1 is pretty incorrect according to modern metabolic understanding, no? A large chunk of LDL production comes from the liver, and complex carbohydrates tend to leave the most LDL behind after running through the liver. Reductions in sweet processed foods would help the most there, not reductions in fats. Exercise helps a good deal with the same problems too.

The study is a bit suspect, and it makes me wonder if all that really happened is that participants replace HFCS with honey, which doesn’t have the same impact on the liver.

> complex carbohydrates tend to leave the most LDL behind after running through the liver.

reduced my carbs, lost 15 pounds (I'm not obese to start with) LDL stayed super high. no decrease of any kind.

> Reductions in sweet processed foods would help the most there, not reductions in fats.

I dont eat sweet processed foods anyway, nope

> Exercise helps a good deal with the same problems too.

tried that, nope

what worked (dramatically) is:

1. cut out dairy

2. take statins

To say LDL cholesterol is misunderstood is an understatement. I recommend this as a primer: https://www.youtube.com/watch?v=DXKJaQeteE0

tl;dw: there are many types of LDL which are not adequately represented in blood tests, unless subject to expensive centrifuges. LDL is how the body delivers fatty acids to be used as energy to the rest of the body, but in contact with high levels of sugar, becomes glycated, vulnerable to oxidation and stays in the bloodstream instead of being used or reabsorbed by the liver. Then it accumulates in the walls lining your arteries.

So the take away is: do not eat tons of fat with tons of sugar if you care about your arteries. One or the other are not necessarily bad.

Also statins are terrible with worse side effects. Fix your diet, not the estimated amount of cholesterol in your blood tests.

Just get an Apo B blood lipid test. You’ll find that it correlates with LDL anyways, but Apo B is the best marker we have, better than measuring the amount of carriers. But unlikely to divorce much, so that kind of LDL “optimism” is kind of a waste of time.

> Also statins are terrible with worse side effects. Fix your diet, not the estimated amount of cholesterol in your blood tests.

Whether or not to take a statin is a _complicated_ decision, based on _many_ variables. Maybe statins didn't work out in your situation, but please don't suggest things like this.

"Fix your diet" is _very_ difficult, as well as ambiguous (e.g. carnivores and vegans will both claim that their diet will save lives. Vegans have more actual data, carnivores are louder and more interested in pointing out possible mechanisms).

The best research we have suggests that statins save a _lot_ of lives. _And_ that most of the "adverse reaction to statin" effects are statistically indistinguishable from people who aren't on statins. Heck, look at the "Adverse Effects" section of the wikipedia page. Cerivastatin _did_ raise the risk of muscle issues, some of them serious. But A) not by much, and B) it's been withdrawn for > 20 years.

FWIW, I'm one of those people who eats "well", runs, lifts, meditates, used to drink white wine until the correlation was disproved,... and still had a cholesterol over 500. Until I started taking my current statin. That means I'm actually one of the comparatively few people on a statin who doesn't know that it reduces my risk (the mechanism of cholesterol regulation and/or production in me is different than in most people. We don't actually know whether statins lower my risk. We do know that statins lower my cholesterol, and that lowers risk for people with the more common mechanisms, so I'm playing the odds.).

Re: side effects, I _think_ I had increased muscle soreness after lifting when I started on statins, but I googled, and that's also a thing that just happens to people around 40. Right now I'm 50, pulling more than twice what I weigh, and still running, so it can't be _that_ big an issue. It's not like I was a professional athlete until I started taking statins. Which is a sample size of 1, but that's backed up by the studies, so...

> "not the estimated amount of cholesterol in your blood tests"

We know that lowering "the estimated amount of cholesterol in your blood tests" correlates with lowering your risk of cardiovascular issues. So actually, yes, as a rule, lower the estimated amount of cholesterol in your blood test. Statins aren't the only way, but they do a lot of good for a lot of people.

NB: I'm not affiliated with any statin producer, except that I take a statin daily. I'm also not a doctor, but I've had ridiculously high cholesterol since I was in utero, and have been trying to keep abreast of the research for about 30 years now.

> The best research we have suggests that statins save a _lot_ of lives.

The best research we have suggests that statins do bugger all, maybe reducing a little your LDL, while other research shows a correlation between LDL levels and longevity. Yes that's right, people living longer tend to have higher levels of maligned LDL. Which means we have no idea how lipid metabolism works still.

If you liked that talk from Dr. Mason about cholesterol, here's one about statins and how little useful they actually are: https://youtu.be/I7r4j1u42V8

They are actually good at reducing cholesterol, sure, but it's just a misunderstood marker. Doctors use it to measure your health but it is not per se dangerous. Having pathological levels of cholesterol in utero would benefit from it, but if you're eating burger and pizzas, fix your diet, a pill's not gonna save you.

People naturally have higher cholesterol as they age, so it may not be that the statin is less effective, but simply that your body is trying harder to increase its cholesterol.

I agree with your take and advice. This year I received a cholesterol tests with about 200 LDL-C (97th percentile). I panicked and switched to a whole food plant based diet and after about 10 days on the plant based diet I payed to have a lab tests my cholesterol again. My LDL-C dropped about 50 points in 10 days on a plant based diet. I eliminated almost all saturated fat and continue to limit them to about 13 grams per day (AHA recommendation, which is especially strict), and my cholesterol has continued to improve over the months.

I haven't started statins yet. My doctor doesn't want to start me on them with my current ~135 LDL-C. I'm going to see what more I can do with diet, exercise, weight loss, etc.

Saturated fats are not an issue; its transfats which are unhealthy. The saturated fat hype was possibly started by the sugar industry, and debunked some good 15-20 years ago by Martijn Katan et al.

you are mistaken, the link between saturated fat and LDL cholesterol is extremely well documented and widely known, also matches my personal experience just for good measure.

the only controversies about reducing saturated fats have to do with secondary effects, such as, "person might eat too many carbs if they reduce saturated fats too much", things like that. There are also some quacks who have tried to claim that LDL cholesterol levels are not important and even that arteriosclerosis is not a cause of heart attacks. You can go pretty far with this kind of stuff, when following the science means one has to radically change their diet in order to avoid heart disease, people really want there to be another answer.

Saturated fats increase total cholesterol and by extension risk, but the ldl ratio is worsened when you include refined carbs and sugar, with little in the way of fiber and protein.

I went on a period of sugar / carb reduction for many months and lost 15 pounds but my cholesterol numbers were unchanged, at that time. radically different diet re: carbs with the same amount of dairy consumption had zero effect on my LDL numbers.