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cholesterol

Remedies for Xanthomas

Xanthomas are yellow subcutaneous agglomerates. The sediment consists of an accumulation of macrophages filled with lipid molecules.

The xanthomas have a soft consistency, a sharp border and appear just below the skin.

Multiple tuberous xanthomas in a pediatric patient. Image from wikipedia.org

The diameter varies from a few millimeters to several centimeters.

The causes of xanthomas are mainly metabolic in nature.

There are various types, with slightly different characteristics that can typify different diseases:

  • Eyelid Xanthomas.
  • Tuberous Xanthomas.
  • Tendon, subperiosteal, fascial and aponeurotic Xanthomas.
  • Xanthomas planes.
  • Eruptive xanthomas.

They are harmless and represent a predominantly aesthetic disorder; on the other hand, the triggering causes are not equally harmless and must be treated or compensated.

What to do

  • By identifying soft and yellowish masses located just below the skin, it is necessary to consult a doctor immediately. The latter will evaluate the importance of a specialist visit or of some diagnostic insights aimed at identifying the causes:
    • The main cause is the primitive-hereditary systemic (rarely local) alteration of lipid metabolism:
      • Hypercholesterolemia.
      • Hypertriglyceridemia.
    • The elitist analyzes to identify these two metabolic pathologies are:
      • Blood analysis.
      • Genetic investigation for congenital defects.
    • The secondary causes are easily recognizable, since in these cases the xanthomas appear AFTER the main symptomatology:
      • Primary biliary cirrhosis.
      • Pancreatitis.
      • Diabetes.
      • Heart failure.
      • Some forms of cancer.
      • Some inflammatory diseases.
    • In some cases, the suspicion of xanthoma is unfounded; this happens especially when the anomaly is constituted by a cyst.
  • The main intervention is the treatment of the triggering agent, most frequently cholesterol and / or triglyceride hyperlipemia, and type 2 diabetes mellitus (hyperlipemia xanthomatosis). The therapy is structured by:
    • Diet.
    • Motor activity.
    • Food supplements or herbal medicine.
    • Drugs.
  • If the xanthomas are large, surgical removal may be necessary.

What NOT to do

  • Do not seek medical attention.
  • Do not perform diagnostic investigations.
  • Do not follow a suitable diet and do not integrate with useful molecules.
  • Do not respect drug therapy.
  • Do not do motor activity.
  • Do not require surgical removal in case of pain or discomfort caused by xanthomas.

What to eat

It must be specified that, in the case of hereditary pathologies, the diet is not always able to make substantial changes; on the other hand, an incorrect diet is certainly capable of aggravating them.

  • For high cholesterol:
    • Foods rich in omega 3 polyunsaturated essential fatty acids:
      • Eicosapentaenoic and docosahexaenoic acid (EPA and DHA): very active from a biological point of view, they are contained above all in fishing products and in algae. They play a protective role against all metabolic pathologies, including high cholesterol. The foods that contain the most are: Sardinian, mackerel, bonito, alaccia, herring, alletterato, ventresca of tuna, needlefish, algae, krill etc.
      • Alpha linolenic acid (ALA): compared to the previous ones it is biologically less active. It has the same function as EPA and DHA. It is mainly contained in the fat fraction of certain foods of vegetable origin or in the oils of: soy, linseed, kiwi seeds, grape seeds, etc.
    • Foods rich in omega 6 polyunsaturated essential fatty acids: they have a function similar to the previous ones. They are more abundant in the diet than in DHA, EPA and ALA. On the other hand, nutritional balance requires that they are not taken in excess of 400% compared to omega-3s.
      • Linoleic acid (LA): they are rich: sunflower seeds, wheat germ, sesame, almost all dried fruit, corn germ and its oils. The derivatives are:
        • Gamma linoleic acid (GLA) and diologamma linolenic acid (DGLA): borage oil is rich in it.
        • Arachidonic acid (AA): peanuts and other dried fruits are rich.
    • Foods rich in monounsaturated fatty acids omega 9:
      • Oleic acid: it is typical of olives, rape seeds, tea seeds, hazelnuts and related oils (in particular extra virgin olive oil). It plays a positive role on cholesterol, very similar to that of essential fatty acids.
    • Foods rich in soluble fiber: these are all plant foods that belong to the III, IV, VI and VII fundamental group of foods. Oilseeds and pseudocereals (amaranth, quinoa, chia, buckwheat, hemp, etc.) also abound. On the other hand, they are proportionally more abundant in fruit, vegetables and algae. They exert a "viscous function", which traps dietary cholesterol and bile salts (via excretion of internal cholesterol) to expel them with feces.
    • Foods rich in vitamin antioxidants: the antioxidant vitamins are carotenoids (provitamin A), vitamin C and vitamin E. They have a beneficial effect on high cholesterol, as they hinder oxidative stress ensuring the efficiency of lipoproteins and preventing atherosclerosis. Carotenoids are contained in vegetables and red or orange fruits (apricots, peppers, melons, peaches, carrots, squash, tomatoes, etc.); they are also present in shellfish and milk. Vitamin C is typical of sour fruit and some vegetables (lemons, oranges, mandarins, grapefruit, kiwi, peppers, parsley, chicory, lettuce, etc.). Vitamin E is available in the lipid portion of many seeds and related oils (wheat germ, maize germ, sesame, etc.).
    • Foods rich in phytosterols: phytosterols are the alter ego of cholesterol in the plant world. From the metabolic point of view, they exert a diametrically opposite effect and favor the reduction of cholesterolemia. Recall that some phytosterols simulate the effect of female estrogens, although the extent of this reaction is not entirely clear. They are foods rich in phytosterols: soy and soybean oil, many oilseeds, red clover, cereal germ, fruit, vegetables and some dietary foods (eg added yogurts).
    • Foods rich in lecithins: they are molecules capable of binding both fat and aqueous compounds; for this reason they are also used as additives. In the digestive tract they bind cholesterol and bile salts reducing their absorption. On a metabolic level they improve the ratio of good to bad cholesterol and lower the total. They are rich in lecithins: soy and other legumes, egg yolk (but is not recommended in the case of high cholesterol), vegetables and fruit.
    • Foods rich in plant antioxidants: the most common are polyphenolic (simple phenols, flavonoids, tannins). Some fall within the group of the aforementioned phytosterols (isoflavones). They behave more or less like vitamins. Lower oxidative stress and optimize lipoprotein metabolism; appear to correlate with a reduction in total cholesterol and LDL. They are very rich in polyphenols: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and their seeds (pomegranate, grapes, berries, etc.), wine, oilseeds, coffee, tea, cocoa, legumes and whole grains, etc.
  • For triglycerides and high blood sugar:
    • Low-calorie diet to lose weight in case of overweight.
    • Moderate carbohydrate food portions:
      • Cereals and derivatives (pasta, bread, etc.).
      • Potatoes.
      • Dehulled legumes.
      • Very sweet fruit.
    • Among the foods rich in carbohydrates, prefer those with a low glycemic index:
      • Integrals or fiber-enriched (such as those added to inulin).
      • Whole legumes.
      • Little or medium sweet fruit.
    • Reduce the glycemic load of meals:
      • Increasing the number (around 5–7 in all).
      • Reducing total caloric intake.
      • Decreasing the portions, especially with reference to carbohydrate-rich foods.
        • Spread the carbohydrates in all meals (with the sole exception of dinner or evening snack).
    • Reduce the glycemic index of meals:
      • By increasing the quantity of low-calorie, fiber-rich vegetables: radicchio, lettuce, zucchini, fennel, etc.
      • Enriching all dishes with low fat and protein (slow digestion and absorption of sugars, and avoid the glycemic surge):
        • Extra virgin olive oil.
        • Chicken breast, cod fillet, egg, lean ricotta, light milk flakes etc.
    • If it is impossible to eliminate the attitude to alcohol, prefer red wine (maximum 1-2 small glasses per day).
    • As for high cholesterol:
      • Eat foods rich in omega 3.
      • Consume foods rich in vitamin and polyphenolic antioxidants.
    • Follow a small fast every day. Some studies suggest that fasting significantly improves blood glucose and triglyceridemia parameters. Without compromising the overall distribution and the balance of the diet, it is possible to spend about 10-12 hours between the last meal of the evening and the first of the following day.

What NOT to Eat

  • For high cholesterol:
    • Foods rich in saturated or hydrogenated fats, especially in trans conformation: they perform a hypercholesterolemic action on the LDL portion:
      • Foods with saturated and bifractionated fatty acids: fatty cheeses, cream, fatty cuts of fresh meat, sausages and cold cuts, hamburgers, frankfurters, palm kernel and palm oil, etc.
      • Foods with hydrogenated fatty acids, many of them in trans conformation: hydrogenated oils, margarines, sweet snacks, salty snacks, packaged baked goods, etc.
    • Cholesterol-rich foods: paradoxically, they seem to have a less hypercholesterolemic effect than the previous categories, but they are not recommended. Abound with cholesterol: egg yolk, fat and seasoned cheeses, offal (brain, liver and heart), crustaceans (eg prawns) and certain bivalve molluscs (eg mussels).
    • Furthermore, it is not recommended to follow a diet mainly based on cooked and preserved foods. Many nutritional principles that promote high cholesterol reduction are sensitive to heat, oxygen and light. It is recommended to consume at least 50% of vegetable products and seasoning oils in raw form (fresh fruit, vegetables and oil seeds).
  • For triglycerides and high blood sugar it is advisable to avoid:
    • Few meals and very abundant.
    • High-calorie foods, especially rich in refined sugar.
    • Meals characterized by large glycemic loads, or too rich in: pasta, bread, pizza, baked goods, polenta, rice, potatoes, very sweet fruit, jam, sweets, etc.
    • Foods with high glycemic index: boiled rice, boiled potatoes, fruit juice, some very sweet fruits (ripe bananas, etc.), sweets, etc.
    • Foods with a prevalence of carbohydrates with few fibers: white bread, white pasta, polenta, etc.
    • Alcohol above 1-3 units per day.
    • Foods poor in "good fats".
    • Foods rich in "bad lipids".
    • Poor or depleted foods of vitamin and polyphenolic antioxidants.

Natural Cures and Remedies

  • Motor activity: it is very important to reduce hyperglycemia, lower high triglycerides, prevent and treat high cholesterol. Although it is assumed that it acts above all by increasing good cholesterol, what matters is that it drastically reduces the atherosclerotic risk and more generally the cardiovascular risk. Aerobic activities characterized by high intensity peaks are more effective.
  • Herbalist based on single products or combinations of: dandelion, artichoke, olive and policosanol.
  • Supplements based on oils derived from fishery products:
    • Cod liver oil: rich in omega 3 essential fatty acids (EPA and DHA), vitamin D and vitamin A.
    • Krill oil: krill is a part of the so-called plankton; as well as omega 3 essential fatty acids (EPA and DHA) it is also rich in vitamin A.
    • Seaweed oil: rich in omega 3 essential fatty acids (EPA and DHA).
  • Fermented red rice: among its various nutritional characteristics, it boasts a significant concentration of molecules similar to pharmacological statins.
  • Supplements based on oils derived from the germ of cereals: the most common is wheat. It is rich in essential polyunsaturated fatty acids and vitamin E.
  • Soluble fiber supplements: mucilage, guar, pectin etc.
  • Chitosan supplements: it is a non-available carbohydrate obtained from the chitin contained in the shell of the crustaceans. It is able to hinder the intestinal absorption of fats.
  • Soy lecithin supplements.
  • Vitamin antioxidant supplements.
  • Supplements of polyphenolic antioxidants.
  • Phytosterol supplements.

Pharmacological care

  • Fibrates: also useful in reducing cholesterol, they are used especially in the treatment of hypertriglyceridemia. Rarely can cause muscle pain and gastrointestinal discomfort in the first weeks of treatment:
    • Fenofibrate (eg Lipsin, Fulcro, Fenolibs, Lipophene).
    • Gemfibrozil (eg LOPID, Genlip, Gemfibrozil DOC).
  • Statins: it is a class of drugs able to reduce the synthesis of LDL in the liver and to increase that of HDL. The most used are simvastatin and atorvastatin. Side effects are few and can include muscle suffering (generally appears in the first few weeks of treatment). They are contraindicated in the presence of dysfunctions and pathologies of the liver:
    • Atorvastatin (eg Totalip, Torvast, Xarator).
    • Simvastatin (eg Zocor, Simvastat, Omistat, Quibus, Setorilin).
    • Pravastatin (eg Selectin, Langiprav, Sanaprav).
  • Nicotinic acid: at high doses it can reduce the blood values ​​of triglycerides and LDL cholesterol, increasing the fraction of HDL. Possible side effects include: itching, headache and skin redness (face and neck):
    • Acipomix (eg Olbetam)
  • Ezetimibe and bile acid sequestering resins: they reduce the reabsorption of bile acids and are not absorbed by the intestine. Ezetimibe can be taken with statins or as an alternative to them. There is the possibility of side effects such as: halitosis, belching, meteorism and constipation:
    • Colestipol (eg Colestid).
    • Cholestyramine (eg Questran).
    • Coleselvam (eg Cholestagel).

Prevention

  • The prevention of xanthomas is adopted only with the awareness of suffering from hyperlipemia or other primary disorders. We recommend:
    • Maintain a normal weight.
    • Practice regular motor activity, especially aerobics.
    • Carry out a correct diet, limiting the foods advised against and increasing those beneficial for high cholesterol.
    • Adopt the drug therapy prescribed by your doctor.

Medical Treatments

  • Surgery: essential especially when xanthomas cause functional discomfort. For example, tendon xanthomas (rarely the tuberoses above the joints) can induce pain or discomfort.

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