how does one lower apob levels

Lowering ApoB levels typically involves a combination of dietary changes, managing insulin resistance, and possibly pharmaceutical interventions:

1. Nutrition: Addressing insulin resistance by adjusting the diet can significantly decrease ApoB levels, particularly by lowering triglycerides, which is closely related to carbohydrate intake.

2. Carbohydrate Restriction: Reducing carbohydrate intake is very effective at lowering triglycerides, subsequently reducing ApoB levels.

3. Exercise: Combinations of resistance training and cardiovascular exercise can improve insulin sensitivity, which in turn can lower lipid levels, including ApoB 1.

4. Pharmacotherapy: When these lifestyle interventions are not enough to achieve the desired ApoB level, pharmaceutical approaches become necessary. Medications like statins are typically utilized to reduce cholesterol synthesis in the liver. With the liver detecting lower cholesterol levels, it pulls LDL from circulation, thus lowering LDL and ApoB levels 2.

Global recommendations for reducing ApoB levels to prevent atherosclerosis aim for levels similar to those present at birth. This level is around 20 to 30 mg/dL and is not achievable by diet alone. Pharmaceutical options, including statins and PCSK9 inhibitors, are effective for lowering ApoB but should be considered in consultation with a healthcare provider 3.

It's important to note that addressing ApoB levels is a strategic intervention, as they are a causative agent of atherosclerosis 4. Always consult a healthcare professional before starting any new treatments or making significant lifestyle changes.

When diet and lifestyle interventions are insufficient to lower ApoB levels to a desired range, pharmacological options are used:

• Statins: Statins are a class of medications commonly prescribed to lower cholesterol levels. These drugs work by inhibiting cholesterol synthesis in the liver. With less cholesterol being produced, the liver compensates by putting more LDL receptors on its surface to pull LDL—and hence ApoB—out of circulation. While statins are very successful at lowering LDL and ApoB levels, the side effect profile includes around 5% of patients experiencing reversible muscle soreness. Cognitive effects are also a consideration when taking statins 1.

It is important to acknowledge that while reducing dietary carbohydrates can successfully lower triglycerides and subsequently ApoB, no dietary intervention alone has been proven to lower ApoB to the levels associated with a significant reduction in atherosclerotic risk, such as 30 milligrams per deciliter. Therefore, in cases where it is necessary to achieve such low ApoB levels, pharmacotherapy with medications such as statins is invariably required 2 1.

Always consult with a healthcare professional for personalized advice and before taking any new medication, to ensure that the benefits outweigh the potential risks.

PCSK9 inhibitors are a class of drugs that have significantly enhanced the treatment of high cholesterol, particularly for patients with familial hypercholesterolemia (FH). Peter Attia, alongside Andrew Huberman, explains that PCSK9 is an enzyme that mediates the degradation of LDL receptors in the liver. In people with overactive PCSK9 genes, the LDL receptors are destroyed too quickly, leading to an inability to clear LDL effectively from the bloodstream, which results in high cholesterol levels.

The discovery of PCSK9 inhibitors was propelled by research into populations with genetic mutations in the PCSK9 gene. Some individuals have mutations that lead to reduced function of PCSK9, resulting in extraordinarily low LDL cholesterol levels and a corresponding decrease in heart disease. The drugs that were developed from this research, PCSK9 inhibitors, work by blocking PCSK9 from degrading LDL receptors, enabling more LDL cholesterol to be removed from circulation.

Dr. Attia shares his personal experience of taking PCSK9 inhibitors since 2015, noting that they are administered via injection every two weeks. These drugs have been shown to significantly lower LDL cholesterol levels in individuals, especially those with FH or others who have not achieved their cholesterol goals through other treatments 1.

Always consult with a healthcare provider to discuss whether PCSK9 inhibitors may be appropriate for you and to understand the potential risks and benefits.

To manage high cholesterol, there are alternatives to PCSK9 inhibitors that can be discussed with a healthcare professional, which may include:

1. Statins: This is a conventional class of drugs that works by inhibiting the enzyme HMG-CoA reductase in the liver responsible for making cholesterol. They are commonly prescribed and have been shown to reduce cardiovascular events.

2. Bile Acid Sequestrants: These work by binding to bile acids, forcing the liver to use excess cholesterol to make more bile acids, which can lead to a decrease in cholesterol levels.

3. Fibrates: These are often used to treat high triglyceride levels and can modestly improve LDL and HDL levels.

4. Niacin (Vitamin B3): At high doses, niacin can lower LDL cholesterol and triglycerides and raise HDL cholesterol.

5. Ezetimibe: This medication works by reducing the absorption of cholesterol from the intestine.

6. Diet and Lifestyle Modification: Incorporating a diet low in saturated fats, trans fats, and cholesterol. Adding exercise, losing weight, and quitting smoking are foundational for managing cholesterol.

7. Dietary Supplements: Some supplements, such as omega-3 fatty acids, plant sterols, and stanols, may help lower cholesterol levels. However, they should be used in consultation with a healthcare provider since they may have interactions with other medications.

These alternatives can be considered based on individual cholesterol levels, the presence of other health conditions, risk factors for cardiovascular disease, and response to previous cholesterol-lowering treatments. It's crucial to discuss these options with a healthcare provider to tailor the approach to your specific health needs and goals.

Reducing ApoB (apolipoprotein B) levels can be approached through nutrition and potential pharmacotherapy. Here are some insights based on the Huberman Lab discussions:

• Carbohydrate Reduction: ApoB levels are associated with LDL and VLDL particles that carry cholesterol and triglycerides. High triglycerides are often driven by high carbohydrate intake and insulin resistance. Thus, reducing carbohydrate consumption can directly decrease triglycerides and, thereby, ApoB levels 1.

• Saturated Fat Modulation: While lowering carbohydrate intake, it's also suggested to reduce saturated fat, which can raise ApoB levels even if triglycerides are well-controlled 1.

• Nutritional Strategy: Initially, nutrition should be optimized to reduce ApoB levels. This includes addressing insulin resistance, since insulin-resistant individuals typically have higher ApoB levels due to elevated triglycerides 2.

• Triglycerides to HDL Ratio: The ratio of triglycerides to HDL cholesterol is essential, with a target of having triglycerides at or below the level of HDL cholesterol. Triglycerides are most responsive to carbohydrate intake, so limiting carbs is often effective at lowering triglycerides, thus potentially impacting ApoB 2.

• Exercise's Role: While nutrition is a powerful tool, exercise also improves insulin sensitivity, which can have a positive effect on lipid profiles, including ApoB 2.

Please note, these dietary tips should be considered general advice, and it's important to consult with a healthcare provider for personalized guidance. Additionally, medication may be necessary for more significant reductions, and a healthcare provider can offer the most suitable options based on individual health status and needs.

In Episode #85 of Huberman Lab Podcast, Dr. Andrew Huberman hosted Dr. Peter Attia, a physician focusing on longevity and healthspan optimization. They covered various topics related to exercise, nutrition, hormones, and their links to vitality and longevity:

• The significance of blood work in assessing healthspan and the recommended frequency for blood testing.
• The importance of key health span biomarkers and body composition metrics, including those related to bone health.
• Discussions around establishing a strong foundation for bone density through strength training and the benefits of whole-body strength for longevity.
• A conversation on the impact of lifestyle choices on all-cause mortality, emphasizing the importance of non-smoking, maintaining strength, and VO2 max as indicators.
• How exercise metrics can be used as a measure of physical fitness and the profound effects of exercise on brain health.
• Deliberations on nicotine and its role in cognitive focus, touching on broader topics of stimulants and brain health.
• Insightful dialogue on hormone management, including the role of testosterone, testosterone replacement therapy, and the nuances of hormone replacement therapy for both men and women.
• The conversation also spanned to the safety of supplements and the complex topic of the relationship between dietary cholesterol and heart disease.
• Lastly, they discussed the potential of peptides and stem cells in medicine, the power of metabolomics, and the benefits of GLP-1 agonists for weight management.

The episode was enhanced with Dr. Attia's clinical expertise in treating the causative agents of diseases, rather than just mitigating symptoms, with a focus on maximizing healthspan—the portion of life spent healthy and free from chronic disease.

Andrew Huberman has discussed the potential use of ashwagandha as a supplement that could help manage cholesterol levels. Ashwagandha is known for its ability to lower anxiety and cortisol. It has been found to have mild effects in clinical studies on reducing depression and can also lower total cholesterol by up to 10%. However, Dr. Huberman cautions that while some people might benefit from lowering their cholesterol, others may not, as cholesterol is essential for the synthesis of hormones like testosterone, estrogen, and cortisol. Too low cholesterol can have negative effects just as high cholesterol can. Thus, it's important to balance cholesterol levels reasonably. It is also worth noting that any supplement regimen should be considered carefully and might best be discussed with a healthcare provider before starting 1.