Introduction

Question: "I have familial hypercholesterolemia, as well as a mutation in my Lp(a). I listened to your 2016 podcast regarding FH and have implemented a low-fat diet and am in the process of fixing thyroid issues. My question is, can you please further explain whether I should be more concerned about overall fat or saturated fat intake?"

To be clear, I am not treating anyone here. I am not a medical practitioner, so I am not treating the disease of familial hypercholesterolemia and this is just educational in nature.

As a general principle, if I'm thinking about familial hypercholesterolemia — I would be thinking more about saturated fat, with that said, I would be testing it.

First it depends on the specific saturated fatty acid, but saturated fat relative to other fats raises cholesterol levels. There are people that dispute that, but the data is super clear. This does not mean that everyone should lower their saturated fat intake because most people can probably accommodate that, right? Most people have a working system to regulate their cholesterol levels.

The thing is with the familial hypercholesterolemia, that system is broken, so you become hypersensitive to all the things that do have some effect. You will be hypersensitive to the fact that saturated fat raises cholesterol levels more so than other fats do — but I think it's more to the root of the problem, based on how these things regulate LDL receptor activity, which is what clears cholesterol from your blood and which is what is broken in familial hypercholesterolemia.

I think a lower-fat, higher-carbohydrate diet is more relevant to the root mechanism.

How do you test this? So, standard lipid panels are dirt cheap, and it is not hard to convince your doctor to order them. You don't need to get fancy. You don't need the NMR and all that other stuff. I'm not saying it doesn't have its place, but if you want to do dietary tests to see what are the big factors affecting you, you just run these standard tests every couple of months and you pick a diet to go on and stay on it for 4-8 weeks and then see what the results are.

So, you do the low-fat diet where most of your fat comes from coconut, which is the Kitavan diet, where they don't have heart disease. You can try that for 4 or 8 weeks, and then look at your cholesterol levels. Next you do the low-fat diet where most of your fat comes from olive oil, which is a more of a Mediterranean approach. You can try that and see what that does to your cholesterol levels.

You tailor your diet to your own response — because I can predict what will generally happen, but the individual person is going to have so many different genetic and other factors, that influence what they're responsive to that they just need to test it out.

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