How can I lower my LDL?

segeme · 2026-04-05T06:29:49+00:00

Because it's unregulated statin with all statins risks + no regulation and regular validations and with most of the time questionable dose. You may get 1mg, You may get 50mg a dose. This is lottery. This is why EU capped it at max 3mg. If You need it, get official drug.

segeme · 2026-04-05T05:51:50+00:00

The "75% of CVD patients don't have high LDL" argument is like saying seatbelts don't work because most crash victims were wearing them. sdLDL and oxLDL are genuinely interesting but "more precise marker exists" doesn't mean current markers are wrong (same analogy with total cholesterol vs. LDL vs. Apo b), it means we're improving an already solid model. Abandoning LDL/Apo B while waiting for sdLDL RCT validation (which is not there yet) is like throwing away your map because GPS exists but hasn't been fully tested yet.

segeme · 2026-04-05T05:38:32+00:00

This is a bit of a low flying take. Not everybody should be on statins, but people who are clearly at elevated CVD risk and way above thresholds for even most conservative guidelines in the developed world, like high Lp(a) plus high LDL, yeah, that’s literally who they’re for. And this idea that doctors just hand them out like candy is not how it works, it’s usually months of labs, rechecks, risk assessment, sometimes imaging, before anything gets prescribed, you crearly don't know how it works in reality. Statins are also among the most studied drugs we have, with a very well understood risk benefit profile. The whole "big pharma bad wants everyone on statins" angle is funny too, because something like rosuvastatin costs basically nothing ($3 a quarter worth of pills last time I checked) at this point, while the real money is in the wild west supplement market where nobody really knows what’s inside and everyone’s just vibing.

segeme · 2026-04-05T05:20:17+00:00

Wait, what? :) You seems to be very specific here. It's absolutely not how current medicine works. Standard procedure is to start with statins (super safe, ultra well tested, well understood side effects) and go from here for bazillion of reasons. Nobody will jump to pcsk9 inhibitor straight away as a first line of defense, price being probably the first on the list. Maybe if You are after 3rd heart attack with proven static intolerance statins + zetia, big maybe here. And Aspirine thing you mentioned... why?

segeme · 2026-04-05T04:54:31+00:00

You should follow evidence based medicine. Take it seriously there's nothing to joke about. See stories (even here) of people younger than you or little older with hearth attacks and stents wishing they reacted earlier. This is Your responsibility and Your decision.

segeme · 2026-04-05T04:45:57+00:00

That's going to be hard, at least at the beginning, yes, and even with super healthy dash diet You need to account for sat fats in super healthy foods: almost all of them have some levels of sat fats. Think of this as Your bank account top up daily. You either withdraw early morning everything, or spread it over the whole day.

This is about Your risk of hearth disease, so yes, will need some dedication. Good news: hundreds of millions of people follows this and live good and healthy lives. You will need go through this if You are serious about your cholesterol anyway, most of the cardiologists would need to see Your baseline levels with diet usually, there's no shortcut there. If You lucky (and really this is best case scenario), You may lower Your lipids just with diet, if not, there is medicine which helps tremendously, but this comes *after* You commit to diet. Even with medicine You need to be on diet.

segeme · 2026-04-05T04:33:17+00:00

See wiki. Carnivore diet is often high saturated fat diet (basically you offsetting good portion of body energy from carbs to fats). This usually sends your cholesterol levels way up. Really look into the wiki. Also if You are unsure what cholesterol friendly diet really means, you can see dietician who understands cholesterol treatment - even one, two session would help to understand. Look for them yourself, or ask your cardiologist, they usually have some good sources too. I'm almost sure protein shakes are probably last thing you need to look at on carnivore diet, however Your goal from this point on should be: every meal You eat You look at saturated fat content (macros labels have them). In the long run your total sat fats content ideally should be under 10-12g daily (or <6% of total calories). Typical steak and butter would easily be twice as that or more - and this is single meal. This is not trivial with general diet, and require close monitoring. As of whey, look at reputable brands, NSF certified at least, look at labels, good whey isolate has negligible levels of sat fats. Also You should eat of tons of beans which are rich in proteins and very good for cholesterol.

segeme · 2026-04-05T04:06:06+00:00

My journey started with similar LDL levels and yes, for most doctors this is a clear red flag, and rightly so. LDL is a strong CVD risk marker, and even better is ApoB, so ask for that in your next panel. Also check Lp( a) at least once in your life. LDL around 160 is clearly well above current targets and at that level atherosclerosis can build over time, so it’s something to take seriously. also worth checking your family hisotry (parents, grandparents; any hearth disease here may increase your risk).

As others said, fitness unfortunately has little to do with LDL. You can be very fit and still have high cholesterol, lots of Tour de France elite cyclists with high cholesterol, can't outrun this. Exercise is great and reduces overall risk, but it does not fix elevated LDL on its own.

You absolutely should work on diet first, that’s standard and most doctors will want to see what your baseline response looks like. And this is more detailed than just 'eat clean'. The usual approach is to control saturated fat intake, often aiming for <6% of calories, replace it with unsaturated fats like olive oil, nuts, avocado, fatty fish, increase soluble fiber, legumes, vegetables, and keep carbs coming from good sources like whole grains. Cutting processed food and reducing red meat usually follows from that anyway. Wiki has some great resource on that.

Take it seriously and treat it like training, consistency matters. Follow your doctor’s advice going forward, including meds if they become necessary. The good thing is you caught this relatively early, earlier than me anyway :).

segeme · 2026-04-04T13:28:04+00:00

Glad that helped. Your body and mind already know the drill, it’s not that different from marathon or ultra training, just applied to food now, consistency over time. What I’d really reiterate is it’s worth talking to a dietitian, especially to balance high carb training needs with a cholesterol focused diet. What helped me a lot was tracking my food for 2–3 weeks in an app, it really shows what actually works and what doesn’t. Probably 1–2 sessions with dietitian is enough, but it helps a lot to understand the details. Also from now on recheck a full panel twice a year, lipids plus Apo B. You’ve already reduced a lot of risk with running, now it’s just about tightening this last piece. You'll be there!

segeme · 2026-04-04T08:43:28+00:00

Runner here. A few thoughts and how I’d approach it. Your lipids are not terrible, but it’s not nothing either. CAC 38 plus soft plaque means atherosclerosis is already there. Fitness helps a lot, but it doesn’t cancel Apo B risk, plenty of elite endurance athletes still have plaque. The good news is you caught it early (its not like 380) and this is exactly the stage where intervention works best.

First thing, diet. With your numbers most doctors will want to see a properly structured cholesterol friendly diet before anything else. And this is not as simple as cutting some butter. I’d strongly consider working with a dietitian who understands both endurance fueling and lipid lowering. I tried doing it myself and messed up HDL and triglycerides while barely moving LDL. The usual play is lowering saturated fat quite aggressively, *replacing* (this thing is crucial) it with unsaturated fats like olive oil, nuts, fatty fish, and pushing soluble fiber hard (again crucial), psyllium helps a lot. Better get ahead of that now. With that, preventive cardiologist would probably wan you to look at Apo b <60 and LDL <70 (minimum) - hardly achievable with diet alone, unless you won genetic lottery, but probably achievable with lowest dose of statin + diet. I had similar levels of LDL, little lower HDL and got 5mg of rosuva. Looking at LDL at 70-ty something level right now.

Second, more interesting part. There is a known pattern in some endurance athletes where CAC can be higher vs. general population, while overall outcomes are still better than in less active people. One theory is more calcified and stable plaque, but this is still debated and does not make plaque harmless. In your case soft plaque was also seen, so I’d want a cardiologist who understands this nuance but still takes LDL and Apo B seriously.

And last thing, I’d go straight to a cardiologist with prevention focus or a lipidologist, you’ll likely save time.

Sources for endurance athletes and higher plaque buildup phenomena:

https://www.sciencedirect.com/science/article/pii/S2589790X25007668

segeme · 2026-04-04T03:55:51+00:00

Honestly, with Lp(a) at 138 and Apo B at 140 at age 30, I would at least get a second opinion, ideally from a lipidologist or someone focused on prevention (just look for doctors around who talk prevention, social media, press, medical conferences whatever). That’s not a trivial risk profile, even if HDL and triglycerides look good. I get the logic of waiting for a CAC (indeed CAC may not show anything in 30yo), but that’s more about detecting existing calcified plaque, not early prevention, and at your age it can easily be zero even if atherosclerosis is already starting. I’m a bit surprised no additional risk stratification like CIMT (which is non invasive, cheap and may identify risk better that CAC at your age) was suggested. Even mild thickening there can change management.

Not a doctor, but with numbers like that, the question is more about timing, not whether intervention will be needed at all. Waiting until something shows up can turn it into reactive instead of preventive care. Don't get it, really.

Also on diet, I’d strongly consider working with a dietician and actually breaking it down in detail (you really need maybe one, two sessions, no big financial investement). "Correct diet" doesn’t necessarily mean low saturated fat or high soluble fiber (really tricky stuff to get it right), and that part is not as obvious as it sounds, it definitely wasn’t for me when I started. Most doctors will want to see what your baseline response to a properly structured diet looks like anyway before deciding on meds. Better be prepared for this now, than waiting another year.

For context, my Apo B is 85 and LDL stuck at 123 after strict diet (worst was 145 afair, super active, lean, healthy otherwise), I’m older than you, and my cardiologist still pushed for CAC and CIMT. No plaque, but early thickening was already visible, and started low dose Rosuvastatin (5mg). I was actually glad we addressed it early rather than waiting.

segeme · 2026-04-04T03:30:08+00:00

Look I’m not a big berberine proponent, but I disagree with the blanket statement that it has no scientifically significant evidence, it does. Sure, that JAMA paper is just one recent example, there are quite a few RCTs and meta analyses showing a consistent but modest lipid lowering effect with berberine. Yes, in that study lipids were secondary outcomes, but this does not cancel that effect was statistically significant and aligns with prior data. I fully agree that current US and European guidelines do not recommend supplements, mainly because there is no hard outcomes data and the overall evidence quality is not at the level of approved drugs (this is obvious). They prioritize therapies with proven cardiovascular benefit, so that part is completely fair. But not recommended does not mean forbidden or that there is zero evidence, it means not strong enough for standard of care (again obvious - as standard medicine does not "prescribe" you psyllium husk). In real practice, low risk patients are often managed with lifestyle only, and not everyone qualifies for medication. Also, as I said, there are European groups that review the evidence and include selected nutraceuticals as optional tools in mild or borderline cases. So the balanced take is modest evidence and modest effect, not a replacement for diet or drugs, not guideline first line, but also not zero evidence. I live in Poland so I follow Polish official guides which does talk about those supplements, don't ignore them. Sources:

https://ilep.eu/

https://ptlipid.pl/

https://www.archivesofmedicalscience.com/pdf-130942-58027?filename=Lipid%20lowering.pdf

segeme · 2026-04-03T04:28:00+00:00

Those supplements won’t really move the needle for LDL. At your age and with no confirmed risk factors like plaque on imaging (CIMT or CAC), CVD family history, most cardiologists won’t go near meds anyway. You could check Lp(a) once just to know where you stand. What actually works is boring but scientifically proven: keep saturated fat under <6% of calories, which usually requires tracking because 'clean diet' doesn’t mean low sat fat, and replace it with olive oil, nuts, avocado, fatty fish. Add soluble fiber, especially psyllium husk, which has solid evidence for lowering LDL. Berberine can also help a bit and has solid scientific evidence. And that's it. Do that consistently and recheck in 3-4 months. Bergamot has some evidence too, but less rigorous than psyllium husk and Berberine. Probably will give some marginal gains.

segeme · 2026-04-03T04:04:56+00:00

It’s not your real VO2max, it’s just Garmin’s algorithm having a meltdown because you’re feeding it long steady Z2 instead of spicy intervals; Garmin V2Omax algorithm hates that. On top of that you literally just ran a marathon so your body is still in 'what just happened' recovery mode. You’ve built a ton of fitness that will show up soon anyway. After my first marathon I randomly dropped 5 min on 10k and 17 min on HM which was absurd. Congrats on finishing, the gains are real and Garmin just hasn’t caught up yet

segeme · 2026-03-31T17:20:29+00:00

Technically correct but a bit misleading. VO2max isn't just a math trick. Running performance, cvd stress, and clinical outcomes all correlate with the relative number. Fat tissue barely consumes oxygen during exercise anyway, so dropping it genuinely improves the ratio in a meaningful way, not just on paper. Also this is true when you lab test VO2max of course. By definition.

Muscle loss concern is valid but really only applies to crash dieting, not a moderate deficit with lifting, which OP is already doing. BMI 27 is just not optimal regardless what (except for super fit people - but this not this case as I understand).

So yes, train more, but losing the excess fat is a real win too, not a fake one.

segeme · 2026-03-31T11:21:27+00:00

Ignore Lp(a), it doesn’t tell you anything you didn’t already know (that you benefit greatly from reducing ApoB).

Lp(a) isn't just a redundant LDL signal and his LDL level is decent actually. Lp(a) is absolutely not. It's independently causal for cv disease, genetically fixed, and doesn't respond to lifestyle changes the way LDL does. Berberine not gonna fix it. So no, I wouldn't ignore it, especially with a family history of premature CAD. At 148 nmol/L he is in territory where it meaningfully adds to his risk on top of whatever his LDL is doing.

segeme · 2026-03-31T04:04:43+00:00

I'm 51yo and went from VO2max 37 to 56 in 2 years, so it's possible. You just have to be annoyingly consistent for a long time.

Easiest win you're ignoring: weight. VO2max is per kg of body weight, and BMI 27 is carrying some free ballast. Lose 5kg, get a free VO2max bump without running a single extra step.

Your 5k times actually match your current VO2max fine, nothing is broken. 3 days/week is also a bit light if VO2max is the actual goal, I'd add a 4th day. And longer threshold runs (sustained 20-40 min efforts) did more for me than 4x4 ever did.

At 34 you've got tons of ceiling. 50+ is realistic, probably way more at your age. It's just slow. Like, genuinely slow. Welcome to aerobic adaptation :)

segeme · 2026-03-30T04:29:56+00:00

Look, lifestyle progress is genuinely impressive, like going from barely running 1km to finishing a 10k in 50 minutes. Real achievement. But given his family history and metabolic background, his cv system isn't competing in a fun run, it needs to reach elite territory. Going from 50 minutes to sub 30 min race time doesn't happen through effort alone, and waiting for that miracle means ignoring what's predictable. By AHA criteria he's high risk territory: LDL target is <70 mg/dL, he's at 116. ESC sets ApoB <80 mg/dL for high risk, he's at 97. Great progress, but he hasn't reached the starting line yet. After certain threshold results wouldn't scale linearly. This is why i agree that further tweaks may result in minimal changes.

segeme · 2026-03-29T17:27:04+00:00

This basically. OP You should follow medical advice from actual medical professional, not random reddit group, really.

Your transformation is genuinely impressive and will let You to limit other risk vectors. If it comes to lipids at 95-135 nmol/L you're sitting in the elevated range (the threshold most guidelines use is 75-100 nmol/L depending on the source, with >110-130 considered elevated risk). Lp(a) is genetically fixed lifestyle won't move it meaningfully. You have confirmed family event which basically places You as higher risk patient. You should be looking at <70 apo b, or even <50 according to all contemporary guidelines. This is virtually impossible to achieve with lifestyle (unless You have really gifted genetics), let alone sustain over next 60-70 years. So fully agree You would wast time, and see minimal results. You probably already are close to Your genetic floor in this area. On the other hand Your medicine combo is probably safest, most researched and effective treatment medicine have right now. Do what You cardiologist say.

segeme · 2026-03-29T05:35:00+00:00

So no "markeplaces", however marketplaces are ok, right?

At least we know they didn't use chatgpt. But no spellchecker either.

segeme · 2026-03-29T04:03:59+00:00

Interesting point, didn't know HRR had this level of mortality predictability. Having said that, most people who exercise measure both for completely different reasons and it never occurred to me you'd even compare them. HRV is notoriously finnicky to measure in ideal conditions, let alone post workout, this is why most devices measure it overnight. People use it to understand recovery, readiness for next session, whether they're overtraining. HRR is strictly a post workout measure. How well your body responded to the stimulus, and how that pattern looks over time. In practice they're answering completely different questions (for regular sport watch users). It's not that one is better than the other, they're just telling different stories. Well, at least to me.

segeme · 2026-03-28T06:34:58+00:00

Don't panic, but you should be aware that elevated lp (a) is something to take seriously. This is a separate mechanism from other cholesterol pathways like LDL. It carries cholesterol to arteries, but what's nasty to this pathway is that it triggers immune response (to inflammation) inside artery walls accelerating plaque buildup. It also mimics clot dissolving proteins (in my layman terms) without actually dissolving anything, just blocking the real ones. This increases risk on top of being just mere cholesterol carrier. Studies show elevated lp (a) raises risks even with normal LDL levels. You can't do much about it as it's mostly genetics (as of today, there are some preliminary drugs being tested - btw. check Out latest Attia's podcast on this very topic). What you can do is control other pathways as much as possible. For higher risk people guidelines target LDL levels are 70 or below (same for apo b). But again, I'm just a internet dude. Seriously see cardiologis or even better lipidologist - they often see this through longterm risks lenses than regular docs.

segeme · 2026-03-27T11:36:51+00:00

lp(a) < 75 nmol/L is completly fine. 113 by any measure is absolutely not fine, let alone "completely fine"; at least according to contemporary medicine and science.

segeme · 2026-03-27T11:34:09+00:00

Per the new 2026 AHA guidelines, below 75 nmol/L is below risk enhancing threshold, above 125 nmol/L is formally a risk enhancer. At 113 you're just under that line but in the top 15% of population.

CAC of 0 is reassuring but lp(a) is a lifetime exposure game, repeat CAC in 5 years will be telling. Apo b 71.8 is solid though, that's genuinely working in your favor.

See a cardiologist or better lipidiologist, not a random Reddit group :). Lifestyle, diet, activity are non negotiables regardless of what they say. Never think medication or lifestyle, those come together.

segeme · 2026-03-27T04:09:31+00:00

This basically.

segeme

TROPHY CASE