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To the Editor.—
The conclusion that estrogen administration (Molitch et al, 227:522, 1974) caused an increase in blood lipids, and that withdrawal of estrogen therapy resulted in a lowering of blood lipids, seems to me to be too restrictive in its interpretation. It is apparent on reviewing the case presentations that the patients, when on an unrestricted diet, had high levels of triglycerides and cholesterol, but, when on low-carbohydrate and low-saturated-fat diets, had more normal blood levels. On searching the bibliography, I see no reference to articles on the effect of fructose and estrogen on liver production of triglycerides, and I cannot help but conclude that the authors have overlooked this important synergy. The articles by Ian Macdonald (Clin Sci 27:23, 1964; Am J Clin Nutr 16:458, 1965; Am J Clin Nutr 18:86, 1966) implicated sucrose as a cause of increased fasting triglycerides. Later, Macdonald (Am J Clin Nutr 20:185, 1967)
Applegate WV. Hyperlipemia During Estrogen Therapy. JAMA. 1974;228(7):826. doi:10.1001/jama.1974.03230320014007