Introduction: Familial hypercholesterolemia (FH) is a genetic disorder that remains underdiagnosed and undertreated. It is characterized by high levels of low-density lipoprotein cholesterol (LDL-C), which leads to an increased cardiovascular disease risk. Pharmacotherapy of FH is based on high-dose statin therapy, often combined with ezetimibe and proprotein convertase subtilisin/kexin 9 inhibitors. The dietary approach is an important and supportive part of FH management. Methods: This review aimed to present the available evidence on dietary strategies in FH patients. The analyzed aspects included macronutrients such as fat and carbohydrate intake, as well as the role of dietary fiber, nutraceuticals (omega-3, beta-glucan, phytosterols, and red yeast fermented rice extract), and overall dietary models. Results and Conclusions: Based on the available data, the Mediterranean diet is a dietary model advised in cardiovascular prevention, including patients with FH. Regarding detailed recommendations, the current state of knowledge indicates dietary fat and saturated fatty acids intake limitation as an advised strategy. Supplementation of phytosterols and fiber can be also helpful in FH.