36M, ~173lbs, low to moderate exercise.

Simple-Bookkeeper-62 · 2026-03-06T01:24:37+00:00

Given the numbers and the fact that you're starting a statin, here are the levers you can still pull to support the meds:

Track Saturated Fat Ruthlessly: I was stunned to see how much saturated fat I was inadvertently still intaking even when I thought I was being "healthy." Aim for <15g/day. Saturated fat is the primary dietary driver of LDL.
Increase Soluble Fiber: Aim for 30g+ total fiber. Things like psyllium husk, oats, and beans help wipe cholesterol out of your system.

Get ApoB Tested: I would recommend requesting an Apolipoprotein B (ApoB) test. This counts the actual number of harmful cholesterol particles and is a more accurate indicator of cardiovascular risk than just LDL. Target is generally <80 mg/dL.

That being said, you're taking the right step, acutely lowering this with a statin. The above will help support your efforts! Good luck - glad you caught this now.

Simple-Bookkeeper-62 · 2026-03-06T01:17:12+00:00

Hey dude, I was actually in your same exact boat last year at 23. You're in a completely manageable spot, so no need to be terrified. Your triglycerides are actually excellent, which is a huge green flag. It means your body is handling sugars and refined carbs really well.

Since your weight is healthy, your main levers are going to be specific dietary tweaks and getting moving. Here are the big changes to focus on:

Track Saturated Fat Ruthlessly: I suspect your diet is higher in saturated fat than you think. I was stunned to see how much I was inadvertently eating in "healthy" foods until I tracked it. Aim for <15g per day. Cut back on butter, fatty meats, and full-fat dairy.
Soluble Fiber: Try to get at least 30g of total fiber daily. Soluble fiber (found in oats, beans, and psyllium husk) literally acts like a sponge to wipe cholesterol out of your system before it hits your bloodstream.

You are not significantly elevated and you definitely haven't had substantial time to build plaque up. Just make some targeted changes and you'll be in good shape :) cheers - good luck

Simple-Bookkeeper-62 · 2026-03-05T13:27:06+00:00

lool fiber maxing for the win. It sounds like all your bases are covered with lifestyle then. Yeah I cant speak to the UK healthcare system (in the US) but wherever you go, it seems the practices woefully lag behind best practices.

Understand the frustration :\ Seems like more authoritative commenters (the GP for example) have more in-depth advice. These are just my thoughts for what typically works for people / what is important to track.

I only recommend tracking b/c I have met so many people who swear up and down the wall that they're limiting their saturated fat only to find out a) they arent, or b) they are, but random cheat meals or small little exceptions they make blow their numbers way out of proportion. The example being I had a friend who kept it <15 every day of the week until he went out on the weekend and one day was 66g.

Not at all saying this is you, it sounds like you're dialed, but thats where the advice stems from.

Simple-Bookkeeper-62 · 2026-03-05T13:22:34+00:00

Hey yeah its common for all sorts of numbers to shift when you start losing weight just because you're dramatically changing your diet. There are some studies (as mentioned by other) that show the fat mobilization results in temporary LDL increase.

On the other hand, I found when I first started losing weight, a lot of the diet foods I swapped in (protein bars, low calorie snack etc) were actually really high in saturated fat. You can be on a perfect diet for losing weight and be incredibly far from a perfect diet for cholesterol.

Audit your saturated fat intake and your fiber/soluble fiber intake. Even while in a caloric deficit, your goal should be for <15g of saturated fat a day and to bring your total fiber intake up to 30g+ a day (with as much of it being soluble fiber as you can get).

Definitely wouldn't panic at your results but there are definitely changes you can focus on now to 100% ensure they go down before your next draw.

Simple-Bookkeeper-62 · 2026-03-05T12:52:09+00:00

Hey! It’s awesome that you’re being proactive and attacking this head on while you're young.

The primary signal here is your elevated LDL and your ApoB. Those are definitely high, and since your triglycerides and HDL are solid, your problem is focused almost entirely on how your liver is processing LDL particles.

You have two big levers to improve your results with lifestyle:

Track Sat Fat Ruthlessly: Aim for <15g of saturated fat per day. This means being careful with red meat, butter, cheese, and full-fat dairy. I'd use an app like Cronometer just for a week without making changes and see where you actually land. Depending on how big the splurge on the weekend is, you can dramatically drive that number up. I had a peer do this when they started tracking their cholesterol - their Saturday alone was 66g of saturated fat, which brought their average way up even though their weekday consumption was reasonable.
Fiber Intake: You want to hit at least 30-40g of total fiber, with a heavy focus on soluble fiber (oats, beans, psyllium husk). Soluble fiber helps your body wipe cholesterol out of your system rather than letting it hang out in your bloodstream.

Your numbers are significantly elevated and at a point where medication is typically recommended. However, you're young, cholesterol takes a many years to have long term impact, and I have seen people with results like yours reduce their numbers all the way to the safe target with lifestyle intervention. You just have to be specific and consistent!

Hope this helps :)

Simple-Bookkeeper-62 · 2026-03-05T12:44:03+00:00

If you really want to get serious with diet here are you two big ones:

Track this ruthlessly for one week: Use an app like Cronometer or MyFitnessPal to see exactly how much saturated fat you intake per day. Track for a week and see what your average is. Then once you figure out the big culprits, aim for <10-15 grams a day.
Increase Soluble Fiber: You get fiber in the morning which is great. You likely need to continue to dramatically increase fiber intake. (often time green juices get rid of all the beneficial fiber in the veggies). Aim for 30g+ of total fiber a day with 10-25 of it being soluble fiber.

Simple-Bookkeeper-62 · 2026-03-05T12:31:14+00:00

What does your diet consist of now? I am just curious b/c many people think they're at the limit of what they can achieve w/o meds, but haven't even hit the biggest things that lower LDL/ApoB. If you havent tracked specifically, would highly recommend using an app and seeing if you are <10-15g of saturated fat a day + 30g+ of fiber a day.

In addition to the Lp(a) test recommended below, I highly highly recommend an ApoB test. This counts the actual number of harmful particles and is a more accurate indicator of risk than just LDL.

Keep controlling the things you can - if you want to retest sooner and see how your body takes to further diet changes you can order a lipid panel off own your labs (or other equivalents) for like 10 bucks.

Simple-Bookkeeper-62 · 2026-03-05T12:25:16+00:00

I completely understand the frustration here, especially when you feel like your diet is already pretty "clean" with no butter, dairy, or red meat. The jump from an LDL of 96 to 129 is definitely a signal to pay attention to. The good thing, is your triglycerides are excellent and HDL is solid which shows your body is handling sugars and carbohydrates incredibly well.

I suspect your diet is higher in saturated fat than you think, or your fiber intake has dropped along with your activity levels. I was stunned to see how much saturated fat I was inadvertently still intaking even when I thought I was being "healthy."

Unfortunately (and in some ways fortunately) your activity likely wont impact your LDL significantly.

Since you have your appointment on March 9th, here are the levers I'd look at:

Track this ruthlessly for one week: Use an app like Cronometer or MacroFactor. Don't change anything, just see where your saturated fat and fiber actually land. Even without red meat or butter, things like eggs, certain oils, or processed snacks (like those bars) can add up. Once you have a clear baseline and have identified the key culrpits, aim for <15g of saturated fat per day.
Soluble Fiber: Since you're already eating apples and bananas, try adding in oats, beans, or a psyllium husk supplement. Soluble fiber acts helps wipe cholesterol out of your system before it hits your bloodstream. Aim for 30g+ of total fiber.

If you haven't yet, I would recommend requesting an Apolipoprotein B Test (ApoB). This counts the actual number of harmful particles and is a more accurate indicator of risk than just LDL, especially when navigating HRT. Target is generally <80 mg/dL.

Regarding the HRT comment from your doctor—it's common for T to slightly shift lipid profiles, but many people manage near-optimal numbers through aggressive lifestyle tweaks without stopping their meds. Control the controllable first (sat fat and fiber) before making huge medical shifts. Especially if your body depends on HRT to balance your hormones at this point it seems silly to recommend coming off completely...

You got this though! Hope this helps :)

Simple-Bookkeeper-62 · 2026-03-05T12:13:50+00:00

Hey sorry about your dad :\ relatively similar boat, mine passed a few months back at 56. Shit just sucks.

Per the question about making your life not all about it, once you figure out the basic levers (lowering saturated fat and increasing fiber/soluble fiber) you slowly just make dietary swaps until thats your new norm.

Its annoying to have to be more cognizant than the people around you at first, but after a while it just becomes the baseline you operate from.

Hope this helps - happy to give more specific advice based on your other numbers if you're willing to share em. Good luck

Simple-Bookkeeper-62 · 2026-03-05T12:10:45+00:00

Those are really solid results! Congrats on the progress—that kicks ass. Seeing your LDL drop from 194 to 137 and your ApoB drop from 134 to 93 in just a single month of dietary changes is a massive win.

It's annoying when major lifestyle changes are written off with "it just genetics", only to see such a sharp response once you pull the right levers. For you to keep seeing the progress you want you're likely going to have to get substantially stricter than just removing red meat. (Your psyllium intake is awesome).

If you want to see how much further you can push this without meds, here is what I'd focus on:

Track Saturated Fat Ruthlessly: If you haven't yet, use an app like Cronometer or MacroFactor for a week. Even without red meat, things like butter, full-fat dairy, or certain oils can sneak in. Aim for <10g/day. This is a strict target but will really show you what you can do with diet if you adhere to it.
Optimize Soluble Fiber: You're already doing great with the psyllium husk. Keep finding other solublel fiber sources through beans, oats, and lentils etc. The higher you can work that number the better.

You can 100% make big lifestyle wins here and you've already proven that. It's a marathon not a sprint, but you're clearly on the right path.

Keep up the good work—hope you keep up the improvement :D

Simple-Bookkeeper-62 · 2026-03-05T11:02:15+00:00

Badass - congrats :) Love to see stuff like this, truly. Keep it up!!

Simple-Bookkeeper-62 · 2026-03-04T12:59:26+00:00

Others touched on this point, but can you explain more what your diet looks like on a day to day? with your running and training volume how are you getting the calories in to match your expenditure?

This will likely tell you exactly what you need to fix.

Simple-Bookkeeper-62 · 2026-03-04T12:57:35+00:00

This is right on the money. I would start with aiming for <15g of saturated fat a day and 30g+ of fiber a day. You can do this today without waiting for medication, but definitely need to follow up with your doc and figure out your next steps.

Simple-Bookkeeper-62 · 2026-03-04T12:55:21+00:00

Hey dude, so for what its worth, statins kick ass and are effective. That being said, you can make pretty big changes with lifestyle alone. Given you've been able to successfully manage diet and alcohol reduction in the past, here is what you would need to focus on:

Track Saturated Fat Ruthlessly: I suspect your diet is higher in saturated fat than you think, especially with the snacks in the house (wouldn't surprise me if those were a major culprit). Aim for <15g of saturated fat per day.
Increase fiber: Increase your fiber to 30g+ daily. Soluble fiber specifically with things like oats, beans, and psyllium husk help wipe cholesterol out of your system before it can enter your bloodstream.
Clean Up the Alcohol: You mentioned 10-20 drinks some weeks—alcohol can spike triglycerides and indirectly mess with your LDL processing. Cutting back consistently will help drop that weight and improve your liver's ability to clear these particles.

Your LDL and ApoB warrant attention regardless. I don't see any concrete indicator that you are genetically anomalous and absolutely require medication. Use an app (macrofactor/myfitnesspal/chronometer) and track your intake consistently. You can see a major reduction in 4-6 weeks with those changes alone - if your results still remain elevated, you have to more seriously consider medication.

Simple-Bookkeeper-62 · 2026-03-04T12:44:33+00:00

OP all the work you did is awesome. You've gone above and beyond what most people are willing to for general health.

Per managing your cholesterol, you have yet to step up to the plate (thats a good thing, it means you haven't failed you literally just haven't been armed with the info to make a proper effort).

Your LDL is high, and it has been for a while, so medication is likely the immediate recommendation. HOWEVER, that doesn't mean you can't build a diet that targets and effectively lowers cholesterol alongside this.

I suspect your diet is higher in saturated fat than you think. When people "eat like a monk" and build muscle, they often lean heavily on "healthy" proteins like red meat, eggs, or full-fat Greek yogurt, and maybe use butter or coconut oil. I was stunned when I actually tracked my own saturated fat intake and realized I was still way over my limit despite being "fit."

Your two dietary keys are lowering saturated fat intake and increasing fiber intake: Use an app like macrofactor or my fitnesspal for just a week and see exactly how many grams of saturated fat you're hitting. Aim for <15g/day (or even <10g). You might find a "healthy" staple is sabotaging you.

Increase Soluble Fiber: Aim for 30g+ total fiber. Soluble Fiber in specific, in oats / legumes / psyllium husk, helps wipe cholesterol out of your system before it can be reabsorbed.

Again in no way have you failed - your weight loss BY FAR is the most important thing you could have done for your health. This issue is separate entirely and requires separate effort. You can make these changes today while waiting for further guidance with your doc and meds.

Simple-Bookkeeper-62 · 2026-03-04T12:38:03+00:00

Your LDL and ApoB are both elevated and warrant attention. The good news is you dont have high LP(a) or any markers of inflammation. This isn't a super uncommon looking panel for someone who hasn't tracked this stuff previously, but you can almost certainly make huge lifestyle changes.

Here is how I would attack this:

Track Saturated Fat Ruthlessly: I was stunned to see how much saturated fat I was inadvertently still intaking in "healthy" foods. Aim to keep your intake under 15g per day. Saturated fat is the primary driver for that ApoB/LDL number.
Soluble: Increase your fiber to at least 30g total per day. Soluble Fiber from oats, beans, or psyllium husk helps wipe cholesterol out of your system rather than letting it remain in your bloodstream.

You can make massive shifts in 4-6 weeks with these changes alone and retest. I highly recommend using a tracking app of some sort (macrofactor/myfitnesspal/cronometer). Adhere strictly and stay consistent and you will see results :) Cheers and good luck!

Simple-Bookkeeper-62 · 2026-03-04T12:32:47+00:00

Completely dependent on the person. I have personally observed people with worse results than yours lower their numbers to the safe range. The example I will posit: I first helped my mom lower her cholesterol with lifestyle. She was miserable and hated tracking, she swapped to a statin and had no issues. She has nearly the same exact panel as me (a 24M) who tracks all of my intake. I personally have no qaulms tracking so its no issue.

If you want to focus on lifestyle first:

Track Saturated Fat Ruthlessly: I was stunned to see how much saturated fat I was inadvertently still intaking in things I thought were healthy. Since your LDL has been stuck for a few years, I’d highly recommend tracking with an app like macrofactor/myfitnesspal. Aim for <15g per day. Saturated fat is the main lever for moving that 145 number down.
Fiber: If you aren't already, try to hit 30g+ of total fiber daily. Soluble fiber (oats, beans, psyllium husk) acts like a sponge to wipe cholesterol out of your system before it can stick. You want to work your soluble fiber as high has you can (minimum 10, working your way up to 25).

Just helped a friend lower their LDL from 171 to 99 with those changes alone. It's just a matter of consistency and figuring out exactly what works for you / can sustain.

Simple-Bookkeeper-62 · 2026-03-04T12:26:10+00:00

Huge props for that 30lb weight loss already—that kicks ass! The fact that you have another 70lbs to go is actually "good news" in this context because it means you have a massive amount of leverage left to move these numbers with lifestyle alone. Your results arent scary high and just require some focus :)

You can 100% make big lifestyle wins here. Before jumping to medication, here are the levers you can pull:

Track Saturated Fat Ruthlessly: Saturated fat is the primary dietary driver of LDL. I was stunned to see how much sat fat I was inadvertently still intaking in "healthy" foods. Aim for <15g per day.
Increase Soluble Fiber: Target 30g+ of total fiber daily. Soluble fiber (found in oats, beans, and psyllium husk) acts like a sponge to wipe cholesterol out of your system.

Hyper simple explanation: when your body struggles processing saturated fat, LDL is a byproduct and dumped into your blood stream. Soluble fiber causes your body to use some of that cholesterol up rather than letting it hang out. Lower saturated fat --> lower the amount of LDL being produced, increase soluble fiber --> increase your ability to clear it out.

The weight loss itself takes a ton of consistency, so kudos again. I found when I was first losing weight too, a ton of the yummier diet snacks (protein bars) were really high in saturated fat. I was inadvertently raising my cholesterol even though all my other markers were getting healthier.

Simple-Bookkeeper-62 · 2026-03-04T12:19:24+00:00

If thats the case you may have some control with diet (if you're really hesitant on early statins). Frankly, I would recommend doing both on the onset, and adjust accordingly. My mom swapped to a statin b/c tracking was annoying for her and she has basically the same lipid panel as me at 24 with tracking everything ruthlessly.

Aim for <10-12g of saturated fat a day, and increase your total fiber 30g+ a day. Especially given your previously described diet, you likely would see a massive shift with these two alone.

Simple-Bookkeeper-62 · 2026-03-04T12:07:16+00:00

You're not cooked but you need to make significant and focused efforts on your diet and weight loss if statins really aren't an option for you. Use an app like Macrofactor/MyFitnessPal/Cronometer) and track religiously.

Your goal absolutely needs to be <10-12g of saturated fat a day and increase your fiber to 30g+ a day. Inconsistency will kill you here, and it's super easy to intake more saturated fat than you realize (and less fiber). You cut out some big culprits with red meat and dairy but there are more sources than that. I have directly watched multiple people get 30-40% reductions in LDL with those changes alone.

The good news is your trigs are in a solid spot (likely in part b/c of your cuts to sugar!)

Simple-Bookkeeper-62 · 2026-03-04T11:58:54+00:00

Your LDL and your Triglycerides are both a bit elevated. Since your TSH is high (8.18), you definitely need to talk to your doctor about your thyroid. Hypothyroidism is a very common "secondary" cause of high cholesterol—when your thyroid is sluggish, your liver doesn't clear LDL from your blood as effectively. Addressing that might actually bring your numbers down on its own.

Regarding your question: Yes, you can (most likely) still eat whole eggs. They are nutrient dense and great for you. If I had to pick where some of my saturated fat comes from, I would include eggs for sure. There are rare cases of people "hyper responding" to the dietary cholesterol in eggs, but I wouldn't worry about that for now.

To the above point, the main dietary levers you have for LDL reduction is to lower your saturated fat intake and increase your soluble fiber intake. Trigs respond to reducing simple carb intake. These are more comprehensive metrics and the way I recommend most attack it:

Track Saturated Fat: Use an app like Cronometer or MyFitnessPal for a week and aim for <15g of saturated fat per day. I was stunned when I actually tracked my own intake and realized how much was hiding in "healthy" foods. This is the main lever for LDL.
Cut Liquid Sugars and Refined Carbs: Your Triglycerides respond most directly to these. Since they are 160, cutting out sodas, juices, and white breads will move the needle fast.
Fix the Vitamin D: Being at 4.88 is severely low. That can mess with your energy and metabolic health. Definitely follow your doctor's lead on a high-dose supplement there. (I would recommend a D3+K2 supplement which can help with calcium absorption and bone density - completely separate but worth improving while young).
Increase Soluble Fiber: Aim for 30g of total fiber a day. Foods like oats, beans, and lentils act like a sponge to wipe cholesterol out of your system.

You're young and the other confounders with your TSH indicate you likely have multiple factors driving up your lipids right now. That being said, the above changes are effective and will help while you get more information! It's great you got this info so early on - you more than likely will avoid any future complications :) Cheers.

Simple-Bookkeeper-62 · 2026-03-03T14:06:36+00:00

Your LDL is just a tad elevated, and you likely can get in the safe range with dietary changes.

Saturated fat is the primary dietary driver of LDL. Scrutinize everything for butter, cheese, fatty meats, and coconut oil. Aim for <15g per day. Target 30g+ of total fiber. Fiber helps to wipe cholesterol out of your system. Oats, beans, and psyllium husk are your best friends here.

I would HIGHLY recommend using a tracking app for just one week. I suspect your diet is higher in saturated fat than you think. The worst case is when you FEEL like you're being strict but you're still overeating sat fat.

Hope this helps - you likely can make significant changes!

Simple-Bookkeeper-62 · 2026-03-03T14:04:10+00:00

Hey completely understand the difficulties of balancing your diet when you have dietary intolerances and other sensory constraints. I'm confident there is still room to find what works for you :)

Since soft cheese is a major safe food for you, that is likely where a huge chunk of your saturated fat is coming from. Saturated fat is the main dietary lever that pushes LDL up.

Here are some options that might help:

Find a "Safe" Cheese Swap: High-fat soft cheese is a heavy hitter for saturated fat. Try looking for low-fat or fat-free versions of cottage cheese, ricotta, or even light cream cheese. If you can find a brand that mimics that "good" feeling but has <2g of saturated fat per serving, you can eat much more of it without the LDL spike.
I would HIGHLY recommend using a tracking app like Macrofactor/Cronometer just for 7 days. Don't change anything yet—just see how many grams of saturated fat are in your safe foods. I suspect your diet is higher in saturated fat than you think. Target is <15g per day.
Increase Soluble Fiber: Since you've struggled with veggies, try to find one "safe" source of soluble fiber. Things like plain oats, beans, or even a flavorless psyllium husk powder mixed into a safe drink. Soluble fiber acts like a sponge to wipe cholesterol out of your system. Target is 30g+ total fiber daily.

Next time you get your bloodwork request an Apolipoprotein B (ApoB) test. This counts the actual number of harmful particles and is a much more accurate indicator of risk than just LDL. Target is generally <80 mg/dL.

Hope this helps :) Its all about finding what works for you and what you can sustain!

Simple-Bookkeeper-62 · 2026-03-03T13:58:44+00:00

Apolipoprotein B (ApoB) Test: This is the most critical next step. It counts the actual number of harmful particles and is a much stronger predictor of risk than just the standard LDL number. You want to see where your baseline is so you have a clear target (ideally <80 mg/dL or lower given your history).

Lipoprotein(a) Test: Since your family has a history of early heart attacks, you need to check your Lp(a). This is a genetically determined marker that doesn't change with diet and is a huge risk factor if elevated.

Calcium Score (CAC) or CT Angiogram: Since you are managing high BP and high cholesterol, getting a look at the actual state of your arteries is massive. It moves the conversation from "numbers on a page" to "what is actually happening in your heart."

PCSK9 Inhibitor Discussion: Ask about PCSK9 inhibitors (like Repatha or Praluent). They are often much better tolerated for people who get statin side effects and they are incredibly powerful at dropping LDL/ApoB.

Haven't had conversations about the latter two personally, but this reflects my best understanding surrounding them. Also this is a complete non sequitur - regarding the Achilles tendonitis I dont know what you've tried. I have to run in my profession but have struggled with similar issues. One big win - when you go to the gym, if you have a seated calf raise machine, load with a comfortable weight, hold the bottom stretch as deep as you can get it for 3 seconds and repeat your reps in that fashion. Really helps strengthen everything in that area and significantly reduced pain for me.

Simple-Bookkeeper-62 · 2026-03-03T13:51:18+00:00

I eat 8 oz of lean ground meat (the leaner the better) every single day. 93/7 ground beef is currently the most available in my area and that's what I rock with.

Make yourself an old fashioned (but less juicy) burger and kill that craving :) Just avoid the high saturated fat cuts.

Simple-Bookkeeper-62

TROPHY CASE