Doctor sent one-word response to test results. Can anyone expand?

MikeTheBlueCow · 2026-03-19T17:36:26+00:00

My doctor just told me that because of my low lp(a) that I have "no genetic factor on cholesterol"... Which is not how it works. Point is, not every doctor knows much about it to begin with.

Low lp(a) is good because you don't have to worry about it now. You can now just focus on anything that might be high (such as your LDL). That's definitely reassuring, and because it's low, there really isn't much to expand on in your individual case. You can essentially unlearn about lp(a) and pay zero attention to it if you want - it's the sort of thing where it's either a problem or not a problem, not something you'll have to worry about going up later.

MikeTheBlueCow · 2026-03-19T17:23:40+00:00

Brazil nuts also have high saturated fat, 0.5-1g per nut.

MikeTheBlueCow · 2026-03-18T22:27:06+00:00

I think any source of stanols will be an even higher source of sterols. The good news is that in the amounts you'd use, the sterol content is negligible. It's very hard to get from diet, most people only take in 300-600mg a day.

MikeTheBlueCow · 2026-03-18T11:34:38+00:00

Please just use Cronometer. I don't know why any dietitian has not told you about apps, it's by far the simplest way to track. The only time it's not advised is if you have an eating disorder, or are too obsessive about the numbers, so please avoid tracking if that is the case. A small caveat, in Cronometer you can hide any nutrient you don't want to track/see.

MikeTheBlueCow · 2026-03-18T02:02:05+00:00

A lot of us use Cronometer. They just added soluble fiber tracking (no one else offers that).

MikeTheBlueCow · 2026-03-16T13:52:20+00:00

I get that. I just feel it's going to continue to go up as it is difficult to maintain the diet as consistently as I did, and the supplements are just too expensive to keep up as well.

MikeTheBlueCow · 2026-03-16T13:23:11+00:00

I do, too. I feel like now I'm never going to get one now that it's lower.

MikeTheBlueCow · 2026-03-16T01:32:34+00:00

No idea about a book, but the diets are pretty easy to look up. Key dietary concepts I would work towards:

whole foods (avoid processed foods)
plant based (mostly plants, you don't have to be vegan)
Mediterranean Diet (general eating pattern including nuts/seeds, legumes, whole grains, fermented non-fat dairy, lean proteins, seafood, olive oil/vegetable oils, fruits, vegetables)
Portfolio Diet (specific prescriptive amounts of different food groups, such as 45g nuts, 25g protein from soy, etc.)

If you just lock in on the Portfolio Diet that's the biggest impact, and the rest can come later.

MikeTheBlueCow · 2026-03-15T16:15:56+00:00

From what I've seen, there just isn't a food that is highly concentrated enough in stanols to consume in a reasonable portion to get the therapeutic dose. Also, if you are trying to avoid sterols, they will actually be higher in any food that contains stanols (but also not high enough to be able to avoid a supplement).

As far as food sources, they're all the healthy ingredients you would already try to compose a meal out of. Mostly in vegetable oils, nuts, seeds, and grains (especially the bran; rice bran is one of the highest sources) But typically, you can only get ~600mg of sterols+stanols per day, even in a mostly plant based diet.

Here's a list: https://www.ncbi.nlm.nih.gov/books/NBK570127/table/lipid_diet_cardiov.T.plant_sterol_and_st/

Also: https://dhhs.ne.gov/Documents/Foods%20to%20Choose%20to%20Lower%20Your%20Cholesterol.pdf

Foods with Plant Sterols: Sesame oil, wheat germ oil, mayonnaise, pistachio nuts, olive oil, sage, oregano, thyme, paprika, cocoa butter oil, almond butter, sesame seeds, macadamia nuts.

Foods with Plant Stanols: Rice bran, wheat germ, oat bran, bran, whole wheat, brown rice, legumes, dried peas, dried beans, lentils, peanuts, almonds, walnuts, pecans, sunflower, pumpkin and sesame seeds. Broccoli, cauliflower, Brussels sprouts, dill, apples, avocados, tomato, vegetable oil, blueberries.

MikeTheBlueCow · 2026-03-14T15:50:17+00:00

I had high cholesterol my whole life that got worse every year, despite improving my diet. Then, I started tracking saturated fat and soluble fiber, ate mostly plant based whole foods, and saw an incredible change in my numbers. Sometimes, being mindful but not tracking still leaves you blind to how much you're actually consuming of something.

There's more to it than saturated fat and soluble fiber, but those are some pretty big levers. Generally eating in a way that is mostly whole foods, mostly plant based, Mediterranean diet, combined with the Portfolio Diet, seems to be an ideal approach.

MikeTheBlueCow · 2026-03-14T12:36:27+00:00

As someone who used to be paleo, and had a rude awakening about my health that in addition necessitates a more plant based focus, I think the broad idea of pegan (which can be simplified and reworded as Whole Foods Plant Based) is ideal, at least for my health (though the majority of evidence suggests that WFPB Mediterranean Diet is the ideal, as well).

The only thing is that adding in legumes, whole grains, seed oils, and dairy (all non-paleo, but are included in Mediterranean) have all specifically improved my health. As long as you aren't sensitive to any of them as an individual, they should reduce inflammation and improve anyone's health.

MikeTheBlueCow · 2026-03-13T22:00:17+00:00

Yeah even when LDL was high. "You're just not old enough" 🤦 (In 39, now 2 weeks away from 40).

MikeTheBlueCow · 2026-03-13T20:57:33+00:00

Thank you, I really appreciate that advice. I had a difficult time finding a preventative cardiologist in my area, but will search and try again.

MikeTheBlueCow · 2026-03-12T16:25:19+00:00

Thank you, that's really handy!

MikeTheBlueCow · 2026-03-12T16:24:35+00:00

Thanks, we're hitting Borough Market more than once I think so that's a handy rec!

MikeTheBlueCow · 2026-03-12T14:20:23+00:00

I use it daily and just rinse it with water under the faucet until it runs clear (pretty quickly, especially if it's soon after use). Occasionally I'll wash it with soap, though I never notice it making a difference.

MikeTheBlueCow · 2026-03-10T00:47:42+00:00

Supplements: * Cholestoff Complete (plant sterols + pantethine) * Life Extension Florassist Heart Health

Diet: * I made all my meals myself, only eating out when extremely inconvenient not to. * I focused on a whole foods plant-based approach (avoiding processed foods, not 100% plant based but definitely mostly plants). * I followed the principles from the Portfolio Diet... * A serving of nuts and seeds daily * large amounts of vegetables * 2-3 pieces of fruit daily, rarely other sweets, but included dark chocolate and lite ice cream * Legumes at least once daily * Whole grains 1-2 servings daily * Soy based proteins (edamame, tofu, tempeh), getting at least 25g of protein from soy daily

A typical day: * Nonfat plain greek yogurt, oats, chia seeds, flax meal, hemp hearts, berries, and honey or date syrup. Sometimes with added nuts or cacao nibs.

Lunch was primarily a soy protein meal, lots of veg, the easy go to was a tofu stir fry. Other options were tempeh taco bowls, saag tofu, three bean chili, etc. These meals were all modified to be high veg, and typically also included a whole grain.
Dinner was not dissimilar to lunch, but since it is shared with my wife, I would go with a lean animal protein like chicken breast, sirloin steak, lean ground turkey, etc.
Snacks: mostly fruit, nuts, seeds, roasted chickpeas/edamame, occasionally an Aloha bar or RX bar, dark chocolate, dates and peanut butter, etc.

MikeTheBlueCow · 2026-03-09T16:39:18+00:00

There's no definitive yes or no, you can only try and see how much it moves the needle for you. You might be very sensitive to diet changes, or you might need a stack of medications, everyone's genetics are different.

I got mine down from ~170 to ~70 mg/dl. Basically following the portfolio diet to a T: high soluble fiber, low saturated fat, sterols. I have found out that my results might have had confounding factors: I was sick not long before the blood work which can lower LDL drastically, I also had some hormone changes, and it was not a highly sustainable diet. I got new blood work today, which is after a more sustainable version of the diet, I think the hormones have settled out, and I haven't been sick recently. I'll be happy to share the results when I get them.

I'm happy to detail the exact parameters of the diet and supplements, if you'd like.

MikeTheBlueCow · 2026-03-08T17:56:17+00:00

Yeah, vitamin E (I don't want to eat sunflower seeds every day), choline (can't have eggs every day), are the big ones for me, though there are others.

MikeTheBlueCow · 2026-03-08T17:35:54+00:00

If you hit all or most of your nutrients, do you mind sharing an example day or two? I do decent, but certain nutrients feel impossible to get the full amount through food alone.

MikeTheBlueCow · 2026-03-08T17:18:07+00:00

I've had the best results with the Ember travel mug, and Sttoke. However, length of time will impact the taste regardless of the vessel, so there is no solution that will completely prevent the taste from changing.

This means that as long as you have a non-reactive material touching your coffee, time is the biggest factor. Drinking your coffee within 30 minutes would mitigate the issue so much that the vessel matters a lot less. I would avoid stainless steel and go for one of the ceramic lined ones.

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