Familial Hypercholesterolemia

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

I do most things right and am in good health, but I have a family history of high cholesterol. My cholesterol is really high and my doctor says I have to do something about it. I’m really worried. What should I do?”

First, thank you to the HMDI visitor who submitted this important question, variations of which new patients have, over the years, asked me on countless occasions.

My short answer: stop losing sleep about it unless you have been diagnosed with an inherited condition called familial hypercholesterolemia that causes exceptionally high, and dangerous, cholesterol.

Aside from this genetic condition, I don’t get excited about the everyday “high” cholesterol that has people scared out of their wits. In fact, I wrote a book in 2012 called The Great Cholesterol Myth in an attempt to educate people about cholesterol. In it, I make the argument that cholesterol needs to be treated differently. By that, I mean, it doesn’t usually need to be treated except with respect because cholesterol is a natural substance made by the body for the body − to construct cell membranes, sex hormones, vitamin D, digestive acids, and much of the brain itself (25%!!!).

Here’s an article that gives you the basic facts about cholesterol.

Familial Hypercholesterolemia

Familial hypercholesterolemia is a different matter, and one you do need to take seriously. Here are the facts:

About one in 400 or 500 people have the most common form, called heterozygous familial hypercholesterolemia. I’ve seen only about one such case a year during my three-plus decades in practice.

What this means is, you inherit a chromosome defect from one parent that impairs your body’s ability to remove cholesterol (LDL) from the blood and maintain a normal level. In this situation, the cholesterol can rise excessively high, substantially increasing the risk of oxidation. It is oxidized cholesterol that’s dangerous as it leads to arterial plaque, and premature heart attacks and cardiovascular disease. Your total cholesterol can soar to 350 to 550 mg/dl.

Keep in mind that you are considered to have so-called “high cholesterol” if your level is over 200.

The rarer type of familial hypercholesterolemia – called homozygous − affects one in a million individuals. You inherit the genetic defect from both parents. Here, the cholesterol level can skyrocket to a 1,000. I never saw a case like this. At such high-rise levels, the blood becomes thick like ketchup and dangerous, and the only real option may be a liver transplant. The liver produces about a quarter of the body’s cholesterol.

Testing and Treatment for Hypercholesterolemia

People from families with a significant history of early heart attacks and very high levels of cholesterol need genetic testing and other appropriate tests. Even children should be tested.

Recently, a new class of powerful and expensive injectable drugs called PCSK9 inhibitors have emerged from years of research and development. They are intended for use against familial hypercholesterolemia as well as well as for patients intolerant of the widely prescribed cholesterol lowering statin drugs or for whom statins are not effective.

Two of the new drugs (Kynamro and Juxtapid) were approved in 2012 and 2013. Two more (Repatha and Praluent) were to be approved in 2015. There are safety concerns with all these drugs.

Cholesterol lowering medications represent a multi-billion pharmaceutical business and my continuing worry, as before with statins, is pushing cholesterol levels to unprecedented and unnatural low levels. I expect that these new drugs will also become overprescribed just as with statins.

My Recommendation

In cases of familial hypercholesterolemia, you need to work closely with your doctor.

If you were to come to me with this kind of a problem, I would use the best of both conventional and alternative medicine.

Conventionally, I might prescribe a statin or, very cautiously, possibly one of the new drugs that are available.

Integrating Alternative Treatments

I would also strongly recommend some integrative, if not alternative, remedies, including the following:

  •  A heart-healthy diet such as my favorite PAMM Diet that combines the best of Mediterranean and Asian healing foods
  • First and foremost, avoid sugar, sweeteners, and, as much as possible, refined carbohydrates which contribute to inflammation and weight gain.
  • Eat tomatoes, spinach, and kale, rich in the antioxidant lutein.
  • Take antioxidant supplements such as CoQ10 (150-300 milligrams) daily, a form of vitamin E called tocotrienol (10-60 milligrams), and vitamin C (1,000 milligrams).
  • 1-2 grams of fish or squid oil for anti-inflammatory protection.
  • Consider supplemental niacin (vitamin B-3, up to 1 gram) to improve HDL cholesterol and nattokinase (50 milligrams) to help thin the blood.
  • Regular physical exercise to help raise HDL cholesterol and lower LDL.
  • Last, but not least, grounding, which can reduce inflammation, improve blood flow, and help thin the blood.

For more information on familial hypercholesterolemia, visit the National Institutes of Health website here.

© 2015 HeartMD Institute. All rights reserved.

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  1. Dee

    on October 10, 2015 at 8:14 pm

    I have FH, with a strong family history of cardiovascular disease. I’m taking fish oil, CoQ10, niacin, magnesium, methyl B vitamins, and curcumin. My problem is that my cholesterol is much higher now than what was normal for me.

    I eat organic and grass-fed food whenever possible, don’t eat any processed foods, grains, legumes, dairy, soy, or sugar. I also eat low-medium oxalate because I’ve had kidney stones. I have stopped eating eggs in case I am a “hyper-responder” to dietary cholesterol. The only other thing I can think of that might be triggering the problem is the addition of coconut products to my diet in the last couple of years. Can coconut cause high LDL/total cholesterol in some people with FH?

    Thank you!

  2. Cathy P.

    on February 13, 2017 at 8:20 am

    I am a 58 year old female with heterozygous hypercholesterolemia. My total number is 10.6 mmol (UK) or 409.89 mg/dl.
    I also have around 50% blocked carotid arteries. The deaths in my family on my father’s side are substantial and on the young side (50 +).

    I have been tried on several statins and I have had serious side effects with them all. I have tried bezafibrates with side effects and even pharmaceutical fish oil causes a reaction. I tried Red Yeast Rice with Co Enzyme Q10 and had similar effects.

    I am just about to enter round 3 with my doctor and a specialist, who, upon hearing I cannot take statins, commenced my treatment with statins. I gave up on him but he has now been reintroduced into my life. This specialist is a researcher and is currently researching people who cannot tolerate statins. But still he prescribed them.

    As I have been told the situation is serious I suppose I can no longer avoid this issue. The cardiac specialist I spoke to today spoke of the PCSK9 inhibitors. Do you think they on their own would help my situation, especially if I increase my exercise and make more effort in the areas you’ve outlined above? I simply cannot take statins. Are these inhibitors anything like statins in their action?

    Many thanks
    Cathy P.

  3. HeartMD Editor

    on April 25, 2017 at 11:15 am

    Hi Cathy,

    Thank you for your question. You can see Dr. Sinatra’s reply in our Heart Health Q&A here.

  4. SUSAN G.

    on June 24, 2017 at 5:32 pm

    Dear Dr. Sinatra,
    I do not know if I have FH, but all my older family members have died of heart or hardening of arteries issues. Since age 45 (I am now 79) I have had consistently total cholesterol over 200 (generally between 250-300. From all my personal research, including your book and Ravnskov on cholesterol myths, I have refused to take statins. In 2013 I had a 3 way coronary bipass and aortic aneurysm repair. Recently a carotid artery ultrasound revealed 50% blockage, especially of plaque. While my total cholesterol dropped from 303 in 2013 to 280 in 2016, the % dropped from 25% to 21% and the ratio raised from 4.0 to 4.8. The highest year was 2007: 325 total cholesterol and ratio of 5.3. The problem with your natural treatment is that I have a personally intolerable hot flash reaction to niacin in a very low amount. I also have high blood pressure – being treated with coreg, losartin, and furosemide (lmy diastolic is always in the normal range, with the systolic between 145-165. My triglycerides My triglycerides are normally and currently below 2.0. I basically eat a Mediterranean diet. Since I have lived 33 years with a knowable high cholesterol (45 was my first test), I wonder if I would be better off not worrying about all this, not add Repatha to my meds, continue my diet and keep blood pressure under control. I would like to live to 90 unless Jesus returns before then when all this will be washed away. Your wisdom as to my personal situation would be much valued! Thank you! Sue G.

  5. SUSAN G.

    on June 28, 2017 at 1:06 pm

    Dear Dr. Sinatra,
    I wrote you a reply as of June 24. Since then, I realized I had a cholesterol panel blood test done on May 25 of this year. I noticed that the results are dramatically improved from 2016. The 2017 read-out is 225 total cholesterol, 65 HDL, with a ratio of 3.5. Triglycerides are 78. What would your response be to this in light of my prior reply of June 24? Looking forward to whatever input you might give me. Thank You! Sue G.

  6. HeartMD Editor

    on July 5, 2017 at 3:20 pm

    Hi Susan, Dr. Sinatra suggests taking Citrus Bergamonte. Clinically-studied Bergamonte comes from the Bergamot-orange—a small, fragrant orange grown predominantly along the southern coast of Calabria, Italy. You may be familiar with citrus fruit if you drink Earl Grey tea. It contains compounds that interrupt production of cholesterol in the liver in turn helping to keep your cholesterol levels in a healthy range.
    In a double-blind, placebo-controlled study, Bergamonte helped participants reduce triglyceride levels, demonstrating why this citrus extract is a good way to help you maintain healthy triglycerides. The same study also showed a boost in HDL, and support for LDL and blood sugar levels. Plus, research shows that Bergamonte also has the ability to support healthy cholesterol ratios.
    Bergamonte is the primary ingredient in Dr. Sinatra’s Advanced Cholesterol Solutions supplement (which also contains a powerful vitamin E complex with both tocotrienols and tocopherols, and 50 mg of vitamin C to help protect against cholesterol oxidation and support healthy blood vessels). It is available at Drsinatra.com. He suggests 2 capsules twice per day. Best of health and happiness,

  7. Nikki Broadwell

    on December 25, 2018 at 8:57 pm

    Total cholesterol 314–I have high LDL,( 203)–high HDL (97) and low triglycerides (68) and normal blood pressure–should I get the extra blood tests offered to test for problems? I am 72 and healthy but doc suggested statins–I said no. Thanks!!

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