Current Cardiology Reports

, Volume 6, Issue 6, pp 464–473 | Cite as

Aggressive diets and lipid responses

  • Claudia Panzer
  • Caroline M. Apovian


Poor diet and physical inactivity, the two major contributors to the development of overweight and obesity, have recently been identified as the second most common actual cause of death in the United States. With the increasing awareness of the strong link between obesity and chronic disease, in particular cardiovascular disease, a myriad of diets have surfaced and many of them claim weight loss depends more on the macronutrient composition of the diet than the number of calories consumed. Long-term outcome data, particularly cardiovascular outcome data, on these diets are sparse. This article summarizes previous and recent reports of popular and aggressive diets, such as low-carbohydrate diets, low-fat diets, and very low-calorie diets, addressing their effects on weight loss and focusing on their effects on lipids and lipoproteins.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Healthy Weight, Overweight, and Obesity among U.S. adults. Accessible at http:/ adultweight/pdfGoogle Scholar
  2. 2.
    Mokdad AH, Marks JS, Stroup DF, et al.: Actual causes of death in the United States, 2000. JAMA 2004, 291:1238–1245. Analysis of epidemiologic, clinical, and laboratory studies on risk behaviors and mortality identifying poor diet and physical activity as the second leading cause of death in 2000.PubMedCrossRefGoogle Scholar
  3. 3.
    Howard BV, Ruotolo G, Robbins DC: Obesity and dyslipidemia. Endocrinol Metab Clin North Am 2003, 32:855–867.PubMedCrossRefGoogle Scholar
  4. 4.
    Denke MA, Sempos CT, Grundy SM: Excess body weight. An under-recognized contributor to dyslipidemia in white American women. Arch Intern Med 1994, 154:401–410.PubMedCrossRefGoogle Scholar
  5. 5.
    Despres JP, Moorjani S, Ferland M, et al.: Adipose tissue distribution and plasma lipoprotein levels in obese women. Importance of intra-abdominal fat. Arteriosclerosis 1989, 9:203–210.PubMedGoogle Scholar
  6. 6.
    Denke MA, Sempos CT, Grundy SM: Excess body weight. An underrecognized contributor to high blood cholesterol levels in white American men. Arch Intern Med 1993, 153:1093–1103.PubMedCrossRefGoogle Scholar
  7. 7.
    Zwiauer KF, Pakosta R, Mueller T, et al.: Cardiovascular risk factors in obese children in relation to weight and body fat distribution. J Am Coll Nutr 1992, 11(Suppl):41S-50S.PubMedGoogle Scholar
  8. 8.
    Hokanson JE, Austin MA: Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of populationbased prospective studies. J Cardiovasc Risk 1996, 3:213–219.PubMedCrossRefGoogle Scholar
  9. 9.
    Castelli WP: Cardiovascular disease and multifactorial risk: challenge of the 1980s. Am Heart J 1983, 106:1191–1200.PubMedCrossRefGoogle Scholar
  10. 10.
    Coresh J, Kwiterovich PO Jr.: Small, dense low-density lipoprotein particles and coronary heart disease risk: A clear association with uncertain implications. JAMA 1996, 276:914–915.PubMedCrossRefGoogle Scholar
  11. 11.
    Serdula MK, Mokdad AH, Williamson DF, et al.: Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999, 282:1353–1358.PubMedCrossRefGoogle Scholar
  12. 12.
    If you want to change your life Atkins can help. Available at http:/www.atkins.comGoogle Scholar
  13. 13.
    St Jeor ST, Howard BV, Prewitt TE, et al.: Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation 2001, 104:1869–1874.Google Scholar
  14. 14.
    American Heart Association statement on high-protein, lowcarbohydratediet study. Presented at the 75th annual AHA scientific sessions. Chicago, IL; November 17–20, 2002.Google Scholar
  15. 15.
    Hegsted DM, McGandy RB, Myers ML, et al.: Quantitative effects of dietary fat on serum cholesterol in man. Am J Clin Nutr 1965, 17:281–295.PubMedGoogle Scholar
  16. 16.
    Keys A: Effects of different dietary fats on plasma-lipid levels. Lancet 1965, 17:318–319.PubMedCrossRefGoogle Scholar
  17. 17.
    Mensink RP, Katan MB: Effect of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 27 trials. Arterioscler Thromb 1992, 12:911–919.PubMedGoogle Scholar
  18. 18.
    Bravata DM, Sanders L, Huang J, et al.: Efficacy and safety of low-carbohydrate diets: a systematic review. JAMA 2003, 289:1837–1850.PubMedCrossRefGoogle Scholar
  19. 19.
    Brehm BJ, Seeley RJ, Daniels SR, et al.: A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab 2003, 88:1617–1623. Randomized controlled trial to determine the effects of a very lowcarbohydrate diet on body composition and cardiovascular risk factor in healthy women.PubMedCrossRefGoogle Scholar
  20. 20.
    Samaha FF, Iqbal N, Seshadri P, et al.: A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 2003, 348:2074–2081. Randomized controlled trial over the duration of 6 months to compare the effects of a low-carbohydrate diet with a low-fat diet on weight loss and cardiovascular risk factors in severely obese subjects with a high prevalence of diabetes and the metabolic syndrome.PubMedCrossRefGoogle Scholar
  21. 21.
    Stern L, Iqbal N, Seshadri P, et al.: The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med 2004, 140:778–785. A 12-month update of the previous report on a randomized controlled trial to compare the effects of a low-carbohydrate diet with a low-fat diet on weight loss and cardiovascular risk factors in severely obese subjects with a high prevalence of diabetes and the metabolic syndrome.PubMedGoogle Scholar
  22. 22.
    Foster GD, Wyatt HR, Hill JO, et al.: A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003, 348:2082–2090. One-year randomized trial comparing the effects of a low-carbohydrate diet with a low-fat diet on weight loss and cardiovascular risk factors.PubMedCrossRefGoogle Scholar
  23. 23.
    Yancy WS, Jr., Olsen MK, Guyton JR, et al.: A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med 2004, 140:769–777. Randomized controlled trial over 6 months comparing the effects of a low-carbohydrate diet with a low-fat diet on weight loss and cardiovascular risk factors.PubMedGoogle Scholar
  24. 24.
    Djousse L, Hunt SC, Arnett DK, et al.: Dietary linolenic acid is inversely associated with plasma triacylglycerol: the National Heart, Lung, and Blood Institute Family Heart Study. Am J Clin Nutr 2003, 78:1098–1102.PubMedGoogle Scholar
  25. 25.
    Harris WS: n-3 fatty acids and serum lipoproteins: human studies. Am J Clin Nutr 1997, 65:1645S-1654S.PubMedGoogle Scholar
  26. 26.
    Harris WS, Lu G, Rambjor GS, et al.: Influence of n-3 fatty acid supplementation on the endogenous activities of plasma lipases. Am J Clin Nutr 1997, 66:254–260.PubMedGoogle Scholar
  27. 27.
    Ginsberg HN, Karmally W: Nutrition and Lipids. Philadelphia:American College of Physicians-American Society of Internal Medicine; 1999.Google Scholar
  28. 28.
    Laidlaw M, Holub BJ: Effects of supplementation with fish oil-derived n-3 fatty acids and gamma-linolenic acid on circulating plasma lipids and fatty acid profiles in women. Am J Clin Nutr 2003, 77:37–42.PubMedGoogle Scholar
  29. 29.
    Lewis SB, Wallin JD, Kane JP, et al.: Effect of diet composition on metabolic adaptations to hypocaloric nutrition: comparison of high carbohydrate and high fat isocaloric diets. Am J Clin Nutr 1977, 30:160–170.PubMedGoogle Scholar
  30. 30.
    Golay A, Allaz AF, Morel Y, et al.: Similar weight loss with low- or high-carbohydrate diets. Am J Clin Nutr 1996, 63:174–178.PubMedGoogle Scholar
  31. 31.
    Campos H, Dreon DM, Krauss RM: Associations of hepatic and lipoprotein lipase activities with changes in dietary composition and low density lipoprotein subclasses. J Lipid Res 1995, 36:462–472.PubMedGoogle Scholar
  32. 32.
    Kiens B, Essen-Gustavsson B, Gad P, et al.: Lipoprotein lipase activity and intramuscular triglyceride stores after long-term high-fat and high-carbohydrate diets in physically trained men. Clin Physiol 1987, 7:1–9.PubMedGoogle Scholar
  33. 33.
    Dattilo AM, Kris-Etherton PM: Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr 1992, 56:320–328.PubMedGoogle Scholar
  34. 34.
    Mensink RP, Katan MB: Effect of monounsaturated fatty acids versus complex carbohydrates on high-density lipoproteins in healthy men and women. Lancet 1987, 1:122–125.PubMedCrossRefGoogle Scholar
  35. 35.
    Anderson JW, Konz EC, Jenkins DJ: Health advantages and disadvantages of weight-reducing diets: a computer analysis and critical review. J Am Coll Nutr 2000, 19:578–590.PubMedGoogle Scholar
  36. 36.
    Patsch JR, Miesenbock G, Hopferwieser T, et al.: Relation of triglyceride metabolism and coronary artery disease. Studies in the postprandial state. Arterioscler Thromb 1992, 12:1336–1345.PubMedGoogle Scholar
  37. 37.
    Stampfer MJ, Krauss RM, Ma J, et al.: A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction. JAMA 1996, 276:882–888.PubMedCrossRefGoogle Scholar
  38. 38.
    Witztum JL, Steinberg D: The oxidative modification hypothesis of atherosclerosis: does it hold for humans?. Trends Cardiovasc Med 2001, 11:93–102.PubMedCrossRefGoogle Scholar
  39. 39.
    Holvoet P, Vanhaecke J, Janssens S, et al.: Oxidized LDL and malondialdehyde-modified LDL in patients with acute coronary syndromes and stable coronary artery disease. Circulation 1998, 98:1487–1494.PubMedGoogle Scholar
  40. 40.
    Sharman MJ, Kraemer WJ, Love DM, et al.: A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. J Nutr 2002, 132:1879–1885.PubMedGoogle Scholar
  41. 41.
    Bergeron N, Havel RJ: Assessment of postprandial lipemia: nutritional influences. Curr Opin Lipidol 1997, 8:43–52.PubMedGoogle Scholar
  42. 42.
    Gaenzer H, Sturm W, Neumayr G, et al.: Pronounced postprandial lipemia impairs endothelium-dependent dilation of the brachial artery in men. Cardiovasc Res 2001, 52:509–516.PubMedCrossRefGoogle Scholar
  43. 43.
    Steinberg HO, Paradisi G, Hook G, et al.: Free fatty acid elevation impairs insulin-mediated vasodilation and nitric oxide production. Diabetes 2000, 49:1231–1238.PubMedCrossRefGoogle Scholar
  44. 44.
    Inoguchi T, Li P, Umeda F, et al.: High glucose level and free fatty acid stimulate reactive oxygen species production through protein kinase C--dependent activation of NAD(P)H oxidase in cultured vascular cells. Diabetes 2000, 49:1939–1945.PubMedCrossRefGoogle Scholar
  45. 45.
    van Oostrom AJ, Sijmonsma TP, Verseyden C, et al.: Postprandial recruitment of neutrophils may contribute to endothelial dysfunction. J Lipid Res 2003, 44:576–583.PubMedCrossRefGoogle Scholar
  46. 46.
    Freedman MR, King J, Kennedy E: Popular diets: a scientific review. Obes Res 2001, 9(Suppl 1):1S-40S. Excellent extensive review on the effectiveness of popular diets on weight loss and other health outcomes.PubMedCrossRefGoogle Scholar
  47. 47.
    Dean Ornish's MD Lifestyle Program. Available at http:/ www.ornish.comGoogle Scholar
  48. 48.
    Mueller-Cunningham WM, Quintana R, Kasim-Karakas SE: An ad libitum, very low-fat diet results in weight loss and changes in nutrient intakes in postmenopausal women. J Am Diet Assoc 2003, 103:1600–1606.PubMedCrossRefGoogle Scholar
  49. 49.
    Hays NP, Starling RD, Liu X, et al.: Effects of an ad libitum low-fat, high-carbohydrate diet on body weight, body composition, and fat distribution in older men and women: a randomized controlled trial. Arch Intern Med 2004, 164:210–217.PubMedCrossRefGoogle Scholar
  50. 50.
    Ornish D: Avoiding revascularization with lifestyle changes: the Multicenter Lifestyle Demonstration Project. Am J Cardiol 1998, 82:72T-76T. Multicenter project demonstrating that patients with severe coronary artery disease were able to avoid revascularization by making comprehensive lifestyle changes.PubMedCrossRefGoogle Scholar
  51. 51.
    Barnard RJ, DiLauro SC, Inkeles SB: Effects of intensive diet and exercise intervention in patients taking cholesterollowering drugs. Am J Cardiol 1997, 79:1112–1114.PubMedCrossRefGoogle Scholar
  52. 52.
    Grundy SM: Comparison of monounsaturated fatty acids and carbohydrates for lowering plasma cholesterol. N Engl J Med 1986, 314:745–748.PubMedCrossRefGoogle Scholar
  53. 53.
    Lichtenstein AH, Van Horn L: Very low fat diets. Circulation 1998, 98:935–939.PubMedGoogle Scholar
  54. 54.
    Schaefer EJ, Lichtenstein AH, Lamon-Fava S, et al.: Body weight and low-density lipoprotein cholesterol changes after consumption of a low-fat ad libitum diet. JAMA 1995, 274:1450–1455.PubMedCrossRefGoogle Scholar
  55. 55.
    Kasim-Karakas SE, Almario RU, Mueller WM, et al.: Changes in plasma lipoproteins during low-fat, high-carbohydrate diets: effects of energy intake. Am J Clin Nutr 2000, 71:1439–1447.PubMedGoogle Scholar
  56. 56.
    Parks EJ, Hellerstein MK: Carbohydrate-induced hypertriacylglycerolemia: historical perspective and review of biological mechanisms. Am J Clin Nutr 2000, 71:412–433.PubMedGoogle Scholar
  57. 57.
    Sacks FM, Katan M: Randomized clinical trials on the effects of dietary fat and carbohydrate on plasma lipoproteins and cardiovascular disease. Am J Med 2002, 113(Suppl 9B):13S-24S.PubMedCrossRefGoogle Scholar
  58. 58.
    Schaefer EJ: Lipoproteins, nutrition, and heart disease. Am J Clin Nutr 2002, 75:191–212. Excellent review on the current knowledge of lipoproteins, nutrition, and coronary heart disease.PubMedGoogle Scholar
  59. 59.
    Connor WE, Cerqueira MT, Connor RW, et al.: The plasma lipids, lipoproteins, and diet of the Tarahumara indians of Mexico. Am J Clin Nutr 1978, 31:1131–1142.PubMedGoogle Scholar
  60. 60.
    Knuiman JT, West CE, Burema J: Serum total and high density lipoprotein cholesterol concentrations and body mass index in adult men from 13 countries. Am J Epidemiol 1982, 116:631–642.PubMedGoogle Scholar
  61. 61.
    Ornish D, Scherwitz LW, Billings JH, et al.: Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998, 280:2001–2007.PubMedCrossRefGoogle Scholar
  62. 62.
    Gould KL, Ornish D, Kirkeeide R, et al.: Improved stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification. Am J Cardiol 1992, 69:845–853.PubMedCrossRefGoogle Scholar
  63. 63.
    Gould KL, Ornish D, Scherwitz L, et al.: Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. Jama 1995, 274:894–901.PubMedCrossRefGoogle Scholar
  64. 64.
    Skerrett PJ, Manson JE: Reduction in the risk of coronary heart disease and diabetes. In Handbook of Exercise in Diabetes. Edited by Ruderman N, Devlin JT, Schneider SS, Kriska A. Alexandria, VA: American Diabetes Association; 2002:155–182.Google Scholar
  65. 65.
    Kramsch DM, Aspen AJ, Abramowitz BM, et al.: Reduction of coronary atherosclerosis by moderate conditioning exercise in monkeys on an atherogenic diet. N Engl J Med 1981, 305:1483–1489.PubMedCrossRefGoogle Scholar
  66. 66.
    Medicare demonstration to test lifestyle change program to reverse heart disease. Available at http:/www.lifestyleadvantage. org/medicare.htmlGoogle Scholar
  67. 67.
    Very low-calorie diets. National Task Force on the Prevention and Treatment of Obesity, National Institutes of Health. JAMA 1993, 270:967–974.Google Scholar
  68. 68.
    Dietary treatment of obesity. Available at http:/www.endotext. comGoogle Scholar
  69. 69.
    Diet and the Initiation of Therapy for Obesity. Available at http:/www.uptdate.comGoogle Scholar
  70. 70.
    Vermeulen A: Effects of a short-term (4 weeks) protein-sparing modified fast on plasma lipids and lipoproteins in obese women. Ann Nutr Metab 1990, 34:133–142.PubMedCrossRefGoogle Scholar
  71. 71.
    Anderson JW, Brinkman VL, Hamilton CC: Weight loss and 2-y follow-up for 80 morbidly obese patients treated with intensive very-low-calorie diet and an education program. Am J Clin Nutr 1992, 56:244S-246S.PubMedGoogle Scholar
  72. 72.
    Uusitupa MI, Laakso M, Sarlund H, et al.: Effects of a very-lowcalorie diet on metabolic control and cardiovascular risk factors in the treatment of obese non-insulin-dependent diabetics. Am J Clin Nutr 1990, 51:768–773.PubMedGoogle Scholar
  73. 73.
    Henry RR, Wiest-Kent TA, Scheaffer L, et al.: Metabolic consequences of very-low-calorie diet therapy in obese noninsulin-dependent diabetic and nondiabetic subjects. Diabetes 1986, 35:155–164.PubMedCrossRefGoogle Scholar
  74. 74.
    Wing RR, Marcus MD, Salata R, et al.: Effects of a very-lowcalorie diet on long-term glycemic control in obese type 2 diabetic subjects. Arch Intern Med 1991, 151:1334–1340.PubMedCrossRefGoogle Scholar
  75. 75.
    Osterman J, Lin T, Nankin HR, et al.: Serum cholesterol profiles during treatment of obese outpatients with a very low calorie diet. Effect of initial cholesterol levels. Int J Obes Relat Metab Disord 1992, 16:49–58.PubMedGoogle Scholar
  76. 76.
    Raitakari M, Ilvonen T, Ahotupa M, et al.: Weight reduction with very-low-caloric diet and endothelial function in overweight adults: role of plasma glucose. Arterioscler Thromb Vasc Biol 2004, 24:124–128.PubMedCrossRefGoogle Scholar
  77. 77.
    Parenti M, Babini AC, Cecchetto ME, et al.: Lipid, lipoprotein, and apolipoprotein assessment during an 8-wk very-lowcalorie diet. Am J Clin Nutr 1992, 56:268S-270S.PubMedGoogle Scholar
  78. 78.
    Hainer V, Stich V, Kunesova M, et al.: Effect of 4-wk treatment of obesity by very-low-calorie diet on anthropometric, metabolic, and hormonal indexes. Am J Clin Nutr 1992, 56:281S-282S.PubMedGoogle Scholar
  79. 79.
    Shoji T, Nishizawa Y, Koyama H, et al.: High-density-lipoprotein metabolism during a very-low-calorie diet. Am J Clin Nutr 1992, 56:297S-298S.PubMedGoogle Scholar
  80. 80.
    Ornish D, Brown SE, Scherwitz LW, et al.: Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990, 336:129–133.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2004

Authors and Affiliations

  • Claudia Panzer
  • Caroline M. Apovian
    • 1
  1. 1.Section of Endocrinology: Nutrition and Weight Management CenterBoston University School of Medicine, Boston Medical CenterBostonUSA

Personalised recommendations