# Fix the insulin. The cholesterol often follows.

> For many people, a bad lipid panel is a metabolic problem first: high insulin pushes triglycerides up and HDL down. Cut sugar and refined carbs, eat in a window, fast 36 hours once a week, lift and walk, and retest at 4–6 months. If ApoB climbs or the numbers won’t move, take them to your doctor.

- URL: https://www.plansforyourbody.com/plans/lower-cholesterol/
- Categories: Heart & circulation
- Updated: 2026-10-06
- Not medical advice: Discuss everything here with a medical doctor before acting on it — supplements included. Your doctor has your bloodwork and history. We have neither.

## The goal

Most people get a lipid panel, glance at “total cholesterol” and move on. That’s like judging traffic by the combined weight of the cars. This plan measures what matters, including the insulin behind it, fixes the inputs with food, fasting and training, and tells you when to hand the numbers to your doctor.

- **Measure:** Lipid panel · ApoB · Lp(a) once · fasting insulin · HbA1c · two-week CGM
- **Change:** Cut refined carbs · eating window · weekly 36-hour fast · strength and cardio
- **Retest:** At 4–6 months: compare, adjust, or take it to your doctor

## Why it matters: Your lipid panel is a symptom report.

- **The default:** Get told your cholesterol is “a bit high”, give up eggs, retest in a year. Meanwhile the insulin resistance underneath keeps pushing triglycerides up, HDL down and fat onto your organs. Plaque doesn’t wait for the next appointment.
- **The better bet:** High triglycerides, low HDL, a growing waist and creeping blood sugar usually travel together. They share a driver: chronically high insulin. Lower the insulin and, for many people, most of the panel moves with it. How far varies, and LDL is the least predictable. That’s the core of Dr. Jason Fung’s and Dr. Pradip Jamnadas’s work.

## How it works: Insulin runs the liver. The liver makes the lipids.

Eat refined carbohydrates and sugar, and insulin rises. Keep it high all day, every day, and the liver turns the surplus into fat. It ships that fat out as triglyceride-rich particles (VLDL), which become LDL. The liver gets fatty, the waist grows, and the lipid panel records the damage.

- **Triglycerides:** Mostly a carbohydrate story. Refined carbs, sugar (fructose especially) and alcohol push them up. They’re usually the first number to fall when you cut those.
- **HDL:** Rises as triglycerides fall, and with exercise and weight loss. A marker, not a lever: drugs that raised it didn’t prevent heart attacks.
- **LDL and ApoB:** LDL-C is the cholesterol inside LDL particles; ApoB counts the particles. High insulin tends to produce more, smaller particles, so ApoB can be high while LDL-C looks fine. Genetics and dietary fat matter too, which is why you measure instead of assuming.
- **Small, dense LDL:** Ronald Krauss’s lab at UCSF did much of the defining work here. When insulin stays high, the liver pumps out more triglyceride-rich VLDL, and those particles get stripped down into small, dense LDL that lingers in the blood. High triglycerides and low HDL are the visible sign of that pattern. In his trials, cutting carbohydrate improved it even without weight loss.
- **TG/HDL ratio:** Already on your panel, and a good stand-in for insulin resistance. Divide triglycerides by HDL. In mmol/L, under about 0.9 is good and over about 1.3 is a warning (in mg/dL: under 2, over 3).
- **Insulin and visceral fat:** Fasting insulin rises years before blood sugar does. Visceral fat, the fat packed around your organs, is metabolically active and inflammatory. It’s the fat Jamnadas targets, and the fat fasting draws on.
- **Lp(a):** A genetic, LDL-like particle. Diet and fasting barely move it. Measure it once so you know what you’re dealing with.
- **hs-CRP:** An inflammation marker. Insulin resistance and visceral fat push it up; it falls as they improve.

## The steps: Measure. Change the inputs. Retest at 4–6 months.


### Measure (Week 0): Get a baseline worth comparing against.

- **Lipid panel** (non-fasting is fine): Total, LDL-C, HDL-C, triglycerides and non-HDL-C. Work out your TG/HDL ratio while you’re there.
- **ApoB** (ask for it): The particle count. Often not run by default, and coverage varies by province, so ask.
- **Lp(a)** (once in your life): Genetic and stable. Canadian and US guidelines both say test every adult once. If it’s high, everything else on this page matters more.
- **Fasting insulin and glucose** (morning, after an overnight fast): Together they give HOMA-IR, a simple insulin-resistance score. Fasting insulin often isn’t covered in Canada. It’s cheap to pay for.
- **HbA1c and hs-CRP** (context): Your three-month blood sugar average, and inflammation.
- **Continuous glucose monitor** (two weeks): A small sensor on your arm for 14 days shows which meals spike you, how high, and for how long. Repeat every 4–6 months to see the trend.

### Change the inputs (Months 1–6): Lower insulin first. Much of the rest often follows.

- **Sugar and refined carbs** (cut hard): Sugar, sweet drinks, juice, white flour and most packaged snacks. The fastest lever on insulin, blood sugar and triglycerides.
- **Real food** (protein first): Build meals on protein, vegetables and natural fats: fish, meat, eggs, dairy, legumes, nuts. Protein and fibre keep you full and flatten glucose spikes.
- **Fats to cook with** (olive oil first): Extra-virgin olive oil, avocado and its oil, nuts, oily fish. Olive oil has the strongest trial evidence: in PREDIMED, a Mediterranean diet with extra olive oil cut heart attacks and strokes.
- **Eating window** (daily, e.g. noon to 8 pm): Eat inside a fixed window and not outside it. Fewer insulin spikes per day, fewer chances to overeat.
- **36-hour fast** (once a week): Dinner one day, then only water, black coffee or tea until breakfast two days later. A standard protocol in Dr. Fung’s clinic: long enough for insulin to fall and the body to draw on stored fat. A pinch of salt helps with headaches.
- **Training** (strength 2–3×/week, cardio 150+ min/week): Lift, and walk briskly or cycle most days. Muscle is where most of a meal’s glucose ends up, so more muscle means more room for it. Cardio makes that muscle more sensitive to insulin. Cardio also lowers triglycerides and raises HDL.
- **Alcohol** (none while fixing the numbers): It goes straight to the liver, raises triglycerides and adds to liver fat. Less is better; none is best while you’re fixing the numbers.

**Before you fast:** Don’t do extended fasts if you’re on insulin or other diabetes medication, pregnant, breastfeeding, underweight, or have a history of eating disorders, unless your doctor approves.

### Supplements (optional, with your doctor’s OK): Four with evidence behind them.

- **Plant sterols** (~2 g a day, split across meals): They block some cholesterol from being absorbed in the gut. Around 2 g a day lowered LDL by roughly 6–12% in pooled trials; the effect levels off near 3 g. No trial has shown they prevent heart attacks. Not for sitosterolaemia, a rare inherited condition. About 2 g a day lowered LDL roughly 6–12%. No trial yet shows fewer heart attacks.
- **Psyllium husk** (~5 g, twice a day, with a full glass of water): A soluble fibre. Always with plenty of water: taken dry, it can choke or block. It binds bile acids, so the liver pulls LDL from the blood to replace them. About 10 g a day lowered LDL by roughly 0.33 mmol/L (13 mg/dL) in pooled trials.
- **EPA/DHA omega-3** (2–4 g/day of EPA+DHA, with food): Count EPA+DHA on the label, not “fish oil”. High doses slightly raise the risk of atrial fibrillation and add to the effect of blood thinners. About 4 g a day cuts triglycerides 20–30%. Whether it prevents heart attacks is disputed (see below). Rhonda Patrick’s approach: test your omega-3 index first and adjust to the result, rather than guessing. Discuss with your doctor first.
- **Berberine** (500 mg, twice a day, with meals): A plant compound studied for blood sugar and lipids; about 1 g a day worked best in pooled trials. Stomach upset is common. It interacts with several medications, adds to the effect of diabetes drugs, and isn’t for pregnancy or breastfeeding. Pooled trials found lower triglycerides and LDL, along with lower fasting glucose and insulin.

### Retest (Months 4–6): Compare. Then decide.

- **Same panel** (repeat everything): Lipids, ApoB, fasting insulin and glucose, HbA1c, hs-CRP. Same lab if you can, on a normal eating day, not mid-fast.
- **Another CGM** (two weeks): Compare with your baseline. Fewer, smaller spikes is the goal.
- **If ApoB rose** (adjust your fats): Some people’s LDL and ApoB rise on lower-carb eating. If yours did, shift your fats toward olive oil, avocado, nuts and fish, ease off butter and fatty meat, and retest. Krauss’s group found that even in people with the small-particle pattern, a very high saturated-fat diet raised ApoB and small LDL. Cutting carbs and piling on butter isn’t the same plan.
- **If the numbers won’t move** (your doctor): Take the before-and-after numbers to your doctor. Whether you need medication is their call. Needing it isn’t failure.

## The rules: Short list. No exceptions.

**Choose:**
- Protein and vegetables at every meal
- Extra-virgin olive oil, avocado, nuts and oily fish for fat
- A fixed eating window, and one 36-hour fast a week
- Strength training, and walking most days

**Avoid:**
- Sugar, sweet drinks, juice and white flour
- Deep-fried and ultra-processed food
- Snacking outside your window
- Alcohol while you’re fixing the numbers

**Non-negotiables:**
- Measure ApoB and Lp(a) at least once.
- Don’t smoke. Quitting cuts the heart risk it adds, fast at first, though not back to a never-smoker’s for years.
- Talk to a medical doctor before you fast or start a supplement.
- Know your units: Canadian labs report mmol/L, US labs mg/dL.

## Checkpoints: What to track, and what good looks like.

Your doctor sets your targets based on your overall risk. These are common reference points, so you know what you’re looking at.

| What | Target | How and when |
|---|---|---|
| Triglycerides | <1.7 mmol/L (150 mg/dL); <1.1 (100) is optimal | Lipid panel. Usually the first number to fall. |
| TG/HDL ratio | <0.9 (mmol/L) · <2 (mg/dL) | Divide triglycerides by HDL. Over ~1.3 (3 in mg/dL) suggests insulin resistance. |
| HDL | >1.0 mmol/L (40 mg/dL) men · >1.3 (50) women | Lipid panel. Rises as triglycerides fall. |
| ApoB | <0.9 g/L (90 mg/dL) for most; lower if high risk | One blood test. If it rises on this plan, adjust your fats and retest. |
| LDL-C | <2.6 mmol/L (100 mg/dL) for most; lower if high risk | Read it alongside ApoB, not instead of it. |
| Lp(a) | <125 nmol/L (~50 mg/dL) | Once. Above this, risk climbs. |
| HOMA-IR | Under ~1.0 is ideal; over ~2.5 suggests insulin resistance | Fasting glucose (mmol/L) × fasting insulin (µU/mL) ÷ 22.5. Retest at 4–6 months. |
| HbA1c | <5.7%, and falling | Every 4–6 months. Diabetes Canada flags 6.0–6.4% as prediabetes; the US threshold starts at 5.7%. |
| CGM readings | Mostly 3.9–7.8 mmol/L (70–140 mg/dL), back down within 2 hours of a meal | Two weeks, every 4–6 months. |
| hs-CRP | <2 mg/L | Repeat if high. A cold can spike it. |
| Omega-3 index | 8% or higher; 4% or lower is the worst-risk group | Finger-prick test of EPA+DHA in your red blood cells. Optional. Rhonda Patrick uses it to judge whether you’re eating enough oily fish, or need more. Red cells turn over slowly, so retest a few months after changing intake. |

Converted values are rounded. Your lab’s “normal range” is not your target: it describes the population, and the population has a lot of heart disease.

## Where experts disagree: Where the doctors don’t agree.

Nobody serious argues that insulin resistance is good for your arteries, or that the particles don’t matter. The fight is over which comes first, and what to do about LDL.

### Is the target LDL, or insulin?

- **Insulin first: Fung, Jamnadas:** Insulin resistance, visceral fat and inflammation drive heart disease. Fix the metabolism and the lipid pattern improves: triglycerides fall, HDL rises, LDL particles get larger.
- **Particles first: Sniderman, Ference:** ApoB particles cause plaque whatever your insulin is doing. Genetic and trial evidence shows risk falls in proportion to how far, and for how long, you lower them.

**Our read:** Do both. Fixing insulin is the foundation; ApoB is the check. If it’s high, or rising, it needs dealing with however good your glucose looks.

### Does high LDL on a low-carb diet matter?

- **Lean mass hyper-responder researchers: Norwitz, Feldman:** Some lean, metabolically healthy people see LDL soar on low-carb diets. Their 2024 study found no more plaque than in matched controls.
- **Most lipid specialists:** Small, cross-sectional, and short compared with how plaque develops. Particles don’t check your HbA1c before entering the artery wall.

**Our read:** Nobody has shown high ApoB is safe over decades. Until someone does, treat a soaring LDL as a reason to adjust the diet, not as a badge.

### Carbs or saturated fat?

- **Carbohydrate first: Krauss:** For the small-particle pattern that comes with belly fat and insulin resistance, cutting carbohydrate is the most effective dietary lever. Limiting saturated fat lowers LDL-C but does little for that pattern.
- **Saturated fat matters too: guideline committees, and Krauss’s own trial:** Saturated fat raises LDL and ApoB. Even in people with small particles, a very high saturated-fat diet pushed ApoB up.

**Our read:** Cut the refined carbs first; that’s the bigger lever for most people on this page. Then let your fat choice follow your ApoB, not a diet tribe.

### Is fasting better than just eating less?

- **Fasting: Fung, Jamnadas:** Fasting lowers insulin in a way that grazing on fewer calories doesn’t, and pushes the body into its fat stores, visceral fat included.
- **Trialists: Liu et al.:** In a 12-month trial, time-restricted eating plus calorie restriction did no better for weight or metabolic markers than calorie restriction alone.

**Our read:** For many people, fasting works because it makes eating less easy to stick to. That isn’t a knock: sticking to it is the whole game.

### Does fish oil prevent heart attacks?

- **REDUCE-IT investigators: Bhatt:** Purified EPA (icosapent ethyl) cut major cardiovascular events by 25% in high-triglyceride patients already on statins.
- **STRENGTH investigators: Nissen:** REDUCE-IT’s mineral-oil placebo raised LDL and inflammation, flattering the drug. Against a neutral corn-oil placebo, an EPA+DHA mix did nothing.

**Our read:** It reliably lowers triglycerides. Whether it prevents heart attacks is unsettled. Take it for the triglycerides, not as insurance.

### Lipids or inflammation?

- **Inflammation first: Ridker, Jamnadas:** Atherosclerosis is an inflammatory disease. Even with low LDL, a high hs-CRP signals leftover risk.
- **Lipids first: most lipidologists:** No ApoB particles, no plaque to inflame. Lower the particles first.

**Our read:** Not either-or. The same things drive both: high insulin, visceral fat, smoking and poor sleep.


## Limits: What this plan won’t fix.

- **Your genes:** Lp(a) barely moves with diet or fasting. Familial hypercholesterolemia (roughly 1 in 250 people) won’t yield to lifestyle changes. If either applies, your doctor’s plan is the plan.
- **Plaque you already have:** Better numbers slow plaque and can stabilise it. They don’t erase a calcium score.
- **Time:** Lifetime exposure is the variable. You can’t refund the years already spent at a high number. You can stop adding to the bill.

*The plan fixes the inputs. It doesn’t rewrite your past or your DNA.*

## Resources

- The Obesity Code — Jason Fung, MD. The case that insulin, not calories, drives weight gain and metabolic disease.
- The Complete Guide to Fasting — Jason Fung, MD, with Jimmy Moore. The practical manual: how to run 16-hour, 24-hour and 36-hour fasts, and what goes wrong.
- [Why this cardiologist recommends fasting](https://drchatterjee.com/513) — Pradip Jamnadas, MD, on Feel Better, Live More. Jamnadas on insulin, visceral fat and heart disease, in his own words.
- [2021 CCS Guidelines for the Management of Dyslipidemia](https://ccs.ca/guideline/2021-lipids/chapter-1-introduction/) — Canadian Cardiovascular Society. What your Canadian doctor is working from: ApoB, non-HDL and once-in-a-lifetime Lp(a).
- [Dietary management of atherogenic dyslipidemia](https://doi.org/10.1007/s11883-025-01335-6) — Shieon Kim, Min-Jeong Shin and Ronald Krauss, MD. Krauss’s 2025 review: why cutting carbohydrate is the main dietary lever for high triglycerides, low HDL and small LDL.
- [How the Omega-3 Index guides EPA and DHA intake](https://www.foundmyfitness.com/episodes/how-the-omega-3-index-guides-epa-and-dha-intake) — Rhonda Patrick, PhD, FoundMyFitness. Why she tests instead of guessing, and what the 8% target means.

## Questions

### What’s the fastest way to lower cholesterol without medication?

Cut sugar, refined carbs and alcohol; triglycerides often drop within weeks. Add an eating window, a weekly 36-hour fast and training to bring insulin down. LDL and ApoB move more slowly and less predictably, which is why you retest at 4–6 months.

### Do triglycerides come from carbs or fat?

Mostly from carbs, sugar and alcohol: your liver turns the excess into triglycerides. Dietary fat raises them briefly after a meal, but high fasting triglycerides are usually a carbohydrate and insulin problem.

### Will fasting raise my cholesterol?

It can, temporarily: LDL often rises during a fast as fat is mobilised. Don’t get tested mid-fast; test on a normal eating day.

### Is ApoB better than LDL?

For most people they agree. When they don’t (high triglycerides, diabetes, insulin resistance), ApoB is the better predictor because it counts particles directly.

### Do I need to fast before a cholesterol test?

Not for the lipid panel, ApoB or Lp(a). Fasting insulin and glucose do need an overnight fast, so book those for the morning.

### Do eggs raise cholesterol?

For most people, eggs have a small effect on blood cholesterol. Some people respond strongly. Your retest will show which you are.

### Should I worry about small, dense LDL?

It’s the pattern that comes with high triglycerides, low HDL and insulin resistance, and it tends to improve when you cut refined carbs and lose belly fat (Krauss’s trials). You rarely need a special test: your TG/HDL ratio and ApoB tell most of the story.


## Sources

- Jason Fung, MD — Nephrologist, Toronto. Author of The Obesity Code and The Complete Guide to Fasting.
- Pradip Jamnadas, MD — Cardiologist, Florida. Clinical assistant professor; known for his lectures on fasting, insulin and heart disease.
- Allan Sniderman, MD — Cardiologist, McGill University. Leading advocate of ApoB over LDL-C.
- Brian Ference, MD — Cardiologist and epidemiologist. Lead author of the EAS consensus that LDL causes atherosclerosis.
- Paul Ridker, MD — Cardiologist, Harvard. Inflammation and hs-CRP research.
- Rhonda Patrick, PhD — Biomedical scientist (PhD, biomedical science). Research and reviews on micronutrients, omega-3s, sauna and ageing; FoundMyFitness.
- Ronald Krauss, MD — Lipid researcher, UCSF. Defined small, dense LDL and studies how carbohydrate and fat change LDL particles.

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