Table of ContentsView AllTable of ContentsBenefits of a Heart-Healthy DietHow It WorksConsiderationsDietary Restrictions
Table of ContentsView All
View All
Table of Contents
Benefits of a Heart-Healthy Diet
How It Works
Considerations
Dietary Restrictions
Familial hypercholesterolemia (FH)is an inherited condition that causes high levels of LDL cholesterol (“bad” cholesterol). This increases the risk of heart disease.
FH almost always requires medication to bring LDL levels to an optimum level. However, diet can be an important part of managing this condition, too. Pairing healthy lifestyle choices such as eating a heart-healthy diet can help reduce the cardiovascular risks that come with FH.
This article will discuss diet strategies that have been shown to lower LDL cholesterol, including filling up on fiber-rich foods, favoring lean protein sources, and more.
The goal in the treatment of FH is to minimize the risk of complications such as heart disease. FH does not have a cure, but a combination of appropriate medications and healthy lifestyle habits can help manage LDL levels. This, in turn, can help reduce the risk of heart problems.
There isn’t a specific “FH diet,” but rather people with FH should follow the guidelines for heart-healthy eating meant for anyone at risk of heart disease. These guidelines are healthy for most people in general. So, you can get the whole family on board.
The American Heart Association (AHA) recommends an eating pattern that emphasizes:
The organization recommends limiting:
While following a specific, named diet plan isn’t necessary, three diet programs follow similar guidelines to promote heart-healthy eating, including:
What Does “Diet” Mean?“Diet” is often used to denote a short-term, calorie-restricted eating practice aimed at losing weight.In the context of this article, “diet” refers to eating patterns.The combination of foods and beverages a person consumes over time constitutes their eating pattern, or dietary pattern.The “diets” referenced here describe overall healthy-eating patterns and guidelines meant for long-term health habits rather than short-term weight loss.
What Does “Diet” Mean?
“Diet” is often used to denote a short-term, calorie-restricted eating practice aimed at losing weight.In the context of this article, “diet” refers to eating patterns.The combination of foods and beverages a person consumes over time constitutes their eating pattern, or dietary pattern.The “diets” referenced here describe overall healthy-eating patterns and guidelines meant for long-term health habits rather than short-term weight loss.
“Diet” is often used to denote a short-term, calorie-restricted eating practice aimed at losing weight.
In the context of this article, “diet” refers to eating patterns.
The combination of foods and beverages a person consumes over time constitutes their eating pattern, or dietary pattern.
The “diets” referenced here describe overall healthy-eating patterns and guidelines meant for long-term health habits rather than short-term weight loss.
The main purpose of following the heart-healthy dietary guidelines for FH is tolower LDL cholesterol.
Eating the foods that are recommended (and avoiding the ones that are not) can also have other benefits, such as lowering or preventing high blood pressure and promoting weight loss for those who need it.
Duration
FH is a lifelong condition that requires ongoing treatment. The dietary guidelines for people with FH are meant to be adopted as a lifestyle, even if symptoms are under control.
While important for both FH and overall health, healthy eating is not a substitute for medical treatment. High LDL in people without FH can often be controlled or managed with lifestyle changes alone, but this is not effective forpeople with FH.
What to Eat
The foods that are recommended for people with FH are fairly straightforward, as are the ones to be limited or avoided.
Verywell / Michela Buttignol
Recommended FoodsFruits (especially apples, grapes, strawberries, and citrus fruits)VegetablesLow-fat dairy productsWhole grains (especially oats and barley)Poultry (skinless)Fish (especially fatty fish)NutsSeedsLegumesUnsaturated fats (as a substitute for saturated or trans fats)SoyFoods fortified with sterols and stanolsFoods high in soluble fiberFoods to Limit or AvoidSaturated fatsTrans fatsRed meat (limit and choose lean cuts)Sugary foods and beveragesEgg yolks (two or fewer per week, including as an ingredient in baked goods and other foods)AlcoholSodium
Recommended FoodsFruits (especially apples, grapes, strawberries, and citrus fruits)VegetablesLow-fat dairy productsWhole grains (especially oats and barley)Poultry (skinless)Fish (especially fatty fish)NutsSeedsLegumesUnsaturated fats (as a substitute for saturated or trans fats)SoyFoods fortified with sterols and stanolsFoods high in soluble fiber
Fruits (especially apples, grapes, strawberries, and citrus fruits)
Vegetables
Low-fat dairy products
Whole grains (especially oats and barley)
Poultry (skinless)
Fish (especially fatty fish)
Nuts
Seeds
Legumes
Unsaturated fats (as a substitute for saturated or trans fats)
Soy
Foods fortified with sterols and stanols
Foods high in soluble fiber
Foods to Limit or AvoidSaturated fatsTrans fatsRed meat (limit and choose lean cuts)Sugary foods and beveragesEgg yolks (two or fewer per week, including as an ingredient in baked goods and other foods)AlcoholSodium
Saturated fats
Trans fats
Red meat (limit and choose lean cuts)
Sugary foods and beverages
Egg yolks (two or fewer per week, including as an ingredient in baked goods and other foods)
Alcohol
Sodium
Note: Serving suggestions are based on theDASH diet’srecommendations for a 2,000-calorie-per-day diet. These amounts will vary based on factors such as individual caloric needs.
The Mediterranean diet has similar guidelines to other heart-healthy plans such as DASH and TLC, with a few exceptions, which are:It emphasizes olive oil as a primary fat source.Animal products (such as dairy, meat, and eggs) are suggested in lower amounts, especially red meat.Red wine is recommended (for those who can consume it safely) in low to moderate amounts, usually at meals.A review of studies has shown that following the Mediterranean diet is associated with lowered total and LDL cholesterol levels, and better health outcomes.Another meta-analysis indicated that the Mediterranean diet may be more effective for the improvement of long-term cardiovascular risk factors than alow-fat diet.More research is needed on how the Mediterranean diet affects LDL cholesterol.
The Mediterranean diet has similar guidelines to other heart-healthy plans such as DASH and TLC, with a few exceptions, which are:
A review of studies has shown that following the Mediterranean diet is associated with lowered total and LDL cholesterol levels, and better health outcomes.
Another meta-analysis indicated that the Mediterranean diet may be more effective for the improvement of long-term cardiovascular risk factors than alow-fat diet.
More research is needed on how the Mediterranean diet affects LDL cholesterol.
Recommended Timing
A healthy diet for FH includeslots of fiber—but start slowly. Gradually increasing your servings of fruits, veggies, and other fiber-rich foods will give your digestive system a chance to adjust and reduce the temporary bloating and diarrhea that can come with an increase in fiber intake.
Choose fruits and vegetables for snacks between meals. This will help you get your total number of servings, it spreads out your servings, and it gives you a low-calorie, high nutrition way to stay satisfied between meals.
Cooking Tips
How you prepare your food makes a big difference to the health benefits.
Some tips to getting the most out of your heart-healthy diet include:
Modifications
Check with your healthcare provider before making any dietary changes to make a plan that meets all of your nutrition needs and goals.
While meat and animal products are included in the guidelines for eating with FH, this eating plan can be adjusted for vegetarian orveganlifestyles.
Flexibility
This eating plan relies on an overview of foods to eat and foods to limit, making it easy to adjust to personal tastes. Foods such as whole grains, vegetables, beans, and other recommended foods can be used in a wide variety of recipes. Unsaturated fats and proteins can be supplied with plant-based foods instead of foods like dairy or fish.
The National Heart Lung and Blood Institute offers awebsite filled with heart-healthy recipes.
Sustainabillity
These guidelines promote long-term lifestyle practices. The goal is to change your eating habits to healthy ones such that it becomes a way of life.
Making changes gradually can help your body adjust to these changes and make the new habits easier to incorporate.
What you eat and how much you eat can change over time. At first, some people with FH may find after discussing a treatment plan with their healthcare provider that losing weight would be beneficial for them.
Once a target weight has been reached, calorie guidelines can be adjusted to maintain a weight that is healthy for you.
Moderation is key as well. While unsaturated fats are healthier than saturated ortrans fats, they have the same number of calories and should not be used in excess.
Similarly, foods such as sugar, saturated fats, or alcohol should be consumed sparingly, but allowing for occasional indulgences is important for long-term sustainability. For example, the DASH diet has a recommended allowance of up to five servings of sweets per week, depending on caloric needs.
These servings may look like:
You can also choose healthier options for your limited foods when you do consume them. The AHA recommends no more than one alcoholic drink per day for women and no more than two for men.Red wine is considered a particularly heart-healthy option.
Before starting this or any new diet plan, consult with your healthcare provider. They can help you determine your caloric needs and if any changes need to be made to the plan to accommodate for other health conditions orallergiesyou may have.
Tell your healthcare provider of any medications you are taking or plan to take, including over-the-counter drugs and supplements. Some foods can interact with medications. Some medications and supplements need to be taken with food. Your healthcare provider can help you manage any conflicts between your medication and your new eating plan.
More Than DietGetting enough exercisegoes hand in hand with diet and medication treatments for FH.The AHA recommends getting at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity (or an equal combination of both) each week.Speak with your healthcare provider before beginning an exercise program to ensure the activities are right—and safe—for you.
More Than Diet
Getting enough exercisegoes hand in hand with diet and medication treatments for FH.The AHA recommends getting at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity (or an equal combination of both) each week.Speak with your healthcare provider before beginning an exercise program to ensure the activities are right—and safe—for you.
Getting enough exercisegoes hand in hand with diet and medication treatments for FH.
The AHA recommends getting at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity (or an equal combination of both) each week.
Speak with your healthcare provider before beginning an exercise program to ensure the activities are right—and safe—for you.
Summary
Adopting a heart-healthy diet in combination with medication and guidance from your healthcare practitioner can go a long way toward managing familial hypercholesterolemia (FH). To get started, fill up your plate mostly with fruit and vegetables, whole grains, beans, nuts, and lean protein sources like fish and poultry. You’ll also want to limit red meat, full-fat dairy, and processed and packaged foods.
A Word From Verywell
While people with FH will need medication to control their LDL levels, eating a heart-healthy diet is a great way to complement your treatment protocol and improve overall health.
A diet rich in high-fiber foods like fruits, vegetables, whole grains, lentils, and beans combined with unsaturated fats found in foods such as olive oil, some nuts, and fatty fish can help reduce LDL and protect your heart.
Limiting saturated and trans fats, sugars and refined grains, and sodium can help reduce the cardiovascular risks that come with FH.
Talk to your healthcare provider about lifestyle and dietary changes you can make to optimize your treatment for FH.
20 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Familial hypercholesterolemia.American Heart Association.The American Heart Association diet and lifestyle recommendations.U.S. Department of Health and Human Services and U.S. Department of Agriculture.2015–2020 Dietary Guidelines for Americans.National Heart Lung and Blood Institute.Your guide to lowering blood pressure.American Heart Association.What is the Mediterranean diet?Harvard Health.11 foods that lower cholesterol.National Heart Lung and Blood Institute.Your guide to lowering your cholesterol with TLC.National Heart Lung and Blood Association.DASH eating plan.Koutsos A, Riccadonna S, Ulaszewska MM, et al.Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: a randomized, controlled, crossover trial.Am J Clin Nutr. 2020;111(2):307-318. doi:10.1093/ajcn/nqz282Abdelhamid AS, Brown TJ, Brainard JS, et al.Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease.Cochrane Database Syst Rev. 2018;7(7):CD003177. Published 2018 Jul 18. doi:10.1002/14651858.CD003177.pub3Guasch-Ferré M, Liu X, Malik VS, et al.Nut consumption and risk of cardiovascular disease.J Am Coll Cardiol. 2017;70(20):2519-2532. doi:10.1016/j.jacc.2017.09.035American Heart Association.The benefits of beans and legumes.Tokede OA, Onabanjo TA, Yansane A, Gaziano JM, Djoussé L.Soya products and serum lipids: a meta-analysis of randomised controlled trials.Br J Nutr. 2015;114(6):831-843. doi:10.1017/S0007114515002603American Heart Association.Monounsaturated fat.Maćkowiak K, Torlińska-Walkowiak N, Torlińska B.Dietary fibre as an important constituent of the diet.Postepy Hig Med Dosw (Online). 2016;70:104-109. doi:10.5604/17322693.1195842Harvard Health.Fiber-full eating for better health and lower cholesterol.Rees K, Hartley L, Flowers N, et al.Mediterranean dietary pattern for the primary prevention of cardiovascular disease.Cochrane Rev. 2014;8:1-55. doi:10.1002/14651858.CD009825.pubNordmann AJ, Suter-Zimmermann K, Bucher HC, et al.Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors.Am J Med. 2011;124:841-851. doi:10.1016/j.amjmed.2011.04.024American Heart Association.How to cook healthier at home.Bushra R, Aslam N, Khan AY.Food-drug interactions.Oman Med J. 2011;26(2):77-83. doi:10.5001/omj.2011.21
20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Familial hypercholesterolemia.American Heart Association.The American Heart Association diet and lifestyle recommendations.U.S. Department of Health and Human Services and U.S. Department of Agriculture.2015–2020 Dietary Guidelines for Americans.National Heart Lung and Blood Institute.Your guide to lowering blood pressure.American Heart Association.What is the Mediterranean diet?Harvard Health.11 foods that lower cholesterol.National Heart Lung and Blood Institute.Your guide to lowering your cholesterol with TLC.National Heart Lung and Blood Association.DASH eating plan.Koutsos A, Riccadonna S, Ulaszewska MM, et al.Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: a randomized, controlled, crossover trial.Am J Clin Nutr. 2020;111(2):307-318. doi:10.1093/ajcn/nqz282Abdelhamid AS, Brown TJ, Brainard JS, et al.Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease.Cochrane Database Syst Rev. 2018;7(7):CD003177. Published 2018 Jul 18. doi:10.1002/14651858.CD003177.pub3Guasch-Ferré M, Liu X, Malik VS, et al.Nut consumption and risk of cardiovascular disease.J Am Coll Cardiol. 2017;70(20):2519-2532. doi:10.1016/j.jacc.2017.09.035American Heart Association.The benefits of beans and legumes.Tokede OA, Onabanjo TA, Yansane A, Gaziano JM, Djoussé L.Soya products and serum lipids: a meta-analysis of randomised controlled trials.Br J Nutr. 2015;114(6):831-843. doi:10.1017/S0007114515002603American Heart Association.Monounsaturated fat.Maćkowiak K, Torlińska-Walkowiak N, Torlińska B.Dietary fibre as an important constituent of the diet.Postepy Hig Med Dosw (Online). 2016;70:104-109. doi:10.5604/17322693.1195842Harvard Health.Fiber-full eating for better health and lower cholesterol.Rees K, Hartley L, Flowers N, et al.Mediterranean dietary pattern for the primary prevention of cardiovascular disease.Cochrane Rev. 2014;8:1-55. doi:10.1002/14651858.CD009825.pubNordmann AJ, Suter-Zimmermann K, Bucher HC, et al.Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors.Am J Med. 2011;124:841-851. doi:10.1016/j.amjmed.2011.04.024American Heart Association.How to cook healthier at home.Bushra R, Aslam N, Khan AY.Food-drug interactions.Oman Med J. 2011;26(2):77-83. doi:10.5001/omj.2011.21
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
MedlinePlus.Familial hypercholesterolemia.American Heart Association.The American Heart Association diet and lifestyle recommendations.U.S. Department of Health and Human Services and U.S. Department of Agriculture.2015–2020 Dietary Guidelines for Americans.National Heart Lung and Blood Institute.Your guide to lowering blood pressure.American Heart Association.What is the Mediterranean diet?Harvard Health.11 foods that lower cholesterol.National Heart Lung and Blood Institute.Your guide to lowering your cholesterol with TLC.National Heart Lung and Blood Association.DASH eating plan.Koutsos A, Riccadonna S, Ulaszewska MM, et al.Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: a randomized, controlled, crossover trial.Am J Clin Nutr. 2020;111(2):307-318. doi:10.1093/ajcn/nqz282Abdelhamid AS, Brown TJ, Brainard JS, et al.Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease.Cochrane Database Syst Rev. 2018;7(7):CD003177. Published 2018 Jul 18. doi:10.1002/14651858.CD003177.pub3Guasch-Ferré M, Liu X, Malik VS, et al.Nut consumption and risk of cardiovascular disease.J Am Coll Cardiol. 2017;70(20):2519-2532. doi:10.1016/j.jacc.2017.09.035American Heart Association.The benefits of beans and legumes.Tokede OA, Onabanjo TA, Yansane A, Gaziano JM, Djoussé L.Soya products and serum lipids: a meta-analysis of randomised controlled trials.Br J Nutr. 2015;114(6):831-843. doi:10.1017/S0007114515002603American Heart Association.Monounsaturated fat.Maćkowiak K, Torlińska-Walkowiak N, Torlińska B.Dietary fibre as an important constituent of the diet.Postepy Hig Med Dosw (Online). 2016;70:104-109. doi:10.5604/17322693.1195842Harvard Health.Fiber-full eating for better health and lower cholesterol.Rees K, Hartley L, Flowers N, et al.Mediterranean dietary pattern for the primary prevention of cardiovascular disease.Cochrane Rev. 2014;8:1-55. doi:10.1002/14651858.CD009825.pubNordmann AJ, Suter-Zimmermann K, Bucher HC, et al.Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors.Am J Med. 2011;124:841-851. doi:10.1016/j.amjmed.2011.04.024American Heart Association.How to cook healthier at home.Bushra R, Aslam N, Khan AY.Food-drug interactions.Oman Med J. 2011;26(2):77-83. doi:10.5001/omj.2011.21
MedlinePlus.Familial hypercholesterolemia.
American Heart Association.The American Heart Association diet and lifestyle recommendations.
U.S. Department of Health and Human Services and U.S. Department of Agriculture.2015–2020 Dietary Guidelines for Americans.
National Heart Lung and Blood Institute.Your guide to lowering blood pressure.
American Heart Association.What is the Mediterranean diet?
Harvard Health.11 foods that lower cholesterol.
National Heart Lung and Blood Institute.Your guide to lowering your cholesterol with TLC.
National Heart Lung and Blood Association.DASH eating plan.
Koutsos A, Riccadonna S, Ulaszewska MM, et al.Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: a randomized, controlled, crossover trial.Am J Clin Nutr. 2020;111(2):307-318. doi:10.1093/ajcn/nqz282
Abdelhamid AS, Brown TJ, Brainard JS, et al.Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease.Cochrane Database Syst Rev. 2018;7(7):CD003177. Published 2018 Jul 18. doi:10.1002/14651858.CD003177.pub3
Guasch-Ferré M, Liu X, Malik VS, et al.Nut consumption and risk of cardiovascular disease.J Am Coll Cardiol. 2017;70(20):2519-2532. doi:10.1016/j.jacc.2017.09.035
American Heart Association.The benefits of beans and legumes.
Tokede OA, Onabanjo TA, Yansane A, Gaziano JM, Djoussé L.Soya products and serum lipids: a meta-analysis of randomised controlled trials.Br J Nutr. 2015;114(6):831-843. doi:10.1017/S0007114515002603
American Heart Association.Monounsaturated fat.
Maćkowiak K, Torlińska-Walkowiak N, Torlińska B.Dietary fibre as an important constituent of the diet.Postepy Hig Med Dosw (Online). 2016;70:104-109. doi:10.5604/17322693.1195842
Harvard Health.Fiber-full eating for better health and lower cholesterol.
Rees K, Hartley L, Flowers N, et al.Mediterranean dietary pattern for the primary prevention of cardiovascular disease.Cochrane Rev. 2014;8:1-55. doi:10.1002/14651858.CD009825.pub
Nordmann AJ, Suter-Zimmermann K, Bucher HC, et al.Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors.Am J Med. 2011;124:841-851. doi:10.1016/j.amjmed.2011.04.024
American Heart Association.How to cook healthier at home.
Bushra R, Aslam N, Khan AY.Food-drug interactions.Oman Med J. 2011;26(2):77-83. doi:10.5001/omj.2011.21
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