What is the best diet for people with FH?

December 27, 2025 •

4 min read

According to the American Heart Association, a heart-healthy diet is a critical component of managing FH, although lifestyle changes alone are not sufficient to fully control this genetic condition. Finding what is the best diet for people with FH involves a lifelong commitment to reducing saturated and trans fats while increasing foods rich in soluble fiber and unsaturated fats.

Quick Summary

A heart-healthy dietary approach, often aligned with Mediterranean or DASH principles, is recommended for managing familial hypercholesterolemia. It emphasizes high fiber intake, lean proteins, and unsaturated fats while strictly limiting saturated and trans fats to help lower LDL cholesterol levels.

Key Points

Heart-Healthy Eating: A diet low in saturated and trans fats and high in soluble fiber and unsaturated fats is critical for FH management.
Medication is Essential: Diet is a complementary strategy for FH, not a replacement for necessary cholesterol-lowering medications.
Emphasis on Soluble Fiber: Foods like oats, beans, and lentils help lower LDL cholesterol by binding to it and aiding its removal from the body.
Prioritize Unsaturated Fats: Replace unhealthy saturated fats with healthy polyunsaturated and monounsaturated fats from sources like olive oil, nuts, and seeds.
Incorporate Omega-3s: Consuming fatty fish like salmon or plant-based sources like flaxseed can help lower triglycerides and support heart health.
Adopt a Proven Plan: Following eating patterns like the Mediterranean or DASH diets provides a solid framework for heart-healthy eating.
Limit Processed Foods: Reduce intake of packaged foods, fried items, and sugary drinks, as they often contain unhealthy fats and sodium.

Understanding Familial Hypercholesterolemia and Diet

Familial Hypercholesterolemia (FH) is a genetic disorder characterized by very high levels of low-density lipoprotein (LDL) cholesterol from birth. This significantly increases the risk of early-onset cardiovascular disease. While medication is almost always necessary to manage FH, a heart-healthy diet is a crucial complementary strategy to minimize risk and improve overall health. The ideal diet focuses on limiting unhealthy fats that further raise LDL, while prioritizing foods that actively help lower cholesterol.

Key Principles of a Heart-Healthy Diet for FH

For individuals with FH, the dietary focus is not just about avoiding unhealthy foods, but about strategically incorporating foods that support cardiovascular health. This involves a shift toward a plant-based eating pattern rich in nutrients, fiber, and healthy fats, with controlled intake of lean proteins. Key components include:

Reducing Saturated and Trans Fats: Limiting intake of saturated fats (found in fatty meats, butter, and palm oil) and eliminating trans fats (often in fried and processed foods) is paramount. Saturated fats raise LDL cholesterol more than dietary cholesterol itself.
Increasing Soluble Fiber: Soluble fiber, found in oats, beans, and certain fruits, forms a gel in the intestines that binds to cholesterol and removes it from the body before it can be absorbed.
Prioritizing Unsaturated Fats: Replacing unhealthy fats with monounsaturated fats (like olive oil and avocado) and polyunsaturated fats (like nuts and seeds) can help improve cholesterol profiles.
Including Omega-3 Fatty Acids: Fatty fish, flaxseeds, and chia seeds provide omega-3s, which can help lower triglycerides and may offer other cardioprotective benefits.
Choosing Lean Proteins: Selecting lean sources of protein, such as fish, poultry without skin, and legumes, helps control overall fat intake.

The Role of Specific Foods

To build a comprehensive diet plan, it is helpful to categorize foods based on their impact on cholesterol and heart health.

Foods to Emphasize:

Fruits and Vegetables: Aim for a wide variety. Soluble fiber-rich options include apples, citrus fruits, berries, sweet potatoes, and eggplant.
Whole Grains: Oats, barley, brown rice, and quinoa are excellent sources of soluble and insoluble fiber.
Legumes: Beans, lentils, and chickpeas are high in soluble fiber and can replace meat in many dishes.
Nuts and Seeds: Walnuts, almonds, flaxseeds, and chia seeds are packed with healthy fats and fiber.
Healthy Oils: Extra virgin olive oil, canola oil, and sunflower oil are great for cooking instead of butter or coconut oil.
Fatty Fish: Include salmon, mackerel, and sardines at least twice a week for their omega-3 content.

Foods to Limit or Avoid:

High-Saturated Fat Foods: Processed meats (sausages, bacon), full-fat dairy, coconut oil, and palm oil.
Trans Fats: Baked goods, fried foods, and some processed snacks.
Excessive Red Meat: Limit lean red meat to small portions and less than 350g per week.
High-Sugar Foods and Drinks: Sugary beverages, candy, and sweets contribute to poor overall health.

Comparison of Diet Types for FH Management

While a heart-healthy diet is the general recommendation, specific eating patterns can serve as a framework. Here is a comparison of two widely-supported diet types.


Feature	Mediterranean Diet	DASH Diet
Focus	Whole foods, primarily plant-based, with olive oil as the main fat source and moderate fish intake.	Lowering blood pressure through reduced sodium and increased potassium, magnesium, and calcium.
Key Components	Fruits, vegetables, nuts, seeds, whole grains, legumes, fish, moderate dairy, and very limited red meat.	Fruits, vegetables, whole grains, low-fat dairy, poultry, fish, and nuts.
FH-Specific Benefit	Naturally high in unsaturated fats and fiber; emphasis on heart-healthy staples is ideal for FH.	Focus on overall heart health and blood pressure control complements cholesterol management in FH.
Flexibility	Highly adaptable with a wide variety of foods. Allows for moderate red wine consumption with meals for those who drink.	More structured with specific serving recommendations. Provides clear guidance on low-sodium choices.
Potential Downside	Can be higher in total fat than a low-fat diet, though from healthy sources. Requires mindful portion control.	Requires careful monitoring of sodium, which may be challenging when eating out.

Practical Strategies for Maintaining an FH Diet

Making significant dietary changes can be challenging, but a few practical strategies can help you stay on track:

Meal Prep: Plan your meals for the week to avoid last-minute, unhealthy choices. Prepare large batches of whole grains, beans, or roasted vegetables to use throughout the week.
Healthy Snacking: Keep healthy snacks like nuts, fruits, and vegetable sticks handy to curb hunger and avoid reaching for processed foods.
Cooking at Home: Take control of your ingredients by cooking more meals at home. Experiment with herbs and spices instead of salt to add flavor.
Read Labels: Become a label-reading expert. Check for saturated fat, trans fat, sodium, and added sugars, choosing low-fat or reduced-fat dairy products.

Conclusion

The best diet for people with FH is not a single, restrictive plan but a sustainable, heart-healthy eating pattern centered on whole, plant-based foods. While diet is not a replacement for medication, it is a powerful tool for managing cholesterol and reducing overall cardiovascular risk. Adopting habits from the Mediterranean or DASH diets, prioritizing soluble fiber, unsaturated fats, and omega-3s, and limiting saturated and trans fats are the core principles. Working with a healthcare provider or a registered dietitian is the best way to tailor a plan that fits your specific needs and ensures long-term heart health. For more science-backed information on healthy eating for cholesterol management, you can consult the Harvard School of Public Health's Nutrition Source.

Recommended Food List

Whole Grains: Oatmeal, barley, quinoa, brown rice, whole-wheat bread.
Legumes: Lentils, chickpeas, black beans, kidney beans.
Fatty Fish: Salmon, mackerel, sardines, trout.
Fruits: Apples, berries, citrus fruits, prunes, avocado.
Vegetables: Spinach, kale, sweet potatoes, broccoli, eggplant.
Nuts and Seeds: Walnuts, almonds, flaxseeds, chia seeds.
Healthy Oils: Extra virgin olive oil, canola oil, sunflower oil.
Low-Fat Dairy: Skim milk, reduced-fat cheese, low-fat yogurt.

Frequently Asked Questions

No, for people with FH, diet alone is not enough to control cholesterol levels due to the genetic nature of the condition. While a heart-healthy diet can reduce overall risk, medication is almost always required to reach optimal LDL cholesterol levels.

Soluble fiber creates a gel-like substance in the digestive system that binds to cholesterol and prevents it from being absorbed into the bloodstream. This helps to lower LDL ('bad') cholesterol levels.

No, healthy fats are beneficial. Unsaturated fats, such as monounsaturated fats (found in olive oil and avocados) and polyunsaturated fats (in nuts, seeds, and fish), should replace unhealthy saturated and trans fats in the diet.

Omega-3 fatty acids, found in fatty fish, walnuts, and flaxseeds, help lower triglyceride levels and support overall heart health. They should be included as part of a balanced diet.

Foods highest in saturated fat include processed meats (bacon, sausage), fatty cuts of red meat, full-fat dairy products, butter, and tropical oils like coconut and palm oil.

For most people with high cholesterol, moderate egg consumption is acceptable, but those with FH should limit intake to about two per week, including eggs used in baked goods. This can vary by individual, so a doctor's advice is recommended.

Focus on cooking methods that don't require adding a lot of fat, such as baking, grilling, steaming, or sautéing with a healthy oil like olive oil. Avoid deep frying and heavy, creamy sauces.

Yes, the Mediterranean diet is often recommended for people with FH because it naturally aligns with heart-healthy principles, emphasizing fruits, vegetables, whole grains, legumes, fish, and healthy oils.