Plans for Your Body · Heart & circulation
The cholesterol plan
Fix the insulin. The cholesterol often follows.
The goal: 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.
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.
- MeasureLipid panel · ApoB · Lp(a) once · fasting insulin · HbA1c · two-week CGM
- ChangeCut refined carbs · eating window · weekly 36-hour fast · strength and cardio
- RetestAt 4–6 months: compare, adjust, or take it to your doctor
Most people treat the number. This treats what’s driving it.
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.
02 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.
Knowing what drives the numbers changes what you do. Here’s the mechanism.
03 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.
04 The steps
Measure. Change the inputs. Retest at 4–6 months.
Measure · Week 0
Get a baseline worth comparing against.
- Lipid panelnon-fasting is fine
Total, LDL-C, HDL-C, triglycerides and non-HDL-C. Work out your TG/HDL ratio while you’re there.
- ApoBask 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 glucosemorning, 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-CRPcontext
Your three-month blood sugar average, and inflammation.
- Continuous glucose monitortwo 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 carbscut hard
Sugar, sweet drinks, juice, white flour and most packaged snacks. The fastest lever on insulin, blood sugar and triglycerides.
- Real foodprotein 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 witholive 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 windowdaily, 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 fastonce 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.
- Trainingstrength 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.
- Alcoholnone 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.
Find it on Amazon: Plant sterols - 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.
Find it on Amazon: Psyllium husk - EPA/DHA omega-32–4 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.
Find it on Amazon: EPA/DHA omega-3 - Berberine500 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.
Find it on Amazon: Berberine
Retest · Months 4–6
Compare. Then decide.
- Same panelrepeat everything
Lipids, ApoB, fasting insulin and glucose, HbA1c, hs-CRP. Same lab if you can, on a normal eating day, not mid-fast.
- Another CGMtwo weeks
Compare with your baseline. Fewer, smaller spikes is the goal.
- If ApoB roseadjust 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 moveyour doctor
Take the before-and-after numbers to your doctor. Whether you need medication is their call. Needing it isn’t failure.
05 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.
06 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.
07 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.
08 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.
09 Resources
Worth your time.
The Obesity Code
The case that insulin, not calories, drives weight gain and metabolic disease.
The Complete Guide to Fasting
The practical manual: how to run 16-hour, 24-hour and 36-hour fasts, and what goes wrong.
Why this cardiologist recommends fasting
Jamnadas on insulin, visceral fat and heart disease, in his own words.
2021 CCS Guidelines for the Management of Dyslipidemia
What your Canadian doctor is working from: ApoB, non-HDL and once-in-a-lifetime Lp(a).
Dietary management of atherogenic dyslipidemia
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
Why she tests instead of guessing, and what the 8% target means.
10 Questions
Questions, answered plainly.
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.
11 Sources
Where this comes from.
Experts drawn on
- 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.
Sources
- Why this cardiologist recommends fasting, with Dr Pradip Jamnadas. Feel Better, Live More podcast.
- 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia. Canadian Journal of Cardiology, 2021.
- Top 10 takeaways: 2021 CCS lipid guidelines. Canadian Cardiovascular Society, 2021.
- 2026 ACC/AHA/Multisociety Dyslipidemia Guideline released. National Lipid Association, 2026.
- Low-density lipoproteins cause atherosclerotic cardiovascular disease (EAS consensus). European Heart Journal, 2017.
- Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts (PREDIMED). New England Journal of Medicine, 2018.
- Calorie restriction with or without time-restricted eating in weight loss. New England Journal of Medicine, 2022.
- Psyllium fiber: regularity and healthier lipid levels? (summary of Jovanovski et al., AJCN 2018). Harvard Health Publishing.
- LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. British Journal of Nutrition, 2014.
- Effect of psyllium (Plantago ovata) fiber on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B: a systematic review and meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 2018.
- Prescription omega-3 medications work for high triglycerides, advisory says. American Heart Association, 2019.
- Effect of berberine on cardiovascular risk factors: systematic review and dose-response meta-analysis. Frontiers in Nutrition, 2022.
- Carbohydrate restriction-induced elevations in LDL-C and atherosclerosis: the KETO trial. JACC: Advances, 2024.
- Fish oil tanks in STRENGTH, making waves for REDUCE-IT. TCTMD, 2020.
- The Omega-3 Index: a new risk factor for death from coronary heart disease?. Preventive Medicine, 2004.
- How the Omega-3 Index guides EPA and DHA intake. FoundMyFitness.
- Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. American Journal of Clinical Nutrition, 2006.
- Effects of a very high saturated fat diet on LDL particles in adults with atherogenic dyslipidemia: a randomized controlled trial. PLOS One, 2017.
- Dietary management of atherogenic dyslipidemia. Current Atherosclerosis Reports, 2025.
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.