—Drs Ratner and Smith-Ratner refer to the use of high-fat diets before the discovery of insulin and a few decades afterward. Although Newburgh and MacKinnon noted no increase in plasma cholesterol levels with these extremely fat-rich (60% to 80% of energy) diets particularly rich in saturated fats, this primarily was because of reducing energy intake. Since the 1960s it has become well known that saturated fats, trans fats, and cholesterol raise plasma cholesterol levels. Therefore, foods such as cream, butter, eggs, and bacon, which are rich in saturated fats and cholesterol, should be restricted. We used a diet with 45% of energy from fat, not 60% as suggested by Drs Ratner and Smith-Ratner. Diets extremely rich in fats (≥60% of energy) can be ketogenic and thus should be avoided. In our opinion, a diet with 35% to 45% of energy from fat (mostly monounsaturated fats) is more appropriate.
Garg A. Varying Carbohydrate Intake in NIDDM-Reply. JAMA. 1994;272(23):1818. doi:10.1001/jama.1994.03520230027019