How to lower your apoB

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This clip is from 276 ‒ Special episode: Peter on longevity, supplements, protein, fasting, apoB, statins, & more.
In this special episode of The Drive, Peter discusses a variety of topics, breaking away from the typical deep-dive format to explore a wide range of common questions submitted by listeners.
In this clip, we discuss:
- Do you need pharmacology to lower your apoB?
- What foods to cut to lower your apoB
- What Peter takes to lower his apoB
- And more
--------
About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 70 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
Learn more: peterattiamd.com
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[@tonycrouse6544]

For most people all you need is a balanced diet of minimally processed foods. I do believe some supplements are beneficial like vit D, vit K2 and fish oil. Don't panic about all these lab numbers because no one knows when your time is coming. I worked 30 years in cardiac critical care and saw many pts who had excellent lipid panels but still developed heart disease. When I worked in general care I saw many older pts who had crappy lipid panels and NO heart disease. Try to find joy in life and embrace gratitude.

[@rodcc]

There are always outliers - like you I worked in critical care and general internal medicine for decades. Too many people are “enjoying life” by over eating and living an unfit lifestyle - take a good look at how these people are “living” their life - if you can call it living. I use to be morbidly obese. Today, im more fit then ever, 16 percent body fat, ruck 10 miles with 45 pounds, resistance train five days a week, and eat a very healthy diet - and I have never felt as good in my life. Attia is SPOT ON.

[@tonycrouse6544]

@@rodcc He's a smart guy but pushes drugs too much. You can live a happy, health life without all the drugs.

[@rodcc]

@@tonycrouse6544 absolutely, but knowing what we know as physicians, most people don’t follow through with what it takes. I’m an advocate for the least meds as possible. It’s terrible how people live their last decade of life, or having a stroke in their 40s and 50s. Just terrible. And boy was I a mess for decades and the damage is done; just trying to mitigate have someone toilet me and spoon feed me tapioca pudding in my 70s and hopefully 80s. Life goes fast

[@tanvir6356]

How about smoking? Many people live a long life despite smoking so it must not be bad for you

[@tonycrouse6544]

@@tanvir6356 Nah crack cocaine is much better. Try some.

[@amyhoop9651]

Thank you Dr. Attia for the detailed description about how the liver receptors respond to apoB

[@cyclingmaven]

Mate, you're a keeper and your courage is recognised and appreciated.

[@doubleunderfire7964]

Love the level of detail provided in these videos. Excellent video.

[@MsQ275]

Super appreciate the LPa pharma info!

[@lotfibouhedjeur]

Thank you, Peter. Really, thank you!

[@jimmccall8030]

Great information, thank you.

[@renzo6490]

An ApoB test helps your doctor analyze whether or not you are at risk for heart disease. It measures the amount of apolipoprotein B in your blood. Apolipoprotein B attaches to negative types of cholesterol that cause plaque buildup in your blood vessels, which can lead to damage and heart disease.

[@cyclingmaven]

I respect any 'expert' who says "probably" and "I don't know".

[@wocket42]

If you watch his older videos from some years back, you'll realize he didn't know anything then and most likely doesn't know anything true today. Until he gets to 100 years he will switch his medication and life style 180 degrees a couple of times. That's what will happen if you follow the leading edge of science and experiments.

[@flyingsodwai1382]

As has been said many times by different philosophers over the years, it's just a sad fact of society that the wise are full of doubts and the fools so damn sure of themselves.

[@johannesswillery7855]

@@flyingsodwai1382 GOAT comment!

[@kddidit08]

​@@flyingsodwai1382 "The best lack all conviction, while the worst are full of passionate intensity." Yeats

[@flochfitness]

@@flyingsodwai1382damn. Good point

[@paulgachot587]

Great information. Thank you! If I have familial hypercholesterolemia / familial combined hyperlipidemia with crazy high apolipoprotein a levels (169 ml/dL most recent) and high LDL (228 most recent) arePeter's combo of the PCSK9 Inhibitor Repatha and the combo drug Nexlizet recommended over traditional statins? I avoid statins because of NAFLD and the other associated risks.

[@BrianCobb-xk8bv]

I am doing research on my husband and he claims his doctor didn’t explain what or how to get a lower numbers! Thank You! You took a lot off my Mind and heart. My husband is my Best Friend and I would be lost without Him! ❤😢

[@ClayTallStories]

I was on OMAD keto for 3 years then went to a whole plant-based diet, oil/ sugar/dairy-free diet, and lowered my LDL 64% and Triglycerides 22%. No statins are needed. Those levels have remained for 19 months and the Angina I had has been gone for a year and I am back in the hills hunting again and running around with my dogs on the farm.

[@MountBlueice]

Wondering what kind of fats were you on Keto? I had assumption Keto increases LDL no matter what?

[@user-ij5ky4lr3x]

Makes sense. Be careful. A lot of people assume that because EVOO is healthy, they can have as much as they want in their diet. It still has some saturated fat. If you eat enough of it, you will get too much saturated fat. Seems like a lot of people are missing this now and drenching everything in EVOO and avocado oil

[@ClayTallStories]

I was eating too much animal fat and dairy@@MountBlueice

[@TheRst2001]

This is really what I should be doing , whats your favourite main meal of the day out of interest ? I like pulses sometimes tofu just wondering what else I can cook :)

[@mertonhirsch4734]

ApoB and blood sugar have a multiplicative effect on CHD risk. ApoB can be higher if your blood sugar peak levels are lower. It is even plausible that ApoB is only problematic because it correlates to glycosylated ApoB.

[@meiocheng817]

61yrs old, got my first CardioIQ test. Only had standard lipid panels before, HDL 71, Tri 68, LDL 131. All my other stuff is good. Then just found out yesterday my Lp(a) 49nmol, seems good, ApoB 103mg seems moderately bad. I'm not on low-carb. I don't count calories, but I did cut back on carbs, since I used to always eat rice, bread, potatoes, pasta etc. Now, I still eat those, but try to eat them less often. I'm going to cut back on the saturated fats, a little, and see how the labs go in 5months when I see my PCP next. If still concerning, maybe a CAC score next.

[@karlhungus5554]

That seems like a good dietary strategy you're employing. I've been thinking of doing the same, though I've been dragging my feet about it. Regarding the Coronary Artery Calcium (CAC) test you mentioned, another possibility you may wish to investigate and consider is the CT Coronary Angiography (CTCA) test. I learned about that from Peter Attia in a different video. No matter which path you take, I wish you success and good health.

[@BornAgainBride]

Have been doing more of a keto-type, carb-light diet about one month, limiting sugar/carbs significantly. I also have been eating sauerkraut and red cabbage prior to my dinners (doing intermittent fasting 18:6 or 19:5 also). Heavy on GRASS FED BUTTER & RED MEAT, and pasture-raised eggs. 1 piece of Rye toast in the AM, and a touch of some starch with dinner. Fruits too (which I don't like, but they have lots of nutrients). Good exercise (gym 3 X week, dancing 1 x week, and I'm a 66 YO female, about 105 lbs, reasonably fit for age. ) On this regimen, my TG dropped from 71 to 58, my HDL went from 97 to 104, my TC shot up to 400! And my LDL is like 205, crazy. My doc is going to have a fit (she's on vaca). I am asking her to test me for LDL A v. B. I suspect my A is high and my B is low. My TG:HDL ratio is crazy low, which I hear is excellent. Keto, or low carb will change your lipids, but I suspect for the better in most folks, depending on that TG:HDL raio, so I hear.

[@jjuniper274]

Dr. Attia, would you kindly address dry eye and complications from it like permanent damage to the cornea that are directly correlated to some statins and ACE inhibitors, and other BP meds? I have been trying to find information on how to correct this. Help please. Thank you.

[@wocket42]

He will tell you that statins are well tolerated and that you need to man up if you want to live to 100.

[@kellyshannon375]

Former cardiac nurse here, now practicing functional medicine, and the daughter of a life-long cardiac nurse . . . statins do not prevent CVD or keep people from having repeat CV events! LDL particle size is how you know your true risk of CVD. Statins inhibit production of protective cholesterol - not good! Genetics definitely play a role. Inflammation is the largest predictor of CVD and disease of all forms. Focus on lowering inflammation through managing stress, getting enough sleep, minimizing toxic burden, avoiding high inflammation foods (gluten, dairy, processed oils, processed and fast food, junk food, pesticides), pay attention to how foods affect you (do you break out after, feel bloated after, feel tired/hungover after, does your heart race after, does your face get red after, are you itchy, do you sneeze after . . . all signs that food is inflaming to you!), get sunlight everyday, get a good sweat going most days of the week, drink clean, reverse osmosis water, replenish your nutrients (minerals, electrolytes, antioxidants), eat minimally processed, grass-fed meats, eat organic whenever possible (EWG Dirty Dozen and Clean 15), move your body regularly . . . I could go on and on. Disappointed at the statin push in this video. That's like putting people with weight loss resistance on ozempic . . . there is so much more to do to achieve weight loss than a drug that has known risks and creates metabolic dependance. UGH!!!! Check the thyroid, check the gut, check stress/cortisol, check hormones!

[@paulabranson6530]

I sure would like for you to help me. Am 60 yrs old and they put me on 10mg of Crestor I have very low blood pressure my Trie is very low, Total is 234 LDL 159 HDL 70 lipo a is 190. My dad had and his side of family all had heart issues. Should I stay on statins I hate them already only 2nd day. I work out everyday.

[@StatzGee]

I'm with you. BUT, I think if your bloodwork isn't changing after lifestyle habits have been altered, or numbers are so out of line that you are incurring a lot of damage, it might be tge best route available if there is urgency.

[@paulabranson6530]

What is best electrolytes to get

[@braydenfracchia96]

I don't think you get it. Go listen to his book

[@cheriemiller-kling4654]

I live in a ‘medical community’ and there are no functional medicine doctors if there were my insurance wouldn’t cover. Very frustrating. Like Covid treatment, our experts, have failed us. We live in a pharma world, so sad. Thanks for the information.

[@thomaskingschillerlein7843]

1. Repatha (evolocumab) 2. Nexlizet (bempodoic acid) 3. Ezetimib (blood thinner like compounds? but w/o statin)

[@daviddelguercio8458]

What would it cost to take these?

[@MrDmitry4ever]

nexlizet has both 2 and 3

[@deborahhall9744]

Ezetimibe is already generic and inexpensive so take that for starters (along with statin or PCSK9i) while waiting for Bempedoic Acid to come down in price.@@MrDmitry4ever

[@7371301]

Repatha is $1,000/month. My insurance company said no without further justification

[@oisteinthomassen]

Ezetimibe lowers plasma cholesterol levels by inhibiting the uptake of cholesterol in the intestine. Pubmed: pubmed.ncbi.nlm.nih.gov/19443695/

[@danielcisco]

I have an ApoB of 146 😢 TG is between 55-75. Going to speak to my DR because I have been working hard on lowering it for more than a year.

[@Sa7biUK]

136 here brother. 39 years old and thin my whole life and mildly active. I feel you. I've ordered Citrus bergamot, fish oil, and vit c to try and lower it. Lots of psyllium husk too but I think statins are on the horizon...

[@danielcisco]

@@Sa7biUK Yeah I have been taking fish oils and Niacin for a while now. Nothing I do seams to make things better at this point. I am avoiding statins. If I do start it would be a low dose 5mg a day as explained in this video it has diminishing returns as soon as you go above it.

[@FeFeronkaMetallica]

I am 26, active, lean, eating well at 151

[@critterdude311]

Are you guys doing Keto or Carnivore diets by chance? I did a 4 month carnivore diet, loved it, but my LDL and ApoB readings went through the roof, presumably from the excess saturdated fats (trigs were low as OP mentioned here). My doctor wants me to revert my diet back and retest blood in 6 months.

[@FeFeronkaMetallica]

@@critterdude311I do low carb 0-100g daily (some days carbs some not) but I use only olive oil, so I dont think the sat. fats are issue in my case. My triglycerides are in low 30s, my ApoA is also around 150

[@RichardMullin-ly1we]

I found this very informative. My LDLc went up significantly after loosing 75 pounds and getting to sub 13% body fat, but I started drinking 64 oz plus of black coffee a day. Will cut back the coffee and tweek the diet more. Thanks

[@tackletalkmenshealth]

What do you think about low dose colchicine to decrease endothelial inflammation?

[@aquamarine99911]

I was in good shape on a strict keto diet, with an ApoB of 186. I added two cans (~600 g) of beans/lentils per day, cut out red meat and eggs, and dropped my ApoB down to 85. Apart from reducing SFA and dietary cholesterol - for those of us who are hypersensitive to such things - the easiest way to drive down cholesterol is dietary fiber. Since I am fit with good BP in my 60s, I'm happy to have my ApoB in the 80 to 90 range. I don't want to take drugs, because then I wouldn't follow my diet so strictly. I just want to feed my body what it seems to want.

[@qilinwang5889]

Thanks for posting this and I will try the same steps and hopefully it can bring down the apoB

[@wocket42]

How high is your CAC score?

[@aquamarine99911]

@@wocket42 I haven't had it measured. A cardiologist prescribed one when my LDL was high, but now I don't really have any indicators of a heart problem and my BP is 110/69, without medication. So I didn't follow through with it.

[@GlennMarshallnz]

Hi Andrew, interesting and insightful comment. In the space of six weeks on carnivore, daily grass fed meat, free range eggs, butter and sardines my cholesterol doubled to 352 total, 278LDL. I was eating six to 12 eggs per day and 1-2 kilos of beef. I’ve decided to switch to 90% whole food plant based, with legumes, old fashioned rolled oats, vegetables and fruit, chia and flax seeds, plus sardines and other fish once a day. I honestly found that after six weeks my skin had also become very oily and smooth. My dad had very high cholesterol and took statins. My BP is similar to yours at 110/72. What does your average daily diet look like? Regards Glenn

[@aquamarine99911]

@@GlennMarshallnz Hey Glenn. I too eat fish every day, but it's red fatty fish - wild Pacific salmon, Artic Char, or rainbow trout. I love sardines, but they cause me gout. I have my mercury levels checked regularly and found I can't eat tuna, even supposedly "low mercury" tuna. So you may want to watch for that. Every morning, I eat berries 20 minutes before my main breakfast of fish with an ounce of walnuts (to balance the Omega 3s with the 6s), steel cut oats (supposedly better than rolled oats), and 142 g mixed green salad with olive oil and .ACV. Both lunch and dinner ~300 g if lentils or one can (~250 g) of kidney, black or pinto beans or chick peas, alongside ~500 g of cruciferous vegetables (red cabbage, broccoli, cauliflower or brussels sprouts). For dinner I'll add 50 g of chicken breast. That's the basic plan, and I like it, but I'll vary things up sometimes. The important thing is to meet your Omega 3, protein and fiber targets. Legumes and fish are the perfect foods for doing so.

[@MiguePizar]

As someone who was morbid, had high cholesterol, pre diabetes and things like that, and now have excepcional blood work, it all started with losing weight, Intermittent fasting, and working out, and I eat quite lot of meat and carbs, but because I do what I said before, my blood work is very good, and no drugs. Best

[@WhatsIQ]

The fasting has no effect

[@MiguePizar]

@@WhatsIQ for me it is, my blood markers are better with fasting, I'm not saying is the cure, just better blood work. Best

[@utubevenky]

@@WhatsIQ its ridiculous statement. fasting helps the body to cleanse itself and cleansing helps the body to be at its peak that it can be at a given point of time. even if it may not be a permanent cure it can atleast help one to have a high performing body for a longer time. autophagy is the minimum benefit one gets from fasting apart from the better inter-cellular connection and reduced inflammation

[@llkoolbean4935]

​@@WhatsIQit does for me as well

[@joerenner8334]

I have never been fat and exercised all my life. High Cholesterol is 100% inherited

[@WolverineTraining]

Thank you Dr Attia. I understand that cholesterol is used for all of the bodies repairs, new cell formation, etc. how do statins affect this process?

[@Mike-du1dc]

As always very informative! Thank You!

[@pb7762]

it would be great to see you have a podcast with Dr Paul Mason

[@milenasenov6228]

Or Dr. Nadir Ali

[@Nicksonian]

No, Mason has a very prejudiced, closed-minded view of science. He is a subscriber to and spreader of the litany of low-carb conspiracy theories, many of which are based on questionable or non-existent science. I don’t always agree with Atilla, but at least he identifies saturated fat as “one of the horsemen of the apocalypse.”

[@hugoanderkivi]

@@Nicksonian Any evidence or just opinion? What you have said is ridiculous.

[@HobzyMcRuse]

absolute nonsense. Sat fat is the ancient fat source we evolved with. The studies are so weak and biased that blame it.@@Nicksonian

[@wocket42]

@@Nicksonian Science says saturated fat is fine. If Peter says otherwise, that's his personal opinion, not science.

[@julianalima2751]

Hey Doctor, how about the progress of arteriosclerosis after statin use? Do you have concerns regarding that?

[@richardnimo]

Love the way Peter speeds up when he saying unnecessary jargon. Very impressive, even though 99 percent of the listeners may have no idea what what he's saying or whether it makes any sense. I am so impressed with the difference between his intelligence and my stupidity! Pity it doesn't teach me anything.🙂

[@leadimentoobrien1221]

I bought ur book expecting u 2 to discuss med thal minor but u did not. I wanted 2 c if it affects A1C. I read elsewhere it does but decreases it, and mine increased.

[@allencrider]

I eat a whole food vegan, salt, oil and sugar free diet. I tested my ApoB and it was 73. I'm 70 years old and have abundant energy to do whatever I want.

[@isabellezablocki7447]

Great Job!

[@bobwilliams9061]

Which whole food diet guru do you typically follow? T. Colin Campbell?

[@allencrider]

@@bobwilliams9061 McDougall & Esselstyn

[@Shabana-hv9ic]

Super interesting facts regarding the effects of statins at high doses vs low. Both my parents are on 40mg of atorvastin and their A1C always comes back high regardless of being on a low sugar diet. Will def discuss lowering their dose with their doctors. Thank you Peter for sharing such vital health information all the time.

[@TB-rx1ue]

How are statins and A1C related?

[@MT-sq3jo]

@@TB-rx1ue Some folks could worsen their insulin resistance by taking statins, even though the effect is not huge as far as I understand.

[@MT-sq3jo]

You did not mention if your parents baseline A1C levels before starting statins… So we could not say if max dose statins has anything to do with your parents insulin resistance. Nevertheless, A1C level should be easier to control than high APOB/LDL-c. For example, exercise has great effect on my blood glucose levels, but zero effect on my blood cholesterol levels.

[@echase416]

@@TB-rx1ueRead up on metabolic syndrome

[@wocket42]

@@TB-rx1ue most statins cause diabetes.

[@MichaelN726]

What do you think of Fenofibrate to reduce triglycerides ?

[@williamhenry3337]

What about APOE2? I have the E2/E3 combination. No one in my family has has heart or alzheimers issues (all died from cancer). I am 75 years old and have held a 19.5 BMI my entire life.

[@etmax1]

I've been on various statins (along with the muscle pain and bleeding), Ezetimibe and Evolocumab (at half dose monthly) and the only one that actually made a dent in my cholesterol was Evolocumab. Now 6 months into that I'm getting serious cramps in almost every part of my body, (hands back, Thighs, calves and feet) (6 months of Evolocumab??). It also has been scrambling my brain, so now we're trying to see whether half dose 6 weekly is going to be a better balance. Watch this space.

[@arubaga]

Become a lean mass hyper responder and get rid of statins.

[@GlobalDrifter1000]

I am in a trial of Olpasiran by Amgen. Phase 3 trial of a siRNA. in phase 2 it recuced lp(a) 95%. A subcutaneous injection once every three months- fingers crossed.

[@wocket42]

Does it also reduce overall mortality and improve general well being? Will be interesting to find out what reducing a associative marker really does. Do you know what the control group gets? It's not double blinded or you don't know if you've got it?

[@vickistonehouse2218]

How long is the trial you are in going to run before the results are released? Do you know how (what the protocol for this study is) the participants were chosen? Or where I can search for this study?

[@thomasweber5560]

Dr. Attia, thank you for the extreme worthfull information, explained in a logical manner. What is the relation between lipoprotein a and Apo B? I understood lipoprotein a is a general indicator of risk for cardio vascular desease. Do I have to concern about high lipoprotein a (>200) if my Apo B is down (90)?

[@AlphaHealthYT]

One Apo B is attached to every Lp(a) molecule. If someone has generally low levels of LDL cholesterol due to diet, lifestyle, or the use of cholesterol-lowering medications, their total ApoB measurement (which includes ApoB from VLDL, LDL, and other lipoproteins) may also be low. However, if the liver specifically produces more Lp(a), this can lead to a situation where Lp(a) levels are disproportionately high compared to other lipoproteins.

[@alpinelove6225]

I am a carrier of two copies of ApoE4. I consumed a predominantly whole food, plant based diet that includes egg whites and fish. My diet is high in COMPLEX carbohydrates and low in saturated fats......my ApoB, my A1c and my triglycerides are all low. I think that it's very important to distinguish between complex carbohydrates and simple. There is a vast difference when speaking about lowering carbs. I thrive on a high carb diet....but complex carbs, very little or no simple carbs. Because I am a carrier of two copies of ApoE 4, I also thrive on a diet low in saturated fats.......not everyone needs to eat more saturated fats to lower ApoB.

[@StatzGee]

Excellent point

[@Marx1963]

My apo b went from 121 to 80 on 3 months of low saturated fat . 60 yo Trig - 38 LDL 88 HDL 54 Total 147

[@drott150]

@marxp2216 Great work! Especially through natural dietary means instead of drugs.

[@rosetulip1231]

So awesome

[@nhtathinfbntb2746]

what did you eat daily/weekly?

[@mysidestitches]

Keto diet?

[@Marx1963]

@@mysidestitches depends what you call keto . I’m not about the medical version which is high fat which I think is ridiculous.( unless you’re using it for medical purposes like epilepsy). I’m high protein low fat but make sure I consume / supplement w/essential fatty acids like omega3s . On average I consume the following - I’m 60 ,5’11 190lbs bodybuilder. Protein - 220-280grams Carbs under 50 grams Fats under 60 grams Averages for 7 days 👆

[@reason3581]

How long after a diet change should you wait before re-testning your ApoB? How long till you see the maximum effect?

[@daviddelguercio8458]

3 months

[@evramirez87]

Hello Doctor. I would like to know your opinion about my case. Total Col. 234 / LDL 159 / HDL 64 / Trig. 54. APOB 106. Fasting glucose 90 HgA1c 5,5, Lip(a) 5.1 PCR = 0, Cortisol 8am 9. I do CrossFit and running (8-10h/week). No alcohol, no junk food, regular and sufficient sleep. Weight:67kg 169cm). My LDL never goes down, should I worry? What can I do differently? Thank you

[@philipsmith6152]

Great video, I’m a 64-year-old male in good physical shape. I have familiar hyper cholesterol, I have two stents in the left descending artery which are 10 & 12 years old, my last CT angiogram 18 months ago was clear. I was part of the worldwide clinical trial for PCSK9 Repatha here in Australia, and since then I have been on fortnightly 80 milligrams injections since. My cholesterol levels have not gone down below 6, my question is, you mentioned two other drugs to use in conjunction with Repatha, could you please tell me what those drugs are and what the likely outcomes, might be? Many thanks Phil

[@dbpantani]

Thr drugs lower APO B . The group of lipoproteins that transport cholesterol. Don't focus on cholesterol but rather your APO B levels. Peter is recommending around 30 to 40mg per decilitre.

[@philipsmith6152]

Thanks @@dbpantani

[@kevinstarski1598]

I didn't fall off the turnip truck but relay all this knowledge on us in a simple manner. I tell guys in my line of work to avoid abbreviations, jargon because they aren't meaningful to most people...Don't make yourself sound smart, the goal is to spread knowledge among people and hopefully improve their health (this is in reference to other videos I see out there)

[@bearclaw5115]

Look up the terms if you need to. I have never watched any of his videos before and I knew what he was talking about.

[@davidflorez1196]

There are terms and things that you need to search up to really understand some topic deeply so the audience also need to put some effort, I don't have any back in medicine I'm not a lipidiologist but I can understand most of what is discussed because I search up some terms and I'm exposed to the topic in the media

[@knutevids]

Try NutritionMadeSimple channel with Dr. Gil Carvalho for more user-friendly reviews and interpretations of the available science. He claims no financial ties to drugs or supplements and speaks in plain language about as much as can be expected with this very complicated subject material.

[@straightgarb]

Bempedoic acid side effects: Tendon problems, including swelling, inflammation, or rupture can occur in the shoulder (rotator cuff), upper arm (biceps tendon), or Achilles tendon at the back of the ankle, within days or months after starting treatment with bempedoic acid.

[@KTravRuNEr]

Thank you. No way would I take this drug as an athlete

[@davidking7606]

I have been doing keto for 3 months to lower triglycerides, as well as taking a lot of Berberine and phosphatidylcholine. My triglycerides did drop from 169 to 147, but my ApoB went up from 119 to 120, and my A1c went up from 5.6 to 5.8. My LDL went from 118 to 134. My Omega 3 is high, and my Omega 6 is within normal range. I have also been intermittent fasting for a couple years, with an eating window between 10:00 a.m. to 6:00 p.m. I am an athlete with under 10% body fat and work out 7 days a week in one form or another, so I do eat a lot of calories. The past few months I have doubled the Salmon, Cod, tuna and sardines. I eat 4 eggs per day and eat lean bison and elk 2-3 days per week, along with non starchy vegetables; i.e. broccoli, culliflower, cabbage, brussell sprouts, spinach, mixed greens, carrots, onions and mushrooms. Any thoughts?

[@daviddelguercio8458]

Your eating way too many carbs. Your A1c indicates you have prediabetes. Blood sugar control is much more important than cholesterol. You need to lower the carbs

[@davidking7606]

@@daviddelguercio8458 Thank you for the reply. I have not eaten carbs in 3 months. No bread, rice, flour, fruits, etc. So that is where I am confused. My triglycerides have dropped 20 points, which makes sense getting rid of the carbs. But my other numbers going up does not.

[@jessicagriffin5920]

@@davidking7606I think you need cut down on the calories overall and do intermittent fasting

[@davidking7606]

@@jessicagriffin5920 I have been intermittent fasting for over 2 years. Usually eat my first meal around 10:00 a.m. (sometimes later), and always eat my last meal by 6:00 p.m.

[@AncestralFuel]

Need to know your fasting insulin to determine your insulin resistance- your pancreas could be working overtime to produce insulin, which could be 10x of optimal- 2 to 3. The way you determine IR is multiply blood sugar by your insulin number and divide that number by 405. It’s called the HOMA-IR calculator. If that score is 2 or above, you are still insulin resistance and need to cut carbs so that the pancreas beta cells can heal. Plant-focused diets always involve eating a lot of carbs so as to get adequate nutrition. My HOMA-IR score is .7 and I the only carb I consume is organic balsamic rice from California. The only thing I want out of the plant kingdom is about 60-100 carbs a day (based on activity). White rice is clean in that organic balsamic rice is mostly free of arsenic and phytic acid with a mild to moderate glycemic index. I don’t buy Peter’s view that saturated fat is bad - a view shared by many doctors and researchers - but has since been debunked in at least one major meta-analysis on the subject. The need to treat number for antibiotics is typically 1, while the need to treat numbers for cholesterol lowering drugs is close to 200 plus for a 70 year old like myself. No thanks I do not want to be one of the 199 who have no impact, only side effects.

[@billytheweasel]

Thanks team Attia, so glad Dr Dayspring is here now too.

[@Joseph1NJ]

Where?

[@billytheweasel]

@@Joseph1NJ With the channel and available for us to hear publicly. When he left clinical practice and lectured only, as we were told, I didn't hear from him for years... publicly. He's in Peter's practice now, they've said.

[@victorbaez3688]

What do you think about Red Yeast Rice doc?

[@AlwaysSeekingTruth13]

I take it and it's been very helpful for lowering as ApoB. Just make sure you get a brand that actually has the natural statins (e.g., HPF Cholestene).

[@butchgalvez6242]

Does MCT oil raise apo-b?

[@hypnotiqpits13]

My Lpa fluctuates 317 to 570 month to month The psk9 inhibitor raised it after 2 months

[@gerard6629]

What do you have to say about the new lean mass hyper responder study?

[@user-vp9hm6bf6c]

Please explain why APOB is simply not just a marker? Most everyone I listen to speak of it implying it as causal. Meaning, speak of lowering VLDL LDL for most and Lpa where possible and therefore, lower triglycerides and LDL...lower carbs , low sat fat, fish oil, lots of fiber and statins when necessary.

[@tama5570]

Where does joy come into all of this Peter?

[@sectionalsofa]

Joy raises ApoB by 25%. Just kidding.

[@4plum]

Joy from living healthily in to your 90s, if you're lucky 😅

[@qilinwang5889]

Well you are not a nerd then because I can totally understand the joy of experimentation, getting information and make a bet on best information

[@Abby-ug4xc]

The idea that bingeing junk and living recklessly is the only way to experience joy is one of the most toxic ways of thinking around. Vegetables are delicious, exercise gives you energy and sports provide you with community and fun :D

[@tama5570]

I dont think a single person consciously believes/ experiences junkfood etc = joy...those are just unconscious habits, like many other unconsicous habits. My point is - is Peter Attia experiencing a significant state of real joy? Doesn't come across joyful to me. Living physically healthy into your 90's is of course an ideal....but what about joy? All this health science is great...but I think joy, above just feeling good, is much rarer, much more valuable, and much more needed. @@Abby-ug4xc

[@gordonv.cormack3216]

So my AboB is 78, through lifestyle. Are you suggesting I should medicate myself lower?

[@gtm5650]

How long will Dr Attia take these drugs?

[@johnrobinson4445]

Short version: use drugs to reduce apoB.

[@peterrecchia6830]

If my lipid numbers (including APO B) are within "normal" range, am I likely to have a pharmacological intervention prescribed and then covered by insurance?

[@BozzleyOfficial]

Are you likely to what?

[@wocket42]

So you are trying to heal an illness that you don't have?

[@peterrecchia6830]

if we are looking at illness as binary, you have it or you don't perhaps. If we are looking at it on a continuum no. I already have some arterial plaque, but i have not yet had a negative cardiac event or diagnosis. I would like to keep it that way. @@wocket42

[@hccparamedic1985]

Does this combination of meds lower cardiovascular inflammation like rosuvastatin does? My understanding is that is also a benefit of rosuvastatin

[@qilinwang5889]

Saw an article saying that ezetimibe does not pcsk9 does. Basically anything that works on your ldl receptors works; blocking absorption does not

[@NAKMUAYACADEMY]

What supplements can I take and diet for : Low testosterone Fatty liver Low GH High blood glucose IBS Lack of sleep ( sleep problems for years ) Apreciate any advice

[@luismarioteixeira658]

To low apoB, reduce Applebee’s first

[@lukeuseforce]

😐

[@ananavarrete7218]

😅

[@michaelbishop9157]

diet isn't enough to be meaningful in reducing most people's risk

[@Seanonyoutube]

@@michaelbishop9157yes it is.

[@amberweber6369]

@@michaelbishop9157 But diet is still very important. Food is information for our biology and processed food aka fake food is not optimal for our health.

[@haripriya2485]

I listened a lot to Attia a few years ago and the way he speaks now about pharma first has me wondering if someone ‘made him an offer he couldn’t refuse’. Seeking opinions on whether this shift is gangstas at work or simply a natural progression of his own journey of discovery. Thanks in advance.

[@Icipher4]

You mean because he's not a conspiracy theorist that thinks the drug companies are out to get people?

[@johnd5941]

He used to say it doesn't matter if you're vegan and eat vegetables alot . That it was just energy inputs that matter. Now he sits here and says lowering saturated fat intake helps lower your APOb. If higher fiber and less saturated fat intake lowers your ApoB he should just say...eat less meat and eat more vegetables. Yes, big pharma or the meat mafia has him under control.

[@juukame]

I'll admit, I've always valued Peter's knowledge and have taken much of it to heart like zone 2. VO2 max training etc. But the one area that I don't align with is his eagerness to go right for the drug treatment path when it comes to statins and lipid management. I can't help but wonder also if there might be some financial conflict of interest

[@Stormie33]

@@juukame It's very concerning when the evidence for the efficacy of statins is so overwhelmingly weak. They DO lower ldl, no doubt, but the resulting boost in health outcomes is extremely slim. Factor in the potentially very serious side effects and they appear to be a neutral proposition at best. I think Peter is so focused on lowering apoB at all costs that he can't see the forest for the trees right now.

[@karoshitv7506]

@@Stormie33 Actually its the exact opposite. Multiple large meta-analyses have shown that statins reduce not just ldl/ApoB but also real cardiovascular disease events (ie. myocardial infarctions and strokes). The degree to which they reduce CVD events is proportional to their ApoB lowering effect. The side effects for statins are generally overstated, such as rhabdomyolysis, which occurs at around 0.5-13 cases per 1000000 prescriptions. The most common side effect which is muscle pain occurs at around 10% and can be fixed either by trying a different statin, such as a hydrophilic one, reducing the dose, or using another lipid lowering med entirely. I personally take a statin for Familial Hypercholesterolemia and have no side effects. ApoB is unequivocally a causal factor in CVD risk and most people are not willing or able to employ a super strict diet or cutting out all saturated fats to reduce it, which is likely why Dr Attia recommends pharmacotherapy for most.

[@meet4sarfraz]

How to test apoB, we dont get normally recommended for apoB in Pakistan. Is there anyway to know my appB value. My bad cholesterol is 134.

[@evalpoul1470]

My husband had a thalamic stroke 7 mo. ago and he cannot take statins due to rhabdo. We're in Ontario Canada and so I'm wondering if there is a more natural supplement route to explore.

[@stevenharris9177]

Yes, there is ! It's called The portfolio diet out of Toronto University. Please check it out

[@videoagogo1]

B3 Niacin (Nicotinic Acid) will reduce Lp(a) by about 20% and depending on your genotype up to 68%

[@scasti70]

@PeterAttiaMD : doesn't the ratio of LDL towards HDL matter any more, when it comes to cholesterol considerations?

[@Seanonyoutube]

No.

[@wocket42]

No. Sales would go down.

[@betterplacetobe7896]

I’m 47 years old, 220 pounds 12% BF, I eat whole food plant, cardio 6x per week 1hr per session, 25000 steps per day, lifting weights for 2hr 6x per week. I use some supplements to complete my diet and I take 10mg Lipitor. Last year I had a CT coronary arteries scan with a calcium score of 0, echocardiogram and everything came back optimal, stress test and I max out the machine. I do bloodwork 3x times per year and my LDL, ApoB and triglycerides are really low. So everything I do work for me.

[@chopchopbc]

Yeah bru , but can you paaaaaaarty!🎉

[@betterplacetobe7896]

@@chopchopbc I don’t need to party it’s useless

[@chopchopbc]

@@betterplacetobe7896 file under “fun at parties”

[@robflel]

@@betterplacetobe7896how about your sense of humour what’s the score on that?

[@betterplacetobe7896]

@@robflel 👎🏻

[@jeffm.8134]

We are all different biochemically. I personally do not do well with saturated fat. I was eatin 2 eggs a day and my APoB is about 99 and ldl is 115. When my my LDL is good my APoB is also always good. When I cut back to one egg a day my LDL is usually normal along with APOB.

[@user-xk9ic5xg6e]

What do you feel about taking Repatha mixed with a statin to reduce triglycerides?

[@jrkob1156]

Statins and Repatha do not have any any TRG lowering power. I have been on both (20mg rosuvastatin and Leqvio, the modern version of PCSK9 that Peter talks about that is being injected twice a year instead of twice a month) for the past 4 month, my LDL has collapsed but my TRG and HDL are exactly the same as what they used to be before. Which is normal, these drugs do not target TRG.

[@simonphuket7782]

Insane! Still subscribing to the cholesterol myths. I follow the GAPS diet formulated by Dr. Natasha McBride, she regards cholesterol as protective and we do not fear high cholesterol. I recently did a CAC test my results were 0 in every artery. My cholesterol was about 290, slightly higher than usual as I had an infection at the time. I have been doing the GAPS diet for over 8 years. I take no pharmaceuticals and 2 supplements which are food based: probiotics and cod liver oil. I am in my late 50s and was in 0-25% for the CAC test. Good luck with your method! BTW, before I discovered the GAPS diet p, I was probably on my way to a stroke, taking far too many supplements without fully understanding their effects on in the body in particular the microbiome.

[@Seanonyoutube]

Insane! Still subscribing to the round earth myth (insert anecdote here)

[@HobzyMcRuse]

I agree. All this modern heart disease tracks perfectly with the SAD diet recommendations from the 1950's. Way too many processed carbs and seed oils.

[@llicit1833]

Look up familial hypercholesterolemia. These people have lifelong high LDL due to their genetics and can lose decades of life, with the worst form (homozygous) seeing people die in their 20's (ie around 60 years of life lost) without treatment. Seems pretty clear cut and nothing to do with big pharma, greedy doctors and all the usual stuff trotted out

[@wocket42]

@@Seanonyoutube even a single anecdote like this falsifies the hypothesis that any cholesterol level above a really low minimum is sufficient to create heart disease even at young ages within a short time. Insane is just to pretend it's otherwise.

[@diceymaan]

There's very few people on the planet who knows more about Cholesterol and Atherosclerosis than Attia, and he is not out here trying to sell you a course, book, or diet. He does not sell the drugs either. I recommend you watch more of his videos to understand how deep his studies are.

[@HisrealnameisLukeFury]

Had a recent blood test and I have have a HDL of 1 and my LDL is 3.6 (should be below 3.0). My non HDL is 3.9. Total cholesterol is 5.0 which is just on the limit. My Triglycerides are 0.9 which is excellent. Have never had my ApoB checked so no idea what it issue. My total and LDL cholesterol is quite stubborn & very hard to get down and I don’t know if I should be worried about it or not - there’s so much conflicting info out there. I’m an omnivore and dunno if I should cut saturated fat out completely. I’m very active (resting HR of 41 at 41 years of age!) and find it hard to keep weight on so I’m very reluctant to cut out the animal products completely and become an malnourished skeleton. My sugars and HBa1C were absolutely fine as well, even eating a teaspoon or two of raw honey a day along with other carbs like oats in the morning. The doctor marked the blood test as normal & no further action but I’d still like them to be better than they are.

[@zerog4261]

Im 55 and am just a tad higher than yourself, so I know your concerns. I've been steady for years and have no history of any heart disease in my family. I think, should I take something but as you say, there is so much conflicting info out there. Ive got a decent vo2 max for my age, still pretty lean and have always kept fit. But...... A dunno, Doc took blood pressure, height, weight and family history and said don't worry about it. As for APOB, I'm from the UK, it's never been mentioned, by anyone. Ive tried private hospitals but doesn't seem to be available

[@Sa7biUK]

@@zerog4261 Hello geezer. I am also from the UK. You can get it here, but from posh clinics on Harley street. I personally got mine from Budapest. Cost about £15 and the results came in 4 working days. I was in Budapest for work so I managed to get it done on the side no hassle in a state of the art place called 'Medicover'. Hope this helps

[@HisrealnameisLukeFury]

@@zerog4261I think we’re known as the worried well… The internet has engendered a lot of neuroticism in us all! I’m in the North of Ireland and you’re right, Ap0B is barely mentioned, neither are CAC scans. The Americans commenting on these videos seem to get these tests done quite routinely, the NHS would probably only test these as a last resort. But no problem on private healthcare insurance I would guess. In regards to diet, I’m may have to cut out animal products (I don’t eat massive amounts as it is) altogether to get LDL down, but I’m not really thrilled at the thought because of how feeble & frail vegans always appear. You’re damned if you do & damned if you don’t. From what I see, different diets lower some blood markers & Raise others which makes it doubly difficult. It’s a real mind fuck if I’m honest. I do know I’m metabolically in Good shape, proper weight for height, sugars, HBa1C, triglycerides all in check but it’s the LDL that slightly bothers me.

[@Mikolas649]

Total cholesterol at 5 is not high, you need it, but trigs are to high for most at. 90

[@CallumCornick]

Have you ever had your APOE genotype checked? Your numbers sound very similar to mine, and I have recently found out I am E4/E4. So now I’m curious if this is linked, as I’m generally very healthy.

[@keithwilkinson5707]

According to a recent blood test my ApoB was too low. i.e. below the normal range.Any suggestions of a healthy way to increase it welcome.

[@AlwaysSeekingTruth13]

I'd do some research, but I don't think it's a problem if your ApoB is lower than usual. Babies are born with a low/ideal level of ApoB; I'd check out some of Dr. Attia's prior comments on this.

[@TraderZer0]

I have what they class as nornal cholesterol here in UK but have just found out I've got 3 fold nornal LPa. I also have elevated antibodies but normal thyroid function. I have no idea what to do as doctors arnt offering anything right now.

[@cadupradoo]

I know anedoctes are not relevant, but since Peter mentioned his own, I'll mention mine: I've had a non-HDL of 200mg/dl, which is absolutely high!! I didn't have a ApoB test back then. Now, after 5 years of healthy low saturated fat nutrition, my Apob is less than 50 only with lifestyle changes (non-HDL under 75). It is possible!

[@boriszolah3770]

Incredible! Great on you!!!

[@dawngonzalez508]

Nice! What is your diet like?

[@cadupradoo]

@@dawngonzalez508 since I've peaked the non-HDL at 200 at age 28 with also hypertension, I've done many changes. First I dropped the smoke and excessive alcohol (but still drinked) and started exercising for the first time in decades. Ive cut down on coke and many other ultraprocessed foods and most calories would come from animal protein and fat (low carbo, but no ketogenic) and got to a non hdl of 150 mg/dl (apob of 101 mg/dl), which was a considerable improvement. I've kept the other changes and then changed to plant based diet. One and a half month on it and non hdl dropped from 150 to 74 mg/dl. After one year improving the overall quality (replacing refined carbohydrates for whole carbs and lowering total fat) I got non hdl to 63mg/dl. Then I've decided to be more receptive of poli and mono unsaturated fats and went from a low fat to a regular fat (but still very low saturated fat) wfpb diet, which I've been for a year. The 63mg/dl increased and kept stable at around 75 mg/dl (apo b at 45mg/dl). Sorry for not getting ApoB data at all times, but I didn't know its role back then!

[@ngana8755]

Maybe you should do a video on how you got yours to go lower.

[@carmenross1077]

I thought these negates the principles most doctors I listened to like Dr.Lustig on METABOLICAL HEALTH, most doctors have not ordered APOB TEST TOO. Statins that I used to take years ago very low dose ,the side effects are tremendous in years to the point of one day I’m unable to move my left arm, and NP that saw me that day says Stop the statin sure enough I did. Lo and behold overtime I am able to move my arm. Very scary I was on low dose of statin. Changed my diet to no sugar ,low carb, moderate protein,exercise diligently strength and cardio,resistance band. Doing alright thank God I’m moving my 4 extremities. I like this guy to have a discussion to Dr. Berry, Dr. Diamond, Dr. Lustig,Dr.Hyman, Dr. Longo , tandoori that cardiologist that Dr. Berry spoke to can’t think of his name that sounds like His name Attia hmm Dr. Avenida whose book title stay away fro my operating table.

[@bearclaw5115]

Most of the docs you cite aren't reliable for scientific truth. Some of them cherry pick studies and mischaracterize them to create a marketable spiel they can sell.

[@jarsenault6418]

I am 78 they have me on a statin 40 mg 2 x a day. I don't take them as gave me bad digestive prob. Never been over weight, never smoked, no high BP. Chlosterol and blood sugars always perfect. Been on med diet since age 30. Yet I have calcium in my arteries re a CT angiogram. A bit dismayed. Going to try Vit K2.

[@barrykearns7193]

Can you provide the efficacy studies showing low dose Rosuvastatin's effect on lowering APO B? Thank you!

[@drott150]

Studies galore on it lowering LDL which is the primary element within APOB.

[@HocDolliday]

Repatha & Nexlizet

[@michaelwatts1186]

See I'm getting mix reviews on if APOB being high is a bad thing.... If your other blood markers are in optimal range. Im really trying not to think that many Drs dont know how the lipid suite really works due to the different variances of different diets.

[@Valoric]

Think triglycerides being high is much more important. Meaning you’re not utilising your energy properly. Cholesterol is a problem when you have crazy amounts, lots of stress or high inflammation. In thirty years imo half or most of the markers we think are important today will be joked about. In twenty years, nutrition has been turned upside down almost from government recommendations.

[@HobzyMcRuse]

I'm not convinced anyone has a clue of an optimal range. Many low carb athletic types have crazy high LDL and apoB with absolutely no signs of heart disease.

[@travistial]

will Insurance cover any of these medications for someone who's APO B is in the 50th percentile? I feel like traditional "medicine 2.0" will think this is fine and just suggest dietary modification.

[@michaelmurphy2795]

Dr.Attia, As someone who’s trying to improve my life span, I went to my PCP and requested a ApoB and he looked at me like I was crazy. Is there any way that you could create a printable one page explanation that a PCP would be able to understand.

[@dougcane4059]

How do you explain the fact that people with higher cholesterol live longer than people with lower cholesterol?

[@soylentgreenb]

That’s mainly confounders and the fact that total cholesterol is a poor indicator of heart disease risk ti begin with. Confounders are things like people who are dying from heart disease being given large amounts of statins; people dying bareöy eating etc. It is difficult to get rid of confounders, but you’ll be all confused if you’re including the people who have low cholesterol because they are dying.

[@psarakis340]

It doesn't help his narrative 😂

[@AlwaysSeekingTruth13]

Dr. Attia isn't pointing the finger at cholesterol; he's saying that high ApoB is casually related to heart disease.

[@generalx-ray7833]

Peter, have you talked/written about the work of David Diamond, PhD and others who seem to think elevated LDL-C / apoB may not always be problematic?

[@wocket42]

Doesn't fit his ideology. Can't change your longevity life style by 180 degrees every couple of years or you will lose credibility.

[@RogueCylon]

He doesn’t want to follow those studies that Dr Diamond believes in. He’s moved away from preaching that.

[@karoshitv7506]

The studies that David Diamond subscribes to are of poor quality and run counter to the overwhelming body of evidence that show that elevated ApoB is causal of CVD risk. Dozens of trial have been performed showing that if you lower ldl/ApoB you lower MI and stroke risk. Peter would be a fool to listen to contrarians who ignore the preponderance of high quality evidence that has been collected over the past several decades on this subject.

[@reydelagarza2953]

For Rosuvastatin, based on efficacy curve, 85% reduction at 5mg, is it the same for atorvastatin?

[@agfairfield8575]

my question too

[@drshanep]

Great info, my concern is how to people afford Nexlizet and Repatha both very $$$ meds? You are talking about $1K a month for those.

[@drott150]

Who cares? Attia's bosses need the money. Time to pay up. But if you can't, don't worry. Studies will start flowing right after the patents run out showing the drugs have less efficacy and more long-term side effects than previously reported. And that you should take the new patented drug that replaces the old unpatented drug that finally "fixes" those issues. Rinse, repeat, etc.

[@liz9147]

Don't live in the USA. Live in a society that has socialised medicine and controls pharma costs.

[@drshanep]

yeah...not even possible for billions of people @@liz9147

[@Joseph1NJ]

I think we regularly underestimate the influence of diet in managing lipid levels. Of course every~body is different, but you don't need to be vegan or vegetarian, just smart about what you ingest, along with some trial and error.

[@Sa7biUK]

Yeah but Dr Attia mentions at the start that diet isn't going to do a lot and that statins are necessary

[@DessicatedCadaver]

And I think we regularly *overestimate* the influence of diet in managing lipid levels. I've had terrible lipids all my life, and no matter what I do with my diet, including vegan, cutting out saturated fats, carbs, monkeying around with low fat, different poly and mono fats and on and on and on, massive exercise, never smoked, with and without alcohol, epic amounts of fiber and so on. Nothing helps. So I really resent the "diet and lifestyle blah, blah, blah" stuff that's repeated ENDLESSLY, everywhere, ad nauseum. NO IT IS NOT ENOUGH for tons and tons and tons of people. That's why we have pharma. Statins help my lipid levels but it's not enough. I can't wait for more and better pharma solutions. I'm happy for those who can manage their lipids through diet, exercise and other lifestyle interventions, but there are vast numbers of us who can't despite our best efforts. When I get my lipid panel blood tests back, there's always a computer generated "advice" from a bot nutritionist "cut out saturated fat". Since I have cut out saturated fat from my diet as far as vegan and beyond for decades now (I try to cut out even vegetarian sources of stearic saturated fat that DOESN'T raise your cholesterol levels!) I find this "advice" highly irritating. It's like when you go to the doc with some issue and they rattle off a string of things to do and not do to solve the issue, and often the biggest one is to "stop smoking" - since I've NEVER smoked and still have the problem I tell them that I'll TAKE UP smoking just so that I can quit smoking and they can chek off the box on their form that says "stop smoking", that way we can move on to real solutions since the problem is still there after "stopped smoking".

[@HisrealnameisLukeFury]

@@DessicatedCadaverI’m with you. I also think we overestimate the value of diet in managing lipids. Genetics is king.

[@Rachel_2112]

​​@@DessicatedCadaverhave you checked for familial hypercholesterolemia?People with it need medication

[@Joseph1NJ]

@@DessicatedCadaver You've obviously had a lot of experience with your genetic propensity to hyperlipidemia. While your frustration is understandable, it's not in the majority, or so says many experts in the field whose names I'll refrain from mentioning. The good news like Peter said, is statins are no longer the only treatment.

[@diceymaan]

Low carb @ low saturated fats is not that difficult if you follow a modifies meditterranean diet. Eat chicken, fish, and lean beef with an abundant amount of olive oil. Olive oil only has 13g of saturated fats per 100g, so you can use it quite freely.

[@andyerbz3979]

My doctor wants me on a Mediterranean style diet now to help bring my cholesterol and ldl down but also put me on 20mg rosuvastatin I told him why not just see what the diet does first to bring it down he says if it goes down along with the diet I will take you off the statins in 3 months time smh

[@reydelagarza2953]

Good stuff, and I know it's very individualized. BUT just to be clear, aren't there similar side effects with bempedoic acid, esp muscle aches, one of the three side effects mentioned pertaining to statins?

[@citadelo5ricks]

Is there a chart/graph of the relationship of saturated fat to cholesterol production? Such that we can understand what is the cost / benefit of saturated fat reduction.

[@citadelo5ricks]

I've come to believe it doesn't exist because it's just not that simple to measure.

[@bryanspencer4856]

What about using red yeast rice?

[@AlexM-vh2pu]

Not regulated plus a lot of supplements out there test high for heavy metals. Keep in mind that statins are made out of red yeast rice. Your better of just taking the statin.

[@qilinwang5889]

Well China has a local product derived from red yeast rice and it is nothing but a natural form of statin😂

[@jeffhutjens]

His two cholesterol drugs are about $1,000 a month

[@spdowntown]

Please point me toward a test that will assess whether or not I have a genetic predisposition to CVD, thanks!

[@Lucas_Jeffrey]

Ask your doctor for a referral to a genetic counselor. Looking for: - FH (familial hypercholesterolemia), second most common genetic condition leading to CVD - LPA genetic risk score, the first most common genetic source of CVD

[@DiniVino]

Is there any link between lowering ApoB so low and negative cognitive effects (like there is with lowering total cholesterol)?

[@voksic13]

I dropped my ApoB to 0,67umol/L (35ish mg/dL) with fasting, high protein/fat, low carb, weight lifting and swimming. Which one of those is the most important one? I do not know, but my ApoB/ApoA is 0,4. I dropped 25kg in the process (while increasing muscle mass by 2kg). At the age of 42.

[@Seanonyoutube]

What was your ApoB at baseline before you did all of this?

[@voksic13]

@@SeanonyoutubeI did not know what ApoB was when I started so I didn't track it :/. I was also more focused on glucose and insulin levels (dropped from 130 to 50) as well as HOMA index (5,2 to 1,9). 2 months after I started (-10kg at that time) I did first basic lipid panel. TG was 1,2 (now 0,5) and LDL was 3,3 (now 2,5).

[@Seanonyoutube]

@@voksic13 so your baseline for LDL-c was already in the normal range. Seems like you are blessed with great genetics to be able to lower it that much with just lifestyle. Congrats! I could never get mine that low without pharmaceuticals.

[@nimblegoat]

For those wanting to go keto ( not my style ) by lots of meat , eggs , butter etc - very important to go low carb hard except berries etc - also the main benefit really kicks in when slim - being slim lowers LDL - think no matter the diet choice, getting low triglycerides is always going to help heart and limit other effects - Muscles soak up glucose - and strength exercise can benefit body for a day or 2 , I dropped red meat except as a guest when offered - so more Mediterranean - I think even if ok for heart with qualifiers - I wouldn't enjoy it that much - plus I think need to keep it less processed to avoid say cancer problems ( Cancer data can take decades )- glad you found something that worked for you

[@voksic13]

@@nimblegoat by BMI metrics, I'm still obese. And yet, my TG and LDL (ApoB too) went to normal before I lost significant amount of weight. And I can raise them with just few days of bad diet, without significant weight gain. I agree, muscles soak up the glucose, and I can see that with CGM and different way my body behaves nowdays, compared to before. I also agree that keto is not necessery, it worked for me combined with TRF/IF/whateverwecallit. And it's not just processed food. I come from one of the mediterranean countries (btw, we eat more meat than fish) and there's not that much processed food; we cook every meal. One exception would probably be bread. One significant thing that I changed in my diet is swapping sunflower oil with what my grandparents used; homemade pork fat and butter (I added ghee too).

[@realfoodcures]

High non-hdl cholesterol increases "risk" of heart disease but has no effect on mortality. So trying to keep ldl and apob down is chasing ghosts. Also, seed oils are promoted as heart healthy because they lower LDL yet study after study shows they damage tissue throughout the body including causing atherogenesis. Add to that high fructose sweeteners causing fatty liver and now you have CAUSES. Seed oils and high fructose are causes. High LDL and ApoB are not causes but rather side effects of these causes. Relying on statins shows incomplete understanding of causes and physiology.

[@joshydillens148]

What study’s are you talking about?

[@AlwaysSeekingTruth13]

ApoB is casually linked to heart disease. Just like smoking is casually linked to lung cancer.

[@erick6102]

Does Nexlizet and Repatha interfere or effect TRT treatment for males in any adverse way?

[@agfairfield8575]

common sense would suggest that since sex hormone production requires cholesterol, having rock bottom numbers as is achieved by Repatha would not help with low T

[@daven6145]

Is it possible for an individual who has FH, at age 40 or 50, to have acceptable cholesterol levels, well within the expert panel guidelines, to have at very high levels of LDL and total cholesterol at age 70? Put another way, if one doesn't have no high cholesterol at age 40, could the very high levels of LDL possibly be due to FH? Thank you!

[@lauriell2297]

Are the alternatives to statins that lower Apo B proven to decrease heart disease with certainty?

[@wocket42]

It's all guesswork and mostly associative anyway. If you want prove, you need to find a human that follows the diet for their life time and lives healthily to 100. As soon as you use "causal markers", all bets are off. No matter what you pretend.

[@homerroad]

Life on Earth? No certainty. Sorry.

[@mannymotta2174]

Is lipoprotein (a) related to apoB

[@seascape35]

I believe they are different. There are a lot of videos on each that can clarify.

[@daviddelguercio8458]

I am 37 and a very active and slim athlete. I played college sports until 23. At 30 years old I had bad anxiety and thought I was having a heart attack which led me to hospital visits. I had a CAC score of 0 and was cleared fully healthy but was told my cholesterol is high. For the last 7 years I have been on and off with working out but staying somewhat pretty fit. I have gone on and off the keto diet. Recently my blood work showed LDL-181 HDL-56 Vldl-18 Total chol 255 ApoB -129 And A1c-5.6 Blood pressure 114 over 70 What led me to get this blood work done is I started to have daily dizzy spells and overall and anxiety. This has gone on for 7 months. Should I be concerned these symptoms I have having are from my lipid numbers and clogged arteries at the age of 37? Or is this really my health anxiety acting up and thinking the worst like usual? Would it be nessasary for me to do another CAC scan when I just had a 0 7 years ago and now still only 37? I keep getting scared about going to get scans likehey will find something wrong with me.

[@michealfriedman7084]

Two things I see... #1 Your HDL needs to be over 60. The easy fix is to light weights. Add a heavy set in. That increases your HDL. #2 For your body type, your blood pressure might be to low. Make sure you are taking a electrolyte with sodium, potassium, and magnesium.

[@JimManley-po1si]

If your anxiety is not something that you have all the time, but comes and goes, and there is nothing that specifically triggers it, I suggest you look up the MTHFR gene mutation. It’s something that 40+% of the population has and has been shown to cause anxiety, amongst other things. You can find out if that’s the issue through a gene test. It’s usually treated with supplementation using a methylated vitamin complex.😊

[@rosetulip1231]

You are worrying yourself sick. Stress has caused your numbers to be bad. Search Wim Hof breathing for beginners. It helps with anxiety. I wish you the best.

[@docmartin4989]

Don’t worry about your HDL. It’s basically impossible to move in a meaningful way and your number is ok anyway. That being said, your ApoB and LDL are not good. I would definitely want to address that quickly. A CAC of 0 at 37 is almost meaningless. Calcification at that age is rare even in the presence of significant soft plaque build up. It is usually the soft plaque that will lead to a cardiac event because calcified plaque is stable and won’t dislodge easily. Calcification is an indicator of soft plaque build up over many years. At 37 your plaque has not had enough time to calcify. So don’t get another CAC but rather get your numbers down. Be aggressive and try statins if needed. Most people have zero side effects. Read what Attia has to say about Medicine 3.0. You are young and now is the time to take action. You want that ApoB around 60 or lower.

[@rosetulip1231]

Read prevent and reverse heart disease by Dr Caldwell Esselstyne.

[@zack_120]

Blood TG concentration doesn't necessarily go together with LDL/ApoB. My TG dropped below 100 through diets along with vigorous exercises, both aero- and anaerobic, but LDL didn't.

[@MT-sq3jo]

same boat here… Vigorous exerciser with a generally healthy plant dominant diet, low TG but APOB remained higher than desired at 100. Finally overcame the hesitation and started taking a baby statin/ezetimibe combo - APOB dropped below 70 in 2 months. I’m not telling anyone that they should not try lifestyle changes. But at the end, when all else fails, you have to make a smart decision if you want to keep status quo, or take pharmaceutical intervention.

[@zack_120]

@@MT-sq3jo 👍 Congrats on the + result and sharing. One thing left for me to try: cut saturated fat intake like lard as I don't have genetic background by lab tests.

[@MT-sq3jo]

@@zack_120 I would recommend you test Lp(a), which would have been ‘lumped’ with LDL or even ApoB in less sophisticated tests. High Lp(a) is purely genetic and is part of the reason why my ApoB was consistently high despite my healthy lifestyle. Lp(a) is even more atherosclerotic than run-of-the-mill ApoB particles. By the way, my plant dominant (not plant exclusive) diet is automatically lower in saturated fat without trying. Good luck with your journey.

[@GJJC13]

Great info. I have good levels of Triglycines at 49, HDL 73, VLDL 3... BUT LDL 304, Apo-b 177! These bad markers started shooting up since I started a "18 hr/day intermittent fasting", about a year ago to lower my LDL, then at 130. My HDL and Triglyceride levels improved, though. .I'm 66 and weigh 130 lbs since year 2000. Eat all the good fish, olive oil, all color veggies, very low carb, walnuts, almonds, peanuts, no red meat, no simple carbs, etc... How worried should I be, given the good markers? How come my LDL and Apo-B are so bad while the HDL and triglyceride levels seem to be good? Since HDL and Trigl levels are good, might I be OK? I want to avoid the "automatic" statin treatment that my Dr will surely suggest. Thank you. I subscribed!

[@giovannigreenard8008]

I had my first test back, and I'm the same, all my markers are good apart from LDL, I also fast 18-20 hours a day. I've stopped now, to see if on the next test they drop. Really starting to question LDL as a marker if no family history of heart attacks or symptoms, ill get a better lipid breakdown done and a calcium scan.

[@GJJC13]

@@giovannigreenard8008 I also thought about stopping the fasting. The whole LDL increase started when I started fasting, but then I read that high LDL is not bad if your Triglycerides are low and your HDL is high. I also read that LDL tends to raise when you start fasting, but then it goes down, but in my case, the more I internittent fast, it seems to go up higher. I've been daily IT for almost a year now, from Monday to Friday. It should have gone down, but went up from 191 to 304! By the way, yesterday I read that there is a correlation of high LDL / heart attack WITHIN patients with high triglycerides, low HDL and insuline resistance. Its like there are 2 schools of thought...

[@MartinSKatz]

If you took your blood panel while fasted for 18+ hours your LDL and APOB will be significantly elevated. Retake the test fasted for between 8 to 10 hours. Also, check out what Dr. Paul Mason says about higher LDL and APOB.

[@newyorkguy158]

I think your HDL is high based on something I heard Dr. Dayspring say. He is a lipid expert. He said that HDL at 60 and above is too high and indicates too much cholesterol in the blood. Since I don't know what else you are eating, I would suggest going off intermittent fasting to see how it affects these numbers.

[@GJJC13]

@@newyorkguy158 Thank you very much. I totally agree with your suggestion.

[@sectionalsofa]

My jaw drops at the comments below. So many folks are on low carb diets-- keto and carnivore-- and don't know why their ApoB is elevated. What would you expect? A diet high in fiber and phytonutrients and low in saturated fat is the way to lower APO B with diet. Not that it will necessarily get you to goal, but at least it will point you in the right direction.

[@flynnoflenniken7402]

My diet's basically just in line with the standard dietary guidelines most countries have. Whole foods and minimally processed foods from a variety of food groups (veggies, fruits, grains, dairy, meat) with the bulk of the diet being fiber rich stuff (plants) and saturated fat and sugar being kept at a minimum. I used to eat less fiber and consume more saturated fat, but my parents have cholesterol issues now, and I didn't actually know what causes cholesterol issues or how to prevent it, so I did some research and cut saturated fat mostly out of my diet and boosted fiber intake. Just trying to see if I can avoid some of their problems as I age. My go-to foods are things like rolled oats soaked in milk overnight, beans, peas, carrots, onions, brown rice, apples, greek yogurt, chicken. Fried rice is my main go-to dinner with the rice, beans, other veggies, and chicken because it's easy and tastes good. Overnight oats for breakfast. Apples and yogurt for either snacks or dessert. No qualms about eating less healthy stuff now and then if I'm socializing though. Thanksgiving's coming up soon lol.

[@qilinwang5889]

Like Peter, I really hate the low carb vs high carb fight, and I think everyone should be nuanced about this. Food source only accounts for fairly small amount of cholesterol, and even though saturated fat causes ApoB to increase we should know that it is particularly detrimental to the hyper-responsive. For the rest it is a cost that must be weighed against the benefits of keto and carnivore, because they do offer unique benefits in other areas. At the end of the day, sugar + high carb is devastating, sugar + high saturated fat is also devastating, if you are eating sugar a lot then the fight on diet style is almost irrelevant.

[@reason3581]

@@qilinwang5889 A whole food plant based diet lowers ApoB and has no downsides. No reason for keto or carnivore.

[@qilinwang5889]

@@reason3581 There is plenty of well documented downside such as lack of source of B12 and lower quality of proteins etc. It does not mean that it is not doable, but I hate the lack of nuance and the ideological fervor that is disguised as scientific thinking.

[@reason3581]

@@qilinwang5889 There is no evidence that a plantbased diet causes deficiency in any essential amino acid. The term high quality protein has no real world relevance. Regarding the B12, most people take some kind of supplement anyway. And a keto diet (not to mention carnivore) will probably need significantly more supplementation than a WFPB diet.

[@jabon112]

Thank you- wish you were my doc. I had no idea there were alternatives, my doc just put me on a low dose statin.

[@canbalcioglu4229]

Hey doc, what would you recommend to a 42 year old male who is close to being underweight but still has high ApoB and triglycerides count? If I cut carbs, then I'll lose even more weight:( Not too eager to use medication as well.. I know it's not fair to ask for a doctor opinion like this, but I try my chances:)

[@juliebrown8375]

I'm not Dr. Attia, but I am a physician. Genetics also plays a huge role in cholesterol synthesis. If you don't have a high saturated fat intake, you may need medication just because of your genetic makeup. Talk to your IRL doctor.

[@whoatethechocolate]

cutting sugar is a great start.

[@calebwert1057]

Increase polyunsaturated and monounsaturated fats (olive oil, walnuts, flax seeds, chia, avocados, sunflower seeds) and increase fibre rich carbs.

[@rosetulip1231]

Would you rather stay at a certain weight or die????