What diet chart is recommended for a patient with distal myopathy type 4 due to a FLNC (filamin C) gene mutation?

Dietary Recommendations for Distal Myopathy Type 4 (FLNC Mutation)

There is no disease-specific diet for FLNC-related distal myopathy, so follow a general anti-inflammatory, heart-healthy dietary pattern that supports muscle health and reduces cardiovascular risk, which is elevated in FLNC mutation carriers. 1

Critical Context for FLNC Myopathy

• FLNC mutations cause progressive muscle weakness, typically starting distally in the legs during the third decade of life, with eventual proximal and hand muscle involvement 2, 3
• Importantly, FLNC carriers have an 8% prevalence of atrial fibrillation and 2-7% risk of stroke, making cardiovascular-protective nutrition essential 1
• The underlying pathology involves protein misfolding, aggregate formation, and impaired cellular protein degradation systems 4, 5

Core Dietary Framework

Vegetables and Fruits (Largest Component)

• Consume 5-7 servings daily with emphasis on variety in colors and types 1
• Prioritize at least half being dark green, red, or orange vegetables 1
• Include 2-3 servings of vegetables and 3-4 servings of whole fruits (not juice) daily 1

Whole Grains (¼ of Diet)

• Choose minimally processed whole grains with carbohydrate-to-fiber ratio <10:1 6
• Consume 6-8 servings daily of whole-wheat bread, whole-grain pasta, brown rice, and oats 1
• At least half of all grain servings must be whole grains 1

Lean Proteins (¼ of Diet)

• Consume legumes (beans, lentils, peas) at least twice weekly as primary protein source 1, 6
• Include 4-5 servings of nuts and seeds weekly (1/3 cup or 2 tablespoons) 1, 6
• Eat oily fish (salmon, mackerel, sardines) twice weekly for omega-3 fatty acids 1
• Limit lean poultry to 6 ounces daily 1
• Restrict unprocessed red meat to maximum 300-500g weekly 1

Dairy Products (¼ of Diet)

• Consume 2-3 servings daily of low-fat or fat-free milk, yogurt, or cheese 1, 6
• One serving equals 1 cup milk/yogurt or 1.5 ounces cheese 1

Healthy Fats

• Use extra virgin olive oil as primary cooking fat 1
• Consume 2-3 servings of healthy oils daily (1 teaspoon soft margarine, 1 tablespoon olive oil) 1
• Emphasize monounsaturated and polyunsaturated fats over saturated fats 1

Foods to Strictly Limit or Avoid

Processed Meats (Critical for Stroke Prevention)

• Limit processed and cured meats (bacon, sausage, hot dogs, pepperoni, salami) to maximum once weekly 1, 6
• This is particularly important given the 2-7% stroke risk in FLNC carriers 1

Highly Processed Foods

• Eliminate sugar-sweetened beverages entirely (sodas, fruit drinks, sports drinks, sweetened teas) 6
• Minimize foods high in refined grains, saturated fat, salt, and added sugars 1, 6
• Completely avoid industrial trans fats and partially hydrogenated vegetable oils 6

Sodium Restriction

• Limit sodium intake to <2000 mg daily to reduce cardiovascular risk and inflammation 6

Sweets and Added Sugars

• Restrict to 5 or fewer servings weekly (1 tablespoon sugar, 1 tablespoon jelly, ½ cup sorbet) 1

Practical Implementation

Daily Meal Structure

• Consume 3-5 meals daily at regular times to support metabolic stability 1, 7
• Make half your plate vegetables and fruits 1
• Make one-quarter whole grains 1
• Make one-quarter protein foods (emphasizing plant-based options) 1

Hydration

• Drink 4-6 glasses of water daily as baseline 1, 7
• Coffee (up to 4 cups daily) and tea are acceptable and may provide cardiovascular benefits 1
• Moderate alcohol intake (if any) to <100g weekly, though it should not be promoted for cardiovascular protection 1

Food Preparation Methods

• Use cooking techniques that preserve nutrients without adding unnecessary calories, saturated fat, or salt 1
• Avoid frying and heavy cream sauces 1

Critical Caveats

• This dietary approach does not treat the underlying myopathy but supports overall health and reduces cardiovascular complications 6
• Weight management is important if obesity is present, as it compounds cardiovascular risk 1
• Protein intake should remain normal (15-20% of calories, 50-100g daily) unless kidney disease develops, at which point reduction is needed 1
• Vitamin or micronutrient supplementation beyond a balanced diet is not recommended 1
• Physical activity (150 minutes weekly of moderate exercise) is equally important and should be adapted to functional capacity 1, 7