“I just don’t want to put the drugs in my body”.
What one patient taught me about the cholesterol conversation.
Elaine came in to the consulting room as she normally does. Unhurried, warm and curious. But I could tell something was sitting on her mind before she even sat down.
We’d spoken a few months earlier about her cholesterol. I’d laid out the numbers, explained the trajectory and then suggested we revisit things.
She’d tried the dietary approach using the portfolio diet, but she wasn’t going to be able to sustain it. It hadn’t worked for her.
Her cholesterol numbers don’t lie.
But they don’t tell the whole story either.
Her lipid profile has been consistently raised in the last couple of years. Her total cholesterol above 8, LDL above 5, non-HDL above 6.
Even on her best result ever, her non-HDL had only come down to 4.8 mmol/L. Her genetic finger print was unmistakeable.
Her CT coronary calcium score had come back at 17, which is low.
It sounds reassuring, and in one sense it is, there’s a very low risk of heart attack.
But she is still in the highest risk category for her age in her early 50s. and that’s precisely the problem. Her trajectory to having a heart attack could be much faster than someone else’s.
Her father had a heart attack in his mid-fifties.
I drew a little diagram. Age on one axis, calcium score on the other.
Where she is now. Where the “bad zone” starts. How her trajectory, if unchanged, gets her there considerably faster than someone starting from a lower baseline.
She watched it take shape on the paper and I watched something shift in her face.
“Yeah. I can see the end of the movie.”
The Real Conversation
Here’s the thing about cardiovascular prevention that they don’t teach you enough in medical school: the evidence is the easy part.
What she said, quietly, honestly, was something far more human.
“I just like to be pretty clean. I don’t want to put things in my body that I don’t need to.”
She knew there might be natural alternatives. She was concerned about the long-term effects on her organs, particularly her liver.
Elaine wanted a conversation for better understanding and clarity, not a prescription handed to her.
So we talked about what the medicine does at a cellular level. Why the rare muscle aches might happen and what you can do about them.
About the liver. How we see might see transient enzyme changes sometimes, but genuine liver injury from statins is extraordinarily rare.
About the fact that I’ve prescribed statins thousands of times and never seen serious liver toxicity, but that there is still a theoretical risk of this.
And then she asked the question I love: “What about the herbal options?”
What the evidence actually says about herbal supplements.
I want to be honest here, because I think patients deserve honesty over false reassurance.
The SPORT trial, published in the Journal of the American College of Cardiology directly compared rosuvastatin 5mg to six popular supplements in people with elevated cardiovascular risk. The six were fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice.
Rosuvastatin was the only intervention that significantly reduced LDL.
None of the supplements outperformed placebo in a meaningful way.
Garlic, in this trial, actually raised LDL slightly.
A nuance worth noting: Supplement quality varies enormously, and some formulations (particularly red yeast rice) have performed better in other studies.
But that variability is itself part of the problem.
A short summary of the most evidence-supported natural options:
Plant sterols (2g/day): May reduce LDL by around 8–12% by blocking cholesterol absorption in the gut.
Reasonable as an add-on to other treatment. But no proven reduction in heart attacks or strokes yet.=, likely because the aren’t enough studies being done.
Red yeast rice: Can reduce LDL by 21–30% in good-quality formulations. Why? Because it has similarity in how the statins work.
Berberine: A modest 4–5% reduction in LDL on its own.
A bigger impact when combined with red yeast rice. My patient is already taking it, a reasonable choice, but insufficient alone for her risk profile; and clearly not having an impact on her blood tests.
Soluble fibre (psyllium, oats): 5–8% LDL reduction.
Safe, well-tolerated, and great for gut health too. No reason not to include it.
Turmeric and fish oil: No significant LDL-lowering effect in head-to-head trials, but notably there might be other reasons why to consider including these.
Now compare all of that to rosuvastatin 10mg: 44–47% LDL reduction.
And in the HOPE-3 trial, a 24% reduction in cardiovascular events in people who’d never had a heart attack.
This isn’t a close contest.
What did Elaine decide?
I didn’t push her. I laid it all out. The diagram, the numbers, the supplements, the medicine, the side effect profile.
And then she said something that I think about often when I reflect on what good preventive medicine looks like:
“So... why wouldn’t I be on it?”
Not because I told her to.
Not because she felt she had no choice. But because she’d walked through the evidence herself and arrived somewhere honest.
She took the blood test form, she’ll repeat her cholesterol and liver profiles. And we’ll speak next week.
What this consultation is really about.
My opinion is that patients who are reluctant to take medication are not being irrational.
They are being human.
They have watched people they love take handfuls of tablets. They’ve read about side effects online.
They value feeling well and in control of their own bodies.
Our job isn’t to override that. It’s to meet it.
When someone tells me they don’t want to put things in their body, they’re not telling me no.
They’re telling me they need to understand why. They’re telling you the threshold for yes is higher than the cholesterol number on a page.
That threshold, once crossed with honesty and respect, tends to hold.
What’s your experience with conversations about cholesterol?
I’d love to hear how you navigate the conversation or have experienced it.