What is ApoB and how can you measure your level?

What is ApoB?

• Apolipoprotein B (ApoB) is a protein found on the surface of certain lipoproteins, primarily low-density lipoproteins (LDL), very low-density lipoproteins (VLDL), and intermediate-density lipoproteins (IDL). These lipoproteins carry cholesterol and fats through the bloodstream.
• ApoB’s role: It serves as a structural component of these particles and is essential for their formation. ApoB is also involved in the delivery of cholesterol to tissues, making it a key player in the development of atherosclerosis (hardening of the arteries).
• Why it matters: ApoB is a strong marker of cardiovascular disease risk because each ApoB particle corresponds to a single cholesterol-containing particle (especially LDL). Higher ApoB levels indicate more atherogenic particles in the blood, which can lead to plaque buildup in arteries.

2. What is Lp(a)?

• Lipoprotein(a) or Lp(a) is a type of lipoprotein that consists of an LDL-like particle with an additional protein called apolipoprotein(a) attached to it.
• Role of Lp(a): While its exact biological function is unclear, high levels of Lp(a) are associated with an increased risk of cardiovascular diseases like atherosclerosis, heart attack, and stroke.
• Why it matters: Elevated Lp(a) levels are largely genetic and independent of lifestyle factors. Lp(a) is considered highly atherogenic because it can contribute to the development of arterial plaques, and it also has a tendency to promote blood clotting.

3. What Raises ApoB?

Several factors can raise ApoB levels, leading to an increased number of cholesterol-carrying particles in the bloodstream. These include:

1. Dietary Factors:
   • High intake of saturated and trans fats: These fats increase LDL cholesterol, which raises ApoB.
   • High sugar and refined carbohydrate intake: Diets rich in sugar can increase VLDL and small, dense LDL particles, both of which carry ApoB.
2. Obesity and Insulin Resistance:
   • Central obesity and metabolic syndrome can increase VLDL and LDL particles, elevating ApoB. Insulin resistance promotes the liver’s production of cholesterol-rich particles, increasing ApoB.
3. Genetics:
   • Familial hypercholesterolemia (FH) or other genetic disorders affecting lipid metabolism can lead to higher LDL cholesterol and ApoB levels.
4. Lack of Physical Activity:
   • A sedentary lifestyle is linked to higher LDL and lower HDL levels, indirectly raising ApoB concentrations.
5. Smoking:
   • Smoking increases LDL cholesterol, oxidative stress, and inflammation, all of which can raise ApoB levels and contribute to cardiovascular disease.
6. Chronic Inflammation:
   • Conditions like chronic stress, autoimmune diseases, or poor gut health can promote higher ApoB through increased VLDL production and alterations in cholesterol metabolism.
7. Alcohol Consumption:
   • Excessive alcohol intake increases triglycerides, which in turn raises VLDL and ApoB levels.

Summary:

• ApoB is a protein that plays a critical role in transporting cholesterol in the body, with elevated levels increasing cardiovascular risk.
• Lp(a) is a genetic variant of LDL that also contributes to heart disease and blood clotting risk, often independent of lifestyle.
• ApoB levels are raised by poor dietary habits, obesity, genetic factors, sedentary lifestyle, smoking, and chronic inflammation, all of which can lead to cardiovascular disease.

Both ApoB and Lp(a) are important markers in understanding cardiovascular health risk, and managing them often requires a combination of lifestyle changes and, in some cases, medical intervention.

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Lowering ApoB (Apolipoprotein B) levels, which are closely linked to the risk of cardiovascular disease, can be achieved through a combination of lifestyle changes, dietary adjustments, and potentially medical intervention. Here are some strategies:

1. Improve Diet Quality

• see below

2. Exercise Regularly

• Engaging in regular physical activity, especially aerobic exercises (like walking, running, or cycling), can help improve cholesterol profiles and reduce ApoB levels. Aim for at least 150 minutes of moderate exercise per week.

3. Maintain a Healthy Weight

• Losing excess body fat, particularly around the abdominal area, can improve cholesterol levels and reduce ApoB. Even modest weight loss can have a positive impact.

4. Reduce Refined Carbohydrates and Sugar

• High intake of refined carbohydrates and sugars can raise triglyceride levels and increase the production of small, dense LDL particles, which contribute to higher ApoB. Focus on whole grains, vegetables, and low-sugar foods.

5. Quit Smoking

• Smoking increases ApoB and LDL cholesterol. Quitting smoking can improve overall cardiovascular health and reduce ApoB levels.

6. Limit Alcohol Intake

• Excessive alcohol can increase triglycerides and negatively affect ApoB levels. Limit alcohol to moderate amounts, if consumed at all.

7. Consider Medical Interventions

• Statins: These are commonly prescribed to lower LDL cholesterol and ApoB levels by reducing cholesterol production in the liver.
• PCSK9 inhibitors: These medications help reduce LDL cholesterol by increasing the clearance of LDL particles from the bloodstream.
• Ezetimibe: This medication can reduce cholesterol absorption from the diet and thus lower ApoB levels.

8. Focus on Anti-Inflammatory Lifestyle Choices

• Chronic inflammation can contribute to elevated ApoB and cardiovascular risk. Managing stress, getting adequate sleep, and eating anti-inflammatory foods (like fruits, vegetables, and fatty fish) may help.

9. Manage Other Health Conditions

• Properly managing conditions like diabetes, high blood pressure, and metabolic syndrome is important for keeping ApoB and cardiovascular risk in check.

Regular monitoring and consultation with a healthcare provider are essential, especially if medical treatments are being considered to reduce ApoB levels.

In ancestral nutrition, also known as a traditional or whole-food-based approach, dietary strategies focus on natural, unprocessed foods to support optimal health, including improving lipid profiles and lowering ApoB (Apolipoprotein B). This approach emphasizes nutrient-dense foods that promote heart health, reduce inflammation, and balance cholesterol levels. 

Here are some nutritional strategies from an ancestral perspective to lower ApoB:

1. Increase Omega-3 Fatty Acids

• Ancestral Sources: Wild-caught fatty fish (like salmon, mackerel, sardines), grass-fed meats, pasture-raised eggs.
• Why it helps: Omega-3 fatty acids have been shown to lower triglycerides, reduce inflammation, and improve lipid particle size, which can lower ApoB. EPA and DHA, found in fish oil, support cardiovascular health by lowering LDL cholesterol and reducing overall cardiovascular risk.

2. Prioritize Monounsaturated Fats

• Ancestral Sources: Olive oil, avocados, nuts (such as macadamia nuts), and grass-fed animal fats.
• Why it helps: Monounsaturated fats help reduce LDL cholesterol and ApoB levels while maintaining or increasing HDL (good) cholesterol. These fats are prominent in Mediterranean diets, which have been linked to improved heart health.

3. Limit Refined Carbohydrates and Processed Foods

• Ancestral Perspective: Avoid processed sugars, refined grains, and artificial ingredients. Focus on whole, unprocessed carbohydrates like sweet potatoes, root vegetables, and seasonal fruits.
• Why it helps: High intake of refined carbohydrates and sugars can lead to insulin resistance, increased triglycerides, and small, dense LDL particles, which raise ApoB levels. By focusing on whole, nutrient-dense carbs, you can improve insulin sensitivity and lower ApoB.

4. Increase Soluble Fiber Intake

• Ancestral Sources: Vegetables (especially root vegetables), fruits (such as berries and apples), flaxseeds, chia seeds, and nuts.
• Why it helps: Soluble fiber binds to cholesterol in the digestive tract, reducing its absorption and lowering LDL and ApoB levels. Fiber also feeds beneficial gut bacteria, supporting overall metabolic health.

5. Emphasize High-Quality, Grass-Fed Animal Proteins

• Ancestral Sources: Grass-fed beef, pasture-raised poultry, wild-caught fish, and organ meats.
• Why it helps: Grass-fed animal products have a healthier fat profile, containing more omega-3s and conjugated linoleic acid (CLA), which supports heart health. Consuming high-quality animal proteins reduces inflammation and provides essential nutrients like CoQ10 and B vitamins, which support heart function.

6. Include Fermented Foods

• Ancestral Sources: Sauerkraut, kimchi, kefir, yogurt, fermented vegetables.
• Why it helps: Fermented foods support gut health by promoting beneficial bacteria, which can influence lipid metabolism. A healthy gut helps regulate cholesterol and inflammation, indirectly lowering ApoB.

7. Support Antioxidant Intake

• Ancestral Sources: Dark leafy greens, berries, nuts, seeds, herbs, and spices (e.g., turmeric, ginger).
• Why it helps: Antioxidants help reduce oxidative stress, which is involved in the oxidation of LDL particles. Oxidized LDL contributes to higher ApoB and cardiovascular risk. Consuming antioxidant-rich, whole foods protects LDL from oxidation and reduces inflammation.

8. Consume High-Quality Fats

• Ancestral Sources: Ghee, tallow, lard from pasture-raised animals, coconut oil, and avocados.
• Why it helps: Saturated fats from healthy ancestral sources like grass-fed animals can support overall health when balanced with omega-3 fats. Avoiding processed seed oils (such as soybean and corn oil) reduces inflammation and improves lipid metabolism, contributing to lower ApoB.

9. Include Herbs and Spices for Cardiovascular Support

• Ancestral Sources: Garlic, turmeric, ginger, rosemary, cinnamon.
• Why it helps: Herbs and spices have potent anti-inflammatory and antioxidant properties. Garlic, for example, is known to lower cholesterol and support healthy blood pressure, while turmeric and ginger reduce inflammation, which can support heart health and lower ApoB levels.

10. Reduce or Eliminate Processed Seed Oils

• Ancestral Approach: Replace processed vegetable and seed oils (e.g., canola, sunflower, soybean oil) with traditional fats like olive oil, coconut oil, and animal fats.
• Why it helps: Industrial seed oils are high in omega-6 fatty acids, which promote inflammation when consumed in excess. High omega-6 intake is associated with an increase in small, dense LDL particles and higher ApoB levels. By avoiding these oils, you can reduce inflammation and improve lipid profiles.

11. Intermittent Fasting or Time-Restricted Eating

• Ancestral Practice: Fasting periods were common in ancestral eating patterns due to food scarcity. Today, incorporating intermittent fasting (e.g., 16:8 method) can help regulate lipid metabolism.
• Why it helps: Intermittent fasting has been shown to improve insulin sensitivity, reduce triglycerides, and lower LDL cholesterol and ApoB. It promotes autophagy, the body’s process of removing damaged cells and promoting repair, which can benefit heart health.

12. Focus on Whole, Unprocessed Foods

• Ancestral Principle: Eat nutrient-dense, minimally processed foods from nature.
• Why it helps: Whole foods provide the nutrients your body needs for optimal function, including managing cholesterol and lipid levels. By avoiding processed, packaged foods, you reduce the intake of unhealthy fats, sugars, and additives that can negatively impact ApoB levels and overall cardiovascular health.

13. Consider the Role of Genetics and Bioindividuality

• Ancestral Nutrition Principle: Tailor nutrition based on individual needs and genetic predispositions.
• Why it helps: Ancestral nutrition emphasizes bio-individuality, meaning that what works for one person may not work for another. Genetic factors can influence how your body processes cholesterol and lipids, and adjusting your diet to your unique needs can optimize health outcomes, including lowering ApoB.

By incorporating these ancestral nutrition principles, you can lower ApoB levels while also supporting overall cardiovascular health and performance as an aging athlete. The focus is on nutrient-dense, whole foods that reduce inflammation, improve lipid metabolism, and support the body’s natural processes for heart health.

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Key Takeaways:

Test	Recommended Age	Target Ranges & Goals	Rationale and Additional Notes
ApoB	30s	Ideal: 20-30 mg/dL Good: Under 60 mg/dL	Better predictor of heart disease risk than LDL-C. Reflects number of LDL particles which are directly linked to risk.
Lp(a)	As early as 30s	Ideal: Below 14 mg/dL High Risk: Above 50 mg/dL	Genetic risk factor for heart disease. Elevated levels contribute to artery plaque formation.
Omega-3 Fatty Acids	Not specified	8-12% combined EPA + DHA level	Important for heart and brain health. Reduces inflammation and supports cognitive function.
Blood Pressure	Regular monitoring	Less than 120/80 mmHg	Indicator of heart and artery health. High levels can cause damage over time.
Continuous Glucose Monitoring (CGM)	Regular monitoring	Average <100 mg/dL Standard deviation <15 mg/dL Avoid spikes over 160 mg/dL	Helps optimize blood sugar levels for metabolic health. Personalizes nutrition and lifestyle adjustments.
DEXA Scans	Not specified	Low visceral fat percentile Positive T-score for bone density	Measures body fat percentage, lean mass, and bone mineral density. Important for assessing visceral fat and bone health.
CT Angiograms	By age 40	No detectable plaque	Screens for plaque buildup in arteries, indicative of increased heart attack and stroke risk.
Cancer Screenings	Colorectal: 40 Prostate: 45	Regular screenings as per doctor’s advice	Early detection of colorectal and prostate cancers. Personalized approach may vary.

 

Heart Health Tests

Heart disease is one of the leading causes of death, so getting the right tests to assess your cardiac risk is critical.

Two important tests that provide a more complete picture of heart health are apoB and Lp(a).

For Professor Andrew Huberman, InsideTracker is a highly recommended testing option.

What is ApoB?

• ApoB stands for apolipoprotein B.
• It is a protein that carries LDL cholesterol (the “bad” cholesterol) in the bloodstream.
• Doctors traditionally look at LDL-C levels to assess heart disease risk.
• However, Dr. Attia believes ApoB is a better predictor because it accounts for all the atherogenic (artery-clogging) particles in the blood, not just LDL.
• So, while LDL-C measures the amount of cholesterol carried by LDL particles, ApoB measures the number of LDL particles themselves.
• More particles means more risk, even if the total cholesterol they carry is not extremely high.

ApoB Target Ranges

Most doctors only worry about ApoB levels above 100 mg/dL.

Dr. Attia recommends more aggressive goals:

• Ideal: 20-30 mg/dL
• Good: Under 60 mg/dL

This is because any ApoB above the bare minimum needed for living (~20 mg/dL) increases heart disease risk.

Getting levels as low as possible in your 30s and 40s helps ensure optimal heart health as you age.

Lowering ApoB

Ways to lower ApoB include:

• Cardio exercise to burn fat and increase HDL (“good” cholesterol)
• Consuming less dietary fat and cholesterol
• Eating more fiber to reduce cholesterol absorption
• Taking cholesterol-lowering medications like statins
• Quitting smoking, which raises ApoB

What is Lp(a)?

Lp(a) is another genetic risk factor for heart disease that contributes to artery plaques.

About 20-30% of people have elevated Lp(a) levels.

Since Lp(a) is largely genetic, levels don’t respond much to lifestyle changes. But testing once gives you your baseline risk.

Lp(a) Target Ranges

• Ideal: Below 14 mg/dL
• High Risk: Above 50 mg/dL

If Lp(a) is high, aggressively lowering ApoB through diet, exercise, and medication becomes even more important.

Lowering Lp(a)

Options for lowering high Lp(a) are limited, but include:

• Medications called PCSK9 inhibitors (not fully approved yet)
• Lowering ApoB levels as much as possible

These two tests provide a more complete picture of heart disease risk beyond just LDL cholesterol.

Knowing your levels allows personalized strategies to reduce risk through lifestyle and medication.

Omega-3 Fatty Acids

Omega-3 fatty acids like EPA and DHA play important roles in heart and brain health.

That’s why testing blood levels of EPA and DHA provides useful insights.

EPA and DHA are long-chain fatty acids that provide many health benefits, which is why Professor Andrew Huberman also recommends fish oil.

They help reduce inflammation, support cognitive function, and promote cardiovascular health.

The American Heart Association recommends getting at least 250-500 mg per day of EPA/DHA to reduce heart disease risk.

When testing Omega-3 levels, the goal is to have a combined EPA + DHA level between 8-12%.

This optimal range is associated with lower risk of chronic diseases.

The average American has a combined level around 4-5%, so there is room for improvement.

It takes about 4 months of consistent omega-3 intake from fatty fish or supplements to significantly increase EPA and DHA blood levels.

So testing gives you a snapshot of your average omega-3 consumption over time.