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To the Editor: We agree with Drs Hu and Willett¹ that the risk of CHD can be reduced by decreasing saturated fat intake; increasing omega-3 fatty acid intake; avoiding refined carbohydrate sources; increasing folate, B₆, and B₁₂ intake; and increasing fruit, vegetable, whole grain, and fiber intake. However, evidence from several trials^2-3 conflicts with their claim that "triglyceride levels increase when dietary fatty acids are replaced by carbohydrates." We agree that studies in which fat was replaced isoenergetically with low-fiber "refined" carbohydrate sources have shown an increase in fasting triglyceride levels.⁴ This is not the case, however, in unrestricted high-fiber carbohydrate diets.^4-5 Barnard³ reported that replacing total fat intake with mostly "unrefined" carbohydrate sources can decrease triglyceride levels by 33%. This was a high-fiber diet with about 10% of calories from fat, 15% to 20% of calories from protein, and 65% to 75% of calories from largely high-fiber carbohydrate . . . [Full Text of this Article]

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