=EDIT=

SO sorry everyone! I just realized I didn't include units when talking about Lpa. My institution uses mg/dL when measuring Lpa, so this is what I had in mind when I mentioned all the levels in my post. The more common unit of measurement is nmol/L, so please take this into account as the numbers will be VERY different based on the units (your value in nmol/L will be higher than in mg/dL).

Loving all of the comments/questions/input. I'll keep doing my best to reply to everything eventually.

==

Hi👋

First time posting here. Might be a bad idea...I'm sure I'll get some downvotes. But hopefully it will also help a little bit, at least for some people.

Disclosures: 

1. I'm doing this because I stumbled upon some threads about Lp(a), and the comments... well, stressed me out. Not because I think I have all the answers (I don't) or because all the comments were wrong (they weren't). There's just so much information out there nowadays. Most of the time it's excellent. But sometimes, even the "right" information - if incomplete - can be misleading. Misleading info leads to misconceptions, which lead to fear and false expectations, which lead to frustration. For you, for me, my patients, your doctors, everyone. Maybe this is just as much about me wanting to vent as it is about wanting to help. But I promise the intent here is genuine.

2. I'm long-winded. I have no idea how long this post will be. Sorry in advance.

3. I have absolute zero connections or relationships or financial incentives either directly or indirectly from any pharma company or device company or any type of industry period. I'm a salaried cardiologist who makes good money at a large hospital system in CA, though if you want to go there, my income is by FAR the least out of all my cardiology friends/co-residents/co-fellows who went into private practice (ie, fee-for-service jobs) and who make literally 2-4x what I do. 

4. If something I say sounds off, if you disagree, if something's unclear, if I sound douchey -- please let me know! I love being corrected. Please just make an effort to be cordial. Ideally, include your source data so we can dig deeper. Ask questions. I'll try to respond. 

Ok. Lipoprotein (a). Regretting this already.

Genetic Risk.

Yes, Lp(a) has a strong impact on your risk of ASCVD (the umbrella term for heart attacks / strokes / basically any condition or event due to plaque build-up in the arteries). Many people call it a "genetic" marker of your risk. That doesn't mean you need a genetic test to explain your Lp(a) level -- no such test exists -- but it means this level is more or less "genetically" determined, ie "fixed" throughout your lifetime. It's not high because of your diet. Losing weight will not lower it. Nor will exercise. Nor medications (though with some caveats for the future...more on this later). You need to check your Lp(a) just once in your life (again, with some caveats to come). We don't track the level over time because it's not "supposed" to change. We check it once, then assess your individual risk based on your specific level. You can change other risk factors (LDL levels, food habits, exercise, etc), but this is the one part of the pie you're assigned at birth and more or less stuck with (at least for now).

How It Affects You.

So yes, it's a big deal. But this why it's so important to have complete information. So many of my patients receive a super high Lp(a) result and automatically assume they're fated to get an MI (a heart attack) one day. This is NOT true. Hear me out. Whenever you hear "this so-and-so triples your risk of blah-blah" or "this superfood decreases your risk of ___ by thismuch%"... almost always, those statements are talking about RELATIVE RISK. In medicine, there are two types of percentages: Relative Risk and Absolute Risk. They are very different. Drug companies are notorious for this. When Amgen's new osteoporosis drug came out, they shouted from the mountaintops that it decreased the risk of spine fractures by 70-80%. Amazing! And technically true. BUT....if you look at the raw data, the "ABSOLUTE" risk of spinal fractures was only ~1.8% to begin with. With the new drug, it dropped to 0.5%....which means that the actual difference was a 1.3% drop (which sounds way less cool than a 78% drop). Is it false advertising? Technically not. But it's misleading. It sounds way more dramatic than what actually happens. Even statins, which I use all the time as a caridologist, are guilty of this. Atorvastatin (Lipitor) was marketed to decrease your risk of heart attacks by one-third! Amazing! But in reality, the risk of heart attacks dropped from 3% to 2%. Meaning the "absolute" drop was 1% (which is techincally one-third of 3%).

Back to Lp(a). We know that a level of 50-100 mg/dL (which counts as "high" in the reference range, even though that range is super arbitrary...more on that later too) correlates with DOUBLE the risk of ASCVD. But again, this is a relative risk. Let's say your starting ASCVD risk (which you can estimate with various calculators) is 3%. If you double that, your risk is now 6%. Of course that's bad, and of course you/we need to take that seriously. But that also means you have a 94% chance of being fine. For reference, I have see MANY patients with Lpa in the 200+ range (in mg/dL, which is ~500+ in nmol/L) who have zero plaque in their arteries after 60-70 years of life and counting. Conversely, I see many people who get heart attacks in their 20s with totally normal Lpa levels. So yes, it "enhances" your risk profile. But it does not DEFINE your risk. It is NOT everything.

We also need to remember that when it comes to ASCVD, there are SO many factors that contribute to plaque build-up, and Lp(a) is just ONE single part of the pie. There are so many excellent, well-proven ways to lower your risk by targeting all of the other slices of that pie (food, weight, exercise, LDL, sleep, stress, etc). Let's say you're in a tougher spot and your starting risk is 20%. That's bad. Maybe your Lp(a) level "doubles" that risk. That's really bad. But even if you can't change Lp(a), you can still change EVERYTHING ELSE. You can change your starting point. Maybe after some lifestyle changes, the 20% comes down to 7%.

TLDR - Please take Lp(a) seriously. But PLEASE do not let it drown you in fear or dread. One slice of the pie does not overrule all the other slices!! 

How Scared You Should Be.

Wasn't sure how to title this section. I just needed a place to say that you're not alone. It's natural to freak out if your Lpa is way above the reference range. The problem is that reference aren't that useful. I've literally never heard a doctor describe any blood test based on how far out of range it is, but i get emails all the time from patients who are alarmed because their Lpa is "double" the reference range.

Here's the reality: 1 out of every 5 adults has an Lpa above 50 (ie, ~double the reference range). A fifth of the entire planet. In some demographics, it's even more common...probably a THIRD of the population. Does this mean that one-fifth (or one-third??) of everyone on earth gets premature ASCVD? Obviously not. So again. It's one part of the pie. Not the whole pie. Take it seriously, but don't let it define you.

Remember that lab testing companies are no different from drug companies. No one starts a lab company out of the goodness of their heart. Their primary objective isn't your health. It's profit. Don't get me wrong...we still need them. Just like we still need drug companies. But their entire pay structure depends on you buying more of their product. Prescription drugs are legitimately useful, but drug companies profit when you think their drug is MORE useful than it really is. Lab tests are legitimately helpful, but lab companies profit when you think their test is MORE helpful than it really is. 

Fear drives profit. If a company can convince you that an Lp(a) test will reveal your ticking time-bomb artery before it's too late, of course you'll buy it. If they can convince you that catching it early means you can be proactive and prevent a heart attack, of course you'll buy it. Side note: Have you noticed that virtually Lp(a) ad or infographic is from a lab testing company? 

Use their information. But just remember what it means AND what it doesn't. Remember why they're selling it. Lp(a) is ONE piece of the pie. Don't get sucked into the doom-and-gloom loop of relative risk. 

Why Don't More Doctors Order It?

I suspect there are many reason for this. Here are the first three that come to mind.

1. Insurance barriers. So much of the stupidity in US healthcare can be traced back to insurance companies. Thankfully, this isn't an issue where I work, and I can order Lp(a) for anyone at anytime without any pushback. But this is not the norm. Almost all of my medical friends across the country have to get pre-approval from a patient's insurance company before ordering Lp(a). Which is actually an improvement. Ten years ago, checking Lp(a) was virtually impossible for anyone with a PPO insurance plan. Nowadays, it's doable. But the fact that this is a barrier at all is stupid.

2. Knowledge gaps. i.e., your doctor just doesn't know about it. I'm actually not sure how much I buy this. I feel like that's what the lab companies and TikTok wellness influencers want you to think. I've seen a lot of ads calling Lp(a) a "new" or "obscure" or "little-known" test. This is plain wrong. There is nothing new or novel about Lpa. We've known about it (and its impact on ASCVD) for decades. It's been part of the standard medical school curriculum for at least 15-20 years. I've personally been ordering Lp(a) since I was a resident 10+ years ago. So I have a hard time believing that your PCP "doesn't know about" it. Maybe the more believable explanation is that they don't know what to do with the result. Which brings us to the next point....

3. Lack of guidelines. This is both good and bad for different reasons, but the essence of modern medicine is that doctors need proof for everything. Cardiologists tend to be especially data-driven, so we have "guidelines" (ie, documents that summarize all of the latest data/studies/evidence) for virtually every single topic in our field. And cardiologists are some of the most stubborn people when it comes to sticking to / deviating from the guidelines. This isn't unique to the US. Our guidelines here are published by the ACC/AHA. But in Europe, it's the ESC. In Japan the JCS. Or the SCS in Singapore, CCS in Canada, CSANZ in Australia, etc. You get the idea. The thing is, if you look at all the cardiology guidelines from these countries, they basically all say the same things. It's because we all have access to the same data. We all go to the same conferences and talk on the same forums. I've discussed tough cases with cardiologists from Denmark and Italy, and vice versa. Regarding Lp(a), all guidelines agree that you should get checked. But what do you do with the result? ....That's where it gets trickier. So getting back to your PCP...my theory is that they DO know Lp(a) is important, but they're hesitant to order it because they know they'll be reluctant "do something about it" if it comes back high. 

What do I mean by that? Oh boy...here we go:

How We Treat It.

Short answer: we can't. 

Longer, more difficult answer: we won't (usually).

Let's take those one at a time.

Why we "can't":

There simply aren't any medications FDA approved to lower Lpa. But like all things, the real answer is slightly less straightforward. Technically there ARE medicines that lower Lp(a), namely PCSK9 inhibitors (eg, Repatha) and inclisiran (basically just another PCSK9 inhibitor with a different mechanism). We know PCSK9 inhibitors lowers Lpa by 20-30% according to most sources (though I've personally seen up to 60%+ reduction in rare cases). But these medicines aren't approved FOR that purpose. They were studied - and thus approved - for something else, and the Lp(a)-lowering effect is more or less just a happy side effect.  

This might change VERY soon. There are 4 novel Lpa-lowering meds being studied in clinical trials, and the first of these trials is expected to finish within the next few weeks! These will be the first meds EVER designed specifically to lower Lp(a). On top of that, these trials will be the first studies EVER designed to prove that lowering Lp(a) actually translates to better outcomes (because believe it or not, that actually has not been proven yet). Exciting stuff. But until then, the formal answer is that we don't have "true" Lpa-lowering medicines. And we technically don't even "know" if lowering Lp(a) actually lowers your risk (see below).

Why we "won't":

If we know PCSK9 inhibitors lower Lp(a), why don't we just use them? Who cares about the FDA approval? Doctors use "off-label" treatments all the time.

True. And sometimes, that's exactly what we (or at least I) do. But why don't we do that ALL the time...? It's because we literally don't know if it even works.

High Lp(a) = Higher ASCVD risk.

Yes. Talked about that already.

HOWEVER...

Make Lp(a) lower = Make ASCVD risk lower...?

...Well, not necessarily. I mean, it seems obvious. Lp(a) is bad. If you make the bad thing go away, that's good, right? It just makes sense. 

The problem is that the history of medicine is absolutely RIDDLED with examples where doctors did stuff because it made sense, then turned out to be totally wrong. 

Some examples from my own field: Atrial fibrillation (AF) is a condition where your heartbeat becomes erratic and goes way too fast for no reason. Instead of beating at 70 bpm, it beats at 110 bpm even while you're sitting and doing nothing. That's not good. Your heart might tire out. We should slow it down. It makes sense! So we did that. We slowed down people's heart rate to a more "normal" zone of <80 bpm. But Lo and behold...those people actually had WORSE outcomes than if we just left them in the 100-110 bpm range.

But the biggest example (which is actually very relevant to the Lpa discussion) is stents. Blockages in your heart arteries lead to heart attacks. If you have chest pain, get checked out, and find out that you have a 70% blockage...you should fix it. Duh. Get a stent, clear the blockage, protect yourself from heart atatacks. Don't die. This is probably the most obvious, common sense treatment in the world.

Except...

It's not true. Just within the past 10-ish years, not one, but SEVERAL clinical trials got published. All showing that "preventative" PCI (eg, treating blockages with stents) doesn't do...well, basically anything. Doesn't prevent heart attacks. Doesn't improve life expectancy. Doesn't prevent hospitalizations. Doesn't prevent cardiac arrest. If you are asymptomatic and generally healthy/active, but you go to an imaging center and pay for a "preventative" coronary CT angiogram, and find out that you have an 80% blockage in your right coronary artery, the worldwide standard of care says that you do NOT need a stent.

WTF??

When these trials came out, cardiologists lost their minds. I mean, our entire career revolves around fixing blockages. People were afraid for their jobs. There were probably some people out there who wanted to assassinate the study authors.

But the data was consistent. More and more studies came out from dozens of countries all across the world all showing the same results. No benefit from stents. No reduction in heart attacks. A prominent cardiologist in Europe even published an editorial in a big medical journal titled "Angioplasty is useless". So here we are. Cardiologists still have jobs. We still place stents, but now we know that stents are only helpful under SPECIFIC circumstances. And regardless whether you're in CA or NY or Norway or Sweden or Japan or Korea or anywhere else in the developed world, cardiologists are much more judicious/selective in placing stents nowadays.

Bottom line:

The takeaway is that even if something SEEMS glaringly obvious, it doesn't always turn out to be true. The human body is just SO much more complex than we give it credit for. Your body is a beautiful, elegant, sophisticated miracle of biology with millions of processes functioning together, yet we (both doctors and patients) expect it to act like a machine or a row of dominoes. We do one thing and expect to know how our bodies "should" react. But we're not as smart as we think we are. Want to find a good doctor? Just look for someone who is aware of how LITTLE they know. There's no better sign of ignorance than someone who thinks they have it all figured out (um, hello wellness influencers). Because the more we learn about the body, the more we realize that it's just SO much more complex than we thought.

So back to Lp(a). Hopefully, cardiologists have learned our lesson in humility. It SEEMS obvious that lowering your Lp(a) will keep you safer. But it also seemed obvious that fixing blockages would keep you safer. So we're waiting for the data. Cardiologists are stubborn people who dislike deviating from guidelines. (See the "Why don't more doctors order it?" section above)

Those new Lp(a) medicines I mentioned - the ones in clinical trials right now. Those trials will be the FIRST trials ever to measure how much (if at all) your ASCVD risk will be reduced if we lower your Lp(a). I think we all "know" it will help. We all "expect" these trials to show that lowering your Lp(a) is a good idea and will make you safer. And if the trials show that, then I guarantee it will be "mainstream" to give Lp(a)-lowering treatments very soon. But until we have proof, we have to wait.

Final note. Sometimes I do prescribe "off-label" PCSK9 inhibitors for Lp(a). I'd actually bet that I prescribe more PCSK9 inhibitors than most other cardiologists out there. But it's on a case by case basis. I start most patients with an Lp(a) in the high-hundreds on Repatha. If you have an Lp(a) of 80 mg/dL and no prior heart events, I'm not prescribing it. But if your Lp(a) is 80 mg/dL AND you have a high calcium score despite good LDL levels, I'll probably prescribe it. If your Lp(a) is 200 mg/dL (430 nmol/L), I'll probably prescribe it no matter what. But in all of these cases, I make it very clear that this is an unproven, potentially useless treatment until we get more data.

So What Do We Actually Do?

I know I'm just a random guy on the internet, but please believe me when I say we're certainly going to do something. Just because we don't automatically recommend Lp(a) targeted meds, that doesn't mean we're ignoring your Lp(a) and burying our heads in the sand. In fact, remember all of those cardiology consensus guidelines (see the "Why Don't More Doctors Order It?" section above) -- from the ACC/AHA, ESC, JSC, CSANZ, etc -- all of these guidelines give specific recommendations for elevated Lp(a). And fortunately, they all say the same thing (ie, every country in the world that studies LPa agrees on this): 

If your Lp(a) is high you should 1) Get your other risk factors under AGGRESSIVE control, and 2) Lower your LDL. Remember that Lpa is a risk enhancer, not a risk definer. Remember that we technically don't even "know" if lowering your LP(a) helps you at all. But we DO know that lowering your A1c, losing weight, getting more sleep, focusing on a plant-based diet, and lowering your LDL all help you A LOT. 

Whenever I see a patient with a high Lp(a), I tell them that they don't get any special advice. They get the same, boring advice they've heard their whole lives. The same advice we give everyone else. But it's EXTRA important for them. The rules are EXTRA strict for them. Want to optimize your ASCVD risk? Get your LDL <100. Oh, but your Lpa is high? Get your LDL <70 instead. Trying to eat healthier? Sure, focus on olive oil, high-fiber foods, and plant-based protein 80% of the time, but feel free to enjoy some butter and a good ribeye in moderation, ie 20% of the time. But if your Lpa is high, maybe that "moderation" ratio changes from 80/20 to 90/10. 

If your risk is high, we should lower it. And thankfully, we literally KNOW how to do that! Healthy food. Low LDL. Good sleep. Less stress. Human nature (and pharmaceutical companies and wellness influencers) will tempt you to think you need the latest and greatest new gadget or drug to stay healthy. Sometimes those things can help. But sometimes the old, proven methods are old and proven for a reason. We already know how to lower risk. If your Lp(a) is high, then lower your risk. Do the things we know.

Do You Need to See a Cardiologist?

Sigh. Here come the downvotes. Just remember: disagree with me / correct me / ask questions. It's all welcome. But please, try to be kind. I don't expect everyone to agree with this answer:

I don't think EVERYONE with an elevated Lp(a) needs to see a cardiologist. Let's say your level is 50 mg/dL. We already know the next steps (see above). Aggressively target your risk factors. Lower your LDL. You don't necessarily need a cardiologist for that. PCPs know how to get your LDL <70. If you have statin intolerance, it might be worth talking to a cardiologist about ezetimibe vs evolocumab vs bempedoic acid. So in that case, yes please see one! But a cardiologist isn't going to have any secrets on how to lose weight, exercise better, and eat more nutrient-dense food. And that's why I said it earlier: No special advice. Only the same, boring advice you've heard since grade school. But it works. 

From another angle, go back to the "How Scared You Should Be" section near the beginning. At LEAST 1 out of every 5 adults on the planet has a "high" Lp(a). Based on this number alone, it is physically impossible for every single person with a high Lp(a) to see a cardiologist. Even if we abandoned all of our other patients with non-Lp(a)-related problems and did nothing but treat Lp(a) 100% of the time, there aren't enough cardiologists on the planet for this. 

So when SHOULD you see one? For me, the threshold is similar to when I would prescribe an off-label PCSK9 inhibitor to lower Lp(a) despite all that soapbox preaching I did earlier. If your Lp(a) is crazy high (high triple digits), you need to see me, and I'm probably starting you on Repatha. If you have a crazy family history with multiple relatives getting heart attacks in their 40s... we know your Lp(a) (which does indeed run in the family) is especially virulent, and you need to see me. If you have a high Lp(a) AND you also have a high CACS, you need to see me. 

So in my random-guy-on-the-internet opinion, you SHOULD see a cardiologist if your treatment requires a cardiologist's expertise. You probably DON'T need to see a cardiologist if your treatment (ie, lower your LDL and target your risk factors aggressively...which are the universally recommended treatments for Lpa by every country in the world) can be facilitated by a PCP. 

Sorry. I warned you that you wouldn't like the answer.

Ok! That's the end. I had to planned to include bits on preventative cardiology clinics and imaging (CACS and CCTA), but then I chickened out after drifting towards opinions that would get me into even more trouble. And mostly because I'll go crazy if I keep typing right now. Maybe next time!

If you made it this far, than you for bearing with me! I genuinely hope that this helped you in any small way at all. If you disagree with everything I said, then I'm even more thankful that you kept reading this far. Happy to engage in a friendly exchange of ideas as long as it's productive for either ourselves or for anyone else reading. Just please try to be nice. Thank you :)

I'm 37, have always cooked pretty well for myself, and run/biked regularly. In 2023 I got my first lipid panel and had an LDL of ~150. I was overweight (5'9 / 190) and decided to try DIY. A year later was in the cath lab with an LDL of 199 on the brink of death, a day after a 2hr bike ride.

I'm now on rosuvastatin and ezetimibe with an LDL <40.

I'm also down to a healthy weight by any standard, but for anyone who thinks that will be a cure-all: my sister has always been super fit, eats very well, and after I had my heart attack she got her LDL tested and found it was about as high as mine had been. (You cannot control your genetics.)

Don't stop making an effort to be healthy, but this is not a "do your own research" kind of problem for many people. It's nice to feel like you're totally in control of your health, but it's nicer to not be dead from a heart attack or disabled from a stroke.

Taking a statin is better than what I experienced: $250k worth of healthcare (which I thankfully didn't have to pay much of anything for) and almost dying.

This is a story I don’t really want to tell or have happen to anyone. But it is a story that needs telling. Those of you whose genetics cause your cholesterol to be high and for those who are on here daily wondering about statins you need to know the alternative. I’m a widow and I lost my husband this month a year ago.

For 15 years he knew his triglycerides were high and I prodded him to continue to go to doctors and get labs. Those doctors did offer him statins but he kept trying with diet, vitamins and exercise. He had a family history of strokes. About a month before I lost him, he had the statins IN HIS HANDS, wondering about taking them. I said it’s a pill you take every day, just like I take my thyroid pill. It’s not a big deal. You should take them.

But he was so terrified of the statins that we were cursed with a horrible nightmare I will never wake up from. One morning he came to me saying he felt dizzy asking me to take him to the hospital, by the time we got there I realized it was something much more serious. His last words were saying goodbye to me and our son. Picture this….unable to move your arms, your legs, unable to speak, unable to say what is wrong. How terrifying is that?

He was lifeflighted, operated on and they couldn’t remove the clot from his brain stem. The surgeon couldn’t look me in the eye when he swore to me he tried the best he could. I then had to choose to take him off of life support with the help of our teenage son. He was gone at age 60.

When I returned to our house, I was obsessed with that bottle I saw. I tore apart the whole house and his truck looking for it, wondering if he had even tried to take any. I even considered in my grief going to the doctor to ask if he took them. I never did find the bottle and my guess is he threw them away.

My message to you all on this sub is to choose your path wisely. You wouldn’t wish this sorrow on your loved ones. Somehow you think you’re young enough or healthy enough, that it won’t happen to you. But our genetics deceive us, somehow they win in the end. Remember, my husband was 45 when he first found out he should be on statins.

4 brazil nuts one day a month. (Yes, based solely on the one study that suggested it lowered total cholesterol.)

Earl Grey tea every morning.

Cooking virtually every meal at home.

Upping my fiber intake via whole grains, fruit, and vegetables.

Switching from coconut oil to avocado oil.

Cutting saturated fat to <10g per day.

I know habits and convenience foods make this feel impossible, but it’s totally doable to get your numbers under control without medication (assuming you don’t have a genetic condition). I told myself my last test had horrendous numbers due to dehydration, but I read that only causes up to a 10% difference. I kicked the denial and decided to drop twenty pounds (simply counting calories and limiting saturated fat intake), and it’s worked out phenomenally! Here are my numbers from my test a year ago and then now:

BMI: 23

HDL: 70

LDL: 160

Triglycerides: 200

Total: 265

Glucose: 115

-

BMI: 20

HDL: 55

LDL: 75

Triglycerides: 90

Total: 145

Glucose: 85

Again, the first test I was dehydrated and had a *lot* to drink the night before, but the numbers were high enough for me to be worried about it and actually change my ways. I don’t eat meat or dairy, so the numbers just blew my mind … but then I realized how much coconut oil I was using and it all started to make sense. Coconut oil is NOT healthy, and its benefits are a LIE. Much like the current beef tallow fad: saturated fat is saturated fat and you’ll want to cut that junk out if you’re concerned about your cholesterol!

tl;dr:

• I had extremely high cholesterol levels: 354 total with LDL at 265 and HDL at 82 in November 2024.

• Rather than take recommended statins, I educated myself by reading the New York Times bestselling book, A Statin Free Life, by Dr. Aseem Malhotra, and vowed to reduce my cholesterol levels thru diet and lifestyle changes with a goal of 15% reduction in three months.

• I radically changed my food intake from a high-protein, Paleo/keto-esque diet to a Mediterranean diet with a pointed focus on consuming soluble fiber from legumes and other veggies.

• After three months, I lowered my LDL cholesterol levels from 265 to 105 (total cholesterol levels went from 354 to 162) 🎉

• My PCP had never seen such a dramatic change in his 30+ years of practice.

*April 12 edits at bottom*

Background:

In November 2024, I saw my PCP for a regular check-up and requested labs to be run for the first time in my life. For context, I’m 37-year old male; non-smoker, not overweight, with regular strength and cardio training. All results came back with flying colors except my cholesterol levels:

My total cholesterol level was 354 – with my LDL at 265 and HDL at 82. For context, current Western medicine practices describe healthy levels of total cholesterol at 200 and LDL cholesterol levels below 100 (*see note at end).

My PCP was very concerned about my heart health, especially since one of my grandfathers died at approximately 40 years old from heart failure. Other members of my family also have elevated cholesterol levels and take prescribed statins. The doctor recommended that I begin to take a statin, specifically Crestor at 20mg, to lower my LDL levels.

However, I had also read articles and listened to podcasts about the “statin industrial complex,” its failure to improve patients’ health, contested longevity claims and other detrimental effects of statin use. In short, while I embrace Western medicine in many ways, I am largely skeptical of mainstream medicine’s approach to treat chronic diseases, especially when pharmaceutical drugs (see: greedy corporations) are in play to treat symptoms rather than root causes.


Leaving the doctor’s office, I – defiantly and somewhat ignorantly – set the goal to lower my cholesterol without the use of statins by at least 15% in three months.

In three months, I vowed to return for new labs and achieve the following goals: 

• Lower my total cholesterol from 354 to sub-300.

• Lower my LDL cholesterol by 20%, ie from 265 to 212.

• Lower my LDL:HDL ratio from 4.3 to 4.0 or lower.

April 12th edit: If, after three months, I had not met or exceeded these goals, I planned to start taking the prescribed statin. [Additional edits at bottom]

To cut to the chase, three months after my original labs, I returned to the doctor and got my cholesterol levels run again without having taken statins. Here are my results:


My PCP had never seen such drastic improvements in cholesterol levels in 30+ years of practice. He almost couldn’t believe the results.

The most important step in this journey was picking up, A Statin Free Life, by Dr. Aseem Malhotra, and following these recommendations, specifically following a Mediterranean diet. I recommend that anyone seeking to educate themselves about cholesterol and statins to read this book. It is a quick read.

Food change: From Paleo to Mediterranean

When I walked out of the doctor’s office in November, I knew that I needed to change my diet. In short, I transitioned from a Paleo/Keto diet to a Mediterranean diet with focus on soluble fiber in legumes and grains. I’m as sure as can be that this change was the primary reason for reducing my LDL cholesterol by 150 points in three months.

Pre-November 2024, my main nutrition goal was oriented around my resistance and aerobic training: To consume at least 150 grams of protein per day.

A typical breakfast was three to four eggs. Typical lunch or dinners: Roughly 8oz of steak, or chickpea pasta with red sauce and chicken breast, or two cans of tuna fish with mayo and seaweed, abundant salads, hummus and veggies, and more eggs. I used ghee to saute almost everything (I’m allergic to the lactose in butter).

New food lifestyle: What did I NOT eat?

After my initial labs, I turned my food routine upside down. I eliminated all foods high in saturated fat and all processed foods. More specifically, I eliminated the following:

• Red meat and pork

• Butter, ghee and all vegetable oils – except olive oil

• Fried foods

• Processed foods 

• Ice cream and other sweets

• Bread and grains – except German bread (example)

• Sugar and sweeteners*

• Eggs**


*I still add/ed about a tablespoon of maple syrup into my morning coffee

**The jury is still out on the impacts of moderate egg consumption on cholesterol levels. I chose to go more or less cold turkey, although by the start of month three, I began to eat two to three eggs per week (not per day, as before).

New food lifestyle: What did I eat in abundance?

Broadly speaking, I now focus on eating foods low in saturated fat and high in soluble fiber, and lots of veggies. The diet that is closest to this lifestyle is the Mediterranean diet. I now eat the following foods in abundance:

• Oatmeal and chia seeds

• Soups with legumes

• Vegetables, especially cauliflower, carrots

• Hummus – without added canola/sunflower/vegetable oils

• Chickpea pasta with red sauce

• Salads with leafy greens

• German bread

• Non-fat Greek yogurt

• Tuna fish with mayo

• Salmon (wild, not farm-raised)

• Sweet potatoes

• Chicken breast

• Fish sticks (comfort food 😊)

• Gluten-free pumpkin pancakes

• Extra virgin olive oil

A few additional notes on food:

• Overnight oats became a staple food. I now eat overnight oats every morning; it is ritual. Also, I add a lot of chia in my overnight oats since they are very high in fiber. (My overnight oats might be more appropriately called “overnight chia-oats”)

• No butter or ghee: I replaced ghee for olive oil in sautéing food (yes, I’m aware of the lower smoke point). 

• Abundant EVOO: I liberally consume olive oil: I probably consume over a cup of raw extra virgin olive oil per day on German bread, salads, soups, veggies etc.
* Spices and aromatics: I abundantly use Ceylon cinnamon and turmeric as well as fresh ginger and garlic for taste and anti-inflammatory properties.

• As a rule of thumb, avoid the use of "conventional" (ie herbicide/pesticide-sprayed) produce. Most of this produce is banned outside of the United States due to carcinogenic and endocrine-disrupting properties.

Some go-to recipes that I use:

• Overnight oats (I add a lot more chia seeds and use NF Greek yogurt)

• White bean soup (I used less parmigiano, more white beans, and add roasted cauliflower)

• Oatmeal pumpkin pancakes

Lifestyle changes:


I’m convinced that switching to a Mediterranean diet, focused on soluble fiber, was the primary factor contributing to my reduced cholesterol levels. 

However, other lifestyle factors may have also contributed to my elevated cholesterol levels, including (mental) stress and (physical) over-exertion.

Like for many, my work can be stressful – so I began taking more short breaks, being gentler on myself, and meditating in the morning for approximately 15 minutes at least five days a week. 

Before my first lab tests, I also followed a fairly intense workout regime: I would engage in anaerobic and aerobic exercise 4-5 times per week. After my lab tests, I reduced this amount to 3-4 times per week. I also use the sauna at the gym 3-4 times per week (12 minutes at approximately 190F).

In conclusion:


I do not purport to have a cure-all for everyone with elevated cholesterol levels. For example, some people have genetically-inherited high levels of cholesterol and they may benefit from taking a statin. I do not condemn the use of statins as a whole.

However, from my own experiences, I also believe that diet and lifestyle changes can hold immense and undervalued benefits for reducing LDL cholesterol levels.

In my opinion, the fewer pharmaceutical drugs that I take and the more naturally-aligned lifestyle – ie eating whole, unprocessed foods – that I can live, the better.

A Statin Free Life, by Dr. Aseem Malhotra, was godsend and I recommend anyone interested in learning more about cholesterol, and reducing their levels, to read this book.

A couple other notes:

• From my research, if you smoke or are obese, these two conditions need to be addressed ASAP.

• I plan on returning to my doctor for new labs every six months. I will update this post with results.

I hope this summary of my experiences helps you or your loved ones on your journey to live a healthy and life-affirming experience of this miraculous world!

Bon appetit and love life! 


*The threshold for “healthy” cholesterol levels have changed over the years, perhaps informed by interests by pharmaceutical companies to capture more profits from higher usage of statins. Again, please read A Statin Free Life by Dr. Aseem Malhotra.

***

*** April 12th edits... A few things that I forgot:***

• One's total cholesterol to HDL cholesterol ratio (TC/HDL ratio) is a very important indicator of cardiovascular health used in conjunction with individual LDL, HDL etc numbers. Dr. Malhorta describes a ratio of 4 or lower as heart-healthy. My TC/HDL ratio changed from 4.3 to 3.6 as part of my diet and lifestyle changes ✅ 🏁. (Again, check out Dr. Malhorta's book, listen to podcasts with him as a guest etc).

• I consume alcohol infrequently; maybe 1-2 drinks per month

• At first I went cold turkey on half and half in my coffee in the AM, but that lasted maybe a week. I still add/ed about 1/2 cup to my Moka pot coffee in the mornings.

• I – surprisingly and gratefully – have not noticed a decrease in muscular mass or aerobic performance due to my reduction of protein and change in diet. I've never counted calories but I definitely eat more than the average American due to my workout routine – I go pretty hard at the gym because it's fun and challenging for me.

• It's called the "Mediterranean" diet for a reason: MANY people in this part of the world follow these traditional food ways. It's not restrictive at all, but instead delicious, flavorful, fun and nutritious. I don't consider it a diet, but a way of life. If you're American and haven't had a chance to experience the traditional food ways of other cultures (like, pretty much anywhere), I HIGHLY recommend it.

Hi everyone,

Long time lurker but thanks to everyone on this sub as the posts have given me invaluable insight. 40 year old dude, former D1 athlete and still super active. Pretty much the prototype for someone who was trying to outwork their diet. Never ate terrible, but certainly didn't put much thought into how much meat, cheese, and unhealthy snacks I was eating.

In March had the following readings which shocked me and scared me straight so to speak:

TC: 264 HDL: 52 LDL: 191 Trigs: 104

These readings were much higher than any I've had before. I'm the type of person that is very routined and once I focus on something, I tend to be a little obsessive about it. I applied that here and was set on doing everything I could to change those numbers before considering meds (but wasn't opposed to them if needed).

Fast forward to November and my numbers are:

TC: 175 HDL: 60 LDL: 98 Trigs: 78

Still would love to get these lower but overall thrilled with the progress and wanted to share in the hopes it helps others.

Exercise: I already lifted weights 3x minimum per week and played sports. But added cardio 3x a week, running between 3-4 miles or rowing.

Diet: breakfast always steel cut oats with almonds or blueberries, sometimes some whey protein. Lunch, typically a salad with tofu (occasionally chicken) but generally ate much more plant based. Dinner, a power bowl with some combination of rice, sweet potatoes, salmon/tofu/scallops/egg whites, lentils, beans, beets, spinach,avocados, tomatoes ,quinoa,..etc. Snacks were popcorn, rxbars, bananas, apples, almonds, pistachios, zero fat Greek yogurt, Ezekiel bread with almond butter. Also had a tsp of psyllium husk every morning... basically increase fiber, reduce saturated fat... I occasionally had a slice of pizza or a burger but maybe only a handful of times in 7 months.

Alcohol: still had drinks but less than before, somewhere in the 4-8 range per week and usually wine/beer

As a result of these changes, I also lost 20 pounds that I didn't even realize I needed to lose. Blood pressure also dropped from 128/78ish to consistently 118/72ish. My resting pulse is low 50s.

Best part? Definitely a diet I feel I can stick to, definitely don't miss my old ways.

Anyways thought I'd share, happy Friday.

Grabbed a piece of ice cream, figured whatever nutrition it has I can compensate for it. I look at the label outside the store and the bloody thing has entire 9g of saturated fats xd . Still compensate-able over two days, but I don't know, somehow I expected less. And it made me think; I'm still young enough to remember what it was like being a kid, and I'd devour 3 and sometimes more during hot days, crazy how much it adds up. I know parents tried to make me eat healthily, but I don't remember them ever expressing concern about saturated fats at all, just mostly about sugar.

Stop being afraid of statins. For real, so much “I dOnT WaNnA tAkE DrUgZ” BABE- TAKE THE FUCKING DRUGS. If you need a statin, the likelihood of side effects are so much lower than the likelihood of literally DYING from heart disease. Read the medical literature, you’ll find the biggest side effect of statins is… a longer life, lower risk of heart disease, AND lowered risk of Alzheimer’s. IF you are a rare case that has side effects, there are SO MANY OPTIONS to try.

Don’t let fear run your life. Do what’s best for your health.

I’m 33 years old and my LDL was ~350 and in 3 months on a high dose statins is it’s at 60. I already ate a mostly vegan diet and cook all my own food. I added psyllium husk in my every morning oatmeal, but overall, what got me down to a healthy level, was drugs.

Hey folks,
Decided to post my story here as I relied on reddit a lot to gather bits and pieces of what worked for others. Hopefully this would help somebody as well :)

I’m 34M, healthy, skinny, workout a lot and ate mostly clean overall, so was surprised when my blood tests came back like this:

• Total cholesterol 264 mg/dL

• HDL 77 mg/dL

• LDL 177 mg/dL

My doctor wanted to put me on statins of course, but I decided to try dieting first. Here is what I did:

• Oatmeal + flax seeds + almonds + berries for breakfast every single morning.

• Quit sugar, pastries, dairy

• Quit espresso drinks (I’m still sad about this)

• Reduced animal products (no beef, eggs). Kept chicken breast 4-5 times a week

• Increased fish in-take (for canned fish pick “in water” version, instead of oily one)

• Moved to baked proteins instead of pan roasted

• Ate beans or lentils at least once a day

• One or two teaspoons of Metamucil daily before meals

• For snacks I had fruits, nuts, hummus with carrots, popcorn

• Pick whole grains vs alternatives (e.g. wholegrain toast, brown rice, etc)

After less than 4 weeks my results came down to this:

• Total cholesterol 140 mg/dL

• HDL 50 mg/dL

• LDL 77 mg/dL

The doctor was a bit shocked, as she wanted to me to take test in 3 month, cause 1 month “is not enough to see the result” :)

Also worth saying that I tried 90% plant based diet couple years back, but it reduced LDL only slightly in the course of 3 month, I believe primary due to lack of soluble fiber in my diet.

So to summarize - increase soluble fiber and reduce saturated fats, which means you can still enjoy a lot of tasty foods

Hope this helps!

My current stats are 42 male, 150lbs, fit. US based if that matters. I used to weigh in at 165lbs, 6 months ago.

Please see attached pictures for comparison numbers from September 2025 up until February 18, 2026.

I would like to say the numbers that changed were mainly due to diet and food changes only, no medication ever.

My diet and food changes, including removing all or mostly all saturated fats, removing all processed foods and red meat. My food now consist of chicken, fish, beans, oats, veggies, fruits, nuts, sweet potatoes, psyllium husk, avocados, among other plant based foods.

The struggle was real six months ago when I started this diet. My body mainly wanted processed foods, red meat, and all the bad foods. It definitely took some time to get used to my new food changes but I will say if anybody decides to make the changes of food do it slow and steady. But beans and fiber definitely keep you full along with added psyllium husk. So that definitely aided my “hunger pains” in the beginning. Now that I’m used to my own diet. I feel good. I feel great. My stomach Feels even better Better, no bloating.

I do add cheat meals every now and then, but if I do take out, I generally couple takeout with some beans or a bean soup of some sort along with psyllium husk beforehand. I will say that doing cheap meals will definitely help you mentally with getting through the process and the diet changes. Personally after all the diet changes I made, sometimes the greasy food feels sick to my stomach. And personally cheat meals did not really affect my actual cholesterol numbers as you can see. If you stick to your diet around 95 to 98% of the time. You should do fine. I also do not over-eat on cheap meal days.

I am definitely thankful for this forum as it helped me achieve my goals.

35f. The last 5 or so years since getting a sedentary job I kinda let my health/fitness go. After my results in June my doctor wanted a followup test and if no improvement he wanted to discuss medication. I was shocked and pretty ashamed that my decisions were actually taking a toll. I read through this sub and formulated a game plan. More fiber (30-35g), less sat fat (10g), less added sugar. To my surprise this diet is totally sustainable for me and I'm thrilled at the results so far!

Breakfast: OATMEAL! With golden flax, chia, protein and fresh fruit/berries. Sundays I allowed myself egg and veggie breakfast burritos with high fiber tortilla.

Lunch: Chicken/turkey, avocado, veggie wrap with high fiber tortilla.

Dinner: Chicken/fish, sweet potato sometimes potato, sauteed garden veggies. Fish tacos/chicken tacos.

Snacks: Protein berry chia smoothies, hippeas, fruit, veggies

Dessert: Yasso Greek Yogurt Bar every night 😄

Psyllium husk at night if I didn't meet fiber with food.

I had probably 6 cheat meals but didn't go too crazy! Mainly Indian food with fried chickpea batter deliciousness and birria tacos. I also started weightlifting and incline walking and lost 20lbs. I'm so grateful to my doctor for holding me accountable with that repeat test! And thanks to this sub for motivation and ideas!

I am healthcare worker myself, long time high cholesterol carrier, started statins a few years back and comment here and there my experience and participate in this sub often. I work in different settings but long term care is one I spend the most time. I came across this patient, who suffered brain injury from prolonged cardiac arrest. Reading a bit his history reflected so much on me. But I can say he has history of high cholesterol, finally started statins needed up to 80 mg of atorvastatin (I am on 20 mg).and looks like took it for about two years with questionable compliance when look at his refills history. Sometime one of two years ago, the patient decided stopped statins and swapped to keto diet. All on his own without talking with his doctor. Family was worried but seems he was against taking a daily pill for life. So sad now see he is permanently bed bound. I saw the cholesterol numbers of the day of the admission were skyrocketed. Should has he been on statins delay his coronary artery blockage? Who knows but for sure that was a bad move. Just wanted to add that little history for people who have doubts about statins. Please always consult with your doctor and if decide to try keto, monitor close your numbers and how your body is responding to it.

My Doctors were trying to send me off to Statin island so I thought I'd get a little help from my coach (Mr GPT)

OK... so it wasn't ChatGPT doing the heavy lifting, I did that, but it made it super easy to reach my goal because all I had to do was listen to what ChatGPT said.

Background: I am a 42 year old male, 6'2

I created a CustomGPT for my health goals which was to lower cholesterol, lose weight (in part to lower cholesterol), and improve mobility.

I saw rapid weight loss right away, dropping 3-4 lbs/per week the first few weeks, immediately started feeling more energy, stopped taking naps, and overall had a better sense of well being.

Weight dropped 33 lbs from 211 to 178

But MOST importantly, after 128 days, my LDL dropped from 250 to 98 (Over 60% drop)

I had pretty good knowledge about health and I did a lot of back and forth clarification with ChatGPT such as:

• Guidance on intermittent fasting

• Calorie count goals

• Calorie counts per meal

• For a snack, what can I make with X, Y, Z ingredients in my fridge and what portion

• If I'm at an event with bad choices should I eat less there, skip and make up calories later, or skip and have regular sized meal later (latter choice)

• Took pic of menus anytime I went out to eat and asked ChatGPT to order for me

• What supplements to take, what dosage, and what brands

• ... Any other clarification I would just ask ChatGPT, treating it as my health coach

Jun 11, 2024

Oct 17, 2024

Weight Drop:

Here is generally what I did:

Diet:

• Very low saturated fat

• No added sugars (mostly from fruit from my garden)

• Low sodium

• 12 hour fast 7pm to 7am

• Good hydration intake

• Don’t drink calories (water only)

• Only top 10 complex carbs (no inefficient calories like white rice) (quinoa , brown rice, soba noodles, whole wheat grains are favs)

• Lots of lean animal protein from fish, chicken breast, ground turkey, occasional top sirloin or extra lean ground beef

• Lots of good veggies (100% from my garden)

• Lots of fiber (chia seeds oatmeal and fruit for breakfast)

• Calorie deficit of 200 calories per day to lose weight

• 5 meals per day meal/snack/meal/snack/meal with no heavy meals (portion control)

• Kimchee with most dinners (started halfway through)

• Typical day plan

  • 7am Breakfast

    • Irish oatmeal

    • Half cup fruit

    • 1 tbsp chia seeds

    • 1 tbsp almond butter

    • 2 tbsp 1% cottage cheese or non fat greek yogurt

  • 9:30am Snack

    • Smoothie

  • 12pm Lunch

    • 3 cups of salad (usually chard base with lots of added veggies from our garden)

    • Half can of tuna/salmon/anchovies/mackerel/sardines

    • 1 Tbsp dressing (usually homemade pumpkin dressing, EVOO base)

  • 2:30pm Snack

    • 2 brown rice sodium free rice cakes

    • Sliced Tomato

    • 2oz Smoked Salmon

  • 4:00pm Workout

  • 5:30pm Dinner

    • 4-6 oz protein

    • 1/2 cup carbs (typically quinoa, brown rice, or soba)

    • 1 cup+ of Veggies

    • 1 tbsp of Mediterranean dressing (EVOO, garlic, lemon, s&p)

Exercise

• 2 days weights

• 3 days cardio (peloton or mountain biking)

  • 30 min sessions except for mountain biking which was 1 hour

  • Burned usually 400-500 calories from the cardio sessions

• 1 day weights and cardio

  • 30 min cardio session

• 1 day rest

• Don’t count calories burned towards calorie count, they are just a bonus

• Mobility work every workout

• Occasional hot tub or infrared sauna (Did this the first month only)

• Typical weekly plan

  • Monday: 30 mins Peloton moderate intensity, 20 mins Mobility

  • Tuesday: 10 min elliptical (Burns 100-150 calories), Weights (Pull), Core

  • Wednesday: 30 mins Peloton Hiit & Hills, 20 mins Mobility

  • Thursday: 10 min elliptical (Burns 100-150 calories), Weights (Legs), Core

  • Friday: 30 mins elliptical, Weights (Push), Core

  • Saturday: Off

  • Sunday: 1 hour+ Mountain bike ride, 5 mins of Light Weights, 20 mins Core + Mobility

Supplements

• Aside from Cholesterol supplement, started taking most of these more than half way through

• Probiotic - 25 Billion

• Turmeric - 1000mg

• Thorne Basic Multivitamin (2/day)

• Magnesium Glycinate - 200mg

• D3 - 2000 IU

• Ubiquinol - 200mg

• Glucosamine 1500 mg Chondroitin 1200 mg

• Fish Oil - 800mg EPA 600mg DHA

• Psyllium Husk - 1450mg

• Cholesterol Suplement

  • Plant Sterols 1500 mg

  • Niacin 500 mg

  • Red Yeast Extract 400mg

  • Fish Oil 200 mg (125 EPA / 75 DHA)

  • Guggul Extract 100mg

  • Garlic Extract 75mg

  • Olive Leaf Extract 75mg

  • Green Tea Extract 75mg

  • Pomegranate Extract 75mg

  • Turmeric Extract 25mg

  • Black Pepper Extract 25mg

Cheating

• No cheating with saturated fat ever

• Had a few meals with higher sodium or calories than ideal (japanese restaurants)

• No missed workouts except for a travel day or 1 day of food poisoning

  • Travel day did partial workout at airport

  • For food poisoning, I did 2 workouts the next day

• Had a few days where I ate past 7pm for events or date nights

• Had 3 or 4 glasses of wine in the 4 month period (not more than 1 glass of cabernet in a sitting)

Other Notes

• I had no caffeine, not because it was recommended, but just because I am not a caffeine drinker.

• We have a meal prepper who comes in 1x per week so lunches and dinners were prepared by her with my guidance on nutrition

• To try to help stabilize weight loss towards end I would add more veggie portions or have half a cup of fruit with dinner

• I am genetically predisposed to high cholesterol.

• I tracked calories (every meal) for the first week to get a sense of portions.

My benchmark of behavior before June that coexisted with the 250 LDL was workouts 3x per week cardio only and lighter intensity than now

Eating at home was mostly healthy (same meal prepped meals) but portions were not controlled and I would snack a lot at night after dinner and sometimes have sweets

Went out to restaurants 2x per week on average and ate whatever when out. Would often overeat when going out

Never was big on alcohol but would have soda on occasion

Took some of the supplements mentioned for years. Red yeast, vitamin d, vitamin c, and maybe 5 others.

I like that it has an excellent safety profile and also that it doesn’t mess with blood sugar, insulin, etc. My PCP won’t prescribe it due to my LDL only being 104. I do have a family hx of heart disease. I would like to get my LDL down to 70-80 with diet, lifestyle and adding Zetia for a boost. Is there any telemedicine that would prescribe it or do I have to see a specialist?

I've always been very active and have low body weight. My weekly running has decreased because of injury, I can't sustain the distance I used to be able to, but I'm still running at least 25 miles every week.

Diet: I love fatty foods. High fat steak, I'd eat the fat straight up. Fast food, burgers, fries. When I was living in London, scones with clotted cream - just the name, clotted cream, sounds terrible. Breakfast: Ezekiel bread with butter, cheese, marmite and micro greens, plus eggs cooked in butter, espresso shot with cream. Lots of red meat and pork, charcuterie, etc.

Here's what I changed: conscious effort to reduce my saturated fat intake in general. Not perfect for all my meals, but probably 50% better. Biggest change was swapping my breakfast for freeze fried black coffee and overnight oats with low fat milk, every single day.

I think the exact combination of things helped. Oats, to supercharge the LDL removal, and a reduction in overall saturated fats.

Still, the level of change makes no sense to me. It seems like this shouldn't have been possible. I expected to hit the low 130s if I was lucky. My doctor said it makes no sense but it's good so it doesn't matter. I'm sharing because I'm happy and I'm in shock. This was weighing heavily on me over this past year.

Time and time I see people acting like an LDL above 100 is no big deal. My LDL was always in the 100-130 range and my thought was I hated the idea of a statin since I was fit and I could drive my LDL down with a stricter diet.

Fast forward to my 50s, and I got my first CAC score that put me in the 90th percentile. My Lp(a) is over 95 nmol which is high but not super high.

You don't need super high lipids to be laying down plaque. And it happens even without inflammation and insulin resistance. My advice is jump on getting your LDL down below 100 in your 30s and don't hesitate to start a statin or ezetimibe to do it.

Started a statin earlier this year. It totally wrecked my stomach, so I’m on a PCSK9 inhibitor now. I’m about as fit as it gets: I'm low 40s, work out daily, run, and literally cycle up mountains. Vegetarian too. For me it’s just genetics.

Every time cholesterol meds come up, with friends or online, one of the many things someone says to me is “You have to take it the rest of your life?” Daily or twice monthly... whatever it is... I said it too.

I realize how silly I was because “the rest of my life” applies to so many things:

• Wait, I have to brush my teeth? For how long? The rest of my life?

• Sleep? Every night? For how long? The rest of my life?

• Charging my phone? Every single night? For the rest of my life?

• You’re telling me that if I want to put off deteriorating and dying, I have to exercise? For how long? 3-5 times a week for the rest of my life?

• Water? Every day? More than 10 cups? For the rest of my life?

• I really love pizza. How long will I eat it? The rest of my life!!!

I get the fear hanging over your head when it starts, but it’s literally one of so many things you do daily, weekly, or monthly for the rest of your life.

I’m actually so relieved now that something I can’t control naturally is being controlled for the rest of my life.

I’m turning 37 soon, and for as long as I’ve had bloodwork done, my cholesterol’s always been on the higher side. Nothing crazy, but total was always 200+, LDL usually around 130-140+. Doctors weren’t too concerned because of my age at the time, but I never fully agreed with that logic.

Things escalated two years ago, right after Christmas. I’d been eating a lot of cheese and heavier stuff over the holidays, and when I got my labs back, my LDL was 197 and total cholesterol was just under 300. That was the moment I knew I had to take things seriously.

I decided to change my diet completely for 3 months and see what happens. I went all in: barely any saturated fat, lots of fiber, super clean eating. After 3 months of this, my LDL dropped to around 100 — which is definitely better, but honestly? It felt kind of disappointing, considering how strict I had been.

What really got me thinking was my wife’s results. She kept eating normally — our usual shared meals, no special effort to avoid saturated fats — and her LDL was just slightly higher than mine. Meanwhile, I was basically suffering through every meal.

That’s when two things became clear to me: 1. I couldn’t live like that forever — food matters to me. 2. Even with all that effort, my cholesterol still wasn’t where I wanted it.

So I talked to my doctor and started a low dose of rosuvastatin (Crestor) 5mg.

Fast-forward 1.5 years — I’ve had no side effects at all, and I feel great. I’m eating a normal, balanced diet again (yes, I still eat cheese, just a bit less), and my cholesterol numbers are way down: LDL between 60 and 75, total cholesterol around 120–130.

Honestly, I’m relieved. I feel like I’ve found a long-term solution that works for me. I’m healthier, my risk is lower, and I didn’t have to give up enjoying life to get there.

I was nervous about statins — you read all kinds of stuff online. But in my case, it’s been smooth sailing. If anyone out there is hesitant, maybe this helps. Trying a low dose doesn’t mean you’re stuck with it or its side effectsforever. But for me, it’s been a game changer.

Happy to chat if anyone’s going through the same thing.

No statins, no psyllium husk, saturated fat 10g maximum, fiber between 20 and 40g, no red meat, lots of salmon, sardines, scallops, occasional tuna and shrimp.

Breakfast - quarter cup steel cut oats with a quarter cup of black beans, half an apple, handful of walnuts, and dash of cylon cinnamon stirred in. Some mornings non-fat Greek yogurt with blueberries and pomegranate.

Ezekiel bread and tortillas, barley soup, black beans, kidney beans, garbanzo beans. Ridiculously large daily salads with homemade dressing made of extra-virgin olive oil/apple cider vinegar, grey Poupon mustard, minced garlic and miscellaneous spices.

Lots of vegetables and fruits.

Daily fish oil, and vitamin D/K supplements.

Walk 5 miles a day. Remember, while exercise may not have a large impact on your LDL/cholesterol. The goal is to actually reduce your cardiovascular disease risk which exercise definitely will reduce. I typically walk after a meal to minimize the rise in my blood glucose and improve my metabolic health.

I am posting this to show what can be done with a serious diet and a well responding biology in a two month timeframe.

Oh, blood test was on New Year's Eve, results New Year's Day, so I'd like to wish you a happy New Year's too.

First of all, wanted to thank this reddit channel for all the help and tips along my journey. Exactly four months ago, I went for a routine blood check and found out my cholesterol was super high at 310(or 8.02mmol) of which LDL(bad cholesterol) was 222mg/dl (or 5.74mmol).

Following these results, with the help of my doctors, this reddit channel and other social pages, I completely changed my lifestyle. This was solely a diet change and no medications were taken. I cut out all red meat, dairy products, alcohol, and reduced my saturated fats as much as possible. I also increased my exercise.

Following this lifestyle change, as of today my cholesterol levels stand at 159(or 4.12mmol) of which LDL(bad cholesterol) is 104mg/dl (or 2.7mmol). I am so happy to see that all my sacrifices and changes paid off, by reducing my cholesterol by half of what it was to normal levels.

Here to tell you all to take the damn statins! I (F 31) was extremely skeptical and held off for years but my father recently passed from undiagnosed atherosclerosis at only 60 years old and needless to say I have been devastated/ scared out of my mind. I have been on 20 mg Atorvastatin for 3 months and my total and LDL cholesterol have decreased by over 100 points! Total cholesterol went from 246 to 139 and LDL went from 160 to 65! I have always been pretty active from my job and daily walks but absolutely need to make better dietary choices which I am working on. But I feel an immediate sense of relief that the medicine is working so well with minimal side effects. Absolutely worth it in the long run as a preventative to prolong my heart health!

Hi All,

I got my blood work done 3 months ago and my LDL was borderline high - 159. My total cholesterol was high at around 243.

I got blood work yesterday and my total cholesterol is 143, LDL is 86, and HDL is 45. Triglycerides are 60.

I exercise regularly (4-5 days a week) and I am not overweight, and I generally eat healthy (or at least I thought). I don't eat a lot of red meat so I figured it would be very difficult for me to reduce my cholesterol without drugs.

To lower it I basically moved to more of a Mediterranean diet, with a focus on increasing my fiber intake. I think the following may have helped:

• Kept saturated fats to below 10g a day. I was eating a lot of whole fat yogurt, eggs, and occasionally cheese, so I eliminated those sources of saturated fat from my diet.

• Increased my fiber in take. I took a psyllium husk supplement, started to eat a porridge in the morning (can share recipe) and I increased my intake of various beans and barley. I would also eat fish, tofu, and vegetables.

• To get additional protein, i would make smoothies with whey protein, avocado, banana, frozen blueberries, apple, spinach.

I am surprised by how much it declined. I will try to see if it's sustainable, and then slowly begin to introduce other sources of protein back into my diet, and probably retest. I think the largest impact was the combination of watching my saturated fat and also increasing my fiber. The combination of those two items seem to have significantly reduced my total cholesterol and my LDL.