Diet and Familial Hypercholesterolemia: Foods to Eat and Avoid

Familial hypercholesterolemia (FH) is a genetic condition that causes high levels of LDL cholesterol—the “bad” cholesterol—in the blood, putting people at risk for heart disease at an early age. If you or a family member has been diagnosed with FH, managing cholesterol becomes a lifelong commitment. And while medication is often necessary, especially for people with FH, diet plays a crucial role in controlling cholesterol levels and improving overall heart health.

Diet plays a crucial role in controlling cholesterol levels and improving overall heart health. According to the American Heart Association, adopting a heart-healthy diet can significantly influence cholesterol levels and reduce cardiovascular risk.

Why Diet Matters for People with FH

Before diving into the specifics of what to eat and what to avoid, let’s take a moment to understand why diet is so important for people with familial hypercholesterolemia. FH is caused by a genetic mutation that affects how the body processes cholesterol, making it impossible to control cholesterol levels through diet alone. But what you eat still matters, and here are a few ways a heart-healthy diet can help:

• Lower LDL cholesterol levels: While diet alone won’t bring cholesterol levels down to a safe range for those with FH, it can help reduce them and support the effects of cholesterol-lowering medications.
• Promote overall cardiovascular health: A healthy diet can improve blood vessel function, reduce inflammation, and support a healthy weight, all of which are important for heart health.
• Teach lifelong habits: For children with FH, developing good eating habits early can make a big difference as they grow and continue managing the condition.

Foods to Eat: Heart-Healthy Choices for FH

The key to managing FH through diet is focusing on foods that can help lower LDL cholesterol and promote heart health. Here’s a breakdown of the best foods to include in your diet if you or your child has FH.

1. High-Fiber Foods

When it comes to food, soluble fiber is one of the most powerful tools in lowering LDL cholesterol. This type of fiber binds with cholesterol in the digestive system and helps remove it from the body. A diet rich in fiber can lower cholesterol levels by 5-10%. Research indicates that increasing soluble fiber intake can lower LDL cholesterol by 5-10% (Verywell Health).

• Oats and barley: These grains are high in soluble fiber, particularly beta-glucan, which has been shown to lower cholesterol. Consider starting your day with a bowl of oatmeal or adding barley to soups and salads.
• Beans and lentils: These plant-based proteins are packed with fiber. Try adding black beans to a salad or whipping up a lentil stew.
• Fruits like apples, pears, and berries: These fruits are high in soluble fiber. Snack on an apple or add berries to your morning oatmeal or yogurt.

2. Healthy Fats

Not all fats are bad! In fact, some fats are essential for heart health, and replacing saturated fats with unsaturated fats can help lower LDL cholesterol. The National Lipid Association recommends that individuals with FH replace saturated fats with unsaturated fats to manage cholesterol levels effectively.

• Olive oil: Rich in monounsaturated fats, olive oil is a heart-healthy option. Use it as a base for salad dressings or drizzle it over roasted vegetables.
• Avocados: This creamy fruit is a great source of heart-healthy fats. Spread it on whole-grain toast or add it to salads for a delicious boost.
• Fatty fish like salmon, mackerel, and sardines: These fish are high in omega-3 fatty acids, which can help lower triglycerides and improve heart health. Aim to include fatty fish in your meals two or three times a week.

3. Nuts and Seeds

Nuts and seeds are rich in healthy fats, fiber, and plant sterols—compounds that can help lower cholesterol levels. Studies have shown that consuming a small handful of nuts daily can reduce cholesterol (Verywell Health).

• Almonds, walnuts, and pistachios: These nuts are particularly beneficial for heart health. Snack on a small portion of raw nuts or sprinkle them on salads for added crunch.
• Flaxseeds and chia seeds: These seeds are high in omega-3s and fiber. Add ground flaxseeds or chia seeds to smoothies, yogurt, or oatmeal for an easy nutritional boost.

4. Plant-Based Proteins

Replacing animal proteins with plant-based options can significantly lower cholesterol levels and reduce heart disease risk. The American Heart Association advocates for the inclusion of plant-based proteins as part of a heart-healthy diet.

• Legumes like chickpeas, black beans, and lentils: These are great sources of protein and fiber, and they’re naturally low in saturated fat.
• Tofu and tempeh: These soy-based proteins are versatile and can be used in stir-fries, salads, or as a meat substitute in various dishes.

5. Sterol- and Stanol-Fortified Foods

Plant sterols and stanols are naturally occurring substances that can block cholesterol absorption in the digestive system. They’re often added to fortified foods and have been shown to lower LDL cholesterol levels.

• Fortified margarine spreads: Some spreads, like Benecol or Smart Balance, are fortified with plant sterols and can help lower cholesterol.
• Fortified orange juice and yogurts: These products often have added sterols and can be included in your diet as part of a heart-healthy plan.

Foods to Avoid: What to Cut Back on for FH

Just as important as what you should eat is knowing what to avoid or limit. For people with FH, certain foods can contribute to higher cholesterol levels and increase the risk of heart disease.

1. Saturated Fats

Saturated fats are one of the main dietary culprits for raising LDL cholesterol levels. Saturated fats in red meat, butter, and full-fat dairy products, as well as trans fats found in fried and processed foods, are major contributors to high cholesterol levels. Limit these to protect heart health, as recommended by the CDC.

• Red meat and processed meats: Limit your intake of beef, pork, lamb, and processed meats like sausages, hot dogs, and bacon. Opt for plant-based proteins or leaner cuts of meat instead.
• Full-fat dairy products: High-fat dairy, such as whole milk, cheese, and butter, is a significant source of saturated fat. Switch to low-fat or non-dairy alternatives like almond or soy milk.
• Fried foods: Foods like french fries, fried chicken, and doughnuts are often cooked in unhealthy oils that contain saturated or trans fats.

2. Trans Fats

Trans fats are the worst kind of fats for heart health, as they not only raise LDL cholesterol but also lower HDL (the “good” cholesterol). These fats are typically found in processed and fried foods.

• Packaged baked goods: Many store-bought cookies, cakes, and pastries contain trans fats, even if they’re labeled “trans fat-free.” Always check ingredient labels for “partially hydrogenated oils,” which indicate the presence of trans fats.
• Margarine and shortening: Some margarine and shortening products still contain trans fats. Look for trans fat-free versions made with healthy oils.

3. Refined Carbohydrates and Sugary Foods

Refined carbs and sugary foods don’t directly increase cholesterol levels, but they can contribute to weight gain and increase triglycerides, another type of fat in the blood that can raise heart disease risk.

• White bread, pastries, and pasta: These foods are made from refined grains, which have had the fiber stripped away. Opt for whole grains instead, like brown rice, quinoa, and whole wheat bread.
• Sugary drinks and sweets: High-sugar foods and drinks like soda, candy, and desserts can cause spikes in triglycerides. Limit these and choose healthier alternatives like water, herbal teas, or fruit.

Making Sustainable Dietary Changes

If you or your child has FH, changing your diet can feel like a big task, but it doesn’t have to be overwhelming. Start by making small, manageable changes—swap out red meat for fish a few times a week, switch to whole grains, and try cooking with olive oil instead of butter. Over time, these changes will add up and support better heart health.

Remember, managing familial hypercholesterolemia is a lifelong commitment, but with the right combination of diet, medications, and lifestyle changes, you can significantly reduce your risk of heart disease. Work closely with your healthcare provider and a registered dietitian to create a plan that works for you and your family.

While familial hypercholesterolemia is a genetic condition, the food choices you make every day can have a real impact on your cholesterol levels and overall heart health. By focusing on heart-healthy foods and avoiding those that can raise LDL cholesterol, you’re taking an important step in managing FH and reducing the risk of future cardiovascular problems.

With a balanced approach to diet, along with the guidance of your healthcare team, you can take control of your FH and live a healthier life.

References

1. Verywell Health: Familial Hypercholesterolemia Diet Guide. Link.
2. Family Heart Foundation: Diet and FH. Link.
3. Centers for Disease Control and Prevention: FH Treatment Options. Link.