Diets designed to promote weight loss and improve atherogenic lipid profiles traditionally include a reduction in total fat and, in particular, saturated fats. This study was designed to test the efficacy of a low-fat diet vs a carbohydrate (CHO)-restricted (low-CHO) diet in hypertriglyceridemic patients on lipid profile, weight loss, high-sensitivity C-reactive protein (hs-CRP), and satiety. Twenty-eight hypertriglyceridemic subjects (based on fasting triacylglycerol [TG] levels exceeding 1.69 mmol/L) were randomized to either the low-CHO or low-fat diet for 8 weeks. Fasting bloods were acquired at weeks 0 and 8 and analyzed for lipids and hs-CRP. Body weight and other anthropometric measures were also obtained. Three random 24-hour food recalls were used to assess compliance during the trial and 2 recalls before randomization to permit individualized dietary education. A significant time-by-treatment interaction was observed (P = .045), wherein the small low-density lipoprotein cholesterol concentrations were reduced by 46% in the low-CHO-assigned subjects and increased by 36% for those assigned the low-fat plan. The observed decrease in TG (18%) among low-CHO subjects, in contrast to the 4% increase for low-fat group, was not significant, nor were there significant differences in hs-CRP, overall dietary compliance, satiety, or the magnitude of body weight loss between groups (low-CHO group, -3.8% vs low-fat group, -1.6%). Favorable reductions in small low-density lipoprotein concentrations after 8 weeks suggest that a moderately restricted carbohydrate diet (20% CHO as energy) can promote a less atherogenic lipid profile when compared to the low-fat diet.