Dr. Boz [Annette Bosworth, MD] - Statins... what keto doctors don't tell you

Short Summary

Main recommendation: Dr. Boz (Annette Bosworth, MD) argues that statins are not evil and can reduce heart disease risk for people with significant risk factors, but that people with high cholesterol who prefer not to take a statin should consistently follow a keto diet and control metabolic markers such as hemoglobin A1c, uric acid, body weight, and mitochondrial health. She explains that her own high total cholesterol does not put her at meaningful risk because of her low overall risk profile, so she would not be prescribed a statin.

Key Points

• Statins do lower cholesterol, which is one heart disease risk factor, and they can improve risk profiles for people with several risk factors, though she does not think they should be added to water supplies.
• Total cholesterol is not the key measure; LDL cholesterol is a calculation in a lipid panel, and the real concern is LDL particles that stay in circulation long enough to enter the artery wall.
• High insulin and fatty liver slow the clearance of lipoproteins: liver receptors ("catcher mitts") become scarce, and the slime layer protecting particles breaks down, so LDL particles lodge in artery walls and can cause plaque that ruptures into a heart attack.
• Statins increase the number of liver receptors, helping lipoproteins recycle out of the bloodstream instead of accumulating in artery walls.
• Her personal risk is low by the Framingham risk tool (under 1% over 10 years), based on her age, no smoking, normal blood pressure, high HDL, and her metabolic habits.

Details Worth Noting

• Concrete instructions: For a patient who does not want a statin, the speaker says they should be consistently keto and control several markers: hemoglobin A1c as low as possible, uric acid controlled, an ideal body weight, and maximized mitochondrial health. Before discussing cholesterol with her, check these numbers first.
• Concrete instructions: Fast at least 12 hours before a lipid panel, because right after eating, chylomicrons (very large triglyceride-carrying particles) are present and a non-fasting result is not reliable for interpretation.
• Concrete instructions: Discuss the risk and the options with a doctor rather than relying on YouTube for medical advice; she frames the video as education, not treatment guidance.
• Her own lipid panel was total cholesterol above 276, triglycerides 88, HDL 107, and LDL 155, taken as a 51-year-old woman with no smoking history and normal blood pressure. She says she fasts weekly, keeps body weight down, keeps blood sugar low, and supports mitochondrial health.
• Patients with cancer history, radiation exposure, high uric acid, diabetes, or a prior heart attack have much higher risk, and she says a keto approach alone is not appropriate for them to avoid statins.
• Statin side effects she mentions include muscle pain, reports from patients that their thinking seems less sharp, and calcification of arteries, though she notes calcification may help in select patients who are about to have a heart attack.

Bottom Line

Cholesterol numbers alone are not enough to judge heart attack risk; the context of insulin, liver fat, and how well LDL particles are cleared matters, and anyone at high risk should discuss statin decisions with a physician.