Episode 4 – An Engineer’s Dilemma: Should I Debug My LDL or Just Take the Statin?
This is the fourth part of my ongoing series on fasting, metabolic health, and the curious adventure of an engineer trying to understand biology using logic, data and the occasional mild panic.
If you haven’t read the earlier episodes, you can find them here:
- Episode 1 – A Journey to Outsmart Blood Sugar (Before It Outsmarts Me)
- Episode 2 – When Fasting Met Blood Donation — An Accidental Experiment
- Episode 3 – When Numbers Tell Stories: My Annual Blood Report Meets Twice a Month Fasting
The Story So Far…
In the last episode, I shared how practicing twice-a-month 36–48 hour fasts and following an 18:6 eating window dramatically improved my glucose levels. My energy went up, my sleep improved, and for the first time in years, it felt like my body and brain were finally running the same firmware version.
I was quietly hoping that my annual blood report would give me a shiny “all clear” stamp.
It didn’t.
The Lipid Plot Twist
Buried in the report was the new villain of this season: my lipid panel.
- Total Cholesterol: 221
- Triglycerides: 104
- HDL: 40
- LDL (calculated): 162
Total cholesterol never impressed me much. As Dr. Robert Lustig likes to say: “Total cholesterol, throw it in the garbage. It means absolutely nothing… you need to know what kind of cholesterol you’re talking about.”
Still, 162 for LDL is not the kind of number you frame on the wall, and my primary care physician reacted exactly as modern protocols expect her to.
Within hours of the lab results, she had electronically sent a prescription for statin. The pharmacy messaged me almost instantly: “Your medication is ready for pickup.”
Appointments may take weeks, but prescriptions fly at fibre-optic speed.
The Oct 21 Confession
At my annual physical on October 21, I decided to be honest.
“Doctor,” I said, “I never took the statin you prescribed last year.”
Her face went into that familiar expression that doctors reserve for engineers, lawyers and people who Google too much.
Last year (2024), she had prescribed 10 mg of statin. I quietly ignored it and, instead, started fasting regularly, shifted to two meals a day, and tried to fix the inputs before accepting a lifelong pill.
She listened, sighed, and said something to the effect of: “If your lipid panel is still bad this year, I will prescribe it again — and this time you really must take it.”
Fair enough.
But when I opened this year’s prescription, I noticed something that instantly activated my engineering brain:
- 2024: Statin 10 mg (never taken)
- 2025: Statin 5 mg
So without taking any statin at all, just by changing lifestyle, I had apparently earned a 50% dose reduction.
The engineer in me immediately plotted a mental graph: keep fasting, extend the trend line, and maybe next year the dose is… 0 mg?
Is this exactly how medical dosing works? Of course not. But try telling that to an engineer who just discovered a pattern.
The Internal Debate: Pill Now or Data First?
That’s when the real dilemma started. A familiar internal argument began between “Obedient Patient” and “Annoying Engineer.”
Questions began to swirl:
- Can fasting and lifestyle alone bring LDL to a safer range?
- Is LDL-C by itself enough to justify a lifelong medication?
- Are my LDL particles mostly small and dense or large and floaty?
- Shouldn’t I understand more before agreeing to a daily pill for the rest of my life?
Biology may be complex, but engineers are stubborn. We like to see the whole diagram before we press “Run”.
So I did what any 2025 engineer would do: I asked a few trusted AI tools, read several articles and listened to some long-form discussions on lipids.
The recurring message was clear:
LDL-C alone doesn’t tell the full story.
The Missing Pieces Behind LDL
This is where two other characters walked onto the stage: a deeper look at particle numbers and a better way to see whether plaque is actually forming in the arteries. Let’s just call them “advanced blood markers” and “artery imaging” for now, to keep things simple.
The idea that really clicked with my engineering mind was this:
- One set of tests can tell you how many potentially troublesome particles are circulating.
- Another test can show if those particles have actually started building plaque on your artery walls.
In other words, one tells you about risk potential, the other shows the actual damage so far.
That combination felt much more satisfying than a single “LDL 162 → take statin” rule.
Why These Extra Tests Matter (Especially to an Engineer)
Think of it this way:
- Your standard lipid panel is like looking at the total number of cars entering a city.
- The advanced markers tell you how many of those cars are heavy trucks with dodgy brakes.
- The artery imaging tells you whether there are already traffic jams and accidents inside the city.
If my “traffic report” shows both a high number of risky vehicles and proof of actual pile-ups inside the arteries, then statins make much more sense to me.
But if the traffic looks busy on paper and, on imaging, the roads are still clear… then it becomes a very different conversation.
Why Am I Doing This and Not Just Obeying?
I often ask myself: why should patients have to reverse-engineer their own treatment plan?
Medicine still runs a lot on statistical averages and guidelines written for populations. But I am not a population. I am a single data point with my own history, habits, genes and quirks.
Yes, doctors must worry about legal risk. Yes, guidelines are written to be safe for the majority. But those of us who think in spreadsheets, graphs and decision trees crave a bit more personalization.
And, most importantly, if I am going to take a pill every day for the next several decades, I want to be absolutely sure I am taking it for the right, well-understood reasons.
When Silicon Valley Meets Artery Valley
Engineers spend years debugging code and chasing down intermittent faults in systems. Our instinct is always:
“Don’t just reboot. Find the root cause.”
So when my LDL came back elevated, I couldn’t just “reboot” by swallowing a statin and hoping for the best. I wanted to profile the system, inspect the logs, and understand whether the real bottleneck was lifestyle, genetics, inflammation, or early plaque buildup.
That doesn’t mean I am anti-medicine. It just means I prefer to read the full specification sheet before I sign up for a lifetime contract.
So What’s the Plan?
Here’s my next step:
- Get the additional blood markers that go beyond standard LDL-C.
- Get an imaging test that can show whether there is already plaque in my coronary arteries.
- Then, sit down with my doctor and decide, with real data, whether statin is the right move for me now.
If those tests show that my arteries are already paying the price, I will have no hesitation in starting the medication. At that point, it won’t feel like surrender; it will feel like a data-driven decision.
If, on the other hand, the tests show that my risk is relatively low despite the LDL number, then I may get a bit more time to double-down on lifestyle, fasting and other non-pharmaceutical levers.
Either way, the decision will be anchored in much more than a single number on a lab report.
And because I’m still an engineer at heart, I am also sketching a simple little decision framework for myself — almost like a flowchart for cholesterol choices. I’ll share that in Episode 5, once I have my own test results in hand so that you can see how the logic plays out on real data instead of just theory.
Your Turn
If your doctor has ever prescribed a medication for cholesterol, did you:
- Start it immediately and trust the recommendation?
- Or did you pause, research, and look for more data the way I’m doing now?
I’d love to hear what you did — and whether you’d make the same decision again with what you know today.
In the meantime, I’ll be out here debugging my own biology, one lab report at a time.
⚠️ Author's Note
These reflections come from an engineer who started learning human biology far too late in life — mostly out of curiosity, partly out of necessity. What began as an attempt to outsmart blood sugar turned into a crash course in metabolism, ratios, and resilience. I’m not a doctor, and this isn’t medical advice. Please consult your physician before experimenting with fasting, diet tweaks, or supplement changes. Think of this as a mid-life engineering project on the body’s operating system — one where trial, error, and humility are all part of the lab work.





In my previous story, I wrote about experimenting with fasting, exercise, and lifestyle tweaks to outsmart my blood sugar, not as a health guru, but as an engineer curious about how the body responds to small system changes.