Cardiovascular Medicine Book

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Low Fat Diet

Aka: Low Fat Diet, Step I Diet, Step II Diet, Therapeutic Lifestyles Changes Diet
  1. See Also
    1. Hyperlipidemia
    2. Hypertriglyceridemia
  2. Efficacy
    1. Reasonable Cholesterol restriction is most effective
    2. Study of 444 men with Hyperlipidemia on Low Fat Diet
      1. 30% fat, 300 mg/day Cholesterol: 5.7% LDL reduced
      2. 26% fat, 200 mg/day Cholesterol: 13.4% LDL reduced
      3. 22% fat, 100 mg/day Cholesterol: 8.4% LDL reduced
      4. 18% fat, 100 mg/day Cholesterol, 13.0% LDL reduced
    3. Confounders
      1. Men taking <26% fat had trouble with compliance
    4. References
      1. Knopp (1997) JAMA 278:1509-15 [PubMed]
  3. Types: Low Fat Diet
    1. New NCEP/ATPIII Guidelines recommend only one diet
      1. Total calories from fat:25 to 35%
        1. Saturated fat <7% of total calories
          1. Examples: Cheese, Whole milk, Red meat
          2. Includes trans Fatty Acids (some margarines)
        2. Polyunsaturated fat 10% or less of total calories
          1. Examples: Olive oil or canola oil
        3. Monounsaturated fat 20% or less of total calories
          1. Examples: Corn oil, peanuts
      2. Carbohydrates 50-60% of total calories
        1. Complex carbohydrates preferred
        2. Examples: Whole grains, fruits, vegetables
      3. Protein 15% of total calories
      4. Dietary Fiber: 20 to 30 grams per day
      5. Cholesterol <200 mg per day
    2. Stage I and II listed for historical purposes
      1. Stage I Diet
        1. Total calories from fat: <30%
        2. Total calories from saturated fat: <8-10%
        3. Total daily Cholesterol: <300 mg/day
      2. Stage II Diet
        1. Total calories from fat: <30%
        2. Total calories from saturated fat: <7%
        3. Total dietary Cholesterol: <200 mg/day
  4. Approach: Meat - under 5-6 ounces per day
    1. Lean Meat
    2. Poultry without skin
    3. Fish (not fried) <5-6oz/d
      1. Cold water fish have unsaturated Omega-3 Fatty Acids
      2. Omega-3 Fatty Acids have goof effect on lipids
        1. Decrease Triglycerides
        2. Minimal effect on LDL
        3. No effect on HDL
  5. Approach: Eggs
    1. Egg yolks <2-4 per week
    2. Substitute 2 egg whites for one whole egg in recipes
  6. Approach: Low fat dairy products - 2-3 servings per day
    1. Skim milk
    2. Low fat yogurt
    3. low fat cheese
    4. Cottage cheese (0-2% fat)
    5. Frozen yogurt
    6. Low fat creamer
    7. Low fat or nonfat sour cream
  7. Approach: Fats and Oils <6-8 teaspoons per day
    1. Use Unsaturated oils
      1. Safflower oil
      2. Sunflower oil
      3. Corn oil
      4. Soybean oil
      5. Canola oil
      6. Cottonseed oil
      7. Olive oil
      8. Peanut oil
      9. Margarine made from unsaturated oils (soft or liquid)
        1. Avoid trans Fatty Acids (higher risk of CAD)
        2. Oomen (2001) Lancet 357:746-51 [PubMed]
      10. Salad dressings made from unsaturated oils
      11. Seeds and nuts (e.g. peanut butter)
      12. Cocoa powder
    2. Avoid Saturated oils
      1. Coconut oil or coconut
      2. Palm kernel oil
      3. Palm oil
      4. Milk chocolate
  8. Approach: Breads and Cereals >6 servings per day
    1. Use low fat breads, cereals and grains
      1. Whole grains
      2. English muffin
      3. Bagels
      4. Cereals
      5. Oats
      6. Wheat
      7. Corn
      8. Multigrain
      9. Pasta
      10. Rice
      11. Dry beans or peas
      12. Low fat crackers
      13. Home baked goods with unsaturated oil and skim milk
    2. Avoid
      1. Croissants
      2. Granola
  9. Approach: Soup - Avoid contents
    1. Whole milk
    2. Cream
    3. Fats or skin
  10. Approach: Vegetables - 3-5 servings per day
    1. Avoid fried vegetables
    2. Avoid Cream sauce
    3. Avoid Cheese sauce
  11. Approach: Fruits: -2-4 servings per day
    1. Avoid fried fruits
    2. Avoid Cream sauce
    3. Avoid Butter sauce
  12. Apporach: Sweets
    1. Beverages
      1. Fruit flavored
      2. Lemonade
      3. Punch
    2. Candy made with sugar, syrup, honey, jam, or preserves
      1. Candy corn
      2. Gumdrops
      3. Hard candy
    3. Gelatin (e.g. Jell-O)
    4. Frozen treats
      1. Frozen yogurt
      2. Ice milk
      3. Sherbet or sorbet
      4. Popsicles
    5. Low fat cookies, cakes, pies, or pudding
      1. Contents
        1. Egg whites or egg substitute
        2. Skim milk
        3. Unsaturated oil or margarine
      2. Examples
        1. Ginger snaps
        2. Fig or fruit bars
        3. Angel food cake
    6. Avoid
      1. Milk chocolate
      2. Coconut oil
      3. Palm oil
      4. Palm kernel oil
      5. Commercial pies or cakes
      6. Doughnuts
      7. Cream pies
  13. References
    1. (2001) JAMA 285:2486-97 [PubMed]

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