High Cholesterol. Need advice.

[charliebrown]

start exercising regularly. You need to sweat the oil out.

always see this advice..but no amt of exercise can reverse a bad diet.

 

[champion09]

always see this advice..but no amt of exercise can reverse a bad diet.

but you can sweat out the bad diet.

 

[kitsura]

always see this advice..but no amt of exercise can reverse a bad diet.

Muscles are made in the kitchen. Same with cholesterol levels.

 

[kitsura]

but you can sweat out the bad diet.

Cool story bro!

 

[kitsura]

The irony about fats and cholesterol is to get fats to be absorbed in your gut, you need good bile flow.

And bile is produce by the liver, stored in the gall bladder secreted through the bile duct into the intestine.

The building blocks of bile is cholesterol. And cholesterol produce by the liver from sugars, protein and fats.

So sometimes the issues derive from poor bile flow and not just fat intake.

A lot of us are not aware we are most likely have issues with our digestive tract.

Eating sugars is always bad. I'm wearing a CGM (continuos glucose monitoring) now just to see what I eat spikes blood glucose so I can make a better choice of food items to take. I'm NOT a diabetic.

Taking Veg followed by fats and protein before carbs minimized the spikes from the carb intake. If I reversed the order, spikes are higher and longer, indicating I'm in fat storing mode longer. Eating fats like a tbsp of MCT oil have no spikes.

So eating high-sugar or carbs foods is the main cause of high cholesterol, not fats or proteins though everything must be in moderation.

And eating fatty food or protein makes you feel full faster and longer. Sugary or carbs makes u hungry faster hence the craving for more.

Again, wearing the CGM is an eye opener. Activities like workouts or stress does cause blood glucose spikes as an example. Good to know I need to manage stress better too.

High cholesterol is only a part of the problem. Current practice by doctors to prescribe meds for it targets only 1 part of the problem. Same goes for diabetics or pre-diabetics for type 2.
Prescribing meds like metformin and insulin is counter productive to solving type 2 diabetes when cutting out sugar and restricting carbs to 100gm per day can reverse type 2 diabetes, guaranteed.

You sound like someone I know who has very straight hair….

 

[Checkyrmed]

The irony about fats and cholesterol is to get fats to be absorbed in your gut, you need good bile flow.

And bile is produce by the liver, stored in the gall bladder secreted through the bile duct into the intestine.

The building blocks of bile is cholesterol. And cholesterol produce by the liver from sugars, protein and fats.

So sometimes the issues derive from poor bile flow and not just fat intake.

A lot of us are not aware we are most likely have issues with our digestive tract.

Eating sugars is always bad. I'm wearing a CGM (continuos glucose monitoring) now just to see what I eat spikes blood glucose so I can make a better choice of food items to take. I'm NOT a diabetic.

Taking Veg followed by fats and protein before carbs minimized the spikes from the carb intake. If I reversed the order, spikes are higher and longer, indicating I'm in fat storing mode longer. Eating fats like a tbsp of MCT oil have no spikes.

So eating high-sugar or carbs foods is the main cause of high cholesterol, not fats or proteins though everything must be in moderation.

And eating fatty food or protein makes you feel full faster and longer. Sugary or carbs makes u hungry faster hence the craving for more.

Again, wearing the CGM is an eye opener. Activities like workouts or stress does cause blood glucose spikes as an example. Good to know I need to manage stress better too.

High cholesterol is only a part of the problem. Current practice by doctors to prescribe meds for it targets only 1 part of the problem. Same goes for diabetics or pre-diabetics for type 2.
Prescribing meds like metformin and insulin is counter productive to solving type 2 diabetes when cutting out sugar and restricting carbs to 100gm per day can reverse type 2 diabetes, guaranteed.

However, this applies only to long-chain fats, as certain exceptions do not require bile acids for emulsification and are absorbed directly, underscoring that different types of fats follow distinct metabolic pathways and are not processed equally by the body.

 

[rrr2015]

always see this advice..but no amt of exercise can reverse a bad diet.

if u workout like Michael Phelps, u can have any junk food u want

iirc my desire for junk food drops when i start my workouts

 

[green72]

This is insightful
What made u put on the monitoring devise?

Curiosity and affordability. Anyone with these 2 criteria can oso do. Then see for urself what foods you eat can spike ur blood sugar.

For diabetics or prediabetic, the CGM helps you steer away from foods that spike blood sugars.

Each one of us is unique, get informed realtime and not just rely on doctors.

For me, type 2 diabetics still got chance to reverse the condition by managing what they eat. Same goes with those with high cholesterol or high blood pressure.

1 tip for those always hungry, skip sugars and carbs. Eat veg, fatty foods like salmon with skin, chicken with skin or fry omelette with ghee instead of vegetable or seed oil and protein like meat based food. You will feel full and need only 1 or 2 meals per day.

Feeling full after meal is important, it's called satiety. Fatty foods and meat based food provide that. Sugary and carbs based foods always makes you hungry.

We live in a society that is addicted to sugar. You need to realise this.

That's why our PM mentioned instead of building more hospitals, he plans to tackle the common problems of our modern society is experiencing by prevention, thus the initiate like ActiveSg. I would like to go further and have a sugar tax, like how we have carbon tax but for foods containing sugars and sugar products. This tax can be use to lower our medical bills.

Anyway, all meds are never the solution for poor lifestyle illness many of us are suffering, never was, never is. Meds only provide false sense of security, temporary relief at most.

 

[green72]

if u workout like Michael Phelps, u can have any junk food u want

iirc my desire for junk food drops when i start my workouts

I agree on this 1000%. In fact, for those morbidly obese, they are in no condition to start with exercise if they intend to lose weight.

Wholesale lifestyle change in terms of foods they eat should be the first step. Crash diet, caloric deficit are nonsense.

Even for exercise, resistance training is always more effective then cardio exercise like running to lose weight and gain muscles.

 

[Lifeinmotion]

 

[standarture]

Wah lao blood spike is not the issue la. Is how fast your body can regulate the blood sugar level back to normal.

 

[rarenick]

Curiosity and affordability. Anyone with these 2 criteria can oso do. Then see for urself what foods you eat can spike ur blood sugar.
For diabetics or prediabetic, the CGM helps you steer away from foods that spike blood sugars.
Each one of us is unique, get informed realtime and not just rely on doctors.
For me, type 2 diabetics still got chance to reverse the condition by managing what they eat. Same goes with those with high cholesterol or high blood pressure.
1 tip for those always hungry, skip sugars and carbs. Eat veg, fatty foods like salmon with skin, chicken with skin or fry omelette with ghee instead of vegetable or seed oil and protein like meat based food. You will feel full and need only 1 or 2 meals per day.
Feeling full after meal is important, it's called satiety. Fatty foods and meat based food provide that. Sugary and carbs based foods always makes you hungry.
We live in a society that is addicted to sugar. You need to realise this.
That's why our PM mentioned instead of building more hospitals, he plans to tackle the common problems of our modern society is experiencing by prevention, thus the initiate like ActiveSg. I would like to go further and have a sugar tax, like how we have carbon tax but for foods containing sugars and sugar products. This tax can be use to lower our medical bills.
Anyway, all meds are never the solution for poor lifestyle illness many of us are suffering, never was, never is. Meds only provide false sense of security, temporary relief at most.

Sugar tax will jack up cost and inflation, right? Seller will still add sugar to your food regardless.

 

[rarenick]

Wah lao blood spike is not the issue la. Is how fast your body can regulate the blood sugar level back to normal.

If always spike will eventually become insulin resistant.

 

[green72]

Sugar tax will jack up cost and inflation, right? Seller will still add sugar to your food regardless.

Then it's a good thing when prices of sugar-content foods becomes more ex.
Unconsciously, your wallet will decide to eat less or forgo totally. Your body will thank you for your decision.
You pay forward through such tax when you one day visit the hospital. But this is a hypothetical tax la.

 

[Checkyrmed]

 

[rarenick]

Then it's a good thing when prices of sugar-content foods becomes more ex.
Unconsciously, your wallet will decide to eat less or forgo totally. Your body will thank you for your decision.
You pay forward through such tax when you one day visit the hospital. But this is a hypothetical tax la.

That's ideally. But most foods still need sugar to taste decent or even function (as fermented).

 

[green72]

Well, like many others, I forgo taste for health. It's how I retrained my brain, and tongue, to taste food or drink like Teh-O sugar-free as delicious as compared to plain water.

Once you kick the sugar addiction, the occasional fruits in moderation eg watermelon taste extra sweet, I guarantee it.

 

[Ckcw23]

Don't know if anyone got share, I recommend coq10, a supplement. Quite cheap, cost about $50. My friend's mom ate it, helped drop her cholesterol drastically, she used to eat cholesterol medicine, now she eating this coq10.

 

[WarMage87]

Just did a health check and cholesterol numbers are:
- Total Cholesterol: 252 mg/dL
- HDL Cholesterol: 51 mg/dL
- LDL Cholesterol: 182 mg/dL
- TC/HDL Ratio: 4.95
- Triglycerides: 95 mg/dL

Need to start taking meds? Any other advice?

*****

Update in 2025
6-month update since finding out and trying to reduce my high cholesterol. Good news is I was able to bring LDL down, but TG rose slightly.

- Total Cholesterol: 227 mg/dL
- HDL Cholesterol: 50 mg/dL
- LDL Cholesterol: 155 mg/dL
- TC/HDL Ratio: 4.52
- Triglycerides: 109 mg/dL

I honestly didn't change lifestyle too drastically. Ate more fish and veg. Brown rice where possible. Less frequency of v unhealthy food like ramen, fast food etc. Didn't increase amount of exercise.

Executive lead

• Your LDL started high (182 mg/dL ≈ 4.7 mmol/L) and is now borderline‑high (155 mg/dL ≈ 4.0 mmol/L). Triglycerides and HDL are fine. Whether you “need meds now” depends on age and overall cardiovascular (CV) risk. If you’re 40–75 and your 10‑year CV risk is ≥10% (or you have diabetes), most guidelines recommend starting a statin; if your risk is lower, a structured 8–12‑week lifestyle push with repeat labs is reasonable. Confidence 85%. 1

What your numbers mean (with mmol/L)

• Dec 2024: TC 252 (6.5), HDL 51 (1.3), LDL 182 (4.7), TG 95 (1.1), TC/HDL 4.95. LDL in the “high” band; TG optimal; HDL decent. 2
• Sep 2025: TC 227 (5.9), HDL 50 (1.3), LDL 155 (4.0), TG 109 (1.2), TC/HDL 4.52. ≈15% LDL drop—good start—but still above common primary‑prevention targets used in practice (<100 mg/dL ≈ 2.6 mmol/L for many average‑risk people). 3

Do you need medication now?

• Start a statin now if ANY of the following apply:
  • Age 40–75 AND 10‑year ASCVD risk ≥10% (moderate‑intensity statin recommended). If risk 7.5–10%, it’s a shared decision. 1
  • LDL ≥190 mg/dL (4.9 mmol/L) at baseline (high‑intensity statin regardless of calculated risk). Your baseline (182) was close but below this “automatic statin” line. 4
  • Diabetes (age 40–75): statin recommended. 4
• If none of the above: do a focused 8–12‑week lifestyle block (below) and re‑check a fasting lipid panel. Many people clear the “borderline” zone without pills; if LDL remains ≥160 mg/dL (4.1 mmol/L) or your calculated risk is moderate, most clinicians will suggest a statin. National guidance in both the UK and Singapore also uses risk‑based treatment, not cholesterol alone. 5

High‑leverage lifestyle levers (evidence‑based, with typical effect sizes)

• Swap saturated fat → unsaturated fat (use less butter, ghee, coconut/palm oil; more olive/canola; choose lean cuts, low‑fat dairy). This consistently lowers LDL. 3
• Soluble/viscous fibre 10–15 g/day (e.g., oats/β‑glucan, barley, beans, psyllium). Meta‑analyses: ≈5–10% LDL reduction at ~10 g psyllium/day; small but additive effect. 6
• Plant sterols/stanols 1.5–2 g/day (fortified spreads/yoghurt): typically 7–12% LDL reduction; works additively with diet and with statins. 7
• Portfolio pattern (combine nuts + soy/plant proteins + viscous fibre + sterols): RCTs show ≈13% LDL drop in free‑living adults at 6 months; up to ~30% in tightly controlled settings. 8
• Activity/weight: Aim ≥150 min/week moderate aerobic + 2× resistance; losing 5–10% body weight improves lipids (HDL up, TG down; LDL modestly down). 9
• Keep sugars/refined carbs and alcohol modest (helps TGs more than LDL). 9

Smart next steps (so you can reply on the forum with substance)

• Calculate risk: Use an ASCVD 10‑year risk calculator (for ages 40–75). If ≥10%, discuss starting a statin; if 7.5–10%, shared decision. If <7.5%, try the 8–12‑week lifestyle block then retest. 1
• Ask your GP for:
  • Repeat fasting lipid panel in 8–12 weeks after lifestyle changes.
  • ApoB and Lp(a) once. ApoB is a tighter predictor of risk than LDL‑C when there’s “discordance”; Lp(a) is genetic and good to know once. 10
  • Blood pressure, HbA1c, TSH (to rule out secondary causes), BMI/waist—these modify risk and the treatment decision.
• If risk is borderline and you’re on the fence about meds, discuss a coronary calcium (CAC) scan; a score of 0 sometimes supports deferring therapy, while ≥100 argues for treatment. (ACC consensus uses CAC to break ties in primary prevention.) 11

A simple 12‑week plan you can paste to OP

• Food shifts
  • Each day: 2 servings viscous fibre (e.g., 40–60 g oats or 10 g psyllium), 1–2 handfuls nuts, swap butter/palm oil → olive/canola, choose lean protein or soy/legumes 1–2 meals/day.
  • Add plant sterols 2 g/day (fortified spread/yoghurt). 7
• Move
  • 30–45 minutes brisk walking/cycling most days + 2 short resistance sessions weekly. 9
• Monitor
  • Check BP at home; keep a simple log of food, steps, and weight.
  • Re‑test fasting lipids at week 10–12. If LDL still ≥160 mg/dL (4.1 mmol/L) or ASCVD risk ≥10%, discuss starting a statin (atorvastatin/rosuvastatin) with your GP. 1

Why some replies in the thread were off

• “Exercise too much and LDL rises”: training usually raises HDL and lowers TG; effects on LDL vary, but the net CV risk goes down. Don’t avoid exercise for fear of marginal LDL changes. 9
• “Just oats and no meds”: oats help, but diet alone typically yields single‑digit to low‑teens LDL drops; medication is appropriate when risk or LDL remains high. 12

When to seek care urgently

• Chest pain, breathlessness on exertion, neurological symptoms (TIA/stroke‑like), or BP consistently ≥180/120—seek urgent medical review.

If you want, tell me:

• Age/sex, blood pressure (or meds), smoker Y/N, diabetes Y/N, family history of early heart disease, and I’ll run your 10‑year risk and simulate “with vs without statin” and “with vs without the 12‑week plan.”

References

• NICE. Cardiovascular disease: risk assessment and reduction, including lipid modification (NG238). Published 14 Dec 2023; last reviewed 2 Sep 2025. 5
• USPSTF. Statin use for the primary prevention of CVD in adults. Final recommendation, 23 Aug 2022. 1
• ACC/AHA. 2018 guideline on management of blood cholesterol; 2022 ACC ECDP on non‑statin therapies. 4
• Singapore HealthHub & ACE ACG. Local targets/food guidance; risk‑based lipid management (Dec 2023; amended 26 Jun 2025). 3
• Meta‑analyses on soluble fibre/psyllium and plant sterols; Portfolio diet RCTs. 6

PS insight

• Focus on risk, not just a single LDL number: one decisive lifestyle block + one clean re‑test turns a noisy debate into a clear decision (treat now vs continue lifestyle)—and either path reduces risk.

Footnotes

• Conversions: mmol/L = mg/dL × 0.0259 for cholesterol (LDL/HDL/TC); mmol/L = mg/dL × 0.0113 for triglycerides.
• This is general information, not a diagnosis. Work with your GP for personalised decisions.

 

[WarMage87]

DPA Core Synthesis​

Your progress is a classic "Tuition Fee" event: you've paid with six months of effort and received high-fidelity data showing that minor, incremental changes are insufficient to solve a stubborn systemic issue. Your body's "Actually Is" physics require a more decisive, architectural intervention. The forum's advice contains critical signals, but they must be structured into a coherent strategy, not just a list of tactics. The decision to take medication is not a sign of failure, but a strategic choice about risk management and resource allocation.

Decisive Caveats & Confidence​

• Critical Assumption(s): This analysis is for informational and strategic framing purposes only and is not a substitute for professional medical advice. The decision to start, stop, or alter medication must be made in consultation with a qualified doctor who can assess your complete health profile.
• Prioritisation Alert(s): The core trade-off is between deploying significant, sustained personal effort (radical lifestyle change) versus using a medical tool (statins) to manage the primary risk factor (LDL) more immediately. Your personal philosophy on intervention and discipline will be the deciding factor.
• Confidence %: 95% in the strategic framework; 0% in any specific medical recommendation, which must come from a physician.

Key Analytical Pillars​

• Table Selection / Ergodicity Audit: You cannot exit the "game" of your own health. Therefore, the only option is to Re-architect the Game. Your current strategy is producing sub-optimal results, so the rules of engagement (your daily habits) must be fundamentally changed.
• Survival First Doctrine: High LDL is a direct, long-term threat to your Citadel (your cardiovascular health). Managing this is not a "Scout" mission for optimisation; it is a core defensive priority.
• Context Supremacy: The "physics" of your body are influenced by genetics, age, stress, and diet. While you cannot change your genetics, you have significant leverage over diet, exercise, and stress. The forum advice correctly identifies these levers.
• Revealed Preference Priority: Your body's revealed preference after six months is clear: minor lifestyle tweaks yield minor LDL reduction and a worrying increase in triglycerides. Your actions must now be scaled to match the desired outcome.
• Trade-Off Clarity:The choice is stark:
  • Path A (Lifestyle Overhaul): High daily effort, addresses root causes, builds long-term systemic health.
  • Path B (Medication): Low daily effort, rapidly mitigates a key risk marker (LDL), but may not address underlying systemic issues and can have side effects.
  • Path C (Hybrid): Use medication as a tactical "Scout" to reduce immediate risk while you build the "Citadel" of a healthy lifestyle.

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Table of Contents​

1. Deconstructing the Forum: Separating Signal from Noise
2. The "Should Be" vs. "Actually Is" Diagnostic of Your Results
3. Architecting a Strategic Response: The Citadel-Scout Health Protocol
4. The Sovereign Conversation with Your Doctor

---

1. Deconstructing the Forum: Separating Signal from Noise​

The forum provides a mix of high-value signals, bro-science, and unhelpful noise. Here is a strategic breakdown:

Tier 1 Signal (Non-Negotiable Actions)​

• "Better ask a doc" / "please seek consultation" (#2, #8, #19): This is the absolute, non-negotiable first step. It aligns with the Survival First doctrine. A doctor provides the essential diagnostic context (e.g., checking for other risk factors like blood pressure) and can authorise medical intervention.
• "Exercise" / "Walk more" (#7, #29, #34): A universally correct lever. Exercise is proven to raise HDL ("good" cholesterol) and improve overall metabolic health.
• "Eat healthily" / Detailed Dietary Advice (#7, #13, #20, #41): This is the most powerful lever you control. The advice from users like KPO_SAHM (#13)is particularly high-signal:
  • Cut: Hydrogenated oils, shortening, margarine, processed foods, sugar, cream/dressings.
  • Add: Oats, fatty fish (sardines, salmon, mackerel).

Tier 2 Signal (High-Impact Systemic Factors)​

• "Losing weight is the fastest way" (#6, #16): Correct. Excess body weight is a primary driver of poor metabolic health, including high cholesterol.
• "Is your job stressful? Relax and have more sleep" (#17): A crucial, often-overlooked point. Chronic stress elevates cortisol, which can negatively impact cholesterol levels and overall health.
• "Cut down on processed food. Exercise more" (#11): A perfect, concise summary of the highest-leverage actions.

Noise & Misinformation (To Be Filtered)​

• "maybe tomorrow can't wake up" / "Prepare a will" (#3, #5): This is unhelpful fear-mongering. Your situation requires calm, strategic action, not panic.
• "cut out the carbs" (#10): Overly simplistic and potentially counter-productive. The type of carbohydrate matters more than the quantity. Refined carbs and sugar are the problem; complex, high-fibre carbs (like oats) are part of the solution.
• "mai jiak eggs?" (#44): This is based on outdated nutritional science. For most people, dietary cholesterol has a minimal impact on blood cholesterol levels.

2. The "Should Be" vs. "Actually Is" Diagnostic of Your Results​

This is the core of your "mind-****." You're stuck in a Schema-Reality Gap.

• Your "Should Be" Map: "If I make some healthy changes, my cholesterol should go down to a safe level. I shouldn't need medication because I'm trying." This map is based on a belief in linear, proportional returns on effort.
• The "Actually Is" Map (Your Blood Test Results):
  • Your LDL only dropped by 15% (182 → 155). This is a positive result but insufficient, as 155 mg/dL is still considered high.
  • Your Triglycerides increased by 15% (95 → 109). This is a negative signal, often linked to diet (especially refined carbs and sugar) and lack of sufficient exercise.
  • The Reality: Your body's system has a high degree of inertia. The minor changes you made were not powerful enough to shift its equilibrium significantly.

The Sovereign Reframe: Your 6-month update is not a failure. It is invaluable data. It has proven that your initial strategy was under-powered. This is a "Tuition Fee" that has bought you clarity. You now know that "tinkering" is not enough; an "architectural overhaul" is required.

​