(Susan) #1

My doc, who is generally favorable to keto, wants to put me on statins for an LDL of 198 (normal < 100), a cholesterol of 0f 302 (normal < 200) and an HDL of 71 (normal > 32).
I understand why she wants to do this. The first 2 numbers are really high. My understanding is that statins do bring down cholesterol, but don’t change the incidence of cardiac events. Does anyone who understands this better have any recommendations?
Background, I’ve been keto with < 20g/day for 4 years but haven’t lost any weight. I’m 250 lbs. I cheat once every month or 2, but not > 50g of carbs. I know I eat too much and ozempic hasn’t helped even a little bit.


What are your triglycerides? That number matters most as does the triglycerides to HDL ratio

Your LDL isn’t worrisome given this diet.

Your HDL is good and with lower triglycerides would make for a fabulous Tri/HDL ratio.

Your total cholesterol depends and maybe someone else might chime in on that one. Dr Nadir Ali showed how those with the highest total cholesterol actually had less incidents of heart disease and diabetes and CVD, etc etc. A inverse relation to incidents of diseases with how high cholesterol was. There’s a good video that explains it all. I’ll post two of his links here for you to watch. Take the time to watch all the way through and rewind/pause as needed to absorb his more complex diagrams. They are good. It really helped me when I had to make decisions about statins:


Also: cheating once a month or so will knock you out of ketosis. It can take a while to get back into it if you haven’t been properly fat adapted. I haven’t cheated in 2 years, so if I were to today, it probably would only take me a few days to get back into ketosis. But many people struggle with that and if you are one of them, cheat days are hurting you.

The only thing I cheat with is more Keto approved foods. Like I might have close to 50g carbs one day but it’s all from Keto foods, never anything from the standard American diet stuff.

Also if you’re eating a lot of fat bombs or packaged Keto foods, that can also hamper weight loss. Most prepackaged Keto foods have a lot of things in them that still disrupt insulin and/or ketosis. There’s very little that is truly Keto. Maybe once you’re at your goal weight they may be ok as you maintain but I don’t believe they help when you’re trying to lose.

Maybe a good IF routine with a single 24-hour fast once a week, plus sticking strictly to Keto foods only without any cheat days, will start the weight loss again? Just musing …

(Doug) #3

They don’t really do much as far as cardiac events, it’s true. Here’s a good recent thread with a discussion about this.

Tip of the hat to @SomeGuy (post #3 there) for what I think is an excellent, concise statement of things - things for which we’ve seen large amounts of evidence over the past years.


Well, that’s easy, but you’ve already identified the issue, you eat too much. Have you tracked with something that actually finds your TDEE, or ever had your metabolic rate tested?

Is Ozempic not pulling down your appetite? If not, did you start out following the Diabetic dosing and made yourself resistant to it? That happens very quickly if you follow the diabetes progression. Also, you pinning it once or twice a week?

For weight loss, most of us that figured it out before the docs did would still start at the 0.25mg/wk until it didn’t work, then went 0.25/mg 2x/wk and ran that as long as possible. The bump mid week helps a lot.

(Susan) #5

Thanks for such a quick response! My triglycerides are163. According to the printout, they’re supposed to be <150

(Bacon is a many-splendoured thing) #6

That’s funny; in 2018, when my LDL was 148, the “normal” limit was 150, not 100. How times have changed!

I imagine it has something to do with the studies finding an extremely strong correlation between the number of people taking statins, and the size of the annual bonuses of pharmaceutical company executives.

As far as cardiovascular risk is concerned, numerous studies have shown that LDL is not a very accurate risk predictor. The best predictor is the ratio of fasting triglycerides to fasting HDL. What were your triglycerides and HDL like? They should have been included in the same lab report.


It is a tad high. But mine were 300+ when I took a statin. I stopped after they came down. Then 2 yrs Keto they stayed down. I know you want them closer to the same number as your HDL, closer to a ratio of 1 or lower. Your ratio is 2.3.

I’m unsure how high would make a statin worth it. I know mine was extremely high so it possibly was worth the risks to get it down quickly.

Someone else who understands more than me will chime in!!

(Geoffrey) #9

My LDL as of a couple of months ago was 195. You know what? I don’t care. You know why I don’t care? Because I’ve done the research that shows that LDL cholesterol is an important crucial building block in cell membranes. Cholesterol also is needed to make vitamin D, hormones (including testosterone and estrogen), and fat-dissolving bile acids. In fact, cholesterol production is so important that your liver and intestines make about 80% of the cholesterol you need to stay healthy. Only about 20% comes from the foods you eat.
There is plenty of research that shows that those with low LDL levels have a higher all cause mortality than those with high LDL, especially in people in my age range.
I’ve also seen the research that shows that statins do absolutely nothing to prevent cardiovascular diseases or heart attacks. The research shows at best a regiment of statins may increase your lifespan by five days. Now is that worth the side effects?
I didn’t think so and that’s why I politely told my doctor “no thank you”.

(Joey) #10

Yes indeed. Just what @Geezy56 said… :point_up:

(Alec) #11

I highly recommend not taking a statin, and trying to get your cholesterol as high as possible. High cholesterol is protective against All Cause Mortality. By suggesting you take a statin, your doctor is inadvertently harming you.

The best the statin manufacturers can do is provide very very unconvincing evidence of their efficacy. And that’s the best they can do with all their hopeless bias. The reality is that all independent research says they are unhealthy.

My doctors have consistently advised me to be on a statin most of my life as I have FH, and my LDL has always been “high”. My LDL is currently 450. I have a CAC score of 10 (which is not zero, but it is very low). I have always politely declined their offer of statins. The last doctor wanted me on a PCSK9 drug (presumably for life as that is the most profitable). I said no thanks.

(Robin) #12

Nice to hear from you, McQueen, Alec McQueen.
Things going well on your side of the planet?

(Alec) #13

Things are going excellently, thanks Robin. I retired last Friday. So now I have all day to run, drink coffee, and read the Ketogenic Forums! :grinning::+1:.

I have a massive list of things that I want to do in retirement. Not sure I will get it all done! :joy::joy::crazy_face:

I have just bought a new zero turn mower, and I have spent the last few days zooming around my land (12 acres) knocking down the out of control brush and mowing the paddocks. Loved it!!

(Joey) #14

Since your new mower doesn’t turn, I can see why it would take a few days. :crazy_face:

Retirement is the best. Congratulations and enjoy!

(Robin) #15

Happy retirement! I remember wondering how I would stay busy… or be content when I wasn’t busy. Turns out, I’m good at both.
Zero turn mower… sounds like fun!
Look forward to hearing from you more often.

(Bob M) #16

So, your HDL is 71 (relatively high for a male), but your trigs are 163? Usually, trigs correlate with carbs, though not always. Some people, for instance, have higher trigs from coffee.

When you got your test, were you eating keto beforehand and, if so, for how long? Was this an overnight fasting test? Did you drink coffee before the test?

(Bacon is a many-splendoured thing) #17

Oh, statins are effective at lowering LDL-C, all right. The problem comes with the results of lowering LDL-C, lol! (Cancer, type II diabetes, cardiovascular disease, higher all-cause mortality, metabolic dysfunction, muscle pain, dementia, impotence erectile dysfunction, and other effects too numerous to mention.)

(Jenna Ericson) #18

I would be cautious of taking a statin, especially on keto. I also question if ozempic is the right choice with keto. While ozempic does make you less hungry it also causes you to make more insulin, and the point of keto is to lower insulin. If insulin is higher than what your body natural would make, you will have to make glucose in response, also meaning your ketones and fat utilization will be blocked.

A statin will cause you to make less cholesterol. You need more cholesterol when you do keto because it is incorporated into lipoproteins that transport fat for energy utilization. The reason you might get muscle aches with a statin is partially because you are blocking production of COQ10 (used in the making of ATP in your mitochondria) and because you are not transporting enough fat for energy in lipoproteins.

(Kirk Wolak) #19

Remember this. Your doctor has a % goal/target of patients following “guidelines”.
My Doc explained. If his % drops below certain thresholds, ALL Of his billings to the insurance company starts to be discounted (as they feel he is not doing his job).

So, when the wife and I got CAC scores. he was able to CLEAR us, so we did not count against his % getting proper treatment. My wife has > 340 total chol. With a CAC=0. I was borderline 202 - 238 range, but < 100 CAC and second CAC showed about 3% increase/yr (well below the 10%) which is LIKE getting a Zero.

There is a huge difference between a Patient with their head in the sand (normal). And someone who is following some science, and using lifestyle appropriately. From the “Statistics” standpoint… It means he is APPROPRIATELY treating his patients… AND then it PAYS better. (or he loses less).

But he was going to ask us to change doctors! (He would see us, but not be our primary care physician).

(Joey) #20

Very interesting angles are shared here… I’ve rarely come across these points taken up this way, which lead us to the same conclusions. Fascinating perspective. Thx.