How to Lower Your ApoB Levels and Live Longer

High levels of ApoB are linked to an increased risk of atherosclerotic cardiovascular disease (ASCVD). Dr. Peter Attia, a renowned expert in the field, provides comprehensive insights on how to effectively manage and lower ApoB levels for better health and longevity.

The Evolution of ApoB Management

Twenty years ago, the primary method to reduce ApoB levels was through high doses of statins. Today, we have a myriad of tools at our disposal, reducing the need for such extreme measures. Dr. Attia emphasizes that no patient should need to rely solely on high-dose statins, thanks to advancements in pharmacology and nutrition.

Exercise: The Misconception

One common question is whether exercise can significantly lower ApoB levels. Dr. Attia clarifies that while exercise has numerous health benefits, it does not meaningfully impact lipoprotein-related risk factors for ASCVD. Thus, the focus shifts primarily to pharmacological and nutritional strategies.

Nutritional Approaches to Lower ApoB

1. Reducing Carbohydrates

Cutting down on carbohydrates can lower triglycerides, which in turn reduces the ApoB burden. When there are fewer triglycerides, the body needs to traffic less cholesterol, contributing to lower ApoB levels.

2. Cutting Saturated Fat

A high saturated fat intake increases cholesterol synthesis and can cause the liver to reduce LDL receptors, leading to higher LDL and ApoB levels. Conversely, reducing saturated fat intake prompts the liver to upregulate LDL receptors, pulling more LDL out of circulation and thus lowering ApoB.

For most people, a diet low in both carbohydrates and saturated fats can significantly reduce ApoB levels. However, achieving optimal levels typically requires more than just dietary changes.

Pharmacological Interventions

PCSK9 Inhibitors

PCSK9 inhibitors are powerful drugs that help lower ApoB levels by increasing the number of LDL receptors in the liver, thereby removing more LDL from the bloodstream. Dr. Attia takes a PCSK9 inhibitor as part of his regimen.

Nexletol (Bempedoic Acid) and Ezetimibe

Nexletol is a combination of bempedoic acid and ezetimibe. Bempedoic acid is a prodrug activated in the liver that inhibits cholesterol synthesis. Ezetimibe, on the other hand, prevents the reabsorption of cholesterol in the gut. This combination effectively reduces LDL cholesterol and ApoB levels with minimal side effects.

Statins

While statins are effective, their maximum efficacy is typically reached at lower doses. High doses primarily increase the risk of side effects such as muscle aches, elevated liver enzymes, and insulin resistance. Dr. Attia recommends starting with low doses and only increasing if necessary.

Future of Lipid Management

PCSK9 Inhibitors Becoming More Accessible

There is optimism that PCSK9 inhibitors will become more widely available and affordable, thanks to advancements in drug delivery methods and increased competition in the market.

Lp(a) Medications

For those with high levels of lipoprotein(a), or Lp(a), a new drug in development shows promise. This antisense oligonucleotide disrupts the synthesis of the protein that turns LDL into Lp(a). Phase 2 trials have shown significant reductions in Lp(a) levels without major side effects. If Phase 3 trials confirm that it reduces cardiovascular events, this drug could become a game-changer.

Practical Takeaways

1. Consult a Healthcare Provider: Before making any significant changes to your medication or diet, consult with your healthcare provider to tailor a plan that suits your needs.
2. Combine Strategies: Use a combination of dietary changes and pharmacological interventions to achieve the best results.
3. Monitor Progress: Regularly check your ApoB levels and adjust your plan as needed to ensure optimal health outcomes.
4. Stay Informed: Keep up with the latest research and advancements in lipid management to make informed decisions about your health.

By leveraging modern tools and strategies, you can effectively manage your ApoB levels and reduce your risk of cardiovascular disease. For more detailed insights, watch the full discussion with Dr. Peter Attia on YouTube.

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