ApoB VS LDL-Cholesterol: Request this Marker Instead
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- Опубліковано 18 чер 2024
- Standard lipid panels are actually mathematical approximations. Emerging data suggests using the very affordable ApoB to ApoA1 ratio as well as lipoprotein particle subtraction testing more accurately assess cardiometabolic disease risk.
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Time Stamps
0:00 Intro
0:45 ApoB why it’s more accurate
1:30 High LDL on a ketogenic diet
2:24 Heart disease deaths increase in the winter
2:59 High LDL after fasted exercise
4:50 What ApoB means and why it matters
7:15 Why Omega-6 seed oils are bad if your LDL is high
9:11 Request your ApoB to A1 ratio instead
9:38 Standard cholesterol tests are a mathematical estimate
12:06: HDL and ApoA-1, how it’s cardioprotective
12:45 Harvard case study of LDL increases on a Keto diet
19:25 Advanced lipoprotein particle testing overview
Medical Technologist here: we measure HDL and LDL directly but calculate the VDL and non cholesterol. It all depends on the analyzer that your blood work is being tested on to satisfy the equation. Bigger labs=more funding=expanded test menu=better analytical procedures (most of the time).
Bur to your point about apo a/apo b, it amazes me no one gets this test. Thank you for this healthy guide! More health advocates and physicians need to see this information.
Why does mine (labcorp) always say "LDL Cholesterol Calc" then?
@blondre3000 "It all depends on the analyzer that your blood work is being tested on to satisfy the equation." In other words, different labs calculate different components. It seems LabCorp's way may be the most common, though, depending how Quest does it.
Thanks for this info!!!!❤
Yes, I don't like the "calc" part. Trying to find a lab/test where they actually measure everything.
I lost 74lbs doing IF/low carb & exercising 7 days a week. My cholesterol went up 264 & LDL 184. My Tri went down to 87 & HDL up 74. A1C 5.2
My doctor freaked said need statin. I said NO.
Even though lost wgt & other lab markers excellent. I am in my 60's on no meds.
reconsider the meds. My dad died at 60 of a heart attack. Because of his death I was able to get to a hospital when I had a heart attack at 38. Nothing dropped my cholesterol via diet or exercise. 80 MG Atorvastatin (generic Lipitor) cut my cholesterol down to normal levels. Then I find out years later my mom has been on a statin for years. Learn the symptoms of a heart attack and your family history. For some of us, our body makes the cholesterol. It's just a pill before bed. No side effects and cut my total cholesterol from 250 to 110.
@@fausto412 Its not the cholesterol that killed him, it's the sugar that does it. Get a cac scan
hsCRP is also a very important, if not the most important measure. Mine went from 12, which is 4x over the reference range, down 85% to 1.8 after 1 year on low carb, nearly zero sugar diet.
My quack said the same. To shut him up instead of statins, I started taking some 2gm omega 3 fish oils for a month and it came right, dropping my levels around 35%. He was happy, but confused. Reduced my bread intake, sugar and veg oils and it came down even more. These Doctors are just drug dealers. When it comes to health, they're of little use.
@@fausto412 yes this is typical, LDL is fine as long as your diet is healthy you will not have much oxidized LDL.
Lab here! Minor correction: when triglycerides are high (>400 mg/dL), LDL is usually measured directly instead of relying on calculation. That said, it will still miss the level of oxidation, and I really appreciate this educational video!
That's good to know. High for triglycerides is 400!!! mg/dl? Isn't this THE most important metric for cardio health? And high is considered 4 freaking hundred for triglycerides, but only 99 for LDL??!!
@blondre3000 oh, not quite what I meant. Anything over 200 mg/dL triglycerides would be considered clinically high (affecting patients). At least some clinics also have a borderline-high category below that, too. The 400 cut-off is methodically high where the triglycerides may significantly interfere with the accuracy of an LDL calculation, so most labs will switch to the more expensive direct LDL measurement.
Also, please note that normal ranges for different components should never be crossed. For example, just 7 mg/dL of potassium will stop the heart instantly. Although the ranges for triglycerides, LDL and HDL are somewhat more similar, they are supposed to be different. Granted, each normal range was established by studying the normal population, so I understand some skepticism if you're carnivore, but I would never recommend interpreting triglycerides by the range for LDL.
@@pondboy3682 Is the LDL-C number a direct measure of the cholesterol being transported inside the low density lipoprotein carrier? When the blood is drawn, the lab then physically separates the cholesterol from the LDL carrier and then measures the cholesterol level. Is that how it works? 🤔
@Raul I have never worked in a large reference lab to answer for LDL-C. Most clinical lab tests have great information available online, though.
It's unlikely to be a physical (eg. centrifugation, filtration) separation, though. Test methods generally involve chemical or antibody-binding methods.
@@pondboy3682 Thanks. It was mentioned in the video that LDL-C was calculated (an estimate using equations) and was not directly measured. Was wondering why LDL-C cannot directly be measured. Guessing it has something to do with the fact that cholesterol can be transported by LDL and HDL carriers (and other carriers including VLDL). HDL carriers tend not to get stuck in the artery walls, while LDL carriers are far more likely to get stuck, so cholesterol from HDL is of less concern than cholesterol from LDL. The lab probably directly measures the *total* cholesterol found in the blood --that should be pretty straightorward -- and then *estimates* whether the source of that cholesterol was from LDL or HDL or VLDL, etc.
Doing OMAD keto for the better part of a year now and dropped about 70lbs, got my blood chem and my ldl was way above the normal range. I exercise daily ,weights and bike. This is why, thanks Mike! From manila PH
Mike, you guys are always on it and a benefit to humankind. I can even say that may be an understatement! Thank you!
4:15 “why would your doctor say stop exercising because it increases your LDL”, pure gold.
THANK YOU! this is the exact information I was trying without success to convey to my doctor last week! I will definitely be printing out the studies and giving them to her.
Honestly, this was THE BEST explanation of these markers I’ve ever heard from any of my health team or from any other health platform 🙌🙌🙌
Loved the video, Mike! Very timely (my parents had their tests done recently), will have to listen to this several times though, very information-dense (like all of your videos, really). Thanks for all your efforts to promote healthy living!
Excellent video and topic, Mike. Thank you for the information, awareness and a voice!
This was GREAT Mike! I'm always trying to understand more about cholesterol. I have mild to moderate CAD, cardiologist wants me on stain, but my ratios have improved so much on carnivore I refuse them. I'm type A, light and fluffy. Cac score of 450 ~by iv contrast. Finally found a low carb cardiologist I'm switching care to in the new year
Good bless for all you do
Merry Christmas!
In my opinion, that was the best of your talks I've seen (and I like your stuff). Going to discuss this tomorrow with my mums doc.
Greatly appreciated
Thanks so much for this video. I have had a few friends who received test results back and didn't know anything (neither did I) on ApoB. Your video was awesome as is your channel.
Mike, you have a gift for making the complicated accessible. Many thanks.
I didn't know the function of LDL until this video. Thanks Mike! I always love to learn something new
Great podcast. Not complicated at all. This is why we love this channel. So please keep more coming. Cheers!
Thank you Mike for all your hard work in researching and sharing these important topics, helping us to better health.
Interesting information. Definitely will include that in my next blood test. Thanks.
Very helpful and very easy to understand. Thank you for posting!
Amazing information and great presentation. It made a lot of sense to me, mainly because I have been reading up a lot about this topic over the past few months. The additional information I got out of this video really explains and enhances my understanding. Thank you!
I knew I saw this video from you before as my amazing daughter sent it to me again. Yesterday I went to my doctor and she wanted to do all that blood stuff. I said all this staten stuff I'm not in on that anymore, but I had remembered too about the testing. Problem was I didn't remember all the names, but with our conversation my nurse practitioner mentioned something else and we had a good discussion even though I struggled. Today as I said listening to the video again and will call her Monday to schedule the ApoB VS LDL cholesterol test. I have also worked hard on getting those bad oils out of my diet when shopping and buying products reading the label! God bless & great to be loved and cared for!
Thanks so much, and Merry Christmas!
Nice work Mike thanks! Merry Christmas!
Love returning to these videos. Mike is amazing. God bless you all!!
Mike than you yet again for breaking this down and supplying the knowledge in an undertsandable form. I'm going to book an Apob test to go along with my other bloodwork that I frequently get done. I hope you and the family have a great Xmas. Best of health for 2022.
Thanks for continuing to share valuable information!
*Great content as usual Mike. Commenting for the algorithm.*
Great information to share with my Dr! Thank you
Great video Mike. A number of board certified cardiologists have been vocal about this for at least a decade. I too wish the current model could change. Sorry to sound so cynical, but cholesterol lowering medications are far too profitable for medical schools to change their curriculum or scripts, especially considering big pharma is their greatest benefactor.
Also too many people want a pill instead of lifestyle change.
@@actyrrel Sadly....and medicine is aware of this...so your doctor casually glazes over the part where he should be encouraging new or drastic lifestyles choices. And big pharma capitalizes on this. But i honestly believe most practitioners wholeheartedly believe lifestyle has little to no impact on your health. And unfortunately RD's and those with an MPH don't have a clue either. Having aquired their knowledge from the generic, antiquated realm of academia.
Agreed, that’s why self education is critically important
@@actyrrel doctors remain ignorant of truth about nutrition. And much of biomedical science. And to hide their willful lack of inquiry, they castigated patients who are educating themselves and being proactive. I have no belief that they think the patients wouldn't do the life style, when the life style they recommend is the SAS diet and medication like statins, both of which cause diabetes.
@@actyrrelthe main problem - people want quick, easy solutions without effort.
Thanks so much for all of these details. Very helpful.
The best explanation I've heard to date. Thank you.
Great content & presentation, brother!
Great video Mike! Not complicated at all. In fact, very lucidly explained. Keep 'em coming!
Great info Mike, as always. Thanks
Enjoyed this video thanks for sharing
Great video! Keep up the good work.
Thank you so much for all the good information!
Thanks for your work, Mike
Great information, thank you. I will be listening to more of your videos.
Making a note to self for that ratio blood test! Thank you!
Thanks for what you do Mike.
What a great explanation Mike... Thanks 👏👏👏
Brilliant video. This information is endlessly fascinating. Thanks for sharing for us all to learn from it.
Excellent video and great information. Recently had my Apob test for the first time. 1.36 ouch. Coupled with LDL of 7.3. Double ouch. 39 years old and moderately active but office worker and eating lots of takeaways almost daily. This video gives great info on cooking yourself and supplements to lower ApoB. Subscribed and taking my next test in 6 months
@mike; brilliant video! I’ve been listening to you for a long time. Thank you for everything that you’re doing. Really appreciate it. I have a bit of a dilemma, I get what you’re saying but I don’t know how I can simplify it to inform my friends and family?
Excellent and informative video!
In my experience the ApoB number goes up when my LDL-C lab value goes up. Similarly, my ApoA1 value increases when my HDL-C value rises. I now eat a more animal-based, high fat diet, which many LCHF/Keto experts would say is healthy, yet my ApoB/A1 ratio has gotten worse. Back in day, on a different diet, my ratio used to be say 0.65, which is great. Now my ratio is about 1.0, which is considered to be high risk. Here's what happened. My cholesterol has gone up a lot on my new diet. My HDL has gone up from 40 mg/dL to 60 mg/dL. OK, that's fine. But my LDL has skyrocketed from 130 mg/dL to 230 mg/dL. Along the way, both my ApoA1 and ApoB values have risen, but my ApoB value went up proportionally more than the ApoA1 value. That screwed up my ApoB/A1 ratio and made it worse. But here's the interesting thing. I believe my diet now could be healthier than in the past. I have now done some SpectraCell lipoprotein panels that show most of my LDL particles are large versus small (which is good). Therefore, despite the worsening ApoB/A1 ratio, I believe (or I hope) that I'm keeping my cardio risk factors in check. Bottom line, don't put a lot of faith in ApoB or the ApoB/A1 ratio themselves. Instead, look at those values in the context of a full lipoprotein panel in order to gauge things properly.
Have your calcium score checked, that is the best way to assess heart attack risk.
You know what you are talking about brother, amen!
Couldn't agree more. Also animal based for the past 3 years. apoB/A1 ratio is 1.4 (238/174). Most LDL particles are large vs small. CAC = 0
What did and it was hard but I’m used to it now is I eating less. No more gluttony. Low calories. My LDL is now 80. Before couldn’t be measured cuz my Triglycerides were 708 now 280. ApoB is at 108. I think next blood work numbers will drop more. If I serve myself mash potatoes it would be less than a handful. Eating pizza, 1-2 slice. And I only eat lunch and dinner. No snacking.
I have the same apoB/A1 ratio after 20 months on carnivore diet. ApoB 179mg/dl and Apo-A1 187mg/dl, Trig 57, HDL 59, Glucose 82, Insulin 2.5. Not worried just yet...😁😁
Love this video! Thanks! Saved, liked, and commenting!
Thank you!’n
Great episode! Very helpful
Yes! Was going in January to get checked up. Good timing!
You always have great info!!!
Great content as always.
Please include the articles that you reference so I can show my doctor. Good stuff.
Great stuff! I been watching my mother suffer from the side effects of statins for decades. She is focused entirely on having low cholesterol and so is her doctor regardless of the consequences.
Thank you for the video and study references. I experienced a Dr reaction as you predicted. I ordered the tests that you recommended. Than you.
Fantastic video! Shared with two of my family members who have been told for years that their levels are going to drop them dead at any second.
I love the new slider shot Mike
Thanks Mike!! Just made my father watch this. 💯
Spectacular information! 👌
Totally understand and I will be speaking with my doctor next visit!
Thanks for these amazing information.
Thanks Mike, great info
It is information like this, that is so important.
Found the LabCorp ApoB/ApoA-1 ratio test at Labcorp. Will recommend it Monday when I see my doctor. Will also share the studies with him.
great report Mike, can you please set up links to the studies so that I can inform my MD.
Loving the content you give! Thank you for all the work you do!
Love your videos.
Thank you for sharing!
Great video. I have been trying to understand cholesterol for the last few years and this is the most clear understanding I have come across. I have been a pro athlete for over a decade and all of my cholesterol levels are fine except for consistently high LDL. It’s been so frustrating because I’m 16-19% bf and I eat healthy. Definitely going to talk to my doctor about the APO-B/A1 ratio and immediately stop consuming the vegetables oils like in protein bars. Thanks for the info so valuable!
This was a little hard for me to follow so I opened up Google Docs, replayed the video at 0.75 speed, and took notes :) thanks for the great information. I hope that in the near future the majority of health "experts" are equipped with the information from your channel.
Fully comprehensible. Totally understandable. Echoed across the ketosphere. Love it. Thank you. Will be ordering those tests shortly.
Thanks for this explanation! My doctor always freaks out on me for this exact reason and I’m super metabolically and physically fit for a 46 year old or even any age.
Great video!
Thanks doc, excellant info....Great..
Blood work came back and it looked alarming at first. I was surprised because I was doing all the things relating to a healthy lifestyle. I was concerned about my lipid panel but I fell much more well-informed and educated on why my results were what they were. Thanks!
Hi Mike - I found a paper showing a graph of how ApoB and ApoA1 are linked to Triglycerides. (Circulation 82(2), 495-506). Using this graph and keying in my triglycerides of 48 mg/dm it showed almost all the LDL was the large fluffy LDL
Thanks for the information, Mike. Very helpful so I can reassure my doc. My LDL-C is driving her crazy, even though I have good numbers for HDL and triglycerides.
Phenomenal breakdown!!
Fantastic info!! Cutting out the unhealthy oils from my diet completely stopped my joint information!
I appreciate the extra 'detailed' knowledge on how I can personally 'positively' impact my health.
Thank you such a good explanation
Thanks for sharing 🙏🏽 fascinating 🙌🏽
My General Physician and Cardiologist really pushed for statins. I pushed back asking for more tests as I’ve had high LDL since my 20’s.
I’m 41. 5’9 185 lbs. 15-19% body fat.
Panel
Total - 300
LDL - 231
Hdl - 41
Tri’s 138
Glucose - 104 (fluke as it’s never been above 100)
ApoB - 150
ApoA- 142
Artery Scan in neck - Very Good or no to little plaque.
CT Calcium Scan Score- 0
I’m finding it a little complicated, I need to listen to it again but its very interesting, thank you.
thank you for this informative video.
I think the ApoB/A1 ratio might have some merit. I was disappointed that Mike never stated values to aim for. I watched the whole video waiting for this info and it never came. Based on what I've learned, a good ratio of ApoB/A1 is 0.7 or less. There is some variation from lab to lab. I found one source that considered anything below 0.9 to be acceptable, and yet others say that indicates increased risk. Some sources say a truly optimal ApoB/A1 ratio is 0.5 or less. ApoB is found in LDL and is associated with cholesterol depositing capacity. ApoA1 is found in HDL and is associated with cholesterol clearing. As I pointed out in another comment, the ApoB value, and I'll now add the ApoA1 value, say nothing about the nature of the particles themselves, which makes the ApoB/A1 ratio a little iffy to hang your hat on, in my opinion.
i understand your explanation of apoB/A1 ratio, im glad you have shared this. i also was wondering about the Lp(a) value. he didn't mention this, do you know? I read that this is a genetic test and even though I was not concerned Dr. ordered this test in place of a fractionated lipid test that I requested for my father. His Lp(a) was 6. i will work on this dr to order the fractionated lipid panel as i feel it would give more info than the other. but would you happen to know more about the Lp(a) test? thank you!
@@dawn1913 When you report results you should always include the unit of measure. Lp(a) is reported either in mg/dL (and the reference range goes from 0 - 30) or in nmol/L (where the reference range is typically 0 - 75). Either way, your father's value of 6 for Lp(a) infers he does not have an issue with Lp(a). Still, your doctor owes it to you and your father to do a "fractionated" lipid panel to get a better sense of things, in particular, the number of small LDL particles (the lower, the better).
@@Malcolm-Achtman 6mg/dL. yes, it's fine. i didn't understand the mention of Lp(a) in the diagram @1919. but not an issue. thanks so much for your response. my father's cardiologist tried to appease me by ordering this (useless) test in place of fractionated panel as i had requested. he is pushing for a statin, which i just got him off the two he had been taken for years, and he refuses to hear about LDL other than my Dad's are too high if above 70. his PCP also prescribed Lipitor (to be mailed to my Dad so he hopefully wouldn't notice) just after my conversation with him expressing he would not be taking any cholesterol meds. he explicitly told me that if he doesn't have his diabetic patients on a statin he gets a low score.... meaning he is "graded" on how many statin prescriptions he writes! It's just insane where doctor's loyalties lie, and it's not with their patients.
the particle size doesnt matter, all are equally arthrogenic except the very high dense lipoprotein
Great information!!
Thanks Mike - exactly what I need -
thank you for the information
JAMA has an article on this topic in the Nov 2021 issue “Association of Apolipoprotein B-Containing Lipoproteins and Risk of Myocardial Infarction in Individuals With and Without Atherosclerosis Distinguishing Between Particle Concentration, Type, and Content”
I’d love to have this information in a logical written form including optimal targets. I’d pay for it.
Thanks Mike!🙏🏻
Looking forward to next week's video
thank you for this!!
This video is super helpful. I recently did a blood draw through Inside Tracker to get detailed insights on my health. My total cholesterol was 249mg/dL. The breakdown was: Triglycerides was 88mg/dL, HDL was 84mg/dL and LDL was 146mg/dL.
Context: I fast 12 to 14 hours daily, eat a paleo diet, train in BJJ and Yoga 4 to 5 times a week, and spend a lot of time walking on the beach and spending time outside walking around.
:D
I would be a very happy with those labs
Wish my hdl was 84… that’s the one that’s the hardest to improve on…
Thank you! Very helpful. I’ve had CAD issues for years. Altho an architect by profession, I’ve been reading a lot of books re cholesterol…fon’t do well with statins. Was able to follow and understood the terminology.
Thank you for the information - whilst I didn't grasp a lot of this info I got enough from it to know about the LDL levels being higher because at 62 my machinery still works good and I do hit the gym - my doc had me on Lipitor and my loving daughter who sent me here says you most likely don't need them and it's doing you more harm than good. I wish they would know the info instead of cookie cutting people. God bless!
Great video
Spot on Mr Mutzel, my doctor noticed that my LDL had increased a few months after I’d started time restricted feeding/keto. I told him that my diet had changed and that seemed to satisfy his concern but I am waiting to see what happens the next time I have blood work done. I have them done annually as I am epileptic and on anti-convulsant medication (keto should also help with this)
Thanks Mike!!