How to lower your apoB

[@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.

[@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?

[@questionauthority-f6i]

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

[@Foxtrottangoabc]

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 :)

[@tracyC7414]

@@ClayTallStoriesbut new studies have proven saturated fats r ok. Dr Ken Barry, Dr Ovadia, Dr Paul Saladino. Ya just don’t know to believe so that’s why we need to dig deeper than just the standard lipid panel. Need to know size of cholesterol. Big n fluffy best. Glad yr feeling so much better

[@amyhoop9651]

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

[@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

[@seanlefloch]

@@flyingsodwai1382damn. Good point

[@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

[@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! ❤😢

[@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

[@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.

[@acke26]

​@@BornAgainBride- I have similar lipid disturbance as you. I bought myselt a cholesterol device to monitor lipid changes depending on diet and supplements I take. I don't know if you've heard of hyperabsorbers. But I'm clearly one if those patients. When I cut carbs my cholesterol skyrockets especially LDL. (Search Nick Norwitz oreo or Dave Feldman LMHR) Also very many supplements that are said to lower cholesterol actually increases my LDL, like Omega3 and some fat soluble vitamins. If you're a hyperabsorber adding carbs to your diet will decrease your total cholesterol and LDL.

[@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 👎🏻

[@HighNetworthNetwork]

My ApoB is 41 mg/dl. I would consider my diet a balanced diet with mainly grass fed beef cooked in tallow usually. Total cals: 2k with weekend refeeds to 2.3k. I am 42 yr old. Male. 1.78m. 72kg Workout everyday varying from strength to functional, cardio 5km run once to twice a week and brisk walking 10k steps everyday.

[@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

[@ivankowalski5009]

You don't eat any salt at all???

[@allencrider]

@@ivankowalski5009 No salt shaker salt, but penty of vegetables and fruit which contains sodium.

[@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.

[@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/

[@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.

[@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

[@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.

[@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.

[@o71394658]

There is no "study after study" showing that seed oils "damage tissue throughout the body." This is nonsense and 100% misinformation. Please stop spreading nonsense thanks

[@g-mannG]

Here comes the grifter 😂

[@haircroak3332]

@@g-mannGlmao everything he said is bullshit

[@heatherandkatychannel136]

My 82 yo Mum was on Rosuvastatin @ 10mg a year ago, but it was raised to 20mg. The GP this year is unhappy her cholesterol levels haven't come down and wanted to increase it to 40mg - I refused, and having watched this it would likely have done her no good. She has mildish dementia, I was more concerned increased statin could make that worse. Fascinating listening to Dr Attia - I wished general GPs knew more of this stuff as its pretty much bread and butter for a general 1st line medic

[@cyclingmaven]

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

[@pizzaiq]

My father had a severe heart event because of crestor within 4 days of taking it. The issue cleared withing 4 days of stopping it. I'd say there is a considerable risk in taking that. I would try alternative things and meds and diet before I resort to dangerous drugs.

[@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.

[@MsQ275]

Super appreciate the LPa pharma info!

[@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

[@andreasmb]

Thank you for the comment! What do you eat in a typical day?

[@Wowzersdude-k5c]

It's all genetic. One day we will know how to tailor the perfect diet for each individual. Genetic differences almost certainly explain why some people can eat tons of saturated fat all their lives with no problems, while others keel over with a heart attack at 40. Genetic researchers haven't been able to untangle the complex genetics behind it all yet, but they will I suspect.

[@A.Leftie]

I replied in almost the same fashion several weeks ago on another video, re people needing to learn the difference between COMPLEX and simple carbs. Society in general tends to lump them all in one big carb stew pot...carbs are essential for regulating our metabolism, and for supplying energy needs. Not everyone can easily metabolize fat for energy.

[@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.

[@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.

[@lotfibouhedjeur]

Thank you, Peter. Really, thank you!

[@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.

[@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

[@lukemurray4961]

He has already answered that you need pharmacological intervention

[@TheFeelyourself]

Your markers are great. LDL has a lot of aspects to it, so high LDL is not a problem, as per my knowledge. Please check out Dr Nadir Ali and many others of why high LDL are absolutely fine.

[@thefamily-lafamiglia7322]

You are fine. Your HDL is in a very good range. Your HDL-TG ratio is great. You don't need to take meds because your ApoB is 15 points over while your other levels are great. Mine was 160 3 weeks ago... I just changed my dite, and 3 weeks later is down to 120. For some reason, this doctor is pushing people to take meds. He advocates for psck9 which are for people with extremely high levels, like 400 plus. I'm not sure why he thinks it's a good idea for people to take that meds when the levels are almost in the normal range. His fear should not be yours.

[@doubleunderfire7964]

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

[@JamesLMachieJr]

I'm a type 2 diabetic so all my doctors are pushing me to take a statin. I have consistently refused and I don't take any medication for my diabetes. I manage through diet alone. Just got my apoB result, 61mg/dL, recent CT angiogram showed no evidence of coronary artery calcification, and my cholesterol panel came back normal. They still insist I need to take a statin.

[@A.Leftie]

With numbers like yours I'd get new Doctors 👍

[@JamesLMachieJr]

@@A.Leftie Unlikely I'll find any doctors in my area that are going to not push me to take metformin and a statin. Every doctor I see for anything gives me shit about it.

[@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 👆

[@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.

[@MarilynMayaMendoza]

I have peripheral artery disease under control and my new PCP refused my request for an ABOB test. He also refused my need for a cardiologist. He said my lipid panel is good. Can you get a test without a doctors prescription? I’m thinking of getting a new doctor.

[@drott150]

@MarilynMayaMendoza Yes you can get a patient ordered (and paid) test through the two main commercial labs in the US. Look them up and order the tests.

[@A.Leftie]

Yes, fire that Doctor...primary care people are a dime a dozen. This one obviously doesn't listen to you.

[@tracyC7414]

I’m glad I heard the part about being on 10mg of statin-which I am n that same kind he talked about-cuz my dr suggested going to 20mg. (Family history heart disease) I said NO. My ldl is 82 (was 110 n that’s when Dr bumped me to 10gms from 5 grams)n since then I have really cut out carbs,especially ultra processed foods. Trying to eat what grows and what eat the stuff that grows. Aka-fruits veggies meat.

[@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.

[@scotthanford9619]

excellent...! i can't imagine these buffet of drugs are sustainable. also, no way of knowing how these novel drugs and combinations fare in the long term. side effects of statins alone are very high.

[@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.

[@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.

[@peterazlac1739]

I have been on a traditional British high saturated fat diet since my birth in 1940. Now at 84 I have low triglycerides, low LDL and do not have IR or any metabolic syndrome. I limit simple carbohydrates except rice, oats and potatoes cooked and cooled to promote restricted starch to promote the production of SFAs in my hind gut, especially butyric acid and eat prebiotic foods like green bananas, mushrooms, whole grains and others. I limit my protein intake to 0.8 g/kg lean mass from animal sources to ensure an optimum supply of essential amino acids, eat a lot of antioxidant red fruits plus broccoli for sulfaraphane, apricots for spermidine and nuts for ALA as well as a range of supplements including vitamin D3 at 5000 units per day that has kept my blood level above 50 ng/ml and with zinc and quercetin for red onions etc ensures an good inate immune response - I did not take the Cov-2 vaccine and have never taken a flu one either and have not had either. I do not eat manufactured foods or high energy drinks and avoid seed oil products and fructose.

[@pintoffanta2510]

What common foods to avoid then?

[@komalthecoolk]

How is it possible that the only way for any regular human to reduce their APO-B is through such powerful medications? Are we naturally meant to have it on the higher side? Something doesn't sit right here. There HAS to be a naturally sustainable way to lower these values even if it takes time.

[@harifederer]

He is looking at it from a ‘maximising lifespan’ point of view. Someone who has CVD predisposition due to genetics probably isn’t meant to live as long than someone without it all else being equal, so in order to game a longer life without problems, pharmacology needs to be part of the process.

[@spacejunkisforever6311]

cardio exercise, particularly moderate-intensity aerobic activities like walking, jogging, or swimming, can effectively lower apoB levels. Peter whiffed on that one right out of the gate in this video.

[@thefamily-lafamiglia7322]

I m trying to reduce my ApoB with dite, exercise, and supplements. Plus, plants sterols and fiber supplement. If I m not able to achive my goal i have introduced PSCK9.

[@acktionjackson666]

I wonder how my Grandfather who was born in 1911 in a farm in Russia was able to live through 3 wars, a 30 year factory job at Ford, being an alcoholic for most of that time, and who ate plenty of saturated fat was able to live until 2007 without a heart attack, stroke, diabetes, or cancer. No Statins or APoB lowering drugs either. Same for my Grandmother.

[@critical_eye1]

Bingo. Natural foods growing up. No fast food industry nor big pharma. In addition to the epidemic of mental health problems worldwide, greatly caused by social media. And now we are shortening lifespan in our modern obsession with extending it.

[@cgrass4035]

I was thinking real food for most of their lives as well

[@alexsmith-gn4tp]

Many I respectfully suggest genetics ? ❤

[@paullevy4656]

Lucky genes that is the reason.

[@Al-Storm]

Genetics. My uncle lived to be a healthy, active 95, he smoked 2 packs a day, plus a pint+ of whiskey, and ate fast food almost everyday. Don't base outcomes on individuals, base it on statistics.

[@oolala53]

I don’t know my ApoB, but recent total cholesterol just tipped over to 212, and LDL-C has risen but triglycerides remain low. I had been keeping saturated fats to under 10% of total caloric intake the last year, and I cut nearly all sugar and ultra processed foods during lockdown and haven’t gone back. That was after eight years of maintaining a 40-lb. loss by moderate means though little exercise. I’m disappointed that he says exercise has a negligible effect on lipids, as after all I have done and cut out, I just can’t see reducing my unprocessed grains and legumes that I feel add variety of texture and satisfaction. With cutting carbs to around 26% of my diet which meant very little grain, legumes, or fruit for around 18 months, my A1c went down by only 1/10 of a point and my LDL-c went up because I was eating more saturated fat foods for variety. I hated it. I never long to reincorporate desserts and most packaged stuff, but much more narrowing of the diet, and I start understanding much heavier people fearing cutting down/out their highly palatable staples. I know from experience with that that I could still experience a lot of pleasure from food without those, but I’ve tried out the alternatives with just regular food by going almost all plants to moderately low carb And it has not been satisfying. I don’t feel better and feel like I’m in fighting invisible battles. When I lost that weight, I was still able to go out to restaurants and do normal stuff, but in moderation that brought my weight down over time. Now I feel like being social around food is like going through a minefield. I worked for years, trying to develop a more diverse social network, but that has proved harder than changing my diet. Ok, enough whining to strangers. Best wishes to all!

[@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

[@brianlane9534]

@@andyerbz3979 "I will take you off..." Does your doctor rule your life?

[@metriczeppelin]

@@andyerbz3979 Your Dr is not in charge of your life, you are. You posted this 7 mo's ago. How did it go? Did he "take you off" the statin's? cheers

[@dawnr.droescher]

I understand that fasting does not affect LP (a). Does fasting affect the results of an APO B blood test? I do understand the importance of fasting for other lipid testing.

[@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).

[@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

[@mowthpeece1]

Look up Lean Mass Hyperresponder. LDL going up with a leaner body is normal for some people and provides zero threat of plaque formation. In fact, you should also look up Dr. Matt Budoff's latest work, on YT a month or so ago...LDL has ZERO relationship to plaque formation AT ALL. No relationship. None. Zip. Nada. We've seen for years that half of all heart attack patients had HEALTHY cholesterol levels. Cholesterol means nothing. Dangerous elements are inflammation, and **clotting factors**. Cholesterol is the responder that goes to repair damage. It cannot cause heart disease. It's blaming the fireman for the fire. The arsonist is inflammation which damages the artery in the first place. The propellant is clots. You cannot have a heart attack without either one of those.

[@edsadowski6307]

Saying to lower “carbohydrates” is misleading, without distinguishing between good (whole food, unprocessed) and bad (processed, refined) carbs. In other words, eating less broccoli and salads is not what you need to do, it’s eating fewer cookies, pastries, chips, and high-carb bread that is important.

[@the_notorious_bas]

Vegetables hardly contain any carbs, so it doesn't make sense to lower their intake anyway. Most of their weight is just water.

[@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

[@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.

[@idontcare4490]

I’m 34, my ApoB is 103 mg/dL. Should I start taking these pharmacological ApoB reducers mentioned here? I am not considering any responses to be official medical advice. But if you had to say… what would you lean towards?

[@AlanRosa-y2b]

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.

[@ApostolisPaspalakis]

So i have 81 hdl, ldl 162, triglycerides 43, total cholesterol 263. i'M 38 and i weigh 72 kgs active etc. According to keto and ketovore im as healthy as an ox. Here, im at risk? what about carnivores talking about how much their life changed with autoimmune deseases disappearing etc. Even i feel the best i've ever felt after eating a ribeye. No bloating, energy boost, clear mind etc. Im not bashing anything. I'm just trying to understand what the right thing to do is here. I had a ct scan done because my cardiologist freaked out about my cholesterol and freking me out in the process. I took a ct scan for my heart and it was spotless of any plaque. In the end, what is the answer? If i feel good and im thin and i haven't gotten sick since i've been eating grassfed meat, organic veggies (not so much because of the recent studies on oxelates and the havoc they have on your body) eggs and saturated and polyunsturated fats like shots of extravirgin olive oil and keeping my omega 3/6 ratio in check. it's bad for me when all other evidence suggests its not? sorry for the tangent, im just tired of being afraid that im doing the wrong thing

[@daviddelguercio8458]

I’m in the same boat as you but I would suggest finding a new doctor. Any doctor that freaks out over and LDL of 161 which isn’t even that high should be fired, also why do you have a cardiologist at 38 with no history of heart issues? To piggy back on your thoughts, I get confused too but after research I have come to the conclusion that the best diet one can consume is a keto medetteranian diet. Which would be low carb and low saturated fats.

[@butchgalvez6242]

Does MCT oil raise apo-b?

[@Statinstories]

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!

[@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.

[@Fliffsportsbook]

Hello. I just recently had blood work done. Male 54, non smoker, no hypertension, insolin is find too. Just looking for affirmation of sorts. Total chl is 275 hdlc 98 non hdl 232 ldlc 215 Triglycerides 98 hdl 43 APO B mg/dl 166 lipo A 9.1 vldl 19 ratio 5.3. I really want to bring my APO B down as quickly as possible. I will adjust my diet. But i want to hit it big time. Can you make and observation for me?

[@crystalslattery1712]

I need help too..what do you recommend?

[@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.

[@USmetallist]

❤ Thank you dear sir Peter Attia

[@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.🙂

[@remodelboostclub]

I wanna go the pharmacology route. What are those 3 drugs that you mentioned and where can I get them?

[@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.

[@malachi487]

@@RogueCylon thats why he's on 3 medications and only in his 40's. He's in bed with big pharma.

[@djm55]

Dr. Attia, thank you -- but as a patient, I'm still a bit confused how we should analyze the results from advanced lipid panels. I'm male, in his 50s. For example, I currently have an ApoB of 56mg/dL, which according to this video is in the optimal range. However, my LDL Total Particle Number is 1372, which is "high" according to the reference range (normal is

[@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.

[@emmaleechase613]

@@TB-rx1ueRead up on metabolic syndrome

[@wocket42]

@@TB-rx1ue most statins cause diabetes.

[@MysticalMagikalMistress]

What do you think about cardiac calcium test? My score was zero. Is this less reliable than Apo B? My ApoB is 116

[@Hanover-ek4jy]

Have you ever checked for cholesterol in your arteries in your neck with a CIMT test?

[@MysticalMagikalMistress]

@Hanover-ek4jy No, I have not. Is that a better way to check than Calcium Test? I am 50 and my BP is normal despite dealing with long covid.

[@Hanover-ek4jy]

@@MysticalMagikalMistress calcium score plaque is usually stable! The most dangerous is the hot liquid plaque in your arteries in your neck!

[@UrsulaPowers]

@lsca22ayala Do you smoke? If yes, then try to get the CIMT test.

[@MysticalMagikalMistress]

@@UrsulaPowers I don't smoke

[@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

[@7solove]

I just had a lipoprotein fractionation test done and while my LDL is a little elevated and HDL is normal, the fraction test indicated 3.4x the max end of the reference range for both small and medium LDL particles! This sounds really bad. On the better news side, it identified me as Pattern A (large and low-density particles) rather than Pattern B (small and high density particles). Any thoughts on these results and what I should follow up on? My doctor who ordered this test told me he does not know it well. The very high particle count seems concerning.

[@axelpool8776]

My ldlp was high as well, 1364, optimal is 960, not as high as urs but my sdldl size was in normal range, as was everything else except , surprisingly, my hdlp was low, 30, because my standard lipid test was always high hdl. I learned that hdlp is more predictive of problems and could be caused by my only other concern from bloodwork, my homocysteine which i also had to ask/ insist on. It is 10% above upper limit.folate didnt help soi tried methylated 1000 mg which got it down a bit, not enuf.i am going to see an endocrinologist, to see if hiking my levo a bit, from 100 to what i used to be on premenopause, 112 to see if that helps. If not i am in ur situation, whT to do? Ur ldlp is really high, try to google legit scientific research to see whT might be the culprit and cure. Good luk, luv to hear how u fare!

[@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?

[@MichaelN726]

What do you think of Fenofibrate to reduce triglycerides ?

[@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.

[@Kananaboo]

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.

[@carinaekstrom1]

What do you mean when you say very low carbohydrate? It seems to me that most people who lower their carbohydrates raise their ApoB considerably. A lot of people can eat lots of healthy carbohydrate and still lower ApoB as long as it's whole food carbohydrate, with its fiber. I'd rather get rid of the animal products than take a statin.

[@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.

[@shaunnoah6436]

If i am 24 years old. Sub 10% bodyfat, work construction, lift 5x a week. Eat whole food based, Grass fed beef,eggs,chicken etc. Dont smoke or drink but have a 121 APO B, is that concerning?

[@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

[@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.

[@draculacod]

eat KFC twice a week 😂

[@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).

[@sophiah8794]

I bought some from Jarrow. But I think I can't tale them because I'm on amlodipine 5mg

[@ShorinRyuGuy]

​@AlwaysSeekingTruth13 Hi. I just started HPF cholestene as well and noticed my fasting blood sugars shoot up about 20 pts after only about a week. Did u notice this at all? How much do you take?

[@gordonv.cormack3216]

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

[@julianalima2751]

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

[@erikbardy1739]

how do you get the health incurance to pay for the pcsk9 inhibitor?

[@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.

[@g-mannG]

Adverse Reactions (Significant): Considerations of Bempedoic Acid Hyperuricemia and gout Tendon rupture

[@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.

[@UsyksmashedFurytwice]

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

[@UsyksmashedFurytwice]

@@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.

[@tackletalkmenshealth]

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

[@candijeter1811]

It would be beautiful if we'd examine this issue based on gender. My family on both sides have high cholesterol. The women live until they are in their 90s and the men die in their 80s of heart failure. My dad had aortic stenosis. He had been treated for high cholesterol but was still accumulating plaque. My mother's cholesterol is in the 300s. She's older than my dad and thriving. My dad just passed at 87. My cholesterol is 375. My lp(a) is over 600. My sister and I tested positive for the family gene. Our triglycerides are in the 60s. We have 0 calcium buildup. Great blood pressure and no other health issues. Yet doctors are super excited to put us on powerful meds. Our cholesterol went crazy during menopause. Menopause causes hormones to go out of wack, which affects cholesterol. No one stops to think that this cholesterol may be saving our lives on some level m. Going in to just lower cholesterol without taking into consideration our overall menopause state could take away valuable nutrients. Please study how women with high cholesterol live longer and don't just go in expecting everyone to strive for the same magical number. This may be doing older women who are generally healthy more harm.

[@ShoppingEmail-dr1fs]

interesting my LDL went sky high after menopause - obviously as cholesterol is not making hormones any more - I always have zero calcium, but starting to develop soft plaque now in 60s.

[@anzhelikademchenko906]

Agree i am also looking for studies/ findings for connection between mesnopause and cholesterol and how we should treat it

[@A.Leftie]

You definitely could be on to something. I just hit a decade birthday and have passed the meno milestone...now, it seems that no matter my dietary approach (no pre diabetes, or elevated sugar), not obese, etc my cholesterol is slowly creeping up. Some of that could be diet as I've been carb cycling and intermittent fasting and lowered simple carbs drastically. I eat very little saturated fat in my diet and no egg yolk...whites only. I've been on Zeria for 6 months and no results...next trying glucomannan and or psyllium. My personal thoughts are that some of this is due to genetic anomalies they aren't aware of yet.

[@sapperstang]

Over the last year I’ve lost 20 lbs, lowered my triglycerides from 400 to 56, lowered my ldl from 150 to 124. My apob a year ago was 85. I only have two data points for apob. Yesterday it was 94. So it went up which is hugely frustrating. I really want to avoid statins.

[@tommydinob]

I’m limited financially. Dropped rosuvastatin from 20mg to 5mg daily. Eat low carb. Run regular release niacin 1000mg twice daily. My numbers are sweet despite the fact that I eat a lot of meat.

[@randyalbertsw1992]

Rosuvastatin is generic and cheap. I’d suggest substituting beans for meat, lots cheaper and the soluble fiber in means will probably lower apob.

[@Joseph1NJ]

Yeah, I used to take a lot of Advil for headaches because I was banging my head with a hammer. I still bang my head with a hammer, just slightly less, so I need slightly less Advil. At least they can't call me a meathead. 🍖🍔🥩

[@tommydinob]

@@Joseph1NJ I don’t get the metaphorical significance of your statement. It infers something is being done incorrectly? Would you be kind enough to elaborate the specifics of what should be changed. I ask in complete earnestness.

[@tommydinob]

@@randyalbertsw1992 beans are a bit too high in carbohydrates for me these days. For decades I did the low fat, low cholesterol diet thing and never had good labs. When I switched to a very low carbohydrate keto diet, my triglycerides sank (as described by Attia). When I added niacin, my LDL dropped down to 80. HDL is strong. I practiced pharmacy for 30 years. Attia is spot on about the rate of diminishing returns with elevated statin use. A low dose mitigates side effects, and is clinically effective, whilst decreasing cardiovascular inflammation.

[@tommydinob]

@@KenHicksJr I’ll check it out…thank you. Before I went keto (which helped me dump 100lbs and re-composition my body) I ate lots of lentils. I do miss them. Paul Saladino warns that beans are high in lectins.

[@nthdimensiondesignsinc.5114]

I tried rosuvastatin 5mg and had muscle soreness. Then I tried Repatha twice monthly and it drove up my blood pressure. My ApoB is 90 and my LDL is 140. What are my options going forward?

[@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😂

[@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.

[@Rockster1989]

Wait a minute, hold on. I love Peter Attia but I have to disagree here. Low carb doesn't necessarily lower apoB, it's the low glycemic index/load that probably contributes to the actual lowering. Fiber is a carbohydrate and it actually lower apoB. Beans are loaded with carbs and in studies lower cholesterol and apoB along with other sources of soluble fiber.

[@Seanonyoutube]

Specifically, the ingestion of soluble fiber lowers Apo-B, and the ingestion of high amounts of refined carbs and sugar raise it.

[@zsuzsuspetals]

right. So it's confusing that he's saying to lower carbs in general. He should have been more specific and what tyeps of carbs. And mentioned that things like fiber and beans can actually lower apob. @@Seanonyoutube

[@Seanonyoutube]

@@zsuzsuspetals yeah he’s not very good with the nutrition side of things.

[@acke26]

Yes, many people experience much higher LDL when cutting carbs. It's called hyperabsorber. I bought myselt a cholesterol device to monitor lipid changes depending on diet and supplements I take. I don't know if you've heard of hyperabsorbers. But I'm clearly one if those patients. When I cut carbs my cholesterol skyrockets especially LDL. (Search Nick Norwitz oreo or Dave Feldman LMHR) Also very many supplements that are said to lower cholesterol actually increases my LDL, like Omega3 and some fat soluble vitamins. If you're a hyperabsorber adding carbs to your diet will decrease your total cholesterol and LDL.

[@A.Leftie]

​@@acke26I'm beginning to think this might be my issue. Not on keto (I've never thought it was sustainable long term, and complex carbs are food for us), or carnivore. I have been carb cycling and intermittent fasting for over a year. Not obese, but trying to get leaner...a good bit was fluid I was holding on to...also have hypertension and not responsive / adverse drug reactions with many common meds. I'm going to research this more and modify natural therapies accordingly...refuse to go down the Statin highway to hell.

[@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

[@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.

[@YShiishening]

What are the names of the drugs he takes? I find it difficult to find the correct spelling with these unusual names

[@Epicurious_Me]

Pcsk9, bempidoic acid

[@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.

[@qilinwang5889]

I'll just document another response I wrote on the low carb fighters: @qilinwang5889 il y a 1 seconde ApoB is causal, meaning that it is the material that is inside the thickened wall. This is why I hate the dumbed down version of the low carb preachings: there are multiple pathways to the same problem: no ApoB, no plaque (necessary condition), no high insulin levels, more difficult for ApoB to go through, no high sugar level, less glycation by-products, no inflammation, less macrophages and less plaque. They are all part of the solution, among them only ApoB the necessary condition. The lipid paradigm WAS wrong because it only look at LDL, which is not even ApoB and IGNORES the other factors; now you are preaching for a paradigm that IGNORES the causal factor. Is that a smart reading of literature? No.

[@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

[@HocDolliday]

Repatha & Nexlizet

[@urbanboutiqueapartment6623]

What is a good level of cholesterol? My Serum cholesterol is 5.9, Serum HDL cholesterol is 1.6 mmol/l and calculated LDL cholesterol is 3.7. I don't know if i am in a god range so please can you help me?

[@pureblood6492]

no mention on how caffeine makes apoB skyrocket?

[@UrsulaPowers]

Holy crap. I saw your post and then googled coffee and LDL and apoB!!! I had not idea coffee could negatively impact these things. I am addicted. Time to cut it out! Thank you!

[@thefamily-lafamiglia7322]

Why would you take 3 meds (especially psck9)? How high was your ApoB? The meds you are taking have fewer side effects, but not zero.

[@nancyevans5176]

Nurse here. You forgot the LDL Particle Count, and the Small and Medium LDL Particle Count. ApoB is very important. Very. But did you know you could have a ApoB of 95 and yet a LDL Particle count of 1600. And Small LDL count double the normal value. This wold be huge on whether or not to be treated. A Coronary Calcium Scan would be needed to discover with those high Particle Counts on whether or not you do have disease. Just saying along with Apoe B get a LDL Particle Count. Google or KZbin this.