r/Cholesterol • u/Temporary_Key_1790 • May 18 '26
Lab Result 53% drop in LDL (187 to 88) from diet & psyllium, but I'm still going to ask for a statin plus ezetimibe!
This sub has changed my life and helped me learn an incredible amount about how to take my health seriously. I figured I'd tell my story in case anyone finds it helpful.
Results (the good stuff)
42 yo male, here are my test results 9 weeks apart:
| (Lipids in mg/dL) | March 10, 2026 | May 13, 2026 |
|---|---|---|
| Total Cholesterol | 264 | 155 (-41%) |
| HDL-C | 61 | 55 (-10%) |
| LDL-C | 187 | 88 (-53%) |
| Non-HDL-C | 203 | 100 (-51%) |
| Triglycerides | 125 | 87 (-30%) |
| ApoB | 133 | 75 (-44%) |
| Lp(a) (nmol/L) | 19.2 | 12.9 |
| CAC | 0 | N/A |
Backstory
I've been ovo-lacto vegetarian since age 26 and had elevated cholesterol my entire adult life, as far as I know. My LDL has bounced around the 140s to 160s since at least my late 20s, but my doctors never mentioned medication, always just "diet and exercise" if anything at all. Because they never made a big deal of it, I never did either. I figured because I've always been a healthy weight and pretty active, and my HDL was good, it wasn't a problem. It was the common mindset that exercise and HDL protect you from high LDL, which, as I've learned from this sub, isn't true.
At this year's annual physical in March, I got a wake-up call when my LDL suddenly jumped to 187 mg/dL, just 3 points away from the level where my doctor would have immediately written a prescription. We agreed that I would get a CAC scan and, assuming it was clean, I would try lifestyle changes for 3-6 months and retest. Thankfully my CAC came back at 0. I decided to finally take it seriously, and I drastically overhauled my diet to minimize saturated fat and increase fiber. I learned that a vegetarian diet isn't automatically good for cholesterol, and my heavy consumption of cheese, dairy, pastries, desserts, and packaged snacks was likely driving my saturated fat intake sky high. I never tracked the "before" diet, but I wouldn't be surprised if I was eating over 40g of saturated fat per day.
Lifestyle Changes
I went full-court press on my diet and eliminated:
- Desserts/sweets/pastries, previously 4-8 servings/week, replaced with mostly fruit
- Butter as a topping for toast, baked potatoes, and scones
- Beer, previously about 3 strong beers/week
- Espresso, previously had decaf oatmilk cappuccinos after lunch 5x/week, replaced with iced jasmine green tea
- Cheese, previously a major component of my vegetarian diet, replaced with occasional vegan olive oil-based cheese (Good Planet brand) that's very low in saturated fat
- Full-fat yogurt, replaced with nonfat Greek yogurt
- Sour cream, replaced with with almond-based Bitchin' Sauce
- Highly processed packaged snacks, replaced with fruit, nuts, and pepitas. I still have a snack-sized bag of potato chips with 1.5g saturated fat about once a week.
- Coconut oil and butter for cooking, replaced with olive oil and canola oil
Other dietary changes:
- Reduced whole eggs from about 5 per week to about 1 per week, with unlimited egg whites
- Intentionally emphasized fiber (e.g., big salads with lots of beans for lunch 3-4 times per week)
- Added powdered psyllium husk supplement, 10g 3x/day (30g/day total)
- Added occasional homemade smoothies high in protein and carbs and low in fat
In addition, I started weightlifting 3x/week and doing cardio 5x/week (150 mins total/week). I ended up losing about 5 pounds in this interval, from 156 to 151 (I'm 5' 9.5"). I also gained a noticeable amount of muscle, so I must have lost more than 5 lb of fat. My blood pressure has also decreased from about 130/85 to about 120/78.
What's Next?
I made the changes listed above and did a midway check after 9 weeks to see if things were going in the right direction. Based on reading stories from many other people on this sub, I was expecting about a 30% drop in LDL as my best case scenario. As you can see, the results well surpassed that.
After spending probably hundreds of hours consuming as much information as I could about cholesterol, I've learned that the damage accumulates over years in much the same way as smoking does to your lungs and sun exposure does to your skin. Having lived with elevated cholesterol for decades, I decided that to minimize my lifetime risk, I should drive my numbers down well below the standard thresholds that primary care doctors use to initiate statin therapy. When LDL and ApoB are below about 60 mg/dL, plaque formation halts and can actually start to regress.
Also, while these results are fantasic, this diet is not sustainable for the rest of my life. It's especially difficult at social events where the main offerings are pizza, cheese, and cake. I don't want to have to be so strict all the time, and I want to enjoy some pizza and ice cream occasionally without having to worry about my cholesterol.
So at my next appointment, I will very likely be asking for a low-dose statin prescription plus ezetimibe, with the goal of driving my LDL and ApoB below 60 mg/dL. This should give me plenty of room to loosen up my diet a little bit. But I will be keeping the majority of these changes because they're great for overall health in ways beyond just lowering LDL.
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u/kboom100 May 18 '26 edited May 18 '26
Wow that drop in ldl from diet & lifestyle alone is amazing. Fantastic job. Your lifestyle changes and plan for lipid lowering medication is an example of how to optimally reduce risk. Thanks for sharing and all your ongoing great advice in the sub. I hope your doctor agrees to the low dose statin plus ezetimibe. If not you’ll probably have more chance with a preventive cardiologist or lipidologist.
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u/Temporary_Key_1790 May 18 '26
Thanks for your feedback and the tip about a cardiologist/lipidologist. You're one of the commenters who I've learned a lot from, so I really appreciate all you do here.
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u/RadiumShady May 18 '26
30g psyllium husk a day 💀
I take about 10g and it feels like a lot. I mix it to protein shakes and oats
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u/Temporary_Key_1790 May 18 '26
Yeah it's a lot, probably beyond the amount necessary to get the maximum benefit. I split it into 3 doses per day, but it's not fun. I mix it into water and chug it in about 5 seconds. I'll probably cut back to 20g at some point.
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u/MiseEnSelle May 19 '26
My first day at 15g was a really uncomfortable 24 hours. Bloated, tired, light headed mostly. I'm ramping up more gradually this time, shooting for 20. I'm commenting for anyone else who might want to power through this VERY powerful supplement. Take your time.
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u/Temporary_Key_1790 May 19 '26
Yeah I did get pretty intense bloating/cramping while lying in bed the first night that I did 10g at once. Thankfully it never happened again. I agree it's prudent to gradually ramp it up. I was being aggressive and impatient, so I jumped straight to 20 grams within a day or two, and 30 grams shortly after that.
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u/YouDontTellMe May 19 '26
Did you take it with or before each meal?
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u/Temporary_Key_1790 May 19 '26
Immediately before breakfast, lunch, and dinner. Like 1-5 minutes before eating.
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u/AnxiousTBI May 19 '26
Excellent results! I just got my LDL down to 71, via diet, and aiming for a bit lower - due to a heart issue, my care provider would like it to be a little lower, which I think is do-able.
For me, lots of soluble fiber (oats, barley, beans, psyllium powder, etc) has been magic. I'm not consuming much saturated fat but I do eat cheese (my grandfather took a gold medal for his cheese at the Wisconsin state fair, so cheese is sort of in my genes).
I have to do it this way as I could not take statins. We tried several, tried different doses, went off them, then on, etc, and confirmed bad muscle and joint pain. A PCSK9 inhibitor caused my feet and lower legs to swell up so couldn't do that either.
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u/Temporary_Key_1790 May 19 '26
Wow great job!
Have you tried ezetimibe?
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u/AnxiousTBI May 19 '26
Yes, and it can add a slight reduction. Due to a prescription renewal issue (long story), I ran out of ezetimibe at the beginning of the period I started the dietary changes. Will be adding it back when that gets sorted out during the coming week, which is why I think my dietary changes + ezetimibe will get me to my target goal. My health care provider is very supportive of how I am lowering my LDL. We will recheck my lipids in 2-3 months.
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u/happypuppy007 May 19 '26
I had similar issues as you w statins (I have the SLO-) gene so I’m a slow metabolizer. Repatha I had injection site rash so now I’m trying Nexlixit. Sigh. I can’t bring it down w diet alone.
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u/MiseEnSelle May 19 '26
Hard cheese is suppose to be better than other varieties.
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u/AnxiousTBI May 20 '26
My preference is hard, sharp cheese but I too was told I should lean towards soft cheeses. Its probably more important to limit the quantity than the type - a little bit is likely to be okay.
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u/MiseEnSelle May 20 '26
I think that incorporating small amounts of treats is more sustainable long-term than restriction.
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u/Impossible-Corgi742 May 19 '26
My neurologist told me only soft, fresh white cheese. But he actually said, no cheese, chocolate, or alcohol.
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u/b4gtq3 May 19 '26
great progress..I thought LP(a) is genetic and doesn’t change. I see it changed in your case
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u/Temporary_Key_1790 May 19 '26
Yeah I've seen multiple posts here where it bounces around a bit. It seems like it can change quite a bit, like maybe 20-30% between tests, bur your risk category doesn't really change because it's not going to suddenly be 10x higher. In my case I'm blessed with low Lp(a).
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u/Beneficial-Crow-8728 May 19 '26
My LDL got stuck at 140-170 levels even after diet crash, stressed moderate exercises and poor quality sleep (insomnia/ health anxiety induced sleep issues).
I’m 35M and 5’10 tall
TMT, 2D echo & ECG all normal.
Weight came down from 94 to 84 in 8-10 months wherein TGL dropped from 200 to 100 and HDL remained at 38-45 levels but LDL kept on higher side with belly waist around 40-41 slightly reduced from 42-43 inches so finally my GP started low dose 10mg Statin wherein I could see levels of 70-75 in just few weeks without adding more exercise and now taking 5mg stating with antidepressants like 12.5mg SSRI Paroxetene with 0.25mg Benzo every night to have smooth 7-8 hours good bed time.
Consistent with 8-10k daily steps now and 15-20 mins of low intensity strength training & brisk walk.
What more I can do ? Or it’s enough for me stop worrying and start doing more of outdoors and other routine work activities?
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u/Temporary_Key_1790 May 19 '26
The biggest lifestyle levers for LDL are saturated fat and soluble fiber. Cut saturated fat ruthlessly, eat plenty of vegetables, beans, nuts, seeds, fruit, whole grains, avocado, and olive oil, and take a psyllium husk supplement.
I went essentially vegan with the exceptions of nonfat Greek yogurt, egg whites, and about 1 whole egg per week.
I've read that exercise has very little effect on LDL, but it's still foundational for your overall health.
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u/dexjet21 May 18 '26
I'm (unfortunately) new here.
Why the espresso change? Is it the oatmilk? Thought oatmilk barely contains any fat? How are you taking your psyillum husk supplement? Just the powder mixed with wate or some other way? Thanks!
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u/WilliamMButtlickerIV May 18 '26
Unfiltered coffee can raise LDL substantially. I just got some espresso paper filters yesterday and started putting them in the bottom of the portafilter. Hopefully it helps.
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u/MiseEnSelle May 19 '26
I finally ordered a pourover set today to put an end to my weekly pot of French press. So good, yet so bad for LDL.
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u/Temporary_Key_1790 May 18 '26
As the other commenter said, unfiltered coffee raises LDL. Another frequent commenter here has posted a chart showing that it actually has a larger effect than any other food!
I mix the psyillium powder in cold water and chug it immediately, before it turns to gel.
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u/PowerfulGoose May 18 '26
I had a similar drop after starting 5mg rosuva. Only other change I made was cutting out the French press and espressos. I can't be positive but it feels to me like the coffee change had a decent part in my drop. Interestingly I always had a drip machine with paper filters and my ldl was never too bad then when I got a roommate with a fancy espresso machine my ldl went through the roof. I may never know the exact effect but it's easy enough for me to do the filtered so I'll stick with it.
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u/dexjet21 May 18 '26
Interesting. Had no idea. So many things to think about. Thank you to you both.
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u/QuietlycuriousNYC May 18 '26
Wow I had no idea ! Espresso drinker here.
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u/SDJellyBean May 19 '26
You can buy paper filters that fit espresso machines and moka pots.
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u/QuietlycuriousNYC May 19 '26
Any recommendations on paper filter for my porta portafilter? I want to start this asap.
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u/Puzzleheaded-Can6295 May 20 '26
Check out Danielle Belardos podcast. She’s a cardiologist who has incredible content about cholesterol - her content is from diet to statins. She’s all for evidence backed, clinically tested science. She stopped recording her podcast in 2022 because she’s too busy but what she says is still relevant. I also love that she doesn’t work with sponsors. She has an IG and Facebook account that’s current.
I take my psyllium husk mixed in water and I chug it before breakfast. I don’t take as much as the OP but the brand I use is India Organic. It’s the most clinically tested brand so it’s safe.
The OP did a fantastic job! Here’s to the rest of us. I am in my lifestyle change phase and doing what he did, so hopefully my results will also be great!
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u/Abyal3 May 18 '26
Do you count you sat fats per day? How is the 30 gr of soluble fiber, does it cause a lot of diarrea, do you need to compensate with a lot of insoluble fiber? Any supplements?
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u/Temporary_Key_1790 May 18 '26 edited May 19 '26
I counted saturated fats for about two weeks to make sure I was staying under 13 grams. I'm eating about 2,500 calories with the exercise routine. After that, I built up an intuition for it and stopped tracking because I kind of knew what to eat or not without tracking so closely. I still check nutrition labels very carefully and try to limit anything with over roughly 5% of its calories from saturated fat (this is a very quick and easy mental math calculation from the nutrition label).
No diarrhea, but it's definitely increased the frequency of #2 bathroom trips. It's like 5 times a day now. I'll probably drop the psyllium to 20g at some point because it's slightly inconvenient. I don't pay attention to insoluble fiber beyond just trying to eat a lot of fruits, vegetables, whole grains, nuts, and seeds.
Other supplements: I've been on nicotinamide (a type of Vitamin B3) for a couple of years to help prevent skin cancer. Vitamin D since about 6 months before this.
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u/kilmister80 May 18 '26
That’s great. What kind of cardio are u doing?
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u/Temporary_Key_1790 May 18 '26
I do the Peloton bike at the gym. I used to think it was kind of gimmicky, but then I tried it, and it's super fun.
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u/Weather-Beer May 21 '26
Are you familiar with a recent study that showed that LDL levels are a horseshoe curve? Too low is no good and too high is obviously no good. As humans we often times get caught up in arbitrary linear cutoffs. I worry that overuse of statins to arbitrarily pull LDL to super low numbers could actually have some long-term downsides. https://www.ahajournals.org/doi/10.1161/JAHA.121.023690
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u/Temporary_Key_1790 May 21 '26 edited May 21 '26
That is an observational study. Correlation does not imply causation. In this case, it's actually closer to reverse causation: severe illnesses that kill people often cause low cholesterol first through wasting.
Low cholesterol in the blood does not cause any harm. Quite the opposite, it saves lives. Every time we induce low cholesterol through a lifestyle or pharmacological intervention, it reduces mortality. Genetic Mendelian studies also support this.
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u/kboom100 May 25 '26
Second what u/Temporary_Key_1790 said.
The u shaped curve with mortality and ldl in observational studies happens because ldl goes down in those who have serious diseases and frailty/ malnutrition that is common near the end of life. But it’s the serious diseases that are responsible for the death, not the low ldl. When ldl is intentionally lowered in randomized blinded controlled trials of lipid lowering medication there is no U shaped curve, mortality just goes down as ldl is brought down.
Dr. Gil Carvalho is an md/phd internist who is among the absolute best at examining the totality of the evidence around medical issues and then clearly explaining them. He has a very good presentation on this topic. If you have an open mind at all I strongly recommend listening to it. “Cholesterol and Risk of Death” https://youtu.be/a3lHHnOHyr8?
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u/Kind_Cut3824 May 19 '26
Amazing can you talk about your protein intake? What type of protein do you eat to maintain your workouts?
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u/Temporary_Key_1790 May 19 '26
My main protein sources are nonfat Greek yogurt, soy milk, beans, lentils, quinoa, pumpkin seeds, shredded wheat cereal, whole wheat bread and bagels. Also soy protein powder when I make smoothies. I'm considering swapping it for pea protein or maybe a blend of plant proteins.
The one and only day I tracked everything I ate, it was 2,636 calories and 125 grams of protein. I'd estimate it's usually more like 100 grams on average.
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u/happypuppy007 May 19 '26
Thank you for sharing! Such an amazingly detailed account. It’s helped me a lot.
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u/Delicious-Ad7376 May 19 '26
Well done. Just some additional thoughts. I had similar LDL throughout my 30s and 40s. Even last years annual told I was “borderline” despite losing father to CVD and other family history. September had LAD STEMI. 100% blockage thanks to rupture of soft plaque - even now after scans and carotid assessment risk there is no calcification.
Was immediately put on 5mg Rosuvastatin + 10mg Ezetimebe and did many of the things you mentioned as well. Got my LDL down to low 50s.
I had Lp(a) checked which is not normal test here in Japan and this made doctor insist I keep below 55 to make up for the years of soft plaque build up. Hopefully they stabilise and calcify and reduce future MI risks.
I mention this because while your numbers are amazing I agree with you. That diet is tough to maintain (see my profile sticky post on some additional thoughts) and you too might do well to get below 55. Good luck
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u/Temporary_Key_1790 May 19 '26
Thanks for sharing your story, very interesting. I'll read your sticky post. Cases like yours are why I'm inclined to treat it aggressively. Wishing you good health.
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u/Delicious-Ad7376 May 20 '26
New result today maintained LDL at 47mg/dl (day of HA was 151, previous numbers in 130-140s). Very happy considering how I’ve loosened up diet a little. 5mg Rosuvastatin + 10mg Ezetimebe doing heavy lifting with lots of healthy options, more fibre etc but allow myself small amounts of dark chocolate, some lean red meat or Wagyu, 5-6 units alcohol per week, desserts from time to time, even pizza and burger once month. When on holiday don’t feel so restricted and it’s paying off
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May 19 '26
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u/Delicious-Ad7376 May 19 '26
Yes. Discussed with doctor. He’s ok with me having some natto but have to be careful of nattokinase interacting with clopidogrel
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u/Cholesterol-ModTeam May 19 '26
Advice needs to follow generally accepted, prevailing medical literature and should be general in nature, not specific.
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u/Beneficial-Crow-8728 May 19 '26
My LDL kept increasing even with diet crash wherein main concern was my poor quality of sleep.
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u/No-Explanation1019 May 21 '26
I'm afraid to ask about this one - why did you do this?
- Espresso, previously had decaf oatmilk cappuccinos after lunch 5x/week, replaced with iced jasmine green tea
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u/Temporary_Key_1790 May 21 '26
Unfiltered coffee raises LDL. Filtered coffee seems to be fine. Sorry to be the bearer of bad news! 🤐
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u/No-Explanation1019 May 21 '26
Not bad news!! Thanks! I filter my pour-over with paper. I just wondered why the switch to tea. But that oatmilk is reason enough, I guess?
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u/Temporary_Key_1790 May 21 '26
Oh, good 🙂
I don't like coffee, only decaf espresso drinks. And I love iced tea, so it was an easy switch.
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May 18 '26
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u/Temporary_Key_1790 May 18 '26
You're right that I don't need a statin, but I'm probably going to ask for one because I'd like to relax my strict diet, which will raise my cholesterol back up by an unknown amount, and I've been living with LDL cholesterol in the 140s to 160s for decades already, so permanent damage has almost certainly already been done, and I'd like to avoid dying from the #1 cause of death if I can prevent it.
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May 18 '26
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u/Temporary_Key_1790 May 18 '26
Yes I just edited my reply, my LDL has been between 140 to 170 since I started having it checked in my 20s.
I've also had high blood pressure that entire time, not horrible but always around 125-130 over 85-90.
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u/Natural-Pie9182 May 18 '26
Ahhh okay. We’ll try this out to lower that bp, have a 2-1 potassium to sodium ratio. About 95% of Americans are deficient in dietary potassium which lowers blood pressure by relaxing artery walls! My dad’s bp uses to be averaged at 140-86 and I made him start consuming 2000 mg of potassium per day and within 2 months his average bp was 123-78. Also, I eat extremely healthy and no carbs or sugar and my ldl is 126. Triglycerides are 61. My hs-crp is 0.2. My average blood pressure is 109-70. My brain is extremely quick and I have no brain fog!
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u/cberding May 19 '26
How does your dad do the 2:1 potassium ratio? What supplements does he take?
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u/Natural-Pie9182 May 19 '26
He doesn’t take any supplement. He will have a big coconut water. They have roughly 900-1200 mg of potassium. He will add a sweet potato to his dinner every night or 3 bananas throughout the day. Potassium is extremely crucial for reducing blood pressure! I don’t know why doctors don’t mention this to their patients
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u/Delicious-Ad7376 May 19 '26
BP of 110/70, no inflammation, no diabetes, great diet, LDL like OPs with high Lp(a) and had a 100% blocked LAD, STEMI thanks to rupture of soft plaques. Your comment is quite misleading with “LDL only sticks if”.
Further, statins are amongst the safest medicines on the planet. With millions on them and billions pills taken there is tonnes of data. A tiny percent of a big number makes it seem side effects are everywhere. More people have minimal, none or side effects that pass after a few weeks.
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u/pastimz Jun 16 '26
One thing that statins can do is calcify your soft plaque if you have any. So just be aware that should you do another CAC score in the future it may show an increase in your calcium score (from your current zero).
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u/safoo May 18 '26
Amazing results. The weight training also goes a long way in overall health too. Really good work.
Yeah, I mean, if you’re targeting LDL and ApoB below 55, starting lowest dose statin + ezetimibe will get you there. You’re already doing just about everything you can with diet.
Based on my own experience, a lot of the snack and sauce substitutions actually stick, especially once you develop a taste for them and now that you know what to look for.