, in fact, worsen the problem. We learned this lesson years ago with the Ornish diet and similar ultra low-fat approaches. When you reduce fat intake significantly to <10% of calories, triglycerides go way up. In those days, it wasn't uncommon to see triglycerides skyrocket past 200 or 300 mg/dl on these diets.

  • jim

    8/26/2011 4:23:10 PM |

    Do saturated fats elevate triglyceride levels in the body?  Jim

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Can you break the “Rule of 60”

Can you break the “Rule of 60”

21. April 2007 William Davis (1)
In the Track Your Plaque program, we aim for conventional lipid values (LDL cholesterol, HDL cholesterol, and triglycerides) of 60—60—60, i.e., LDL 60 mg/dl, HDL 60 mg/dl or greater, triglycerides 60 mg/dl. Most participants do indeed reach these target values.

When I tell this to colleagues, they’re stunned. “You can’t possibly get those numbers in most people.” And I can sympathize with their plight. After all, they are stuck with relatively lame tools: statin drugs, the American Heart Association diet. I’d be surprised if they ever achieved 60—60—60.

But can you drop your heart scan score even if you don’t reach the 60—60—60 targets? Yes, you can. The Rule of 60 is only a guideline, a tool that helps more people achieve our goals. The Rule of 60 does not guarantee reversal (drop in heart scan score), nor does not achieving the targets completely destroy your chances.

We have had many people drop their scores even if they haven’t reached the targets. On the other hand, we’ve also had people who failed at first, only to see success once they achieved the 60 mg/dl targets.

But which one are you? That’s the problem. We possess limited capacity to predict who will or who will not drop their scores from the start. We know that there are factors that stack the odds in your favor (e.g., optimism, lack of Lp(a), ideal weight, vitamin D >50 ng/ml, etc.). We know that there are factors that make it tougher (overweight, Lp(a), pessimistic attitude, underappreciated hypertension, higher heart scan scores, etc.) But at the start, we just don’t know who truly needs to adhere to the Rule of 60. So we suggest that everyone, at least in the beginning, aim to achieve it.

I had an exception the other day. Rich did everything by the Track Your Plaque book. However, a starting low HDL of 27 only rose to 37 after one year of effort—way below our 60 mg/dl target. Yet a repeat heart scan showed 23% reduction.

Why would Rich be so successful despite a persistently very low HDL? There may be a number of reasons. One explanation could be that conventional measures of HDL fail to distinguish between what HDLs truly work and what do not. Look at ApoA1 Milano; remember this story? The people in the secluded mountain village of Limone-Sul-Garde in northern Italy have HDL cholesterols of 8-15 mg/dl yet do not experience excess vascular atherosclerosis, suggesting that what little HDL they have is super-effective.

Yes, large HDL seem to be more healthy and effective than small HDL, but perhaps there’s more to it. However, nobody has a HDL effectiveness test ready for us to use.

In the meantime, we continue to suggest that the Track Your Plaque Rule of 60 be considered as a means of making plaque reversal as likely as possible. You and your doctor can always adjust in future, depending on your heart scan score results.
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Comments (1) -

  • Anonymous

    7/8/2008 4:45:00 AM |

    "The people in the secluded mountain village of Limone-Sul-Garde in northern Italy have HDL cholesterols of 8-15 mg/dl yet do not experience excess vascular atherosclerosis, suggesting that what little HDL they have is super-effective."

    Isn't further investigation warranted?  Some other dietary factor
    or lifestyle habit may be the reason and not because "what little HDL they have is super-effective."
    this assumption could be missing something previously unknown.

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