May 31, 2025

Nutrition -- Cholesterol

How much is too much? There have been various guidelines, such as 200 mg or 300 mg per day. The current guideline is "as little as possible", which I think is indeed what a person ought to shoot for (i.e. shoot for 0).

I now have an entirely separate page on eggs. They have a huge amount of cholesterol, but that content is also a topic of controversy, so ...

The controversy is about the connection between cholesterol in your diet and the cholesterol in your blood. Leaving that aside, let's focus on the cholesterol in your blood.

The main source of cholesterol in your blood is your liver. Your liver manufactures cholesterol, and it makes more when you eat a lot of saturated fat. So if you want to lower your cholesterol, the game is to eat less saturated fat. I try to limit my daily intake to 10 grams.

There is a clear connection between high blood cholesterol levels and heart disease.

I like to focus on the LDL level. LDL is the "bad" cholesterol.
When I first woke up to all this my cholesterol level was: 

Early 2025, LDL = 143
June 2025 with careful diet, LDL = 99
August 2025 with diet and a statin drug, LDL = 57

A talk with my friend Dave 6-28-2025

Dave is a great source of information. He is exactly my age, is active like me (even more so), and seems to have very similar heart problems. He is addressing cholesterol via a combination of diet and statins. In 2015 he began to experience angina and began dealing with his heart. 
Pre-2015 his total cholesterol = 200+, typical LDL = 140+
2017 with diet and mediocre med compliance, total = 159, LDL = 95
2025 with diet and diligent med compliance, total = 117, LDL = 55
What I take from this is that diet only got him half way to where he is now.
Some people would say LDL less than 100 is your target.
Dave says that he wants less than 75, as that has been shown to actually allow resorption of non-calcified artery deposits.

What I find exciting is that he has reduced his LDL from 140+ to 55 -- exactly what I hope to duplicate.

In fact he says that in 2015 they did a contrast enhanced CT scan and observed 50 percent blockage in some arteries. Now in 2025, they did a scan and see 32 percent blockage, so his reduction of cholesterol has really paid off. In particular he no longer experiences angina during strenuous exercise like he once did.

Dave also takes a medication called Zetia (ezetimibe). What I read is that Zetia works in the intestines to inhibit the digestive tract from taking in dietary cholesterol. This would seem almost belt and suspenders given Daves careful attention to diet.

Dave says he once took Rosuvastatin, but switched to Atorvastatin after having side effects of weakness in his Quad muscles. No problem with Atorvastatin. He describes the side effects as: "feelings of vague weakness and discomfort in my quads".

Also he now takes 20 mg -- he used to be on 10 mg, but his doctor wanted to see if bumping up the dose improved LDL levels without side effects. Dave says it did (lowering them by 10) without noticing any side effects.

Dave sees Gundeep Singh at Marshall Cardiology on E Glenn and likes him a lot.

Statins

My doctor has prescribed Rosuvastatin (Crestor) 10 mg for me. The other, perhaps more common statin is Atorvastatin (Lipitor).

Both of these work in the liver by inhibiting an enzyme called HMG-CoA reductase. Apparently the liver uses this enzyme to manufacture cholesterol, which it needs to do -- but not too much of it.

So, why Rosuvastatin instead of the wildly popular Atorvastatin? I read that "R" is more effective than "A" in reducing LDL levels and is generally considered to be more potent.

Rosuvastatin has been associated with a higher risk of developing new-onset diabetes mellitus requiring medication and cataract surgery, while Atorvastatin may be linked to a higher risk of muscle pains and memory loss.

Nothing is without risk and you have to balance benefits against risk.

A big mistake would be to take statins and then feel that you could continue to eat a normal American diet. Why not attack cholesterol with a combination of diet and statin drugs.
Have any comments? Questions? Drop me a line!

Tom's home page / tom@mmto.org