Researchers in Brazil are testing whether a heart-healthy diet combined with plant-based supplements can better lower cholesterol in people with familial hypercholesterolaemia, a genetic condition causing dangerously high cholesterol. The DICA-FH study will follow 300 participants for 120 days, comparing a special Brazilian diet alone against the same diet plus phytosterols (plant compounds), krill oil (fish supplement), or both. Results are expected in July 2026.
Researchers in Brazil are testing a special heart-healthy diet combined with supplements to help people with familial hypercholesterolaemia—a genetic condition that causes dangerously high cholesterol. The study, called DICA-FH, will follow 300 participants for four months to see if adding plant-based compounds called phytosterols and krill oil (a fish supplement) can lower cholesterol better than diet alone. According to Gram Research analysis, this is the first major test of this Brazilian diet approach specifically designed for people with this inherited cholesterol problem, combining traditional dietary changes with modern supplements.
Key Statistics
A randomized controlled trial protocol published in BMJ Open in 2026 plans to enroll 300 Brazilian participants with familial hypercholesterolaemia to test whether a culturally adapted heart-healthy diet combined with phytosterols and krill oil supplements reduces LDL cholesterol and lipoprotein(a) levels over 120 days.
The DICA-FH study uses a factorial design testing four groups: diet alone, diet plus 2g daily phytosterols, diet plus 2g daily krill oil, and diet plus both supplements, allowing researchers to determine whether each supplement provides additional benefit beyond dietary changes.
According to Gram Research analysis, this is the first major clinical trial testing the Brazilian Cardioprotective Diet (DICA Br), adapted from the Portfolio Diet, specifically in people with inherited familial hypercholesterolaemia, addressing a gap in evidence for this high-risk population.
The Quick Take
- What they studied: Whether a special heart-healthy diet from Brazil, with or without plant supplements and fish oil, can lower cholesterol levels in people with familial hypercholesterolaemia (an inherited condition causing very high cholesterol).
- Who participated: 300 people aged 16 and older in Brazil who have familial hypercholesterolaemia and are already taking cholesterol-lowering medications. Participants will be split into four groups receiving different combinations of diet and supplements.
- Key finding: This is a protocol paper describing the study plan, not yet showing results. The study will measure whether the Brazilian Cardioprotective Diet (DICA Br) combined with phytosterols and/or krill oil reduces harmful cholesterol and lipoprotein(a) levels after 120 days compared to diet alone.
- What it means for you: If successful, this research could offer people with inherited high cholesterol a more affordable, food-based approach to managing their condition. However, results won’t be available until late 2026, so this is early-stage research that needs to be completed before making changes to your treatment plan.
The Research Details
The DICA-FH study is a randomized controlled trial, which is considered the gold standard for testing whether treatments work. Researchers will randomly assign 300 Brazilian participants into four equal groups. One group gets the special diet plus placebo pills (fake supplements). The other three groups get the same diet but with different real supplement combinations: phytosterols alone, krill oil alone, or both supplements together. This factorial design allows researchers to test whether each supplement helps on its own and whether they work better together.
Participants will follow their assigned plan for 120 days (about 4 months). Everyone will receive genetic counseling and whole-genome sequencing to understand their specific genetic cholesterol problem. The researchers will measure cholesterol levels at the start and end of the study to see which approach works best.
This study design is particularly strong because it uses randomization (like a coin flip) to assign people to groups, which reduces bias. The placebo control means researchers can tell if supplements work beyond just the diet effect. The factorial design is efficient—it tests multiple questions in one study.
Familial hypercholesterolaemia is a serious genetic condition where people inherit genes that make their bodies produce too much cholesterol, even from childhood. Standard medications help, but they’re expensive and don’t work perfectly for everyone. This study tests whether a culturally adapted Brazilian diet—designed specifically for how people in Brazil eat—combined with affordable supplements could be a practical addition to medication. Understanding which supplements (if any) actually help is important because people often spend money on supplements that don’t work.
This is a high-quality study design with several strengths: it’s randomized (reducing bias), placebo-controlled (so researchers can measure real effects), and uses a factorial design (testing multiple questions efficiently). The study includes genetic testing and counseling, showing attention to the underlying biology. However, this is a protocol paper describing the planned study, not results yet. The relatively small sample size (300 people) and short follow-up period (4 months) mean the study can detect moderate effects but might miss small ones. Results are expected in July 2026.
What the Results Show
This paper is a study protocol—it describes the research plan before results are collected. Therefore, there are no findings to report yet. The study is designed to measure two primary outcomes: low-density lipoprotein (LDL) cholesterol levels and lipoprotein(a) levels after 120 days of following the assigned diet and supplement plan.
The researchers will compare how much each group’s cholesterol drops and whether adding phytosterols, krill oil, or both supplements produces better results than diet alone. They’ll also track whether people stick to the diet and supplements (adherence) and whether anyone experiences side effects.
The study is expected to conclude in July 2026, at which point the actual results will be published. This timeline means we won’t know the findings for several more months.
Beyond the main cholesterol measurements, the study will track other important blood fat markers including triglycerides, HDL cholesterol (the ‘good’ kind), and apolipoprotein B levels. Researchers will also measure how well people follow the diet and supplement plan, which is important because even the best treatment doesn’t work if people don’t stick with it. Safety monitoring will track any adverse events or side effects participants experience.
The Portfolio Diet, which the Brazilian diet is adapted from, has shown promise in previous research for lowering cholesterol through foods like nuts, plant sterols, soy protein, and soluble fiber. However, this is the first major study testing this approach specifically in people with familial hypercholesterolaemia in Brazil. Previous research on phytosterols and krill oil separately suggests they may help lower cholesterol, but testing them together in this population is novel. The Brazilian adaptation is important because diet recommendations work better when they match local food cultures and availability.
This is a protocol paper, so we cannot yet evaluate how the actual study performs. However, the planned study has some limitations worth noting: 120 days is relatively short to assess long-term dietary changes and supplement effects. The sample size of 300 is moderate—large enough to detect meaningful differences but might miss smaller effects. The study focuses on Brazilian participants, so results may not apply equally to other populations with different genetics or food cultures. The study requires participants to already be on cholesterol medications, so results apply to people with moderate-to-severe familial hypercholesterolaemia, not mild cases.
The Bottom Line
This is a protocol paper, so no clinical recommendations can be made yet. However, people with familial hypercholesterolaemia should continue taking prescribed cholesterol medications while awaiting these results. If you’re interested in dietary approaches, discuss the Portfolio Diet concept with your doctor—it emphasizes nuts, plant sterols, soy, and fiber, which have existing evidence. Do not start phytosterol or krill oil supplements without consulting your healthcare provider, as they may interact with medications. Confidence level: Moderate (based on existing evidence for individual components, not this specific combination).
This research is most relevant to people with familial hypercholesterolaemia (both probable and definite cases) who are already taking cholesterol medications. It’s also important for cardiologists, genetic counselors, and nutritionists treating this population. People with regular high cholesterol (not the genetic form) should wait for results but may benefit from the dietary principles. This research is less relevant to people with normal cholesterol levels.
Results are expected in July 2026. If the supplements prove effective, it typically takes 6-12 months for findings to be published in peer-reviewed journals and another 6-12 months for clinical guidelines to be updated. Real-world adoption usually takes 1-2 years after that. So practical changes to treatment recommendations probably won’t happen until 2027-2028 at the earliest.
Frequently Asked Questions
What is familial hypercholesterolaemia and why is this diet study important for it?
Familial hypercholesterolaemia is an inherited genetic condition causing dangerously high cholesterol from birth, even in children. Standard medications help but don’t work perfectly for everyone. This study tests whether a culturally adapted diet plus affordable supplements could improve cholesterol control beyond medication alone, offering a practical addition to treatment.
Can I start taking phytosterols or krill oil now to lower my cholesterol while waiting for these results?
Consult your doctor before starting any supplements, as they may interact with cholesterol medications. While phytosterols and krill oil show promise individually, this study will test whether they work together in people with familial hypercholesterolaemia specifically. Your doctor can advise whether starting now makes sense for your situation.
When will we know the results of this study and can I apply them to my treatment?
Results are expected in July 2026, with publication likely 6-12 months later. Clinical guideline updates typically follow another 6-12 months after that. So practical changes to treatment recommendations probably won’t happen until 2027-2028. Until then, follow your doctor’s current recommendations.
Is the Portfolio Diet something I should try now if I have high cholesterol?
The Portfolio Diet emphasizes nuts, plant-based proteins, soy, and soluble fiber—all supported by existing research for cholesterol reduction. It’s reasonable to discuss with your doctor as a dietary approach while awaiting DICA-FH results. However, this study will test a Brazilian adaptation, so results may differ from the original Portfolio Diet.
Who should participate in this study or wait for results to apply them?
This study targets people with probable or definite familial hypercholesterolaemia already taking cholesterol medications. If you have this genetic condition, discuss with your doctor whether participating or waiting for results makes sense. People with regular high cholesterol should also monitor this research, as dietary principles may eventually apply to them.
Want to Apply This Research?
- Users with familial hypercholesterolaemia should track their LDL cholesterol and lipoprotein(a) levels every 3 months (or as recommended by their doctor), recording the specific numbers and dates. This creates a clear trend line showing whether dietary and supplement changes are working.
- Users can start implementing Portfolio Diet principles now: add one serving of nuts daily, include plant-based proteins like soy or legumes at lunch, and increase soluble fiber through oats or beans. Track adherence by logging these foods daily. When the DICA-FH results are published, users can adjust their approach based on evidence.
- Set up quarterly reminders to check cholesterol labs with your doctor. Log supplement intake (if taking any) daily in the app. Track dietary adherence to heart-healthy foods weekly. Create a dashboard showing cholesterol trends over time, making it easy to see whether your current approach is working and to discuss results with your healthcare provider.
This article describes a research protocol for a clinical trial that has not yet produced results. It is not medical advice. People with familial hypercholesterolaemia should continue taking prescribed cholesterol medications and consult their healthcare provider before starting any supplements or making dietary changes. This study is expected to conclude in July 2026; clinical recommendations should not be based on this protocol alone until results are published and reviewed by medical professionals. Always discuss any changes to your cholesterol management plan with your doctor or cardiologist.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.