014: Dietary Management of Heterozygous Familial Hypercholesterolemia (HeFH)

Mastering Nutrition Episode 14

Jun 23, 2016

Introduction

In this episode, I discuss dietary management of familial hypercholesterolemia (HeFH).

This question was asked on the Facebook Live episode from 06/16/2016, “Ask Chris Masterjohn, PhD Anything About Heart Disease,” but I was unable to get to the question within Facebook’s time limit.

Please note that HeFH is a medical issue and the purpose of this episode is not to diagnose or treat anyone with HeFH. This is educational in nature and the information should only be used to manage HeFH under supervision of a qualified health professional.

Herein, I discuss why I believe the Kitavan diet should serve as an ancestral diet on which to model dietary management of HeFH. It is a low-fat, low-cholesterol, high-carbohydrate diet where most of the fat is highly saturated because it comes from coconut, some of it is is from fish, and where the carbohydrate mostly comes from starchy tubers but some comes from fruit.

Show Notes

In this episode, I discuss dietary management of familial hypercholesterolemia (HeFH).

The best way to get to the root of the problem in heterozygous FH is to take the one working gene for the LDL receptor and try to bring it up to the expression level that would be found in someone without FH. This can be done by maximizing the biological activity of thyroid hormone (within the range considered euthyroid) and by maximally suppressing PCSK9 activity with the help of strong insulin signaling. These come down to managing good body composition and eating a low-fat, protein-adequate, micronutrient-adequate, high-carbohydrate diet.

Restricting cholesterol may be helpful, but it also comes at the cost of cutting nutrient density, since some of the most nutrient-dense foods — liver and egg yolks — are also rich in cholesterol. Therefore, it should be #2 in the line of defense rather than #1.

Replacing saturated fat with polyunsaturated fat and using statins should both be tools in the kit, but they should be tools much further down the line of resort because they are less related to the root of the problem and they may come at costs that compromise health and longevity.

You can use this to navigate through the episode if you want to find specific parts:

0:28 Introducing ChrisMasterjohnPhd.com and the cool trick you can use to find show notes easily: thedailylipid.com/n where “n” is the episode number. So, for example, thedailylipid.com/16 redirects to the show notes you are reading right now (If you link to the show notes, however, please use the actual URL rather than the short cut.)Update: this has been changed to chrismasterjohnphd.com/n
4:36 Cliff notes for this episode.
6:02 Introduction to heterozygous familial hypercholesterolemia (heterozygous FH or HeFH)
11:06 Thyroid hormone and PCSK9 as the two critical regulators of LDL receptor activity
11:43 Specific importance of thyroid hormone
15:53 Specific importance of PCSK9
16:48 PSCK9 responds to the fasting-feeding cycle
18:32 PCSK9 responds to inflammation
20:14 PCSK9 responds to blood cholesterol levels
23:16 Maximizing insulin signaling is the best way to maximally suppress PCSK9 activity
24:06 The Kitavan diet can be used as an ancestral diet on which we could model dietary management as the first line of defense against poor LDL receptor activity in HeFH
27:53 Potential costs and benefits of restricting dietary cholesterol
33:55 Statins and PUFA should be tools in the kit, but shouldn’t be the first or second line of defense.
40:19 Catch my upcoming Facebook Live episodes: the next one is this Saturday, June 25 at 2:00 PM eastern time and the theme is “Ask Chris Masterjohn Anything About Methylation!”
41:41 Follow me on Snapchat for 23andMe tutorials and other stuff (chrismasterjohn is my username)

Links Related to Episode 16

The Facebook Live episode on heart disease.

Genes, LDL-Cholesterol Levels, and the Central Role of LDL Receptor Activity in Heart Disease

The Central Role of Thyroid Hormone in Governing LDL Receptor Activity and the Risk of Heart Disease

Mastering Nutrition Episode 11: Paleof(x) Grab Bag: Carbs, Sex Hormones, Type 1 Diabetes, and More

PCSK9 and LDL Receptor Degradation: Regulatory Mechanisms in Cicrculation and in Cells

What Can Familial Hypercholesterolemia Mortality in the 19th Century Teach Us About Genetics? (this covers the potential benefit of high LDL-cholesterol during conditions where early and prevalent mortality is due to infectious disease)

The Kitava Study

Episode 2 of my 3-part series with Chris Kresser, where we discussed blood cholesterol levels in ancestral populations free of heart disease

My writings on fatty liver disease and choline

Coenzyme Q10 protects against PUFA-mediated longevity reduction in rats