In my clinic, I don’t prescribe statins. That might sound shocking, but the more we learn about metabolic health, the clearer it becomes that these drugs don’t deliver on their promise for everyone with “high” cholesterol. Many people, especially those on a ketogenic diet, see their cholesterol numbers—particularly LDL—shoot up and start to panic. They hear the message that if statins aren’t the answer, then maybe they don’t have to worry about heart disease at all. Is that true? While I don’t worry about high cholesterol in the same way other doctors do, I absolutely worry about heart disease. The key is understanding that high cholesterol isn’t the disease; it’s often just a symptom. The real problem is something much more sinister: insulin resistance. Let me show you how I think through this and guide my patients back to true metabolic health. (Based on the insights of Dr. Annette Bosworth)
Key Takeaways
- Heart disease is not primarily a cholesterol problem; it’s a symptom of an unhealthy metabolism driven by chronically high insulin (insulin resistance).
- Instead of a standard lipid panel, a more advanced test called an LP-IR score provides a much better prediction of your future heart attack risk by measuring how your body handles fats.
- Activating your body’s cellular cleanup process, known as autophagy, is critical for reversing damage. This can be measured and achieved by lowering your Dr. Boz Ratio (glucose divided by ketones).
- For high-risk individuals, specific medications can act as a temporary “bridge to safety” while you work on reversing the underlying metabolic issues.
1. Reverse the Real Culprit: Insulin Resistance
Let’s start with the root cause. That high total or LDL cholesterol you see on your lab report isn’t the villain it’s made out to be. Think of those circulating fat droplets as passengers in a car. The real danger is the driver: high insulin. It’s no coincidence that heart disease and diabetes almost always show up together in a patient’s chart. So why do we treat them as separate issues, calling diabetes a “risk factor”? The truth is, they are both symptoms of the same underlying disease—an unhealthy metabolism that has been fueled by too much insulin for far too long.
Here’s how it works. Every time your blood sugar spikes (from eating carbs and sugar), your pancreas releases insulin to manage