ApoB, LDL and Lpa: My Perspective (Part 1)

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[jspfromnycgloba]

While i appreciate your videos, this was a very convoluted way of explaining or presenting an already complex topic.

[JohnBarrow]

Cardiologists like Mohammed Alo here on YT state that the particle size theory, fluffy, not fluffy, was completely debunked years ago. And he's a double board certified cardiologist who's been practicing for years.

And here you are stating the opposite. Do you see why the constant mish-mash of conflicting health information causes nothing but confusion to lay people, like myself? Very dangerous. Somebody's wrong and we're the ones who pay the price.

[Hawk-courage]

fundamental knowledge of vascular and heart disease is the key 🗝️ to save people lifes thanks 🙏 alots ❤to you from Libya

[GaryBruyere-fb]

Dr. Brewer... you're a good doer!

[lloydhlavac]

This still confuses me, as I have very high LDL (over 300) a very high particle count (over 3000), but my LDL is nearly all large pattern A, with hardly any small pattern B, and my HDL in my last test was over 100.

[tienbao]

I've been on Keto and IF since last September. First of all, I am a non-diabetic with A1C around 5.3, but decided to join my wife with this diet and fasting. My wife has been a diabetes type 2 most of her adult life. After 7 months, her latest A1C has dropped from 6.7 to 5.3 thanks to this new lifestyle.. However, her fasting glusoce and fasting insulin results indicated that she's still somewhat insulin resistant. My A1C also lowered to 4.9, glucose 93 mg/dl, fasting insulin 2.1 uIU/mL. Hence, my calculated HOMA-IR is 0.48 (93 × 2.1 / 405), which indicates that I'm insulin sensitivity. The point I'm trying to make is: I'm not insulin resistant, my A1C is excellent, obviously I'm consuming very low carbs, but how come my Apo-B is way too high (148 mg/dL)? This is quite contrary to the content of this video. My LDL and total cholesterol have elevated since I started this diet plan, 224 and 306 respectively. I watched many Keto doctors explained it's normal for these two lipid markers to elevate when you're on a ketogenic diet. But Apo B was not explained if it is also elevated from this diet?

[thegoldenmean]

Informative video. TY for posting. More about the comments: I'm a fan of Attia and Dayspring. That said we are humans and therefore not infallible. Science is not infallible; The science is evolving and therefore the science of lipid and lipid metabolism is also not infallible. There is always going to be inferences and nuances in the data (Devils in the details) in how's its interpreted. Science, good science puts a mirror up to itself. Attia and Dayspring are not a religion, but they have a clear grasp of the science as Dayspring is an expert lipidologist. 

No one is posting age here and specific population data. Yes certain people are going to have catastrophic outcomes and certain people will not based on your own personal genetics not population or society as a whole once its teased out. By all means continue smoking if you think you are invincible to lung cancer. I'm not willing to take that chance. Statins clearly are under some scrutiny base on recent findings about how the data was interpreted. That doesn't mean for high risk/very high risk groups they should stop taking cholesterol lowering medication like statins especially if that individual can more than tolerate them with nearly zero side effects. Get your individual tests done. My APO-B has crept up (along with a myriad of other lipid indicators) and I eat a clean omnivore diet (to much cheese). The doctor suggested a calcium score knowing that it really only images hard and not soft plaque. Individualized blood tests, genetic markers, lifestyle and family history should be your guide. In the last 45 days, I've now gone off most saturated fats since I've got 4/5 SNP's alleles for saturated fat. I'm nearly 58, very active and know some family history (thus the extensive genetic testing). I do not tolerate statins and I'm looking into alternatives medications (sadly very expensive and not covered unless catastrophic). I've lowered my total/LDL/triglcerides just by lifestyle modifications of eating a ton more fiber and really watching saturated fat intake. I'll be taking another APO-B, LP(a) test in the coming weeks to see if those numbers have followed the total/ldl and triglycerides. Have common sense be your guide and do follow the science even though there may be bumps in the road.

[lophiz]

Wow. That explanation was a long way around the ball park.
Bottom line: Get an apoB blood test and lower it to 60 or below to avoid ASCVD. All the rest is noise.
Here are three actions you can take to lower your apoB:
1. Reduce your weight to a normal BMI or slightly below.
2. Replace saturated and trans fats with unsaturated fats in your diet.
3. Consume soluble fiber.
You can eat any diet you want, but it must include these three actions. There are more actions you can take, but these three make the largest impacts.
A good proactive plan is to learn the lifestyle behavior's of serious MD's and PhD's who do actual research in the health topics of your concern. They tend to go out of their way to avoid the disease they are studying. In fact the three actions above I took directly from docs walking the talk. Good luck.

[johnny]

A comment on Attia. If you wanted to get a balanced view of the carnivore diet, would you ask Shawn Baker? Of course not, he's all in, it works for him, he is an advocate for it and not so much an objective scientist, but at least he admits it. Attia and Dayspring on the other hand refuse to admit personal bias. Both have been on a max lipid lowering strategy for years, Attia because his family cvd history is so horrible, Dayspring because his waist and cac score have been very elevated for 25 years, neither is any more objective about drugs than Baker is about meat. I appreciate anyone who helps re-position Attia's statin fanaticism, its very much needed. Doc Brewer is about the only guy out there who practices belief-moderation.

[elisa]

I get so confused on my Cardio IQ tests. I have FH. My LDL’s have always been in the 350’s, HDL 44-65 ( fluctuates) normal Triglycerides howeber my fractionated testing shows Pattern A, Optimal AP little A, but high particles ldl in small & medium and borderline low Large particle- Apob is high 240. If pattern A is large fluffy, how can I have so many small LDL particles?

[skipbanksfun]

Very confusing. But I still I thank you
Skip Banks

[marionalbergo]

Thank you Dr.Brewer for this new format that is informative and clear. If I understand this video the LARGE Hdl/ldl deposit their cholesterol to cells that need it and replace cholesterol with fatty acids and then recycle them thru the liver. This is good - yes? Because the fat is being taken out of the blood system and disposed. Yes the HDL/LDL are sacrificed in the process but their mission has been fulfilled. Can anyone confirm this for me

[scotthamlin]

Makes sense I think. My problem is I have a high burden of calcium buildup showing up on CAC tests still after 4 years keto and now almost carnivore. I’m in this LMHR group, for those who have heard of it, and participated in their test so hoping that paper gets released soon to clear more things up. For now, my last LDL was over 300 and HDL was in 90’s and triglycerides in the 50’s so I think I’m doing good where I am while taking no meds anymore.

[ElCid_]

Thanks for trying but I’m still very confused by ApoB etc.

[ouch]

High fat diet for APOb is the recommendation?

[perlaespejo]

very interesting doc, thank u so much

[saliksayyar]

There is no evidence about larger or smaller particles, it has to do with the number of ApoB containing particles, one to one to particle, not size. Also LP(a) also contains ApoB.
Atia is an influencer and a clinician, not a lipidologist. He consults Dr Dayspring, so read him or read the research of Allan Ginsberg from Canada.

[sandraw.]

With regards to Your very last statement, are you saying that high fat diets help with AblB? I eat carnivore style.

[StanDupp]

Is it possible for a human to have an LDL of 155 mg/dL but an ApoB of 75 mg/dL on the same test date?

[cgArtsy]

My apo b is 70 but my ldl small and med particles are too high. How can that be? (My triglycerides are 48 and my HDL is 65. Apo little a is also good. )