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Modest reduction in fat may be better than drastic cuts

You can never be too rich or eat too little fat, right?

Wrong, suggests a study that found moderate reductions in the amount of fat in a person's diet are better than drastic ones when it comes to lowering the risk of heart disease in people with high cholesterol.

Men who got 26 percent of their total calories from fat lowered their LDL, or so-called "bad" cholesterol, by 13.4 percent, researchers reported in Wednesday's Journal of the American Medical Association.

Men who cut their fat intake more -- to 22 percent of total calories -- did no better in reducing "bad" cholesterol, but they reduced levels of HDL, the so-called "good" cholesterol, and raised levels of another blood fat called triglycerides. Elevated triglycerides are associated with a higher risk of heart disease. "It's become a very popular notion that the less fat a person eats, the better off they are, as far as heart disease risk is concerned," said the study's lead author, Dr. Robert H. Knopp, a professor of medicine at the University of Washington School of Medicine in Seattle.

Genetics
Instead, he said, the study suggests that extreme fat restrictions do not help and may even be harmful.

Dr. Dean Ornish, an advocate of very low fat diets, said the findings send a misleading message that a dozen previous studies contradict.

The study measured risk factors for heart disease -- not heart disease itself, said Ornish, a faculty member at the University of California at San Francisco.

He noted that in his own research, a vegetarian diet limited to 10 percent of calories from fat reversed the clogging of arteries in patients with heart disease, as evidenced on heart scans.

Knopp's study involved 444 men with elevated "bad" cholesterol levels in their blood. Some men also had elevated triglycerides.

The men were divided into groups that ate varying levels of fat: level 1, 30 percent of calories from fat; level 2, 26 percent; level 3, 22 percent; level 4, 18 percent.

"The surprising thing was that total fat restriction below the level 2 diet had no further benefit and had an adverse effect on triglycerides and HDL," Knopp said.

Before the one-year study, the men were eating a more typical American diet -- about 35 percent of total calories from fat and up to 13 percent of total calories from saturated fats, believed to be the most harmful kind.

Men assigned to level 4 who were supposed to eat only 18 percent of calories from fat but actually averaged 22 percent HDL is called "good" cholesterol because higher levels of it are associated with less risk of heart disease. With LDL, the reverse is true -- higher levels are linked to a higher risk of heart disease.

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