High LDL cholesterol despite plant based diet

[Jebus]

My wife just had a blood test as she has felt a bit week and dizzy at times. The blood test revealed an elevated LDL count 5.2 mmol/L (203 mg/dl). I found this surprising as she is almost entirely on a plant based diet. Here are some details about her:

38 years old
African (black) race
HDL a bit over range (1.9mmol)
Triglycerides normal
Family history of high cholesterol
Had a hysterectomy a year ago
Diet: A bit too much processed vegan food, a bit too much vegan (coconut oil based) cheese, but also eats a bunch of healthy things such as nuts, veggies, fruits, and grains.
Consumes a bit too much alcohol
Exercises a couple of times per week at moderate exertion level

@DrDavid

Local physician recommends she goes on cholesterol reducing medication. Any insight would be appreciated.

[DrDavid]

My wife just had a blood test as she has felt a bit week and dizzy at times. The blood test revealed an elevated LDL count 5.2 mmol/L (203 mg/dl). I found this surprising as she is almost entirely on a plant based diet. Here are some details about her:

38 years old
African (black) race
HDL a bit over range (1.9mmol)
Triglycerides normal
Family history of high cholesterol
Had a hysterectomy a year ago
Diet: A bit too much processed vegan food, a bit too much vegan (coconut oil based) cheese, but also eats a bunch of healthy things such as nuts, veggies, fruits, and grains.
Consumes a bit too much alcohol
Exercises a couple of times per week at moderate exertion level

@DrDavid

Local physician recommends she goes on cholesterol reducing medication. Any insight would be appreciated.

To sum it up - she has an elevated LDL in spite of a fairly healthy lifestyle.

Considering her family history, she might have an inherited condition - familial hypercholesterolemia (FH). That is a genetic disorder that prevents normal removal of LDL from the blood. It can be diagnosed with a genetic test.

Either way, I doubt she has much to gain in cholesterol reduction by any additional lifestyle changes. I agree with the recommendation that she starts taking cholesterol reducing medication.

[Jebus]

Considering her family history, she might have an inherited condition - familial hypercholesterolemia (FH). That is a genetic disorder that prevents normal removal of LDL from the blood. It can be diagnosed with a genetic test.

Thanks, that's what I suspected after a bit of research although FH seems more common in white people. How does the genetic test work? Could she do this alone or do the other family members have to come along.

On another note, she has had several blood tests over the years. Unfortunately, she has not kept the results but she does not recall any doctor ever mentioning that she had high cholesterol. That's why I also suspected the operation may have something to do with it.

[DrDavid]

Thanks, that's what I suspected after a bit of research although FH seems more common in white people. How does the genetic test work? Could she do this alone or do the other family members have to come along.

She can do it alone. If the test is positive, other family members should be informed. Then they can have their cholesterol checked and possibly do the genetic test. Knowing if you have FH is especially important for reproducers.

On another note, she has had several blood tests over the years. Unfortunately, she has not kept the results but she does not recall any doctor ever mentioning that she had high cholesterol. That's why I also suspected the operation may have something to do with it.

Are you sure she has had her cholesterol checked before? Checking blood lipids is not indicated in healthy, younger people. The exception would be a known family issue with high cholesterol (which she has). If she knows where she's taken blood tests before, the results should be obtainable.

As for the hysterectomy; estrogen does lower LDL so the reduced estrogen after a hysterectomy could raise the levels of LDL. I don't know how significant that increase could be. That said, any changes in estrogen/LDL would be counteracted by any hormone replacement therapy (HRT).

If she has had significantly lower LDL in the past, then the hysterectomy is likely the cause of the increase. If LDL was high before the operation, then FH is a more probable culprit.

[brimstoneSalad]

Diet might not have a huge impact, but you could try some more liquid vegan cheese recipes with canola oil instead of coconut if she'd tolerate more of a sauce rather than solid cheese; you can also achieve some level of solidity by adding agar. There are some sliceable recipes that are low in saturated fat. It might help in reduction of total cholesterol. Coconut isn't very bad (it's better than dairy), but it's not totally benign so it can make sense to limit it.
Taking a vegan algae based DHA/EPA might also help a little.

Alchohol is often to blame for health problems, but since her triglycerides are fine this is probably a rare case where it isn't.

Hormone related makes a lot of sense if it correlates with this. Maybe she was somebody with higher than normal estrogen levels and the HRT isn't cutting it anymore? Either that or genetic bad luck like Dr David said.

[Jebus]

a sauce rather than solid cheese; you can also achieve some level of solidity by adding agar. There are some sliceable recipes that are low in saturated fat.

Thanks. We'll try that. Please let me know if you have a favorite recipe.

[brimstoneSalad]

a sauce rather than solid cheese; you can also achieve some level of solidity by adding agar. There are some sliceable recipes that are low in saturated fat.

Thanks. We'll try that. Please let me know if you have a favorite recipe.

I just put nuts in a blender, sometimes with soymilk (avoid the flavored ones like silk, which have some weird sweet masking flavor even in the unsweetened that's a problem for savory cooking), a little nutritional yeast, salt, some canola oil, a bit of lemon juice and vinegar. That makes something mostly passable. An emulsifier like soy lecithin will help the oil stay mixed in if you're having separation problems.

Alternatively, you can ferment it and that will give a richer flavor (and sourness without lemon/vinegar). A bit of unsweetened vegan yogurt with active cultures will start it off. Doesn't take long, overnight in a warm spot might be enough.

Follow the directions on the agar package for ratio of agar to water (replace the water with your liquid nut cheese blend) if you want to make it solid. If it's not solid enough, just use more. Sometimes acids interfere with the agar and it takes a bit extra.

If you want your cheese to get that rich browning taste from baking it (like on a pizza), add a little bit of xylose to it (not xylitol, but xylose).
If you want a more believable cheesy taste like in cheddar daiya, you'll need to use a cheddar cheese flavor extract (which is probably vegan). There are very few available to consumers, though, not sure if you'll be able to find one. last time I searched I didn't see anything, but this came up on Amazon this time:
https://www.amazon.com/Amoretti-Cheddar ... B00K685E16

It's supposedly dairy free, but I would suggest you email or call to ask about the ingredients and the growth medium, and see if there are any animal products in it.
https://amoretti.com/products/cheddar-cheese-extract-os

Something like that would last a long time, and be more convincing than nutritional yeast.
You could also buy lactic acid directly and add that instead of vinegar or lemon juice (less convincing taste) or fermenting it (which is convincing, but inconvenient). Never done that personally (nor used a cheese extract). I've done the other stuff though.

[brimstoneSalad]

I tweeted at them:
https://twitter.com/PhiloVegan/status/1 ... 8548926464
@amoretti I noticed you're selling your cheese extracts to the general public, and from what I saw they're kosher dairy free. Are there any animal products in the formulation or culture media for your cheddar, parmesan, blue, or cream cheese extracts?

Anybody reading this, please like/retweet to increase the chances of them responding. If these are vegan, that would be pretty cool and would help a lot in making convincing mostly whole food nut cheeses at home.

[brimstoneSalad]

Looks like it's out of stock on Amazon, but they sell through their site. Not sure if they ship internationally.

https://amoretti.com/products/cheddar-cheese-extract-os
https://amoretti.com/products/parmesan- ... extract-os
https://amoretti.com/products/blue-cheese-extract-os
https://amoretti.com/products/natural-c ... extract-ws

CONTACT US
If you any have questions regarding your order or any items we offer on our website, contact us.

Give Us A Call:

1.800.AMORETTI (266-7388)
( Monday - Friday - 8am to 5pm Pacific Standard Time )

1.805.983.2903
( Outside the United States )

Simply Email:

[email protected]
Reference your order number and one of our customer service associates will be in touch with you right away.
It's that simple.

Form that I don't think they respond to email unless your order number is in it. I'd call them. They might reply to the tweet, though, we'll see.

[carnap]

Its really not surprising that someone following a vegan diet would end up with high cholesterol, most of the factors that tend to raise cholesterol are not related to the amount of animal products you eat. For animal products its really the saturated fat that tends to increase LDL, but vegans can easily have the same issue with eating coconut/palm oil based products.

Also a hysterectomy doesn't not necessarily mean the ovaries have been removed, since removing them (the ovaries) can increase disease risk they often don't remove them unless there is a good reason. So this would be an important detail. And people with familial hypercholesterolemia usually have much higher cholesterol levels.

Personally if it was me I'd experiment a good deal with lifestyle before I committed myself to a lifetime of medication.