To the Editor.
—News media across the country reported the findings by Dr Gould and colleagues1 that very low-fat diets can lead to regression of coronary artery disease. Although their results are encouraging, we urge caution in treating patients with such diets. Schaefer et al2 have reported that low-fat diets without weight loss lead to a decline in high-density lipoprotein cholesterol (HDL-C) and increases in triglycerides and ratio of total cholesterol to HDL-C. We3 suggested that low essential fatty acids (EFAs) may be the cause, but no comment was included in the article by Gould et al1 about the long-term effects of the diet on levels of EFAs or about the fact that the treatment may be harmful in certain patients. The following case illustrates the problem.A 66-year-old man with a family history of premature death attributable to heart disease, a previous myocardial infarction, and
Siguel E, MacBeath BR, Lerman RH. Very Low-Fat Diets for Coronary Heart Disease: Perhaps, But Which One?. JAMA. 1996;275(18):1402. doi:10.1001/jama.1996.03530420030028