REMEDIES FOR XANTHOMAS

What to do

Finding soft, yellowish masses located just under the skin, it is necessary to seek immediate medical attention. The latter will evaluate the importance of a specialist visit or some diagnostic investigations aimed at identifying the causes:

The main cause is the systemic (rarely local) primitive-hereditary alteration of lipid metabolism:

Hypercholesterolemia.
Hypertriglyceridemia.

The elite 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 above all when the anomaly is constituted by a cyst.

The main intervention consists of the treatment of the triggering agent, more frequently cholesterol and / or triglyceride hyperlipemia, and type 2 diabetes mellitus (hyperlipemic xanthomatosis). The therapy is structured by:

Diet.
Motor activity.
Food supplements or herbal medicine.
Medicines.

If the xanthomas are large, surgical removal may be required.

What to eat

It must be specified that, in the case of hereditary diseases, 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 essential omega 3 polyunsaturated fatty acids:

Eicosapentaenoic and docosahexaenoic acid (EPA and DHA): very active from a biological point of view, they are mainly contained in fishery products and algae. They play a protective role against all metabolic diseases, including high cholesterol. The foods that contain the most are: sardines, mackerel, bonito, sardinia, herring, alletterato, tuna belly, garfish, seaweed, 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 seed, grape seed, etc.

Foods rich in essential omega 6 polyunsaturated fatty acids: they have a similar function to the previous ones. They are more abundant in the diet than DHA, EPA, and ALA. On the other hand, the nutritional balance requires that no more than 400% of omega 3 be consumed.

Linoleic acid (LA): they are rich in: sunflower seeds, wheat germ, sesame, almost all dried fruit, corn germ and related oils. The derivatives are:
- Gamma linoleic acid (GLA) and linolenic dihomogamma (DGLA): borage oil is rich in them.
- Arachidonic acid (AA): peanuts and other nuts are rich in it.

Foods rich in omega 9 monounsaturated fatty acids:

Oleic acid: it is typical of olives, rapeseed, 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 vegetable ones that belong to the III, IV, VI and VII fundamental group of foods. There is also an abundance of oil seeds and pseudocereals (amaranth, quinoa, chia, buckwheat, hemp, etc.). On the other hand, they are proportionally more abundant in fruit, vegetables and algae. They exert a "sticky function", which traps dietary cholesterol and bile salts (pathway of excretion of internal cholesterol) to expel them with the faeces.
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 crustaceans and milk. Vitamin C is typical of sour fruit and some vegetables (lemons, oranges, mandarins, grapefruits, kiwis, peppers, parsley, chicory, lettuce, etc.). Vitamin E can be found in the lipid portion of many seeds and related oils (wheat germ, corn 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. Remember that some phytosterols simulate the effect of female estrogens, even if the extent of this reaction is not entirely clear. They are foods rich in phytosterols: soybeans and soybean oil, many oil seeds, red clover, cereal germ, fruit, vegetables and some diet foods (eg added yoghurts).
Foods rich in lecithins: these are molecules able to bind both fatty and aqueous compounds; for this they are also used as additives. In the digestive tract they bind cholesterol and bile salts reducing their absorption. At the metabolic level they improve the good-bad cholesterol ratio and lower the total. They are rich in lecithins: soy and other legumes, egg yolk (but it is not recommended in case of high cholesterol), vegetables and fruit.
Foods rich in plant antioxidants: the most common are polyphenolic in nature (simple phenols, flavonoids, tannins). Some fall into the group of the aforementioned phytosterols (isoflavones). They behave more or less like vitamins. They lower oxidative stress and optimize lipoprotein metabolism; appear to correlate with a reduction in total and LDL cholesterol. They are very rich in polyphenols: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and relative seeds (pomegranate, grapes, berries, etc.), wine, oil seeds, coffee, tea, cocoa, legumes and whole grains, etc.

For high triglycerides and high blood sugar:

Low calorie diet for weight loss in case of overweight.
Moderate portions of carbohydrate-heavy foods:

Cereals and derivatives (pasta, bread, etc.).
Potatoes.
Hulled legumes.
Very sweet fruit.

Among the foods rich in carbohydrates, prefer those with a low glycemic index:

Wholemeal or enriched with fiber (for example those added in inulin).
Whole legumes.
Slightly or moderately sweet fruit.

Reduce the glycemic load of meals:

By increasing the number (about 5–7 in all).
By reducing your total calorie intake.
By decreasing the portions, especially in reference to foods rich in carbohydrates.

Divide carbohydrates into all meals (with the only exception of dinner or an evening snack).

Reduce the glycemic index of meals:

By increasing the amount of low-calorie vegetables rich in fiber: radicchio, lettuce, zucchini, fennel, etc.
Enriching all dishes with low fat and protein (they slow down digestion and the absorption of sugars, and avoid the glycemic surge):

Extra virgin olive oil.
Chicken breast, cod fillet, egg, lean ricotta, light cottage cheese, 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 balance of the diet, it is possible to allow about 10-12 hours to pass 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 cured meats, 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.

Foods rich in cholesterol: paradoxically they seem to exert a less hypercholesterolemic effect than the previous categories, but they are not recommended anyway. They are abundant in cholesterol: egg yolk, full-fat and aged cheeses, offal (brain, liver and heart), crustaceans (for example shrimps) and certain bivalve molluscs (for example mussels).
Furthermore, it is not recommended to follow a diet based mainly on cooked and preserved foods. Many nutritional principles that favor the reduction of high cholesterol are sensitive to heat, oxygen and light. It is advisable to consume at least 50% of vegetable products and seasoning oils in raw form (fresh fruit, vegetables and oil seeds).

For high triglycerides and high blood sugar it is recommended to avoid:

Few meals and very abundant.
High-calorie foods, especially rich in refined sugar.
Meals characterized by large glycemic loads, i.e. too rich in: pasta, bread, pizza, baked goods, polenta, rice, potatoes, very sweet fruit, jam, sweets, etc.
Foods with a high glycemic index: boiled rice, boiled potatoes, fruit juice, some very sweet fruits (ripe bananas, etc.), sweets, etc.
Low-fiber carbohydrate foods: white bread, white pasta, polenta, etc.
Alcohol in excess of 1-3 units per day.
Foods low in "good fats".
Foods rich in "bad lipids".
Foods poor or depleted 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 hypothesized that it acts mainly by increasing good cholesterol, what matters is that it drastically reduces atherosclerotic risk and more generally cardiovascular risk Aerobic activities characterized by high intensity peaks are most effective.

Herbal medicine based on single products or combinations of: dandelion, artichoke, olive tree and policosanols.

Supplements based on oils obtained from fishery products:

Cod liver oil: rich in essential omega 3 fatty acids (EPA and DHA), vitamin D and vitamin A.
Krill oil: krill is a part of the so-called plankton; in addition to omega 3 essential fatty acids (EPA and DHA) it is also rich in vitamin A.
Algae oil: rich in omega 3 essential fatty acids (EPA and DHA).

Fermented red rice: among the various nutritional characteristics, it boasts a significant concentration of molecules similar to pharmacological statins.

Supplements based on oils obtained from the germ of cereals: the most common is that of wheat. It is rich in essential polyunsaturated fatty acids and vitamin E.

Soluble fiber supplements: mucilage, guar, pectin etc.

Chitosan supplements: it is an unavailable carbohydrate obtained from the chitin contained in the shellfish carapace. It is able to hinder the intestinal absorption of fats.

Soy lecithin supplements.

Vitamin antioxidant supplements.

Polyphenolic antioxidant supplements.

Phytosterol supplements.

Pharmacological treatment

Fibrates: also useful in reducing cholesterol, they are used above all in the treatment of hypertriglyceridemia. They can rarely cause muscle pain and gastrointestinal discomfort in the first weeks of treatment:

Fenofibrate (e.g. Lipsin, Fulcro, Fenolibs, Lipofene).
Gemfibrozil (for example LOPID, Genlip, Gemfibrozil DOC).

Statins: is a class of drugs capable of reducing the synthesis of LDL in the liver and increasing that of HDL. The most used are simvastatin and atorvastatin. Side effects are few and may include muscle pain (usually appears in the first weeks of treatment). They are contraindicated in the presence of liver dysfunctions and pathologies:

Atorvastatin (e.g. Totalip, Torvast, Xarator).
Simvastatin (for example Zocor, Simvastat, Omistat, Quibus, Setorilin).
Pravastatin (e.g. 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 redness of the skin (face and neck):

Acipomix (e.g. Olbetam)

Ezetimibe and bile acid sequestering resins: reduce the reabsorption of bile acids and are not absorbed by the intestine. Ezetimibe can be taken with statins or alternatively. There is the possibility of side effects such as: halitosis, belching, bloating and constipation:

Colestipol (eg Colestid).
Cholestyramine (for example Questran).
Coleselvam (e.g. Cholestagel).

Prevention

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 aerobic.
Follow a correct diet, limiting the foods not recommended and increasing those beneficial for high cholesterol.
Adopt the drug therapy prescribed by the doctor.