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.
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.
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.
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
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.
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...😁😁
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.
@ty Ty 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.
@ty Ty 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.
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!
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.
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.
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.
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
Thanks u for this clear explanation After being on a clean keto diet for 7m my LDL was 40% > range but but HDal was 70% > range and all my liver markets were off the charts healthy
Thank you for this info. Recently, I have been perplexed as to why two of my friends have been put on statins by their doctor. From knowing these people for years, they are both highly active and eat healthy whole food diets. It made no sense to me that people who fit that criteria would have harmful cholesterol levels, and in my opinion statins are over prescribed. I will suggest to them your video and that they consider getting retested.
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
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.
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.
Every doctor should watch this video. The information is critical and lifesaving. You are kind in the way you approach doctors' lack of knowledge in this area. I feel it's inexcusable that medical schools don't include nutrition education. The AMA obviously does not have the public's best interest at heart. Teaching about disease and how to treat disease with pharmaceuticals is the goal of mainstream medicine. That is one of the greatest contributors to the state of our health in this country. (There are others, including the processed food industry being allowed by the FDA to sell us toxic substances labeled as "food.") Most docs would not appreciate patients presenting them with this information. Thank God there are some docs who are recognizing the shortcomings of traditional medicine, educating themselves, and making some positive changes.
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.
@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.
Thank you so much for the detailed information. Great video!!! Yes , you did explain the information as simple as you could. However, if the listener isn’t in the health field. It will be challenging to understand. I am Registered Nurse. I’ve been doing my own research on the topic. This is what I’ve been doing. I walk every day, Treadmill 3 times a week, I drink four 16oz bottle water daily. I take Fiber psyllium husk daily, Coq 10 supplement daily, Flaxseeds, chia seeds, hemp seeds daily and Fish oil. My total Cholesterol was very high 286 and came down to 256. NO STATIN. I have a Registered Dietitian that is helping me. Please follow your doctor’s orders but do your OWN research.
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!
I don't need an specific cholesterol test, if my cholesterol is sky high on an almost zero carb diet, it surely is for a good reason. My body is smarter than me.
That's very bad reasoning. Your body could have genetic polymorphisms for high cholesterol and a "zero carb diet" isn't even necessarily healthy in all circumstances.
Great info as usual. Thanks for all you provide. I found being carnivore, I don't burn any longer so no sunscreen for this super pale guy. 2 summers in a row.. Correlation, 100%. Now to look at what oxalates do to your body as a whole
I'm a Respiratory Therapist and have a pretty good understanding of harmful foods and the importance of a clean diet, exercise etc, I would greatly appreciate a screen shot of the specific tests you recommend, their names and labs. You speak very quickly and its a bit hard to follow. I do, however, greatly appreciate all the info. Perhaps you could put links below to the papers you cited. You said VAP isn't as informative as the other tests but I don't know specifically the names of the tests to request from my doctor. Thanks again.
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”
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
If you're sporting ultra elevated LDL there is no possibility your ApoB will be anywhere close to the standard range. When Peter Attia and Dayspring go on and on about how important ApoB is, it's just a kinder gentler way of saying your LDL is way too damn high. They go hand in hand. This focus on ApoB is caused so much confusion. Many times I've seen somebody post their lipid results and they are totally cool with their LDL 450, but shocked at their ApoB and then want to know how to lower it. If you are fine with your very high LDL then you must be fine with your high ApoB.
Thank you so much for the important information, Mike. One suggestion for you, will you please slow down, while your talking? It’s hard for me to keep up with all you’re saying.
Wow first 30 seconds describes an EXACT scenario I experienced. Super fit and healthy but high LDL. Doc wanted to put me on a statin. Found a new doc that specialized in seeing athletic folks and he said the first doc is out of his mind. Gonna get apo-b checked next
It’s not that they’re inaccurate. The numbers are correct. The issue is that the raw number is a poor metric for risk in and of itself. Like you said, much more nuanced than just a number.
First of all thank you. You're saying a lot but at the same time not much. What I mean is you're throwing so much info at us but in the meantime not clearly explaining them. So I think you probably do not understand what you tell (at least not 100%). If you can't explain something in the simplest terms it means you probably didn't understand it in the first place. I truly believe that you are genuine and sincere and trying to help. So thank you anyway. Thanks to you, I will go other places and do more research.🙏
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!
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!
Her CRP is almost as equal mina as well as Homocyst. my LDL is about 290. I also do intermittent fasting. I am not worried about it at all. my HDL is lower though but it is in the high mid's 70'smy TG is 81. I am an old fart of 63
My mom has had high cholesterol her entire life and she finally found a cholesterol specialist. He’s the one who told her she probably had high levels at birth, and that’s why the statins do nothing but make her feel awful. Now she’s on Praluent - what her doc calls a “miracle drug”. She, too, has always been incredibly healthy and taken great care of herself.
@@chowceo this one is also for cholesterol but the mechanism of action is different than a statin (it’s an injection almost like an epi-pen that you use once every 2-3 weeks). It helps by blocking a PCSK9 protein that contributes to high levels of HDL and helps clear bad cholesterol out of the bloodstream :)
Great Video.....One suggestions....Need to slow down speed specially at 11:05 when you are telling about sensitivity/specificity.....which are statistical term most of the people are unaware and need to understand more
Thanks for your video Mike. A few months ago I was diagnosed with non alcoholic fatty liver which coincided with a period where I had lost my appetite for life. I’d always been very active with cycling, going to the gym and eating a decent diet. The year before finding out about my liver I stopped almost everything and started eating rubbish (sweet tooth) hence I put on almost 2 stones. Well after the bad news, I decided to get back to my exercise routine and to follow intermittent fasting (16/8 up to 20/4) with I cannot say a keto diet, but for sure low carbs, implementing lots of greens and good fats like olive oil and nuts. I’d been taking statins for my high cholesterol but after the advice of a friend (Doctor) specialised on liver’s diseases, I decided to stop taking them. Well, my liver has gone back to its normality and I’m so happy about it but my cholesterol has gone sky high total 299 ldl 231 hdl 53 triglycerides 74 and finally glucose 78. That was quite a shock, but after seeing your video, you put my mind at ease. For sure I’ll try and do an advanced lipid profile test but at least I know that the very high cholesterol might be due to losing lots of weight by mobilising my fat. Thanks again CIAOOOO
This was awesome. I am just learning about particle sizes etc. I have to listen again because you talk so fast about the names of the particles it’s hard to keep them straight. Slow down please. And I’d love you to do a video on exact labs to order because when I was looking to order , they are very similar and the LipoA has a 1 and some don’t etc. I am determined to get this understood. Thank you . Loved the visuals !!! 😊
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.
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.
I do not understand much of this, but learning slowly. I am not on stating but trying to learn the truth about the human body and regeneration which I have seen happen to my knees through another Health Channel. So happy to hear a health program devoid of all the panic. Thank you.
Great video and very informative. I'm heavy meat keto to control my IBD which is 90% better. My is LDL 344 AND HDL and tryglyceride are in good range. However I just discovered I have Xanthoma on the eyelid. I'm waiting for a Lipidology clinic but I'm worried about that my doctor may want to put me on the stains. No other risks of heart disease except for the high LDL.
@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?
I started a liberal keto/paleo diet last February. I'm 54 Years old. I did 5 One handed push UPS the other day. Also when I do cardio I have to get my heart rate in the 160s In order to break a sweat when I'm doing the HIIT. I have a doctor's appointment coming up and I'm sure my LDL is going to be higher than it was in July when it was in the 230s. Thanks for the information I will show him parts of the video where you get into details.
I think we must also consider Deanna's AST and ALT levels. They are pretty high which may also mean that she had developed fatty liver or some sort of liver damage.
I think that I'm going to rewatch this one, thanks Mike because I do have some concerning lipid labs and a twice the reference range C reactive protein. I'm thinking that the last couple of years have taken a toll and weight gain.
This is me….My LDL is up but everything else looks good. Thank you for this info! My dr told me to take a statin despite me exercising and having a healthy weight.
Last year I gave up *salad dressings* that use any oil but avocado oil. I now consume no vegetable seed oils that I'm aware of. As a result, I suffered almost *no nasal congestion* this past winter! I've been suffering head congestion all winter for most of my life, but no more! I even turned down the humidifier and still no congestion.
A piece of data which might be helpful for those measuring their hba1c. At age 31, height of 173cm Asian(Indian), a weight of about 74kg with 1 hour HIIT exercise for 5 days a week my hba1c was 4.8. About 4 months later at weight of about 72kg and very less daily exercise, my hba1c was 5.4 . This made me realise that however healthy your weight, exercise atleast 1 hour a day at highest possible intensity for 5-6 days per week. I am still working on evaluating effect on hba1c by moving from carb heavy to low carb diet.
My LDL is 184, HDL 93 and my triglycerides are 48. My fasting blood sugar is 78-83 and my HbA1C is 5.1 My problem is with the sudden increase with the lives enzymes AST at 42 and ALT at 82. My doctor wanted to put me on statins and claimed that I have a fatty liver according to my test result. I cannot take any medication because I am breastfeeding ( my baby is 7-months-old). I do not know what to do! I do not eat junk food nor sugar and I switched to very low carb diet now.
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.
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.
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
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...😁😁
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.
@ty Ty 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
@ty Ty 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.
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!
Great podcast. Not complicated at all. This is why we love this channel. So please keep more coming. Cheers!
4:15 “why would your doctor say stop exercising because it increases your LDL”, pure gold.
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
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.
Mike, you guys are always on it and a benefit to humankind. I can even say that may be an understatement! Thank you!
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.
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
I’d love to have this information in a logical written form including optimal targets. I’d pay for it.
Thanks u for this clear explanation After being on a clean keto diet for 7m my LDL was 40% > range but but HDal was 70% > range and all my liver markets were off the charts healthy
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 🙌🙌🙌
Thank you for this info. Recently, I have been perplexed as to why two of my friends have been put on statins by their doctor. From knowing these people for years, they are both highly active and eat healthy whole food diets. It made no sense to me that people who fit that criteria would have harmful cholesterol levels, and in my opinion statins are over prescribed. I will suggest to them your video and that they consider getting retested.
High cholesterol is mostly genetic though.
@@johncalla2151 But does not necessarily mean one should take a drug for the rest of their life does it?
🇷🇺
@@johncalla2151it could be sometimes but sometimes it's by a sugar addiction
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
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.
Please include the articles that you reference so I can show my doctor. Good stuff.
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.
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.
Every doctor should watch this video. The information is critical and lifesaving. You are kind in the way you approach doctors' lack of knowledge in this area. I feel it's inexcusable that medical schools don't include nutrition education. The AMA obviously does not have the public's best interest at heart. Teaching about disease and how to treat disease with pharmaceuticals is the goal of mainstream medicine. That is one of the greatest contributors to the state of our health in this country. (There are others, including the processed food industry being allowed by the FDA to sell us toxic substances labeled as "food.") Most docs would not appreciate patients presenting them with this information. Thank God there are some docs who are recognizing the shortcomings of traditional medicine, educating themselves, and making some positive changes.
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.
Fully comprehensible. Totally understandable. Echoed across the ketosphere. Love it. Thank you. Will be ordering those tests shortly.
Thank you so much for the detailed information. Great video!!! Yes , you did explain the information as simple as you could.
However, if the listener isn’t in the health field. It will be challenging to understand.
I am Registered Nurse. I’ve been doing my own research on the topic.
This is what I’ve been doing. I walk every day, Treadmill 3 times a week, I drink four 16oz bottle water daily. I take Fiber psyllium husk daily, Coq 10 supplement daily, Flaxseeds, chia seeds, hemp seeds daily and Fish oil.
My total Cholesterol was very high 286 and came down to 256. NO STATIN.
I have a Registered Dietitian that is helping me. Please follow your doctor’s orders but do your OWN research.
Just got some results today; 5.6 A1c, total cholesterol 165 (HDL 77), 24.3 bmi (at about 13% body fat). I might get this test and compare
Why?
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.
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!
I don't need an specific cholesterol test, if my cholesterol is sky high on an almost zero carb diet, it surely is for a good reason. My body is smarter than me.
That's very bad reasoning. Your body could have genetic polymorphisms for high cholesterol and a "zero carb diet" isn't even necessarily healthy in all circumstances.
@@johncalla2151 Don't even dare you to blame genetics, that's a really bad excuse...
@@LeParadoxHD It's not an excuse, it's known reality.
Great info as usual. Thanks for all you provide.
I found being carnivore, I don't burn any longer so no sunscreen for this super pale guy. 2 summers in a row.. Correlation, 100%. Now to look at what oxalates do to your body as a whole
Yeah, the oxalate question. I've heard a lot from Elliot Overton (EO Nutrition) & Sally Norton on this.
Interesting
I'm a Respiratory Therapist and have a pretty good understanding of harmful foods and the importance of a clean diet, exercise etc, I would greatly appreciate a screen shot of the specific tests you recommend, their names and labs. You speak very quickly and its a bit hard to follow. I do, however, greatly appreciate all the info. Perhaps you could put links below to the papers you cited. You said VAP isn't as informative as the other tests but I don't know specifically the names of the tests to request from my doctor. Thanks again.
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”
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
Great info, much appreciated! Don't dumb down. We need this better information. Screwdrivers, not sledgehammers...and ldl c is a sledgehammer
Thank you Mike for all your hard work in researching and sharing these important topics, helping us to better health.
If you're sporting ultra elevated LDL there is no possibility your ApoB will be anywhere close to the standard range. When Peter Attia and Dayspring go on and on about how important ApoB is, it's just a kinder gentler way of saying your LDL is way too damn high. They go hand in hand. This focus on ApoB is caused so much confusion. Many times I've seen somebody post their lipid results and they are totally cool with their LDL 450, but shocked at their ApoB and then want to know how to lower it.
If you are fine with your very high LDL then you must be fine with your high ApoB.
The high cholesterol sounds like what dave feldman is researching
Thank you so much for the important information, Mike. One suggestion for you, will you please slow down, while your talking? It’s hard for me to keep up with all you’re saying.
Love returning to these videos. Mike is amazing. God bless you all!!
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
You know. I get that doctors are busy but if a busy lawyer doesn’t keep up to date with the law - it’s called professional negligence.
Wow first 30 seconds describes an EXACT scenario I experienced. Super fit and healthy but high LDL. Doc wanted to put me on a statin. Found a new doc that specialized in seeing athletic folks and he said the first doc is out of his mind. Gonna get apo-b checked next
Enjoyed this video thanks for sharing
So very true!
Love this video! Thanks! Saved, liked, and commenting!
Thank you!’n
Mike, you have a gift for making the complicated accessible. Many thanks.
It’s not that they’re inaccurate. The numbers are correct. The issue is that the raw number is a poor metric for risk in and of itself. Like you said, much more nuanced than just a number.
First of all thank you. You're saying a lot but at the same time not much. What I mean is you're throwing so much info at us but in the meantime not clearly explaining them. So I think you probably do not understand what you tell (at least not 100%). If you can't explain something in the simplest terms it means you probably didn't understand it in the first place. I truly believe that you are genuine and sincere and trying to help. So thank you anyway. Thanks to you, I will go other places and do more research.🙏
Excellent video and topic, Mike. Thank you for the information, awareness and a voice!
It is complicated but cutting out seed oils is easy. Thanks for the video!
The best explanation I've heard to date. Thank you.
Fantastic info!! Cutting out the unhealthy oils from my diet completely stopped my joint information!
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!
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!
Her CRP is almost as equal mina as well as Homocyst. my LDL is about 290. I also do intermittent fasting. I am not worried about it at all. my HDL is lower though but it is in the high mid's 70'smy TG is 81. I am an old fart of 63
Not to mention that alot of people are eating a higher amount of sugar, pastries and over eating in general during winter months due to holidays.
Very helpful and very easy to understand. Thank you for posting!
There is also link between increased LDL, and therefore increased CVD. But i agree, ApoB is a better marker.
My mom has had high cholesterol her entire life and she finally found a cholesterol specialist. He’s the one who told her she probably had high levels at birth, and that’s why the statins do nothing but make her feel awful. Now she’s on Praluent - what her doc calls a “miracle drug”. She, too, has always been incredibly healthy and taken great care of herself.
What is Praluent for? My mother the same high cholesterol as she’s 92. No meds for her and she’s fine
@@chowceo this one is also for cholesterol but the mechanism of action is different than a statin (it’s an injection almost like an epi-pen that you use once every 2-3 weeks). It helps by blocking a PCSK9 protein that contributes to high levels of HDL and helps clear bad cholesterol out of the bloodstream :)
I get it. It is complicated and interesting. I am going through this now.
Great Video.....One suggestions....Need to slow down speed specially at 11:05 when you are telling about sensitivity/specificity.....which are statistical term most of the people are unaware and need to understand more
Great video Mike! Not complicated at all. In fact, very lucidly explained. Keep 'em coming!
I’m finding it a little complicated, I need to listen to it again but its very interesting, thank you.
Thanks for your video Mike. A few months ago I was diagnosed with non alcoholic fatty liver which coincided with a period where I had lost my appetite for life. I’d always been very active with cycling, going to the gym and eating a decent diet. The year before finding out about my liver I stopped almost everything and started eating rubbish (sweet tooth) hence I put on almost 2 stones. Well after the bad news, I decided to get back to my exercise routine and to follow intermittent fasting (16/8 up to 20/4) with I cannot say a keto diet, but for sure low carbs, implementing lots of greens and good fats like olive oil and nuts. I’d been taking statins for my high cholesterol but after the advice of a friend (Doctor) specialised on liver’s diseases, I decided to stop taking them. Well, my liver has gone back to its normality and I’m so happy about it but my cholesterol has gone sky high total 299 ldl 231 hdl 53 triglycerides 74 and finally glucose 78. That was quite a shock, but after seeing your video, you put my mind at ease.
For sure I’ll try and do an advanced lipid profile test but at least I know that the very high cholesterol might be due to losing lots of weight by mobilising my fat. Thanks again CIAOOOO
if i may ask, how was our fatty liver dx? was there a lab value or a scan you had done? thank you! ....and I'm supper glad for your return to health!
Thanks for continuing to share valuable information!
Yes! Was going in January to get checked up. Good timing!
This was awesome. I am just learning about particle sizes etc. I have to listen again because you talk so fast about the names of the particles it’s hard to keep them straight. Slow down please. And I’d love you to do a video on exact labs to order because when I was looking to order , they are very similar and the LipoA has a 1 and some don’t etc. I am determined to get this understood. Thank you . Loved the visuals !!! 😊
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.
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.
Brilliant video. This information is endlessly fascinating. Thanks for sharing for us all to learn from it.
Love your videos.
Great video
I do not understand much of this, but learning slowly. I am not on stating but trying to learn the truth about the human body and regeneration which I have seen happen to my knees through another
Health Channel. So happy to hear a health program devoid of all the panic. Thank you.
I would love to find out what you do to your knees. I just call it old age. Not liking it.
Great video and very informative. I'm heavy meat keto to control my IBD which is 90% better. My is LDL 344 AND HDL and tryglyceride are in good range. However I just discovered I have Xanthoma on the eyelid. I'm waiting for a Lipidology clinic but I'm worried about that my doctor may want to put me on the stains. No other risks of heart disease except for the high LDL.
Thanks so much, and Merry Christmas!
Thanks Mike!! Just made my father watch this. 💯
15 years working as a data scientist here. An AUC of 65% for the ApoB/apoA1 paper is borderline useless.
@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?
It is information like this, that is so important.
Interesting information. Definitely will include that in my next blood test. Thanks.
I started a liberal keto/paleo diet last February. I'm 54 Years old. I did 5 One handed push UPS the other day. Also when I do cardio I have to get my heart rate in the 160s In order to break a sweat when I'm doing the HIIT. I have a doctor's appointment coming up and I'm sure my LDL is going to be higher than it was in July when it was in the 230s. Thanks for the information I will show him parts of the video where you get into details.
WHHHHOOAAA i had no idea cholesterol measurements are based on an estimating equation. That seems very significant
One of the best videos I’ve seen and I’ve seen a lot on lipids. So I’m curious about what would be better to help vitamin C or as you mentioned CoQ10?
IMO CoQ10!
I think we must also consider Deanna's AST and ALT levels. They are pretty high which may also mean that she had developed fatty liver or some sort of liver damage.
Nice work Mike thanks! Merry Christmas!
I think that I'm going to rewatch this one, thanks Mike because I do have some concerning lipid labs and a twice the reference range C reactive protein. I'm thinking that the last couple of years have taken a toll and weight gain.
Thanks Debra. Let me know if it makes more sense the second go around.
Great information to share with my Dr! Thank you
Making a note to self for that ratio blood test! Thank you!
I love the new slider shot Mike
Thanks for what you do Mike.
Great information, thank you. I will be listening to more of your videos.
This is me….My LDL is up but everything else looks good. Thank you for this info! My dr told me to take a statin despite me exercising and having a healthy weight.
Great content & presentation, brother!
Last year I gave up *salad dressings* that use any oil but avocado oil. I now consume no vegetable seed oils that I'm aware of. As a result, I suffered almost *no nasal congestion* this past winter! I've been suffering head congestion all winter for most of my life, but no more! I even turned down the humidifier and still no congestion.
What a great explanation Mike... Thanks 👏👏👏
Thank you so much for all the good information!
A piece of data which might be helpful for those measuring their hba1c. At age 31, height of 173cm Asian(Indian), a weight of about 74kg with 1 hour HIIT exercise for 5 days a week my hba1c was 4.8. About 4 months later at weight of about 72kg and very less daily exercise, my hba1c was 5.4 . This made me realise that however healthy your weight, exercise atleast 1 hour a day at highest possible intensity for 5-6 days per week. I am still working on evaluating effect on hba1c by moving from carb heavy to low carb diet.
My A1c typically is in 4.5-4.8% Range ....4-5 times cardio plus weights every week 171cm 65kg. Have been on low carb since 2018.
Thanks for your work, Mike
My LDL is 184, HDL 93 and my triglycerides are 48. My fasting blood sugar is 78-83 and my HbA1C is 5.1
My problem is with the sudden increase with the lives enzymes AST at 42 and ALT at 82. My doctor wanted to put me on statins and claimed that I have a fatty liver according to my test result. I cannot take any medication because I am breastfeeding ( my baby is 7-months-old). I do not know what to do! I do not eat junk food nor sugar and I switched to very low carb diet now.