Cholesterol
People with familial hypercholesterolemia (FH) have an inherited defect in the gene which encodes for the low-density lipoprotein (LDL) receptor, which disrupts the normal control of cholesterol metabolism and leads to high LDL levels in the blood.
In the UK, the NICE Guidelines state that adults with a baseline total cholesterol above 7.5 mmol/l are to be assessed for a clinical diagnosis of FH.
Medication, including statins, may be offered to reduce LDL levels in the blood. If you are offered medication, you should follow the advice of your Consultant and GP.
My expertise is in diet and lifestyle interventions to support optimal health. So, I have researched whether medication alone is enough to inhibit the development of coronary heart disease (CHD) following a diagnosis of FH or whether diet and lifestyle interventions also have a role to play.
Research suggests that the blood tests of individuals with FH who go on to develop CHD exhibit risk factors associated with raised blood insulin levels or increased susceptibility to clot formation.
Markers associated with raised blood insulin levels
These include:
Elevated triglycerides,
Elevated fasting blood glucose,
Elevated HbA1C,
Abdominal obesity, and
High blood pressure.
Influence of diet and lifestyle
Research suggests that the lower carbohydrate, higher healthy fat approach may be of benefit to individuals with FH who are exhibiting elevated triglycerides, fasting blood glucose, HbA1c, abdominal obesity and/or high blood pressure.
This makes sense: a low carb, higher healthy fat approach has been successfully adopted by Dr David Unwin in relation to his patients with type 2 diabetes and pre-diabetes. Dr Unwin found that his patients who received the low carb dietary advice had the benefit of statistically significant improvements for HbA1C, blood pressure, weight, triglycerides and total cholesterol.
Research also points to smoking and stress as significant factors in the development of CHD (specifically clot formation) in individuals with FH.
What next?
This is a complex area to navigate. My Instagram posts contain lots of information about optimising your health through diet and lifestyle. Do have a look.
If you would like my personal support and would like to talk about working with me to make dietary and lifestyle changes to support your cardiovascular health, please book a free 30 minute Zoom call using the link below.
Sources:
Diamond, D. et. al. (2020) “Dietary recommendations for familial hypercholesterolaemia: an evidence-free zone”, BMJ Evidenced-Based Medicine, pp. 1-7.
Unwin, D. et. al. (2020) “Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years”, BMJ Nutrition, Prevention and Health, pp. 1-10.
