ApoB VS LDL-Cholesterol: Request this Marker Instead

Standard lipid panels are actually mathematical approximations. Emerging data suggests using the very affordable ApoB to ApoA1 ratio as well as lipoprotein particle subtraction testing more accurately assess cardiometabolic disease risk.

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Time Stamps

0:00 Intro
0:45 ApoB why it’s more accurate
1:30 High LDL on a ketogenic diet
2:24 Heart disease deaths increase in the winter
2:59 High LDL after fasted exercise
4:50 What ApoB means and why it matters
7:15 Why Omega-6 seed oils are bad if your LDL is high
9:11 Request your ApoB to A1 ratio instead
9:38 Standard cholesterol tests are a mathematical estimate
12:06: HDL and ApoA-1, how it’s cardioprotective
12:45 Harvard case study of LDL increases on a Keto diet
19:25 Advanced lipoprotein particle testing overview

[JoyJJ]

I lost 74lbs doing IF/low carb & exercising 7 days a week. My cholesterol went up 264 & LDL 184. My Tri went down to 87 & HDL up 74. A1C 5.2
My doctor freaked said need statin. I said NO.
Even though lost wgt & other lab markers excellent. I am in my 60's on no meds.

[snipe]

Medical Technologist here: we measure HDL and LDL directly but calculate the VDL and non cholesterol. It all depends on the analyzer that your blood work is being tested on to satisfy the equation. Bigger labs=more funding=expanded test menu=better analytical procedures (most of the time).

Bur to your point about apo a/apo b, it amazes me no one gets this test. Thank you for this healthy guide! More health advocates and physicians need to see this information.

[pondboy]

Lab here! Minor correction: when triglycerides are high (>400 mg/dL), LDL is usually measured directly instead of relying on calculation. That said, it will still miss the level of oxidation, and I really appreciate this educational video!

[Malcolm-Achtman]

In my experience the ApoB number goes up when my LDL-C lab value goes up. Similarly, my ApoA1 value increases when my HDL-C value rises. I now eat a more animal-based, high fat diet, which many LCHF/Keto experts would say is healthy, yet my ApoB/A1 ratio has gotten worse. Back in day, on a different diet, my ratio used to be say 0.65, which is great. Now my ratio is about 1.0, which is considered to be high risk. Here's what happened. My cholesterol has gone up a lot on my new diet. My HDL has gone up from 40 mg/dL to 60 mg/dL. OK, that's fine. But my LDL has skyrocketed from 130 mg/dL to 230 mg/dL. Along the way, both my ApoA1 and ApoB values have risen, but my ApoB value went up proportionally more than the ApoA1 value. That screwed up my ApoB/A1 ratio and made it worse. But here's the interesting thing. I believe my diet now could be healthier than in the past. I have now done some SpectraCell lipoprotein panels that show most of my LDL particles are large versus small (which is good). Therefore, despite the worsening ApoB/A1 ratio, I believe (or I hope) that I'm keeping my cardio risk factors in check. Bottom line, don't put a lot of faith in ApoB or the ApoB/A1 ratio themselves. Instead, look at those values in the context of a full lipoprotein panel in order to gauge things properly.

[boddhs]

Doing OMAD keto for the better part of a year now and dropped about 70lbs, got my blood chem and my ldl was way above the normal range. I exercise daily, weights and bike. This is why, thanks Mike! From manila PH

[thailandfruitmonster]

Great video Mike. A number of board certified cardiologists have been vocal about this for at least a decade. I too wish the current model could change. Sorry to sound so cynical, but cholesterol lowering medications are far too profitable for medical schools to change their curriculum or scripts, especially considering big pharma is their greatest benefactor.

[Malcolm-Achtman]

I think the ApoB/A1 ratio might have some merit. I was disappointed that Mike never stated values to aim for. I watched the whole video waiting for this info and it never came. Based on what I've learned, a good ratio of ApoB/A1 is 0.7 or less. There is some variation from lab to lab. I found one source that considered anything below 0.9 to be acceptable, and yet others say that indicates increased risk. Some sources say a truly optimal ApoB/A1 ratio is 0.5 or less. ApoB is found in LDL and is associated with cholesterol depositing capacity. ApoA1 is found in HDL and is associated with cholesterol clearing. As I pointed out in another comment, the ApoB value, and I'll now add the ApoA1 value, say nothing about the nature of the particles themselves, which makes the ApoB/A1 ratio a little iffy to hang your hat on, in my opinion.

[DodjiSeketeli]

Great podcast. Not complicated at all. This is why we love this channel. So please keep more coming. Cheers!

[Kinjo]

*Great content as usual Mike. Commenting for the algorithm.*

[michelesteward]

This was GREAT Mike! I'm always trying to understand more about cholesterol. I have mild to moderate CAD, cardiologist wants me on stain, but my ratios have improved so much on carnivore I refuse them. I'm type A, light and fluffy. Cac score of 450 ~by iv contrast. Finally found a low carb cardiologist I'm switching care to in the new year

Good bless for all you do
Merry Christmas!

[thewildwilsonshow]

I knew I saw this video from you before as my amazing daughter sent it to me again. Yesterday I went to my doctor and she wanted to do all that blood stuff. I said all this staten stuff I'm not in on that anymore, but I had remembered too about the testing. Problem was I didn't remember all the names, but with our conversation my nurse practitioner mentioned something else and we had a good discussion even though I struggled. Today as I said listening to the video again and will call her Monday to schedule the ApoB VS LDL cholesterol test. I have also worked hard on getting those bad oils out of my diet when shopping and buying products reading the label! God bless & great to be loved and cared for!

[chrysalis]

THANK YOU! this is the exact information I was trying without success to convey to my doctor last week! I will definitely be printing out the studies and giving them to her.

[fxrvw]

Mike, you guys are always on it and a benefit to humankind. I can even say that may be an understatement! Thank you!

[christinekhariv]

Loved the video, Mike! Very timely (my parents had their tests done recently), will have to listen to this several times though, very information-dense (like all of your videos, really). Thanks for all your efforts to promote healthy living!

[SabiUK]

Excellent video and great information. Recently had my Apob test for the first time. 1.36 ouch. Coupled with LDL of 7.3. Double ouch. 39 years old and moderately active but office worker and eating lots of takeaways almost daily. This video gives great info on cooking yourself and supplements to lower ApoB. Subscribed and taking my next test in 6 months

[willemvanriet]

Thanks u for this clear explanation After being on a clean keto diet for 7m my LDL was 40% > range but but HDal was 70% > range and all my liver markets were off the charts healthy

[steve]

Hi Mike - I found a paper showing a graph of how ApoB and ApoA1 are linked to Triglycerides. (Circulation 82(2), 495-506). Using this graph and keying in my triglycerides of 48 mg/dm it showed almost all the LDL was the large fluffy LDL

[kathleensmith]

Honestly, this was THE BEST explanation of these markers I’ve ever heard from any of my health team or from any other health platform 🙌🙌🙌

[ElHolyBoy]

Fully comprehensible. Totally understandable. Echoed across the ketosphere. Love it. Thank you. Will be ordering those tests shortly.

[johnalice]

Please include the articles that you reference so I can show my doctor. Good stuff.