How early and aggressive lowering of apoB could change the course of ASCVD | The Peter Attia Drive
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- Опубліковано 21 вер 2024
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I'm 68 years old, active and in relatively good health (to the naked eye). Oh, and I live in Italy. Getting ready to do my annual blood works and your book and podcasts have opened my eyes. When I asked my doctor to include Lp(a)-P and ApoB he said, "Dr. Google is one thing, practicing medicine is another. In 40 years of professional life, I have never prescribed the analyses you asked for. HDL and LDL are fine." Now what? I can translate passages of "Outlive" for him or change doctors. 🙃
Suggest paying for (on your own) through outside lab (if possible) an extended lipid panel that includes ApoB, Lp(a)etc. Find a naturopath that will assist with that if needed. Request from your MD a coronary artery calcium score scan. If LDL is high your doctor may be OK with that one. I am in USA, but get what labs and testing I can get through MD/insurance and then get the rest via my naturopath and outside labs by paying out of pocket. I also spend a lot more on supplements than I would on insurance covered statins, but that’s my preference. Also some significant lifestyle changes are indicated (for my lipid profile & family history) and not everyone wants to do that either. Keep trying to find answers/solutions.
Just read what you’re saying. He’s done the same test for 40 years. That alone is a red flag and demonstrates what is wrong with the current healthcare system. Does he actually think he’s still current with up-to-date information. Find another doctor?
It seems that is not expensive. Do the APO B.
Sounds like you have a good guy who does not follow this pseudo science.
@@ms.knapik3668 This way you can worry yourself into an early grave right?
I told my new primary doctor I read Dr. Peter Attia‘s book Outlive and I would like all those tests done (not even knowing what “all” meant as I’m not trained in the medical field). Surprisingly, he sai, “I read the book and I follow him as well and listen to his podcast, The Drive”. He instantly ordered me a bunch of bloodwork and tests. I looked out big time that my new primary is young and following current medicine.
Great doctor! My dr said, when I asked for cholesterol analysis, ‘don’t tell me what to do’
What is the name of your doctor? By any chance is he in CA?
@@denisee1021 I live in NY. He lives in NY.
This is so frustrating!! I had a relatively well regarded lipidologist at UTSW tell me he didn’t want to even think about treating my ApoB (135 mg/dl) until I got off a low carb diet and got my LDL number lower. He told me to eat more pasta! I’m looking somewhere else.
I looked up a formula for calculated ApoB, which is ApoB = -33.12 + 0.675 x LDL + 11.95 x ln(TG). TG is triglycerides and ln is the natural logarithm function.
Since this formula uses the LDL and triglycerides numbers to estimate ApoB, it appears to be logical to focus on reducing LDL and triglycerides to reduce ApoB.
Total cholesterol = LDL + HDL + 0.2 x TG. Note that the ApoB formula above more heavily weights the TG number and that HDL does not even figure into ApoB. This is apparently because ApoB is not found in HDL, just ApoA. Good luck!
You would treat BOTH if you got off a low carb diet. Go whole foods, plant based, no oil, and your ApoB and LDL will both go down 70%.
@@MrBigNoodle There is no evidence going plant based leads to better longterm health outcomes. There is a case to be made for lowering animal-derived sat fats but I'm not sure about this in a more isolated, non-SAD setting. There is no evidence for getting rid of animal-based proteins. Furthermore, the biggest effect I've ever seen in a controlled environment was something like a 3 or 4% reduction in apoB, not controlling for other factors like processed carb intake or sugar.
@@WybjornVR There's mountain of evidence. You're just to stubborn to accept new information that goes against your beliefs because you like eating animal products.
Eat beef and fruit, I’d stay away from wheat and grains, eat raw cheese, fermented foods, butter , ghee
But how? How to lower ApoB?
YES BUT HOW DO YOU LOWER IT WITHOUT DRUGS?
37y F, LDL 186, ApoB 140. I’m thin and mostly eat healthy. Help!
The issue with this information is finding a dr who knows who to manage these markers is near impossible. And there’s no discussion on what medicines are used by Dr Atilla to treat apob so I can’t even bring that into to my Dr. Basically you’re saying “if you have high Apob you’re screwed….good luck “ :(
I'm going to experiment on myself to figure out why I have an elevated apo B and how to lower it. Stay tuned
Integrative MD
@@irondirectprimarycare9440 My ApoB is also elevated. One area I'm looking into is saturated fat, since I was eating a very high amount of saturated fat. There's a blog post out there somewhere from Attia on people who eat higher fat diets swapping saturated fat for monounsaturated fat, and having success lowering their ApoB. It seems to be only specific to people who are sensitive to saturated fat in this way, but it's the route I'm going first for my own personal experiment.
He has already said on previous podcasts that he uses a combination of low-dose statins (pravastatin), PCSK9 inhibitors, and ezetimibe. Unlikely you'll get PCSK9 inhibitor covered by insurance, so low-dose statins + ezetimibe.
@@irondirectprimarycare9440 any updates?
What about the toxic side effects, increase in diabetes and increase in Lp(a)?
How to lower ApoB?
There was I, looking at my Apo B of 76 thinking that’s pretty good and here Peter saying south of 60 is required. How to do that?
The problem with this short info segment is that one gets the impression that ApoB is the ONLY cause of ASCVD. He states that ASCVD would most likely be eliminated if we fixed the ApoB levels. That appears as a fairly naive statement, to put it mildly. I think the current literature sees ASCVD as a multi causal disease, receiving contributions from anything that increases oxidative stress on the arterial glycocalyx. These stressors include chronically elevated BP, insulin dysfunction, dietary factors (including eating too much or eating too little, eating the wrong combination of macronutrients, mistiming the eating windows etc), poor sleep, lack of regular exercise and on it goes. I’m a little disappointed to say the least. Especially after having read his book.
Without elevated ApoB, atherisclerosis will not occur regardless of whether other risk factors are present or not.
@@reason3581 I’m afraid you are mistaken but I wish you weren’t.
Having a normal Apo B level can certainly be a positive sign, as it suggests that the number of atherogenic particles in your blood is within a healthy range. However, it's important to understand that atherosclerosis is a complex process influenced by multiple factors, not just a single biomarker like Apo B. Other risk factors, such as genetics, LDL cholesterol levels, HDL (high-density lipoprotein) cholesterol levels, blood pressure, smoking, diabetes, inflammation, and overall lifestyle habits, can also contribute to the development of atherosclerosis.
Even if your Apo B level is normal, it's still possible to develop atherosclerosis if other risk factors are present. On the other hand, having a normal Apo B level can be an indicator of a healthier lipid profile, which may lower your overall risk of developing atherosclerosis.
@@user-fl5lr1nm5v I’m not talking about what your doctor calls ”normal”. I mean what people call physiological levels, like you have when you’re a child. If you ApoB is 40-60 the other factors won’t be enough to cause atherosclerosis.
@@user-fl5lr1nm5v Yes. Look at Lp(a) for ex.
@@user-fl5lr1nm5v "Normal" is not what we're shooting for here, we're trying for optimal, so ideally sub-40, maybe even sub-30 if you're willing to include pharmacological intervention.
My ApoB is HIGH yet my Triglyceride/HDL Ratio is 1.14. So one says heart attack the other says I'm protected. Having a problem with Science. Anybody?
ApoB is the much better indicator for risk of heart disease according to Attia and a few of his guests.
@@mediaskate648 Yeah and that's what they said about cholesterol. Notice the drug of choice is a Statin. Such BS
@@bobknob8261 The statin dosage they are recommending is 8x lower than standard though.
@@mediaskate648 and that makes it OK huh? What are you ? A Pharm rep? And high cholesterol or high ApoB is this a sign of Liver disease? Isn't that where this is all made?
@@bobknob8261 Lol because all pharmaceuticals are evil right - it's not a black and white world my friend. There's much grey and middle ground. Look for some nuance, it's not all or nothing.
I'm going to figure out how to lower my Apo B and increase HDL. I have everything else going in my favor. High T, 0 CACS, no CRP/ESR concern.
I have the same issue. My hdl,ldl-p, lipoprotein A, vldl, all suck. . 0 CAC and low CRP though so I have that going for me. Despite diet being dialed in, regular cardiovascular excercise I see no improvement. Not really sure where to go from here but feel like we’re just waiting around for bad things to happen.
@@imprezivr61 what is your testosterone level? I suspect that high T is associated with these markers. Both you and I are cardiovascular fit with low inflammation. I don't see a huge risk for us.
@@irondirectprimarycare9440 do you mind if I e-mail you and bounce some thoughts off you?
@@imprezivr61 sure
Anyone know if an ApoB lab needs to be done in a fasting state?
How can I find a doctor that actually understands these tests Peter is talking about. I asked my doc for an insulin resistance test bc I have diabetes in my family, but the doc said anything we find in that test would not matter bc the treatment would be the same as if we find issues in the A1c. Is he right? In other words, if something was wrong with ur blood sugar, we would also find that in A1c, so no need to do insulin resistance test. But the test must exist for a reason.
If you have an elevated A1C, you have insulin resistance. If you don't yet have an elevated A1C, an elevated insulin level would suggest that you have insulin resistance but that for now, your pancreas is functioning adequately. An A1C is not a volatile number, but an insulin level is quite volatile throughout the day which makes it hard to read. There aren't any standardized insulin levels yet, meaning no one has really established what "high" and "low" are.
ok, well seems like ur agreeing with my doc that a1C is all that's needed. Well, what about the tests that are specifically for insulin resistance? It doesn't seem like your assertion about no established highs and lows for inulin is correct. Here's the info on the other tests I found:
The following test results show Prediabetes2
* A1C-5.7 to 6.4 percent
* FPG (insulin resistance)-100 to 125 mg/dL (milligrams per deciliter)
* OGTT-140 to 199 mg/dL
-OGTT: The test usually takes around 2 to 3 hours to complete because blood samples are taken at multiple time points after glucose consumption.
-FPG: The FPG test is relatively quicker, as it requires only one blood sample taken after the fasting period.
@@juliebrown8375
I see, so you agree that A1c is always the first step and the other tests are just a further drill down. Maybe I ask if you're a nutrition or health professional? Maybe you came to this knowledge from self education.@@TimGautier
Thanks. What do you think about me getting tests: ApoB, Lp(a)etc. @@TimGautier
A1C shows your blood sugar levels going back the last 3 months.
A high A1C, means, chronically elevated blood sugar levels going back the last 3 months.
Oh man this is so bloody confusing. I though you were the guy who said high LDL didn’t really matter to cardiovascular disease. Isn’t apoB the thing that is attached to LDL for most of its short life through our blood steam. I’m really about to give up on this cholesterol subject and just eat what I want.
Check out Podcast #185, Dr. Allan Sniderman goes into great detail about the different types of LDL, the risk associated with it and how it differs from ApoB.
It's because it's not that important how much LDL cholesterol is on lipoproteins. It's the amount of lipoproteins that's way more important. If you think about it, the total amount of LDL cholesterol can be the same with low or high amount of lipoproteins (more or less LDL cholesterol attached to these). You have to be aware of having low amount of lipoprotein particles; secondly of having larger instead of smaller lipoprotein particles. Only after that we should look at cholesterol itself. So particle number, particle size and after that the rest.
ApoB is an indicator of the number of LDL particles you have. If you have high LDL but low ApoB, it indicates you have large LDL particles, which are not problematic...however if you have high or low LDL and also high ApoB, it indicates you have a a large quantity of smaller LDL particles, which are more problematic from a atherosclerosis standpoint.
@@adamanderson7761 thank you for clearing that up for me.
@@adamanderson7761 This in not true in my case, in terms of the relationship you describe between Apo B and LDL particle size. I have high LDL and a high number of LDL particles, and high Apo B, but most of my LDL is large pattern A, with hardly any small pattern B. I got an NMR cholesterol test which shows all this.
It sounds like you are a walking talking advertisement for statins? In all fairness, why did you not mention the side effects? Lower testosterone, increased blood sugar(increase type 2 diabetes risk), muscle pain. Also give us your thoughts on why statins are not effective in reducing LDL-P? To remind everyone, LDL-P is the killer component of LDL. It is responsible for taking millions of lives yearly. Please good doctor, we await your response
How do you lower APOB?
Awesome interview. Would Dr. Attia care to comment on Dr. Dr. Aseem Malhotra comments on JRE regarging statins? I respect both these men, but it may seem as though they contradict here. VERY CURIOUS!!
I am sorry, but suggesting everyone be on pharmaceuticals is just a hard no. This isn't just bad advice, its bad science. Want to lower Lp(a)? Look at Vit C, L-Lysine, and L-proline. Come on people.
Data doesn't agree with you
Where do things line up with very high ApoB, BUT also having very high ApoA1, and a ratio of .72?
I understand ApoB should be < 60.. but I've also seen that if your ratio of ApoB to ApoA is less than 0.5 then you can still be good, despite a high ApoB?
As far as reducing ApoB, aside from statins, PCSK9 inhibitors, ezetimibe... any thoughts on the usual recommendations for a 'healthy' diet.. lots of omega-3s, switching saturated fats to mono, soluble fiber, isolated soy protein.. lower body weight, no fructose & trans-fat?
Hey Ben - yours are the PERFECT Questions on this topic : ) TOO BAD they DIDN'T See Fit to reply to you ( : -StayWell
Only pharmacologics can get you down to the 30 apoB levels Peter recommends. ... he's stated that, too
@@mikevaldez7684 Niacin can bring this down quite easily - this is over the counter.
My understanding is that ApoB should be at "non-detrimental" level by following all you listed above. I wonder if we have any hard number at this point or if we're just spitballing.
Weird I just got some results for and it said under
For the first time ever, had my apoB tested, it's 150! Scared the hell out of me and my HDL is 35. I need to radically change things where do I start ?
I have been an exercise guy my entire life. I am 44. Good shape. I have a few lbs to lose by I exercise constantly and eat relatively healthy.
This feels like a death sentence. Can I become a patient of Peter Attia?
Go low carb and do resistance training and check labs again in 3 months.
And do an colonoscopy every day of your life to eliminate the risk of colon cancer
Probably need to go on a Statin or Bempedoic acid. Almost any MD can help you there. Just keep up the blood work in regular intervals and keep measuring.
I appreciate this video, I have struggled to understand what all the different results within an advanced lipid panel mean, and how much significance I should assign to each. Male, in his 50s.
For example, I currently have an ApoB of 56mg/dL, which according to this video is in the optimal range. However, my LDL Total Particle Number is 1372, which is "high" according to the reference range (normal is
Your results are almost exactly as mine and I’m confused too. No one replied here. Did he do a video addressing these outliers like you and i? I’m 51 Black female not over weight. Although prediabetic and possible LADA and why I am zeroing I on all these metabolitic biomarker a
buy them meds. only costs $1800 a month. big pharma. yay!!!
Very informative video
how low can we go?
Interesting stuff.
Sounds like he’s saying ALL apo-b is bad. But there are 2 types of LDL, small dense oxidized and the more benign large buoyant type. Apo b are on both types.
Both types can enter the artery wall.
Sooner the better, lower the better. That's what the data demonstrates.
Which medication is best for lowering ApoB?
statins
@@mohamedtawfeeq8524
Hehehe
burger king
@@PMO438 tried it, didn’t work
A healthy diet low in processed foods which contain the unhealthy fats. Taking medication is just adding to your troubles.
@peterattiamd apob 95, LDL 130,tot chol 210, calc score 0- 58 yr old active male-Dr wants statins, I’m not really feeling that route, thoughts?
Stick to your intuition on this. Your numbers are not that bad and statins are one of the very most dangerous drugs of the maintenance drugs.
Can someone explain how the "calcium score" is related to heart disease? What test do I need to measure it?
You need a cardiac CT scan to get a calcium score. The score tells you how much if any existing build-up of calcified plaque you have in your coronary arteries.
60 ? isnt that too low ?? am I misreading this
Using drugs targeting LDL to lower apob sounds like a recipe for disaster. But food and lifestyle can they get it done? Also you can drop the long disclaimer. Nobody can sue a doctor talking on UA-cam about blood tests for malpractice lol.
What does Dr. Attia think about eating nuts and seeds as the source of fat for a ketogenic diet for those with the APOE4 allele?
Would the high omega-6 content be a concern? I ask because I do not really like avocados and EVOO.
What about the phytosterols of nuts and seeds for those with sterol hyperabsorption?
nuts and seeds are good and hypersterolemia is extremely rare
@@lianjohnston461 Nuts and seeds offer little nutrition and contain many anti-nutrients.
Use ghee or butter or coconut oil instead of EVOO… these are better for yo ur heart than nuts…
The infant analogy doesn’t make any sense to me. There are so many things that are different between infants and adults. 😅
Prescribe low-fat plant-base diet, not statins!
I am not an expert but what ypu eat may not always lower LDL particularly when eating is good and exercise is high. No silver bullets except a Statin as needed.
Diet has less influence on cholesterol than most people think and even less influence on ApoB. The best dietary intervention would be >4g/day of EPA from oily fish.
@@halbritt Low-fat vegan diet is sufficient for almost everyone. Only FH patients require drugs. I cured people via diet personally. The hard part is to convince the patient.
@@halbritt Age impacts cholesterol, too.
it doesn't have to be low fat. Nuts, seeds, avocados' etc all lower apoB