Lipid Management Breakthrough: Beyond Medication

43-year-old male with severe familial dyslipidemia despite maximal statin therapy (atorvastatin 80mg). LDL persistently elevated at 5.7 mmol/L (220 mg/dL) despite medication compliance. Strong family history of premature cardiovascular disease (father died age 52 from MI). Cardiologist recommending addition of PCSK9 inhibitor. Patient seeking nutrition intervention before escalating to expensive injectable therapy.

Baseline Assessment

• LDL-C: 5.7 mmol/L (220 mg/dL) - very high risk
• Total cholesterol: 8.4 mmol/L (325 mg/dL)
• Triglycerides: 220 mg/dL (elevated)
• HDL: 38 mg/dL (low)
• On atorvastatin 80mg + ezetimibe 10mg
• Weight: 192 lbs, BMI 28.2 (overweight)
• Diet: Typical American diet, high in processed carbs

Therapeutic carbohydrate restriction targeting triglyceride reduction and HDL optimization. Portfolio Diet principles for LDL reduction (plant sterols, viscous fiber, soy protein, almonds). Coordinated with cardiology for close lipid monitoring.

Nutrition Protocol

• Carbohydrate target: <100g/day to reduce triglycerides and improve lipid particle quality
• Eliminate all refined carbohydrates and added sugars
• Plant sterol supplementation: 2g daily
• Viscous fiber: psyllium 10g daily, increased vegetable intake
• Fatty fish: 4x/week for omega-3 benefits
• Almonds: 1.5 oz daily (Portfolio Diet component)
• Eliminate trans fats, minimize saturated fat
• Focus on whole, unprocessed foods

Nutrition therapy achieved medication-level LDL reduction. This case demonstrates that even familial dyslipidemia can respond to aggressive nutrition intervention. Carbohydrate restriction dramatically improved triglycerides and HDL (metabolic syndrome features), while Portfolio Diet components directly reduced LDL. Patient avoided expensive PCSK9 inhibitor therapy (cost: $5,000-$14,000/year). Emphasizes nutrition as first-line therapy before medication escalation, even in genetic dyslipidemia.