I wrote this letter, which was published in the Canadian Medical Journal, in response to their fatally flawed review on how to manage high triglycerides. The authors sought to promote the concept that a low-fat diet is the way to manage high triglycerides. High triglycerides is one of the most responsive conditions I have ever seen in medicine. Simple restriction of all grains and sugars--which is the basis of my latest book, Dr. Mercola's Total Health Program--seems to be the solution for nearly everyone with this problem. I have yet to find a cooperative patient who has failed to normalize their triglycerides with this approach.

By Joseph Mercola, D.O.

The ratio of high-density lipoprotein cholesterol to triglycerides has been documented as one of the most important cardiovascular risk factors.1 However, Michelle Fung and Jiri Frohlich2 perpetuate the myth that a low-fat diet will be helpful in the management of this problem.

Lichtenstein and Van Horn3 extensively reviewed this approach a few years ago. Examination of their evidence suggests that a low-fat dietary regimen will produce a result opposite to the desired effect: triglyceride levels will actually increase.

This outcome is not surprising if one considers that insulin resistance may be one of the driving forces behind elevated triglyceride levels. In fact, insulin resistance may be the culprit in many of the problems observed in high-triglyceride states.4,5

Since only 3 macronutrient components are available for any diet, a low-fat diet automatically entails increases in the protein and carbohydrate fractions. Most people eat a fixed amount of protein, so the majority of the calories would be shifted to carbohydrates. The problem occurs when the person consumes grains with a high glycemic index, rather than vegetables, as an alternative to fat. The grains are rapidly metabolized to simple sugars, which are clearly associated with elevated triglyceride levels.6

An alternative therapeutic approach is to radically reduce consumption of all grains and simple sugars. In contrast to the pharmacologic options that are traditionally applied, it is simple and inexpensive to substitute green leafy vegetables, which have a low glycemic index, for grains and sugars, and there are no toxic effects.

Canadian Medical Journal April 1, 2003; 168

1. Gotto AM Jr. Triglyceride: the forgotten risk factor. Circulation 1998;97(11):1027-8. [Free Full Text]

2. Fung MA, Frohlich JJ. Common problems in the management of hypertriglyceridemia [published erratum appears in CMAJ 2003;168(1): 16]. CMAJ 2002;167(11):1261-6.[Free Full Text]

3. Lichtenstein AH, Van Horn L. Very low fat diets. Circulation 1998;98(9):935-9. [Free Full Text]

4. Jonkers IJ, van de Ree MA, Smelt AH, de Man FH, Jansen H, Meinders AE, et al. Insulin resistance but not hypertriglyceridemia per se is associated with endothelial dysfunction in chronic hypertriglyceridemia. Cardiovasc Res 2002;53(2): 496-501. [Medline]

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. Am J Clin Nutr 2003; 77 (1): 43-50.[Abstract/Free Full Text]

6. Ostos MA, Recalde D, Baroukh N, Callejo A, Rouis M, Castro G, et al. Fructose intake increases hyperlipidemia and modifies apolipoprotein expression in apolipoprotein AI-CIII-AIV transgenic mice. J Nutr 2002;132(5):918-23. [Abstract/Free Full Text]