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Dietary Recommendations for Familial Hypercholesterolaemia: an Evidence-Free Zone

Authors :
Jeff S. Volek
Abdullah A Alabdulgader
Zoë Harcombe
Uffe Ravnskov
Blair J. O'Neill
Sherif Sultan
Malcolm Kendrick
Michel de Lorgeril
David M. Diamond
Aseem Malhotra
Source :
BMJ Evidence-Based Medicine. 26:295-301
Publication Year :
2020
Publisher :
BMJ, 2020.

Abstract

We have evaluated dietary recommendations for people diagnosed with familial hypercholesterolaemia (FH), a genetic condition in which increased low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk for coronary heart disease (CHD). Recommendations for FH individuals have emphasised a low saturated fat, low cholesterol diet to reduce their LDL-C levels. The basis of this recommendation is the ‘diet-heart hypothesis’, which postulates that consumption of food rich in saturated fat increases serum cholesterol levels, which increases risk of CHD. We have challenged the rationale for FH dietary recommendations based on the absence of support for the diet-heart hypothesis, and the lack of evidence that a low saturated fat, low cholesterol diet reduces coronary events in FH individuals. As an alternative approach, we have summarised research which has shown that the subset of FH individuals that develop CHD exhibit risk factors associated with an insulin-resistant phenotype (elevated triglycerides, blood glucose,haemoglobin A1c (HbA1c), obesity, hyperinsulinaemia, high‐sensitivity C reactive protein, hypertension) or increased susceptibility to develop coagulopathy. The insulin-resistant phenotype, also referred to as the metabolic syndrome, manifests as carbohydrate intolerance, which is most effectively managed by a low carbohydrate diet (LCD). Therefore, we propose that FH individuals with signs of insulin resistance should be made aware of the benefits of an LCD. Our assessment of the literature provides the rationale for clinical trials to be conducted to determine if an LCD would prove to be effective in reducing the incidence of coronary events in FH individuals which exhibit an insulin-resistant phenotype or hypercoagulation risk.

Details

ISSN :
25154478 and 2515446X
Volume :
26
Database :
OpenAIRE
Journal :
BMJ Evidence-Based Medicine
Accession number :
edsair.doi.dedup.....23f4b91c7389d6f5effacafa3b127f5f