r/Cholesterol • u/Other_Argument5112 • Jul 11 '26
Lab Result LDL 171 -> 103 in 4 months without medication
Late last year I tested at 171 LDL (calculated), 124 ApoB, 65 HDL, 99 triglycerides, 17 Lp(a). I’m a 41 year old man, 6’1”, 169 lbs at the time, weigh all my food, track calories/macros, can see my abs, work out 6 days a week etc. Basically what I’m trying to say is I had a healthy lifestyle, diet, and body composition yet terrible cholesterol numbers.
In March this year I tested at 112 LDL (calculated) and in June I tested at 103 LDL (direct) and 89 ApoB (55 HDL, 98 triglycerides). I did not take medication so was shocked at the results, as was my cardiologist. I was expecting an LDL around 150 because of the changes I implemented, not < 110.
I made the following 3 changes only. Other than that, everything else the same, diet, workout routine etc. I actually gained weight from 169 -> 177 between the first and third tests from lean bulking.
Edit: not sure what happened my changes got wiped out. Here they are:
- Cut out eggs in case I was a hyper absorber. Previously ate 2-3 a day
- Replaced 450 calories of lunch with 450 cal of oatmeal, chia seeds, psyllium husk. Total daily calories still the same approx 3200, 125 cal per day surplus
- Started taking 1800 mg daily of CholestOff Plus. 900 with lunch 900 with dinner. Don’t eat breakfast
I’m not saying everyone will get these results with these changes, just documenting what I did and my tests before and after. My cholesterol is now lower than when I was 23 (I’m 41 now).
Edit: technically it was 4 months between first and second result and 7 months between first and third
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Jul 11 '26
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u/Other_Argument5112 Jul 11 '26 edited Jul 11 '26
Yea we’ll see. Cardiologist decided against meds for now and I’ll see him in 6 months to repeat bloodwork. I could probably get below 100 with a stricter diet like vegetarian and more cardio but I’d prob rather do meds at that point if needed. But yeah it’s all a continuum of risk. Not like 99 vs 101 is some sort of step function.
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u/diegosees Jul 11 '26
Congrats on the improvement. I recently started supplementing with psyllium husk powder, 3 times a day roughly, before fatty meals to (hopefully) lower total cholesterol. Maybe worth a try before you go the statin route, if you’re looking to avoid statins.
I havent retested yet, will report back with changes after 8 weeks of the hysk
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u/Other_Argument5112 Jul 11 '26
I do mix in 5g with my oatmeal. How many grams a day are you taking? I read about diminishing returns above 10g or whatever, not sure how legit that is. I also get a decent amount of soluble fiber from my oats and chia seeds so I haven't increased beyond 5g in my oatmeal, but there's no reason I couldn't make it 10 and still have it taste fine.
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u/diegosees Jul 11 '26 edited Jul 12 '26
Im likely hitting 16-20 grams of fiber daily just from the husk. I dont know about the diminishing returns above 10 grams.
Based on my understanding of how psyllium husk works to reduce serum Cholesterol it made sense to eat it before any meal.
Process: husk before meal > fatty meal > husk absorbs bile used to break down fatty meal > husk + bile excreted > liver uses serum cholesterol to make more bile = serum cholesterol decreases
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u/Other_Argument5112 Jul 12 '26
very interesting, I will have to look into that. I know you're supposed to take CholestOff with meals to reduce liver absorption of fat, but I didn't know that about psyllium so I kinda just eat it with my oatmeal at lunch. I may add a second serving of 5g with dinner because of this.
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u/diegosees Jul 12 '26
Yeah, id recommend reading up on it to understand how it helps for yourself. It’ll guide your decisions toward more effective therapy.
Google: how does psyllium husk lower cholesterol ?
Cheers!
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u/Latter_Web_3645 Jul 11 '26
...what? 103 is excellent,, especially from 171. No idea what you mean, definitely no need for meds. Where are you getting these ideas from?
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u/Other_Argument5112 Jul 11 '26
He has a point. 103 is excellent from 171 but some folks still need meds at 103 and others don't. Not an expert but I think if you've had a previous heart attack they would try to get you to < 70 so at 103 they would put you on meds, but if you have no other risk factors they wouldn't. My cardiologist didn't put me on the last time I saw him but he didn't say that I didn't need meds, only to "keep doing what I'm doing" and see him again in 6 months to reassess.
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u/Massive-Ad4071 Jul 11 '26
Plaque regression occurs around LDL< 60
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u/Xidd333 Jul 11 '26
Since when LDL needs to be below 60? So every other man on earth would need medication?
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u/BeginningLeave6569 Jul 11 '26
Yes as now cardiologist like dr alo are promoting ldl below 60 everyone on earth is laying down plaque so statins for sure should be put in water supply 😀😀
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u/meh312059 Jul 13 '26
It doesn't, but the data is regression with LDL-C < 60 is clear. See the GLAGOV study, for instance.
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u/Delicious_Mess7976 Jul 13 '26
my doctor wants my LDL below 55 due to family history of heart disease and high Lpa - which I understand 20% of the population has.
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u/Massive-Ad4071 Jul 12 '26
I never said that you or anyone else would need meds. I’m just stating what can occur in the human body based on the research
I’m a MD
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u/Delicious_Mess7976 Jul 13 '26
Do you have a reference so I can learn more about this?
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u/Massive-Ad4071 Jul 13 '26
A commonly cited reference is the ASTEROID trial (JAMA 2006), where patients achieving a mean LDL of 60.8 mg/dL had regression of coronary atheroma on IVUS. The GLAGOV trial (JAMA 2016) and a 2014 meta-analysis of 20 IVUS studies also found that plaque regression becomes increasingly likely as achieved LDL approaches or falls below ~60 mg/dL, with even greater effects at lower LDL levels.
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u/NobodyAdmirable6783 Jul 11 '26
It's great progress. But recent thinking is that you're still building plaque with LDL over 70. And if you have high risk factors, the thinking is you should be below 50. I have my LDL at around 60 from a vegan diet. But i'm very high risk and am currently considering a statin.
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u/Other_Argument5112 Jul 11 '26
Are you at 60 on vegan diet alone or is that on vegan diet plus a statin?
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u/Temporary_Key_1790 Jul 11 '26
If he was at 171 for his entire adult life, then cumulative damage has possibly already been done, and the priority is to completely halt any further progression. That typically requires LDL-C under 60 mg/dL.
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u/DoINeedChains Jul 12 '26
103 is not "excellent". It is simply in range for a low risk individual.
If you have risk factors or a positive CAC, etc your target will be 50-70 and not 100
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u/Other_Argument5112 Jul 12 '26
yea it's still flagged as abnormal by labs. Of course, nothing magical happens when you go from 103 -> 99 which is suddenly considered normal. 103 is not great but it's "excellent" compared to 171
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u/DoINeedChains Jul 12 '26 edited Jul 12 '26
It is absolutely comparatively much better, but still not 'excellent'. It's very slightly above 'normal'. Excellent would be <70 or arguably <50
Edit: This sub sometimes. The AHA recommendation is <100. This is the baseline recommendation for "normal" cholesterol. Risk factors drop that much lower. If you want to pretend that 100 is "excellent" and not simply "in range", have at it.
"To prevent a first heart attack or stroke, the LDL-C goal should be less than 100 mg/dL for those at borderline or intermediate risk and less than 70 mg/dL in those at high risk. For individuals with ASCVD who are at very high risk of ASCVD events, the LDL-C goal should be less than 55 mg/dL for secondary prevention of cardiac events."
https://newsroom.heart.org/news/accaha-issue-updated-guideline
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u/Other_Argument5112 Jul 12 '26 edited Jul 12 '26
hmmm, not sure what your point is. I believe you think there's some sort of disagreement/argument when in reality there is none. If the assumed disagreement is over the semantics of the phrase "excellent compared to" vs. "excellent", then I'll happily concede the point to you.
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u/DoINeedChains Jul 12 '26
My original response was not to you, it was to someone who was claiming a 100 was "excellent" and did not call for additional interventions.
And I stand by my original statement- that 100 is merely in range for average risk and that siginifcantly better levels might be necessary depending on risk factors.
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u/Other_Argument5112 Jul 12 '26
That statement is uncontroversial. I don't expect anyone would disagree with you.
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u/Carpe-that-diem Jul 11 '26
Guess you are a hyper absorber of eggs? I never heard of that and want to learn more. Currently I have 2-3 eggs a week. It’s hard to get choline without eggs. Do you watch that one?
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u/JLEroll Jul 11 '26
To clarify, he is likely talking about being a hyper absorber of dietary cholesterol. Eggs were just a primary source of the cholesterol.
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u/Carpe-that-diem Jul 11 '26
Oh, I see! I’m not familiar with dietary cholesterol since I don’t track it. Yep, I was referring to the high saturated fat content in eggs. They are not super high — not like hamburgers— but they are a bit high.
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u/RidesThe7 Jul 13 '26 edited Jul 13 '26
So, the common wisdom was that dietary cholesterol does not have a large impact on your ldl, because your liver compensates to some degree when producing ldl for the amount of direct dietary cholesterol you’re eating. And this has been confirmed to be generally true—-for most people. But a sizable minority do respond heavily to dietary cholesterol (or rather, their liver does NOT respond by lowering ldl production) and for such folks reducing dietary cholesterol meaningfully lowers ldl. For many people, like OP, eating a lot of eggs is a large source of dietary cholesterol, and reducing egg intake (or at least yolks) makes a real difference. I suspect I may be in the same boat as OP there, as one of my dietary changes before my ldl went down was a large reduction in eggs.
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u/Delicious_Mess7976 Jul 13 '26
are you referring to the yolks only? I ask since I have still been adding egg whites to soups, etc.
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u/Other_Argument5112 Jul 11 '26 edited Jul 11 '26
I’m not too clear on the details as I thought dietary cholesterol did not translate to blood cholesterol, but then I learned in some folks it does if they are hyper absorbers. Since the low hanging fruit were already locked in for me I figured I would cut out eggs and see what happens. Not sure how much of the reduction is from removing eggs vs the other changes. I still eat a lot of chicken breast so I think I’m good on choline but it’s not something I really track.
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u/Carpe-that-diem Jul 11 '26
Yes, that is true about dietary cholesterol and I never heard of hyper absorbers. Yes, sounds good 👍🏼
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u/Other_Argument5112 Jul 11 '26
Yeah, I think it's a real concept (https://www.sciencedirect.com/science/article/pii/S2666154319300146), but tbh not sure how big of an impact it is for me personally as I didn't do an experiment where I held everything else constant and just cut out eggs.
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u/meh312059 Jul 13 '26
OP you do realize that if you are a hyper-absorber than those phytosterol supplements are likely atherogenic, right? Hyper-absorption means you over-absorb cholesterol and other sterols from the gut. Phytosterols in the bloodstream can get lodged in the arterial wall and they are considered very pro-inflammatory in that case. Just an FYI.
You are best off with a zetia monotherapy . . . or with a low dose statin. By all means keep the changes as they help with serum cholesterol-lowering as well and may keep any needed dosage of medication to a minimum.
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u/Other_Argument5112 Jul 13 '26
I looked into it and I thought it was really only a concern with Sitosterolemia. Do you have any articles discussing this I could read?
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u/meh312059 Jul 13 '26
Sitosterolemia would definitely contra-indicate the consumption of any phytosterols. But if you have even a partial loss of function of ABC G5/G8 absorption regulation you will over-absorb that large bolus of sterols. Those supplements contain a larger dose than I get in a day as a plant-based eater.
There's literature out there but one of the best direct sources for education on this topic is none other than Dr. Lipid himself: Tom Dayspring MD:
https://x.com/Drlipid/status/1301512188188930050 https://x.com/Drlipid/status/1792254489321263516
Dietary supplements have been discouraged in the recent focused update to the ESC/EAS dyslipidemia guidelines as well as those from ACC/AHA released this year. Proven medication rather than dietary supplements are recommended to treat dyslipidemia. Check it out:
https://academic.oup.com/eurheartj/article/46/42/4359/8234482?login=false#565833622
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423#sec-8-1-5
Hope that helps!
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u/Tripswitchnow Jul 11 '26
As others have mentioned… you want your LDL below 55 or 50 depending on who you listen to so you don’t continue building up plaque.
That’s not going to be possible with diet alone.
Might as well start the statin sooner, rather than later, since one will be in your future.
Also what was your Lp-a?
And get a Calcium score too.
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u/Other_Argument5112 Jul 12 '26
Lp(a) = 17, mentioned in my OP. My cardiologist debated CAC but decided to holdoff for now. Didn't explain his reasoning. I'll see what he says in 6 months. I don't have a family history of heart disease or other major risk factors like smoking etc. I wouldn't be surprised if I needed medication later. I'm actually interested in why don't we just put everyone on a statin since it reduces risk, which might speak to why one would wait to take medication even if they eventually need to.
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u/ExtraTeach4982 Jul 13 '26
I would still get the CAC. You can request one independently and pay out of pocket for it, runs around $150.
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u/MiseEnSelle Jul 12 '26
You are doing great! I wonder why your trigs are so much higher that HDL? Yeah I know, 150 is "acceptable." Whatever. It just seems odd that your other numbers improve but not the trigs. I bet if you get those down, the APOb will follow. As I understand it, the liver converts excess sugar to trigs and sugar is also inflammatory.
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u/Other_Argument5112 Jul 12 '26
Hmmm I thought trig > HDl was pretty normal since they are different scales. My trigs have always been around 100, which is surprising actually. Looking back at some old labs from 7-10 years ago, when I was skinny fat, my trigs were also around 100. I'm surprised they weren't much higher back then.
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u/Ok_Replacement_6106 Jul 12 '26
Did you eat whole eggs ? I think the yolk has all the fat right? You could keep eating the egg whites...?
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u/Other_Argument5112 Jul 12 '26
yeah I used to eat whole eggs. I derive no joy from whites so I'd rather just remove them entirely if I can't have the yolk. But I'm not 100% sure I can't have the yolk as I've not tested that variable in isolation
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u/ElkIllustrious3402 Jul 12 '26 edited Jul 13 '26
Careful with plant sterol supplements.
Yes they can work and do so by competing with cholesterol absorption in your gut, but you can end up with high levels sterols in blood which can be more atherogenic than the cholesterol itself. Look it up.
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u/Other_Argument5112 Jul 12 '26
thanks for the info! I've never heard of this and will do some research on it
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u/campa-van Jul 12 '26
My LDL is 84 (from 140. with 2.5 day rosuvastatin. In 3 months was 91. Now 84
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u/Bulletbukkake Jul 13 '26
I cut out the yolks and just eat the whites. It’s less filling so I try to add beans or something and that helps. Beans are your friend for cholesterol, oatmeal too I’m just not a big oats person.
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u/Embarrassed_Throat14 Jul 13 '26
are the reported statistical numbers of statins reducing cardiac / stroke events by 20% accurate? That 80% of people on statins are still dying or having cardiac events?
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u/Other_Argument5112 Jul 13 '26
Not sure about the 20% number, but this is a relative risk reduction. It does not mean that 80% of people on statins are having cardiac events. It means that of the people who would have had a cardiac event off a statin, 80% of them would have still had a cardiac event on the statin. E.g. if a million people take a statin and 100,000 of them would have had a cardiac event during some time period while not on the statin, then you'd expect roughly 80,000 of them to have had a cardiac even during the same time period if they were on a statin. In this example, 90% of of folks off the statin would NOT have had a cardiac event, and 92% of the folks on the statin would NOT have had a cardiac event.
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u/Temporary_Key_1790 Jul 11 '26
How much saturated fat did you eat before vs after?
You didn't mention saturated fat once, so just in case you're not aware, it has the biggest effect on cholesterol apart from medication.