One of the most intriguing studies, commonly referred to as the DIANA study, was conducted by Berrino et al.1 This study demonstrated that the plasma insulin-lowering effects of low-fat intake decreased insulin resistance as a result of reduced body mass index and waist circumference.1,28,29 Additional benefits were obtained by increasing omega-3 fatty acid and mono-unsaturated fatty acids while decreasing refined carbohydrate intake, with the goal of improving insulin sensitivity.30-32
Low-fat diets have been thoroughly tested. Diets that limit fat intake to 10%-25% of total calories significantly reduce plasma estradiol concentrations. Nine studies showed a mean 7.4% estradiol decrease in premenopausal women and, in four of the studies, a dramatic 23% after menopause.33 However, these studies did not distinguish between the types of dietary fats. Most participants in these studies also had increased intakes of fiber-rich foods. In the DIANA study, a serum estradiol reduction of 18% was achieved with fat reduction from 37%-31% of total calories as a result of shifting consumption from animal to vegetable fats and focusing on low glycemic-index foods.1
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