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Dietary Recommendations for Familial Hypercholesterolaemia: an Evidence-Free Zone

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 e...

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Autores principales: Diamond, David M, Alabdulgader, Abdullah A, de Lorgeril, Michel, Harcombe, Zoe, Kendrick, Malcolm, Malhotra, Aseem, O'Neill, Blair, Ravnskov, Uffe, Sultan, Sherif, Volek, Jeff S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8639944/
https://www.ncbi.nlm.nih.gov/pubmed/32631832
http://dx.doi.org/10.1136/bmjebm-2020-111412
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author Diamond, David M
Alabdulgader, Abdullah A
de Lorgeril, Michel
Harcombe, Zoe
Kendrick, Malcolm
Malhotra, Aseem
O'Neill, Blair
Ravnskov, Uffe
Sultan, Sherif
Volek, Jeff S
author_facet Diamond, David M
Alabdulgader, Abdullah A
de Lorgeril, Michel
Harcombe, Zoe
Kendrick, Malcolm
Malhotra, Aseem
O'Neill, Blair
Ravnskov, Uffe
Sultan, Sherif
Volek, Jeff S
author_sort Diamond, David M
collection PubMed
description 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.
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spelling pubmed-86399442021-12-15 Dietary Recommendations for Familial Hypercholesterolaemia: an Evidence-Free Zone Diamond, David M Alabdulgader, Abdullah A de Lorgeril, Michel Harcombe, Zoe Kendrick, Malcolm Malhotra, Aseem O'Neill, Blair Ravnskov, Uffe Sultan, Sherif Volek, Jeff S BMJ Evid Based Med EBM analysis 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. BMJ Publishing Group 2021-12 2020-07-05 /pmc/articles/PMC8639944/ /pubmed/32631832 http://dx.doi.org/10.1136/bmjebm-2020-111412 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle EBM analysis
Diamond, David M
Alabdulgader, Abdullah A
de Lorgeril, Michel
Harcombe, Zoe
Kendrick, Malcolm
Malhotra, Aseem
O'Neill, Blair
Ravnskov, Uffe
Sultan, Sherif
Volek, Jeff S
Dietary Recommendations for Familial Hypercholesterolaemia: an Evidence-Free Zone
title Dietary Recommendations for Familial Hypercholesterolaemia: an Evidence-Free Zone
title_full Dietary Recommendations for Familial Hypercholesterolaemia: an Evidence-Free Zone
title_fullStr Dietary Recommendations for Familial Hypercholesterolaemia: an Evidence-Free Zone
title_full_unstemmed Dietary Recommendations for Familial Hypercholesterolaemia: an Evidence-Free Zone
title_short Dietary Recommendations for Familial Hypercholesterolaemia: an Evidence-Free Zone
title_sort dietary recommendations for familial hypercholesterolaemia: an evidence-free zone
topic EBM analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8639944/
https://www.ncbi.nlm.nih.gov/pubmed/32631832
http://dx.doi.org/10.1136/bmjebm-2020-111412
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