Very Low Fat Diets

To the Editor: I would like to respond to the recent Science Advisory from the American Heart Association Nutrition Committee on very low fat diets.1 The advisory ignored much of the published scientific data supporting the value of a very-low-fat diet (VLFD) for the prevention and control of coronary heart disease (CAD). No mention was made of the vast amount of epidemiological data supporting the value of a VLFD. Numerous publications from the recent China project document that a society of millions existing on a VLFD has 1/25th the incidence of heart disease we have in the United States.The statement cites 1 study by Ornish and 1 by myself from the Pritikin Center showing “impressive” results. The statement then goes on to criticize the VLFD studies for having a small number of subjects with limited follow-up. The writers ignored the previously published data on 4587 participants from the Pritikin program.2 They also ignored the follow-up data previously reported from the Pritikin program showing good long-term compliance and the avoidance of bypass surgery, as well as the control of diabetes and hypertension.3 4 They criticized the studies for not controlling for weight loss, which is a natural consequence of a VLFD. Because obesity is a major health problem in the United States, the American Heart Association should be supporting the VLFD, not criticizing it.The statement criticizes the VLFD for causing a rise in triglycerides. The writers fail to recognize that a low-fat diet does not cause triglycerides to rise if the fat is replaced by unrefined, complex carbohydrates, naturally high in fiber, as reviewed by Anderson et al.5 Ornish et al6 reported regression of CAD on a 10% fat-calorie diet in spite of a rise in triglycerides.The drop in HDL cholesterol on a …