LDL stuck at 190 after years of keto - help?
Mid-40s, male. Looking for some honest input from people who've been here.
I've been eating low-carb / keto for a few years now. My LDL has not come down — if anything it's drifted up:
- Oct 2021: LDL 169 mg/dL
- May 2025: LDL 190 mg/dL
- Dec 2025: LDL 192 mg/dL, ApoB 124 mg/dL
So roughly four years on the same way of eating and the LDL/ApoB just won't move in the right direction.
The odd part is that everything else looks like the diet is working. Over that same period:
- Triglycerides went from 356 → 178 → 84 mg/dL
- HDL went from 52 → 58 → 60 mg/dL
- Lp(a) came back very low (<7 nmol/L)
- CRP low, liver enzymes excellent
The flip side: HbA1c crept from 5.2% to 5.7% in about seven months, and I had a coronary calcium scan in 2025 that came back at CAC = 10 (80th percentile for my age/sex), so there's already some early calcification.
My current thinking is this: I've got another full blood panel coming back in about a week. After that, rather than jump straight onto a statin, I was planning to deliberately reintroduce carbs and come off strict keto for three months, then re-test, and only then decide whether to start a statin.
Two questions for the group:
- Does reintroducing carbs for three months and re-testing before deciding on medication seem like a sensible next step, or a waste of time given the numbers?
- For those who've had a high LDL on keto that wouldn't budge — what actually changed the number for you, if anything did?
Appreciate any perspective. Happy to add more detail from the panels if it helps.
EDIT for context: my keto is very "clean" - my saturated fats are low, my keto consumption is chicken, sardines, avocados, broccoli, egg whites, kefir, nuts, blueberries...