All FH patients require lifestyle management, and very few of these patients will not require lipid lowering drug therapy.  All patients with FH should be counseled regarding the following lifestyle modifications.  Therapeutic lifestyle changes and dietary adjuncts include reduced intakes of saturated fats and cholesterol, with

• total fat limited to 25% to 35% of energy intake, 
  
  
• saturated fats to 7% of energy intake, and 
  
  
• dietary cholesterol to no more than 200 mg/day.  

Use of plant stanol and/or sterol esters should be considered, up to 2 g/day if necessary, as well as soluble fiber, in the range of 10-20 g/day.  Increased physical activity and decreased caloric intake should be initiated to achieve and maintain a healthy body weight, and alcohol consumption should be limited.  Emphatic recommendation for avoidance of any tobacco products is important, and clinicians are encouraged to refer patients to registered dietitians or other qualified nutritionists for medical nutrition therapy.