3

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Can Paleo help with *hereditary* (familial) high blood cholesterol (hypercholesterolemia type II a)?

Answered on August 19, 2014
Created April 05, 2013 at 9:08 AM

An online acquaintance whose father died of the disease at age 29 has recently gone from SAD to Whole30. Her LDL has increased to 380 (up from 330) and her HDL has dropped (to 32, down from 45) since. Her doctors now want her on statins. She also has Hashimotos's, but most importantly, it's been confirmed since age 12 that she also has the disease her father had, which is hypercholesterolemia type II. Understandably, she's freaking out. She's 35 and doesn't know what to do, go on with Whole30, give up Paleo altogether, eat lots of fiber and low fat like her doctors are telling her to...? (Ironically, I was going to post the article by Mark Sisson on dietary cholesterol, until I saw that in the same article, further down, he basically states that people like her are going to die sooner rather than later, and aren't relevant for the rest of the population.

"Let me also add that everyone???s cholesterol profile is going to be different, no matter what. And I acknowledge that a very small percentage of people out there genuinely have true hereditary high blood cholesterol, familial hypercholesterolemia, a metabolic condition with impaired or even lack of ability to metabolize cholesterol. This condition can have serious health consequences. By the way, this condition, in its heterozygous form affects at most 1 in 500 people. Total serum cholesterol in these folks is in the 400 mg/dl range (as opposed to the 200 recommended). The homozygous form affects about 1 in 250,000. You likely don???t know anyone in this category because their disorder almost always ends their lives at a very young age.")

I really feel for this young woman. Can anyone help?

742ff8ba4ff55e84593ede14ac1c3cab

(3536)

on April 09, 2013
at 09:31 PM

@Janknitz, I also eat a lot of fruit and fat for that matter, and my HDL is in the high 70's and trigs in the low 30's. Obviously we are all different.

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on April 08, 2013
at 08:17 PM

I used to think like that too, that upping carbs will increase my trigs. Actually the opposite happened. My trigs went even lower, from 90s to 60s, on a higher carb Paleo. I was 99% sure though that increasing carbs would increase my trigs. Trigs are really a marker of caloric overconsumption, not carb consumption. You would think in countries like Japan where almost everyone consume at least 150g of carbs daily they would have higher trigs. Not so, I've seen people with trigs <50 eating 3 square meals of rice. Low trigs are not the exclusive province of low-carbers.

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on April 08, 2013
at 08:12 PM

If she's confirmed w/FH T2 then that rules out hypo/F3 and undue dietary response to SAFA/ApoE4 as culprits. With that diagnosis, she doesn't have much room to maneuver. She does need statins because she will have out of control atherosclerosis. With LDL that high her TC is likely to be over 450, and HDL at any level isn't protective at that high TC. Unfortunate but in this case, conventional medicine is the only option I see.

800e726cb5dff569fd8edf604c3e2793

(1655)

on April 08, 2013
at 02:54 PM

Generally speaking, lowering LDL is more important than maintaining high HDL. However there's a lot of individual variability is response to statins -- I think she should try them and see how they affect her blood lipids. If there's no gain, she can stop.

D68b53f72622fe338df20f09e6ffdca4

(15)

on April 07, 2013
at 07:53 PM

Unfortunately, her dad died two weeks before she was born, so she wouldn't know... Thank you so much for your thoughtful response.

Medium avatar

(39831)

on April 07, 2013
at 12:29 AM

Also, sat fat are definitely contraindicated with FH. I guess you're just straight up wrong about everything.

Medium avatar

(39831)

on April 07, 2013
at 12:28 AM

Also, my HDL is in the high 80s, so you're wrong on both counts.

Medium avatar

(39831)

on April 07, 2013
at 12:26 AM

Janknitz: I eat 300g of carbs every day and tons of fructose and my TGs are in the 30s. Stop spouting ignorant bullshit.

19acef0aed67ef8dc1118d8e74edb349

(2954)

on April 06, 2013
at 05:40 PM

What if statins make her HDL worse? Statins don't just lower LDL, an not all LDL is bad anyway.

Cbdc8318738324492f2d5918868ce4c9

(1211)

on April 05, 2013
at 10:09 PM

I'm not FH, but ApoE4, and have 32 trigs, 78 HDL with 50s/20s% C/F. My trigs go up to 79 eating higher fat (50%) with LDL 2x-increase, while HDL stays about the same.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on April 05, 2013
at 04:28 PM

What of the low-fat, high-carb SADers who get better numbers doing so? While I'm not a doctor and only can comment from reading quite a few accounts of folks with exploding TC levels on paleo with PH... FH is a whole other ballgame really.

3491e51730101b18724dc57c86601173

(8395)

on April 05, 2013
at 03:12 PM

I would say the sat fats of the paleo diet MAY be contraindicated with FH, but I'm not sure we know just yet. She should be seeing a lipidologist. But upping carbs is NOT better. Increasing carbs will blow triglycerides through the roof and decrease HDL. That will be harmful, not helpful.

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7 Answers

4
Cbdc8318738324492f2d5918868ce4c9

(1211)

on April 05, 2013
at 12:30 PM

Might be able to get some ideas from a paleo follower with Familial Hypercholesterolemia, Jonathan Carey, who has increased HDL from 34 to 91:
http://www.tripleyourhdl.com/

3
Medium avatar

on April 07, 2013
at 12:21 AM

High fat, low carb/fiber shot my cholesterol to 393 from 180 (now back to 190 when I removed the lunacy). It's happened to tons of people. Eat a pile of dairy fat and take a ride on the simulated FH roller coaster. Boosting it further if you already have FH is insane.

She should do what her doctors tell her and eat a bunch of soluble fiber and avoid butter/cream/coconut like the plague. I bet she hyperresponds to dietary cholesterol as well. She should also be focusing on doing whatever it takes to ensure that her slow turnover LDL pool stays free of oxidation as much as possible. This means a lot vitamin C, a lot of vitamin E (raw sunflower seeds) and the other antioxidants present in fruits and vegetables. Fuck it, everyone should be doing that no matter what.

If all else fails, statins are probably a good idea. People with FH are probably the only ones who truly benefit anyway.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2583391/

3
800e726cb5dff569fd8edf604c3e2793

on April 05, 2013
at 03:38 PM

I'd tell her to take statins. She's different from the general population genetically and her genes set her up to die early. If she doesn't want to die early, she'll need to fight her "natural" cholesterol metabolism and at the moment the most effective tools we have are statins.

And yeah, she should try to find the most competent cardiologist available to her...

19acef0aed67ef8dc1118d8e74edb349

(2954)

on April 06, 2013
at 05:40 PM

What if statins make her HDL worse? Statins don't just lower LDL, an not all LDL is bad anyway.

800e726cb5dff569fd8edf604c3e2793

(1655)

on April 08, 2013
at 02:54 PM

Generally speaking, lowering LDL is more important than maintaining high HDL. However there's a lot of individual variability is response to statins -- I think she should try them and see how they affect her blood lipids. If there's no gain, she can stop.

2
32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on April 05, 2013
at 12:38 PM

Paleo is essentially gasoline on a fire when it comes to FH, as far as I've seen. Reducing the fat and upping carbohydrate might help. Statins generally are the course of action even paleo gurus agree on.

You'll still have some paleo folks dismissing high cholesterol as long as the types or ratios are "correct", but high cholesterol does mean something is amiss.

Cbdc8318738324492f2d5918868ce4c9

(1211)

on April 05, 2013
at 10:09 PM

I'm not FH, but ApoE4, and have 32 trigs, 78 HDL with 50s/20s% C/F. My trigs go up to 79 eating higher fat (50%) with LDL 2x-increase, while HDL stays about the same.

Medium avatar

(39831)

on April 07, 2013
at 12:28 AM

Also, my HDL is in the high 80s, so you're wrong on both counts.

3491e51730101b18724dc57c86601173

(8395)

on April 05, 2013
at 03:12 PM

I would say the sat fats of the paleo diet MAY be contraindicated with FH, but I'm not sure we know just yet. She should be seeing a lipidologist. But upping carbs is NOT better. Increasing carbs will blow triglycerides through the roof and decrease HDL. That will be harmful, not helpful.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on April 05, 2013
at 04:28 PM

What of the low-fat, high-carb SADers who get better numbers doing so? While I'm not a doctor and only can comment from reading quite a few accounts of folks with exploding TC levels on paleo with PH... FH is a whole other ballgame really.

Medium avatar

(39831)

on April 07, 2013
at 12:29 AM

Also, sat fat are definitely contraindicated with FH. I guess you're just straight up wrong about everything.

Medium avatar

(39831)

on April 07, 2013
at 12:26 AM

Janknitz: I eat 300g of carbs every day and tons of fructose and my TGs are in the 30s. Stop spouting ignorant bullshit.

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on April 08, 2013
at 08:17 PM

I used to think like that too, that upping carbs will increase my trigs. Actually the opposite happened. My trigs went even lower, from 90s to 60s, on a higher carb Paleo. I was 99% sure though that increasing carbs would increase my trigs. Trigs are really a marker of caloric overconsumption, not carb consumption. You would think in countries like Japan where almost everyone consume at least 150g of carbs daily they would have higher trigs. Not so, I've seen people with trigs <50 eating 3 square meals of rice. Low trigs are not the exclusive province of low-carbers.

742ff8ba4ff55e84593ede14ac1c3cab

(3536)

on April 09, 2013
at 09:31 PM

@Janknitz, I also eat a lot of fruit and fat for that matter, and my HDL is in the high 70's and trigs in the low 30's. Obviously we are all different.

1
Fd7b128cf714044a86d8bd822c7a8992

(4292)

on April 06, 2013
at 06:55 PM

I think she should get tested at least a couple more times, since cholesterol can really fluctuate in women with the menstrual cycle, especially if she's on the pill.

Also, it's not a strict choice between Paleo and SAD. Would it be easier for her to do a modified, higher-carb, lower-fat version of Paleo, more like WAPF-style eating, with lots of fruits and tubers, some lower-fat meat like chicken or lean beef, and fish? Maybe even fermented/sprouted legumes, or traditional fermented sourdough. It's not really Paleo but it sure beats SAD junk food!

1
0382fa263de4c83328dc34a56e25437f

on April 06, 2013
at 05:47 PM

Nora Gedgaudas and other nutritional science writers have made compelling arguments that diet is key in the expression of genetic tendencies. In short, the idea is that an optimal diet can only stack the odds in one's favor. We have a great deal more control over what we inherit than most people think.

1
19acef0aed67ef8dc1118d8e74edb349

(2954)

on April 06, 2013
at 05:19 PM

If there's really no getting away from dying earlier than most people, wouldn't it be a good idea to make those years as healthy as possible? If so, Paleo would be the way to go (rather than SAD), if it gives a higher quality of life.

This is important to me too, I don't have FH, at least that I know of, but dying young from heart problems is a issue for women in my family. My gandmother was even disabled because of heart issues since she was young. I already started showing heart problems when I was 22, so like your friend, I'm scared. I've already decided not to have children, both for my sake and the child's sake.

Cholesterol tests vary each time you take them, that 45 to 32, it doesn't matter, it could have been 32 then 45. You have to see the results and trends over time, not just react based on one or two test results.

With any change in diet, test results can suddenly change. keep testing and look at the pattern over the months.

Chances are, I'll die young, so my priority is to have a quality of life as good as I can until then. Thankfully, eating Paleo has helped me a lot already.

Statins might make things worse instead of improving quality of life: http://www.westonaprice.org/cardiovascular-disease/dangers-of-statin-drugs

Scroll down to Basic Science of Pathogenesis: http://www.westonaprice.org/thumbs-down-reviews/cholesterol-wars-steinberg

Understanding the role of different types f cholesterol:
http://www.marksdailyapple.com/forum/thread4723.html

With this disease the body can't remove the bad LDL from the blood. So I would do everything I could to prevent damage to my body (anything that could cause bad LDL and triglycerides to rise). I would take enzymes with bile to help digestion (cholesterol is needed for bile which is needed for digestion). And get vitamin D levels tested and ask the doctor if vitamin D shots would help if it's low (I'm not sure... cholesterol is needed for vitamin D)

It seems the doctor is treating her condition the same way they treat high cholesterol in the rest of the population... in which case, it might be better to just keep doing Paleo.

What may cause high LDL: http://perfecthealthdiet.com/2011/03/answer-day-what-causes-high-ldl-on-low-carb-paleo/

My body had been sick for years, so I guess as Paleo gave my body what it needed to heal itself, LDL was raised temporarily.

Things that helped improve my condition and improve my LDL, besides "just paleo":

Eating fatty beef, egg yolks, and fatty fish as my main sources of protein.

I eat oysters, cod liver (not oil), beef/chicken liver, or beef/chicken heart for breakfast.

I use bone broth as much as I can in cooking, I generally get one or two cups per day.

Eating beef tallow as my main source of cooking fat (I use about 3 or 4 tablespoons when cooking), and occasionally coconut oil, as well as other animal fats when I can find a good source. I try to avoid butter or milk unless it's raw and grass fed, but since it's expensive I don't get to have lots of it anyway... :-)

Eating two meals per day whithin 6 hours of each other. This makes a huge difference, I wonder why!

No nuts. I believe nuts can be just as bad as grains.

I eat high-carb vegetables, but I limit high-carb fruits.

Other things (I'm including everything I can think of in case it's helpful). I take coq10, vitamin D3, sublingual b12 (I had neuropathy which improved a lot with Paleo, but still have some brain damage. I'm not sure if it's because I need even more B12, or if it could be vascular dementia. If it is, I don't think it can be cured ).

When I make my broth every week, I dilute some magnesium on it. I try to get plenty of vitamin C from vegetables to better absorb iron.

Pay attention to all minerals and vitamins. I was deficient in several, even on pale. That's why I'm eating all these things I listed.

Here are the basics:

http://www.westonaprice.org/vitamins-and-minerals/mineral-primer

http://www.westonaprice.org/vitamins-and-minerals/vitamin-primer

If you search on their website for a particular nutrient, it might have more detailed information. It's important for heart health, it made a huge difference for me.

...

One question to ask her:

"What advice, if any, did your dad follow, and what good did it do to him? If it didn't give him a good life, are you sure you want to follow that same advice?

D68b53f72622fe338df20f09e6ffdca4

(15)

on April 07, 2013
at 07:53 PM

Unfortunately, her dad died two weeks before she was born, so she wouldn't know... Thank you so much for your thoughtful response.

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