—The case described by Dr Siguel and colleagues raises 3 issues. Because of differing views, Dr Ornish and I respond separately.Frequently, triglyceride levels increase and HDL-C levels decrease for individuals on vegetarian, high-carbohydrate diets. Since low HDL-C, particularly with high triglycerides, incurs substantial risk of coronary events,1,2I do not recommend a high-carbohydrate strict vegetarian diet. Reducing carbohydrate and weight lowers triglyceride levels and raises HDL-C levels.3For this reason, my Program for Preventing or Reversing Coronary Heart Disease utilizes less than 10% of calories as fat, no-fat low-carbohydrate protein sources, low-carbohydrate sufficient to maintain lean body habitus, and volumes of vegetables for fiber and phytonutrients. These protein sources include no-fat yogurt, no-fat cheese, skim milk, no-fat cottage cheese, and egg whites or soy protein, supplemented optionally with some turkey, chicken, fish or buffalo/venison with cholesterol intake below 50 mg/d and 10% of calories as
Gould KL. Very Low-Fat Diets for Coronary Heart Disease: Perhaps, But Which One?-Reply. JAMA. 1996;275(18):1402–1403. doi:10.1001/jama.1996.03530420030029
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