Issue 113 Item 5 High-Saturated-Fat, Low-Starch Diet Safe, Effective for Weight

After six weeks of diet treatment showed patients lost 5.14 percent of their total body weight. A diet high in saturated fats and low in starch produced dramatic weight loss without adverse effects on lipid profiles in obese, atherosclerotic patients treated to goal with statins.

The findings were presented here Friday by Michael Stillabower, MD, and colleagues at Mill Creek Medical Center, Wilmington, Delaware, United States, at the annual meeting of the American Association of Clinical Endocrinologists (AACE).

The study enrolled 23 nondiabetic patients, all with atherosclerotic cardiovascular disease but without acute events in the previous six months. All patients had a body mass index of greater than 27 (mean 37.3±5.9), and all had low-density lipoprotein (LDL) levels treated to goal with statins (3-hydroxy-3-methylglutaryl-CoA reductase inhibitors). Statins were continued at the same dose throughout the study.

After baseline morphometric and laboratory measurements, patients were prescribed a diet with 50 percent of calories from saturated fat, 20 percent from protein, and 30 percent from carbohydrate. Minimum calorie intake was 1,800 kcal/day. Patients were encouraged to consume plentiful amounts of fruits and vegetables.

Repeat measurements after six weeks of diet treatment showed patients lost 5.14±2.42 percent of their total body weight. There were corresponding decreases in neck, waist, and hip circumference. Lipid profiles were unchanged except for a decrease in serum triglycerides from 140.3±84.8 to 85.6±42.1 mg/dL. Fasting plasma glucose and fasting plasma insulin both decreased, presumably reflecting the increased insulin sensitivity typically associated with weight loss.

Mean systolic blood pressure decreased by 8.0±4.1 mm Hg (p=0.07), and mean diastolic pressure decreased by 4.8±2.6 mm Hg (p=0.09). This decrease in blood pressure was not significant..

Although the diet was nonketotic by design, five patients had detectable urine and serum ketones at the end of the study. Four of these five were ketotic at baseline, and there was no significant difference in weight loss between patients who did and did not excrete ketones.

Plasma levels of homocysteine and C-reactive protein demonstrated a statistically significant increase, although levels of these inflammatory markers remained below those typically associated with cardiovascular risk. Flow-mediated brachial artery dilation decreased, an effect that has been previously associated with high-fat meals. However, the post-diet levels were outside the range typically associated with cardiovascular risk.

"This is more of a feasibility or pilot study," said study author James Hays, MD, in an interview with Doctor’s Guide. "What you’d really want to do is another group in which you induced comparable weight loss and see if these lipid levels hold up. Ideally we’d like to do that in people not taking lipid-lowering medication," since the statins may have blocked the expected adverse changes in lipid profiles in this study.