About Familial Hypercholesterolemia - Ask a Nutritionist

Transcript:

Teresa: Hello and welcome to “Ask a Nutritionist”, part of our Dishing Up Nutrition series where we focus on a topic in depth that was requested by listeners. I'm Teresa Wagner, a Registered and Licensed Dietitian, and today I'll be discussing a health condition that may be new to you, familial hypercholesterolemia.

What this is is a rare genetic disorder that causes someone to have very high levels of low density lipoprotein or LDL cholesterol, commonly referred to as the bad cholesterol. So for individuals with this condition, they will usually have high levels of LDL even while following a good diet and exercise routine.

Ideally, we would want a healthy LDL level to be less than 100 milligrams per deciliter, but for those with familial hypercholesterolemia, their LDL level is usually two to three times higher than normal, 200 to even higher than 400 milligrams per deciliter in the most severe cases.

Functions of LDL cholesterol

So let's back up and talk about what LDL cholesterol is and what it does for us. As I said earlier, it is referred to as the bad cholesterol, but it does serve an important function in our body. Our blood vessels can become inflamed and damaged from things like a poor diet, high in sugars and bad fats, chronic stress, medications, smoking, alcohol. When we have inflammation on the inside of our blood vessels, they can become damaged.

The LDL cholesterol is the patching material that comes along and acts like a band aid, patching it up. If you continue to have damage, you can imagine that those band-aids, well, they start to pile up, and this creates plaque. And as the plaque builds up, it causes the blood vessels to become more and more narrow and hardened.

That’s where the cardiac risk develops because a piece of plaque could break off and cause blockage in a smaller blood vessel down the line, or the thickening of the arteries can cause a complete blockage, potentially causing a stroke or a heart attack.

So the LDL is actually there to help and is not intended to be the enemy. The trouble happens when we are making too much of it over time, leading to a condition called atherosclerosis, which literally means hardening of the arteries.

How does familial hypercholesterolemia come to be?

So how does familial hypercholesterolemia or let's just call it FH for short, come to be? FH results from mutations in the genes responsible from removing that LDL cholesterol from the bloodstream. Because of these mutations, the liver is less effective at clearing LDL cholesterol, leading to an increased risk of early onset heart disease, sometimes even beginning in childhood or young adulthood.

There are two main types, heterozygous FH, which is inherited from one parent. This type occurs in about one and 250 people. There's also homozygous FH, which is inherited from both parents and is much more rare, but is more severe. It only occurs in one in 300,000 to 1 million people. You may be diagnosed with FH after having a lipid panel ordered at your doctor's office, which show very high levels of cholesterol.

Another consideration your Dr. may take into account is a family history of early onset heart disease, and there's also a genetic test that can be used to confirm the diagnosis.

What does a healthy cholesterol diet look like?

So all this being said, if you get the diagnosis, what can you do? Your doctor will likely put you on a cholesterol lowering medication. Unfortunately in this case, because it is a genetic disease, diet alone won't be as effective in getting your LDL to a healthy level as it is for someone without the condition.

But that doesn't mean that diet doesn't matter. In fact, prioritizing a heart healthy diet is even more important in this case because you are already up against a genetic disadvantage. So what does a healthy cholesterol diet look like?

It's going to follow some of the same principles that we always recommend here on Dishing Up Nutrition, real food in balance. Avoid ultra processed foods that are full of heavily refined oils and high in carbohydrates and sugar. Overeating sugar and refined oils create a big risk factor for our heart health.

They're the types of foods that damage your blood vessels. Cutting sugar and refined carbs helps lower the small dense LDL particles, the kind that are the most harmful. So what do you eat? Well, at each meal you should be aiming for four to six ounces of high quality animal protein, a couple of cups of non-starchy vegetables, and about a tablespoon of natural fat.

Your protein can come from wild caught fish, grass fed meats, and pasture raised eggs and poultry. Avoid heavily processed meats like sausages and other cured meats with added nitrates. However, minimally processed sausages like nitrate free chicken sausage, can be a convenient option for a ready to eat protein. But let's just do it more in moderation.

For carbohydrates, it's best if most come from non-starchy vegetables. Aim for at least one to two cups, about the size of two fists with each meal. Not only do veggies provide tons of heart healthy antioxidants, but they're also rich sources of fiber. You may have heard of eating high fiber foods for heart health, and that's true.

Fiber binds cholesterol to then be carried out of the body through the stool. The best way to get fiber is by eating a variety of veggies. Yes, other carbohydrate foods from nature have high fiber too like fruits and legumes, whole grains, but we want to keep those in moderation in order to not spike our blood sugar; keep those higher carb foods to about a half a cup at a time.

Nuts and seeds, well, they're also a great source of fiber, which leads me to our third macronutrient: fat, natural fats. In other words, fats that come from nature like olive oil, avocados, nuts, seeds, support healthy cholesterol levels. We recommend using olive oil or avocado oil for cooking and/or for using as the base of salad dressings and marinades.

Grass fed butter and extra virgin coconut oil can be used in moderation, but avoid using anything labeled hydrogenated, such as margarines and shortenings. Consuming these types of fats regularly raise LDL cholesterol and put you at risk for heart disease. Saturated fat is often a part of the cholesterol conversation, and maybe it's something to consider with familial hypercholesterolemia, but not with the idea of the complete elimination of those animal fats.

The worst combination of foods for heart health and cholesterol levels is the combination of saturated fat with high carbohydrate and sugary foods. Think pancakes with butter and syrup. A bacon cheeseburger on a bun with French fried potatoes.

I would argue keep the butter, lose the pancakes and syrup. Keep the beef, the cheese, and even the bacon if it's high quality. But rather than the bun and the deep fried potatoes, have it as a lower carb cheeseburger bowl with lots of veggies, lettuce, tomato, onion, and add a small amount of diced sweet potato for a well-rounded meal that would fuel your day.

Key supplement considerations to support cholesterol

And finally, I want to talk about some key supplements I like to use with clients to help support their cholesterol. There are many we can experiment with, but please don't feel like you need a supplement list as long as your child's Christmas list to see improvements.

Talk with a dietitian here at Nutritional Weight & Wellness to help you find the one, two, or maybe few that would be the best fit for your situation. For example, I like to use omega-threes. This supplement has been used for a long time to help lower inflammation in the blood vessels.

Omega-threes are also wonderful for increasing our HDL. You know, the good cholesterol. I've used Bergamot with clients. Bergamot may sound familiar to those who are familiar with essential oils. As I've heard, it's a popular choice for aromatherapy, skin and haircare. I do not recommend taking it orally, though. The bergamot used to improve cholesterol levels comes in a capsule.

We carry Ortho Molecular’s Bergamot and suggest taking one cap three times a day with meals. It helps to shift the sticky, dense cholesterol particles to the fluffy, less harmful type.

Another supplement I may use is Vitamin C. It works as an antioxidant and improves the health of the lining of the blood vessels where damage from oxidized cholesterol takes place better than supplements though, eat a diet rich in vegetables and fruits and supplementation may be unnecessary.

N-Acetyl-Cysteine or NAC is another supplement that works as an antioxidant that helps prevent oxidation of LDL cholesterol. It's an antioxidant, prevents oxidation.

CoQ10 is also a supplement that works as an antioxidant. Just to repeat the importance of antioxidants, when LDL cholesterol is oxidized in the cells of the lining of the blood vessel, this sets the stage for a cascade of events that lead to atherosclerosis, plaque formation, and the narrowing of the blood vessels.

A different type of supplement we may choose to use is Plant Sterols. Research has shown that phytosterols, plant-based compounds structurally similar to cholesterol, compete with cholesterol for absorption, and therefore play a key role in supporting healthy cholesterol levels.

Lastly, a lesser known supplement than I've been excited about lately is nattokinase. Nattokinase is an enzyme extracted from natto, fermented soybean. Research suggests that Nattokinase may help suppress the progression of plaque buildup in the arteries, and in some people it's been shown to lower Lp(a).

Lp(a) is a type of cholesterol that is similar to LDL cholesterol, but it is an independent and a more potent risk factor for cardiovascular disease. Like familial hypercholesterolemia. Lp(a) levels are primarily determined by genetics and it is difficult to lower them with diet and exercise.

I recently though had a client lower her Lp(a) by 13 points in a three month period, and the only change she had made was adding Nattokinase to her supplement stack. Of note, though, this supplement can intensify the effects of anticoagulants, antiplatelet and blood pressure medications. Please do not combine meds like warfarin, aspirin, or any anti-hypertensive med, as these can increase your risk of bleeding and bruising, or talk to your trusted doctor or pharmacist before starting.

Well, to wrap up today's episode, if you've been diagnosed with familial hypercholesterolemia, it's important to work closely with your doctor and a knowledgeable dietitian to keep your cholesterol levels in a healthy range. Diet is one thing you can control even when you can't change your genetics.

Real food makes a real difference for your health. If this episode resonated with you, please share it with a friend or leave us a review so that we can help even more people make that connection between what they eat and how they feel. And if you have a question that you'd like us to answer, let us know.

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