A carbohydrate restricted diet is superior to a low‐fat diet in subjects with metabolic syndrome

Abstract

Metabolic syndrome is associated with high triglycerides, low HDL cholesterol, and a predominance of small LDL particles. We compared the effects of a standard American Heart Association low-fat diet (<30% fat, <10% saturated fat) to a carbohydrate (CHO) restricted diet (about 10% carbohydrate) in overweight men and women with high TG (>150 mg/dL) and low HDL-C (men <40 men, women <50 mg/dL). Fasting blood collections were performed on two separate days for determination of lipids and an oral fat tolerance test was done to assess postprandial lipemia before and after 12 weeks. Weight loss in the CHO restricted group (n=20, age 32.6 yr, BMI 33.5 kg/m2) was two-fold greater than the low-fat group (n=14, age 36.5 yr, BMI 32.9 kg/m2). Compared to the low-fat diet, the CHO restricted diet was associated with an increase in HDL cholesterol (−2% and 13%), a decrease in triglycerides (−11% and −51%), and a decrease in postprandial lipemia (−5% and −47%). There were no differences between diets on total or LDL cholesterol, but there was a significant increase in peak and mean LDL particle size on the CHO restricted diet. In subjects with elevated triglycerides and low HDL cholesterol, a low-fat diet does little to improve their dyslipidemia. A CHO restricted diet on the other hand was very effective at ameliorating the features of metabolic syndrome.