FCS Diet and Dangers

Wahida Karmally, MS, RD, CDE, is the Director of Nutrition in The Irving Center for Clinical Research and an Associate Research Scientist and Lecturer in Dentistry at Columbia University. While at the National Lipid Association's (NLA) 2018 Scientific Sessions in Las Vegas, Nevada, she sat down to explain the challenges and importance of diet in patients with familial chylomicronemia syndrome (FCS), how much fat can be eaten (and which kind), and the dangers of pancreatitis when too much fat is consumed.

Karmally: There are some conditions where you need very little fat in the diet, and one such disease is called familial chylomicronemia syndrome (FCS), where we ask the patients to eat very little fat, but at the same time, we want them to understand it’s important to optimize nutrient intake. We pay attention to essential fatty acids and also micro nutrient intakes because when you’re on a low-fat diet, there are certain nutrients that are fat soluble, like fat soluble vitamins, and we have to make sure the patient is getting all those nutrients in order to prevent other complications.

At the same time, we have to understand it’s a very challenging diet. It’s very hard to eat very little fat when we are in a high fat environment, and it’s so easy to get a packet of cookies and muffins that are loaded with fat. The patient has to pay a lot of attention to the ft intake because they could end up with a horrible condition called pancreatitis and, at the same time, if they eat too much fat on a daily basis, they will have abdominal pain, get nauseous, and it affects the quality of life.

We have to, as healthcare providers, get patients to participate in their meal planning and what works for them—if they can put in more time for grocery shopping on the weekend to plan what they enjoy eating without any fat added to it. The only oil that they can use is a medical food called MCT oil, which is medium-chain triglycerides.

It compromises of two fatty acids: caprylic and capric. These have carbon chain lengths of 8 and 10, and these are the only fatty acids that can be used in food preparation. These fatty acids come from coconut oil, but you should not consume coconut oil because it has other fatty acids that are harmful to an FCS patient. There’s only one company in the United States that makes it, Nestle, and it can be obtained through prescription through the doctor.

When using MCT oil, it’s important to understand it’s not a frying oil. It has to be used at low temperatures, so it’s best when you prepare a tomato-based stew with vegetables and beans por with vegetable broths. You can add the oil after you prepare it so you’re not cooking the oil at high temperatures.

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