In today’s fast-paced world, awareness of the impact of lifestyle and diet on long-term health is increasing. Apolipoprotein B (ApoB) is one of the most significant factors affecting heart health. Elevated levels are a known risk factor for heart attacks and strokes, but the good news is that ApoB levels are modifiable through lifestyle changes, particularly diet and exercise. This article explores science-backed strategies to lower ApoB levels, promoting a healthier heart.
Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user’s own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Understanding ApoB
ApoB is a protein found in several lipoproteins, including low-density lipoproteins (LDL), often called "bad cholesterol." Each ApoB protein molecule carries lipids, including cholesterol, to tissues throughout your body. The issue arises when the concentration of ApoB-containing particles is too high in your blood.
Apolipoprotein B (ApoB) is a vital protein involved in cholesterol metabolism, particularly in the formation of lipoproteins crucially linked to cardiovascular health, including LDL, VLDL, and Lipoprotein (a). The ApoB number represents the plasma number of LDL particles, which research indicates to be a better predictor of Cardio-vascular risk than just LDL-C which determine the amount of cholesterol carried in the particles.
ApoB Blood Test
When you receive a lipid panel, you're likely familiar with Total Cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and Triglycerides (TGs) listed in the results. However, many people may not be aware that a more comprehensive test is available to assess the risk of atherosclerotic cardiovascular disease (ASCVD).
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An ApoB blood test measures the number of these particles in the bloodstream. High apolipoprotein B levels strongly indicate cardiovascular disease (CVD) risk, even if your LDL levels are normal. Unlike traditional cholesterol tests that measure total cholesterol levels, ApoB testing offers a more accurate assessment of your risk for heart disease by directly measuring the number of atherogenic particles in circulation.
The Apolipoprotein B’s normal range in blood tests varies depending on age and sex. However, lower levels of less than 80 mg/dL of blood are generally associated with a lower risk of heart disease. Consult your healthcare provider for guidance on interpreting your specific results. The normal range for apolipoprotein B is generally below 120 mg/dL (milligrams per deciliter), or 1.2 g/L (grams per liter), and optimally below 90 mg/dL (0.9 g/L). Some labs may report a slightly different range for men and women. Testing ApoB is not part of routine practice, but doctors will use ApoB to help determine your risk of heart disease if you have a family history of heart disease or other heart disease risk factors (i.e. high cholesterol and triglycerides).
ApoB and Cardiovascular Risk: Scientific Evidence
ApoB is primarily associated with LDL (Low-density lipoprotein), often termed as ‘bad cholesterol,’ due to its atherogenic properties.
- Atherosclerosis and ApoB: A study by Sniderman et al. (2006) published in Circulation: Cardiovascular Quality and Outcomes highlighted the strong correlation between ApoB levels and atherosclerosis progression.
- ApoB as a Predictor of Cardiovascular Risk: Superko and Gadesam (2008), in their research published in Current Atherosclerosis Reports, emphasised the predictive superiority of ApoB over LDL cholesterol levels in assessing cardiovascular risk.
- Inflammation, Lipids, and Cardiovascular Events: Catapano et al. (2018) investigated the interplay between vascular inflammation, lipid profiles, and cardiovascular outcomes in their study published in Atherosclerosis.
VLDL, IDL, and LDL molecules contribute to the hardening of the arteries and heart disease because they can lodge in blood vessel walls and help build up plaques. Many observational studies show that high apoB levels are strongly linked to an increased risk of heart disease.
Natural Strategies to Lower ApoB Levels
Lowering high ApoB levels is a vital step towards safeguarding cardiovascular health. Lowering your ApoB levels naturally is achievable through a combination of a heart-healthy diet, regular exercise, weight management, stress reduction, and other lifestyle changes. Here are evidence-based tips to help you effectively lower your ApoB levels:
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1. Embrace a Plant-Based Diet
Studies have found that a plant-based diet is ideal for improving overall heart health. Foods rich in fiber, antioxidants, and healthy fats, such as fruits, vegetables, whole grains, legumes, nuts, and seeds, reduce inflammation and improve cholesterol metabolism.
How it works: The fiber in plant-based foods is crucial in lowering cholesterol absorption. Additionally, plant-based diets are low in saturated fats, which can raise LDL cholesterol and increase ApoB levels.
Practical Tips:
- Eat a variety of fruits and vegetables. These foods are rich in vitamins, minerals, and antioxidants that support heart health.
- Switch from refined grains to whole grains like oats, quinoa, and brown rice. They are higher in fiber and can improve lipid profiles.
- Incorporate beans, lentils, chia seeds, almonds, excellent plant protein sources, and heart-healthy fats.
2. Reduce Saturated and Trans Fats
Saturated fats, found primarily in animal-based foods like fatty cuts of meat, butter, full-fat dairy, and trans fats in processed foods, are known to raise LDL cholesterol and ApoB levels.
How it works: These unhealthy fats contribute to the increased production of atherogenic lipoproteins, which leads to higher ApoB levels and a greater risk of plaque buildup in the arteries.
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Practical Tips:
- Choose lean protein sources like meat, poultry, and fish cuts or plant-based protein sources like tofu, tempeh, and legumes if possible.
- Swap butter and margarine for heart-healthy oils like olive, avocado, and flaxseed.
- Avoid foods high in trans fats, like baked goods, fast food, and packaged snacks.
3. Increase Fiber Intake
Dietary fiber, especially soluble fiber, can significantly lower ApoB levels by reducing the amount of cholesterol absorbed from the diet. Fibre, particularly soluble fibre, binds to cholesterol in the digestive tract and helps remove it from your body, lowering LDL and ApoB levels.
How it works: Soluble fiber improves the body's ability to manage cholesterol, reducing LDL cholesterol and ApoB levels.
Practical Tips:
- Oats, barley, beans, lentils, and other foods rich in soluble fiber are recommended, as are fruits like apples and pears.
- Add soluble fiber supplements like psyllium husk if you're not getting enough fiber from your diet, which can help lower cholesterol levels.
- When getting fiber through diet, it’s important to focus on soluble fiber. For example a cup of kale has 7g fiber-but 70% is insoluble.
4. Focus on Omega-3 Fatty Acids
Omega-3 fatty acids, found in salmon, mackerel, and sardines, as well as in flaxseeds, chia seeds, and walnuts, reduce the production of atherogenic lipoproteins. They also improve the overall lipid profile by lowering triglycerides and raising HDL cholesterol. Omega-3 supplements, particularly those containing EPA and DHA, can help lower LDL cholesterol and ApoB levels.
How it works: Omega-3 fatty acids are anti-inflammatory and enhance lipid metabolism, reducing ApoB levels.
Practical Tips:
- Make fatty fish a regular part of your meals twice or more weekly.
- If you’re vegetarian or vegan, add ground flaxseeds, chia seeds, and walnuts to your meals to boost your omega-3 intake.
5. Exercise Regularly
Regular physical activity can balance cholesterol and HDL ratio, creating a more favorable balance for heart health. Exercise helps the body regulate fat metabolism, leading to decreased levels of ApoB-containing lipoproteins and an overall improvement in cardiovascular function.
How it works: Exercise helps the body regulate fat metabolism, leading to decreased levels of ApoB-containing lipoproteins and an overall improvement in cardiovascular function.
Practical Tips:
- Engage in walking, cycling, swimming, or jogging for at least 150 minutes weekly.
- Include strength training exercises twice weekly to improve muscle mass, metabolism, and overall health.
- In addition to formal exercise, staying active throughout the day can help reduce your risk of cardiovascular disease. Take the stairs instead of the elevator, go for a walk during lunch breaks, or stand up and stretch regularly if you have a sedentary job.
Workouts that lower ApoB are broadly similar to workouts that improve VO2Max.
6. Maintain a Healthy Weight
Being overweight or obese can negatively impact ApoB levels and increase the risk of heart disease. Maintaining a healthy weight can help lower ApoB levels and improve cardiovascular health. Excess body weight, especially around the abdomen, is linked to higher ApoB levels and an increased risk of heart disease.
How it works: Excess body fat, particularly abdominal fat, can contribute to higher levels of ApoB and other cardiovascular risk factors. Losing weight can help improve lipid metabolism and reduce inflammation. When you carry excess weight, your body produces more LDL particles, leading to higher ApoB levels.
Practical Tips:
- Focus on a nutrient-dense, balanced diet rich in whole foods and low in processed foods to support weight loss and heart health.
- Pay close attention to your calorie intake, especially when consuming high-calorie foods, to avoid overeating.
- A realistic and sustainable weight loss goal is losing 1-2 pounds weekly.
7. Manage Stress
Chronic stress can negatively affect your heart health and elevate ApoB levels.
How it works: Managing stress effectively can help improve your overall health and reduce ApoB levels.
Practical Tips:
- Deep Breathing Exercises: Deep breathing can calm the nervous system and reduce cortisol levels.
- Sleep quality is essential for maintaining a healthy heart and reducing ApoB levels. Aim for 8-9 hours of sleep per night and create a consistent sleep routine.
8. Quit Smoking and Limit Alcohol Consumption
Smoking and excessive alcohol consumption are two lifestyle factors that can negatively impact your heart health and raise ApoB levels.
How it works: Smoking damages the blood vessels and increases inflammation in the body, which can raise ApoB levels and contribute to the development of atherosclerosis. While moderate alcohol consumption (such as one drink per day for women and two drinks per day for men) may have some heart-protective benefits, excessive alcohol intake can raise LDL cholesterol and ApoB levels.
9. Consider Supplements
Certain supplements can also support heart health and help lower ApoB levels when combined with a healthy diet and lifestyle.
- Omega-3 supplements, particularly those containing EPA and DHA, can help lower LDL cholesterol and ApoB levels.
- Niacin is a vitamin that has been shown to reduce LDL cholesterol and ApoB levels when taken at high doses.
- Plant sterol supplements are recommended by the National Lipid Association to lower ApoB.
Additional Dietary Considerations
- Avoid Refined Carbohydrates and Added Sugars: Refined carbohydrates and added sugars can raise insulin levels and promote the formation of small, dense LDL particles, which are more atherogenic.
- Limit Coffee Intake: Drinking lots of coffee (over 2 cups/day) is linked to higher ApoB levels. A surprising, and easy, swap is to replace unfiltered coffee (French press, espresso) with filtered coffee. contains cafestol and kahweol, which raise ApoB and LDL.
- Reduce Fructose Intake: The population consumes 25% or more of energy from added sugars.
- Avoid AGEs: Compounds in fried and roasted foods called advanced glycation endproducts (AGEs) are able to raise ApoB levels.
Addressing Insulin Resistance
Insulin resistance is when the body no longer responds to the hormone insulin. Insulin decreases ApoB production by promoting apoB breakdown and clearance in the liver. In another observational study of 1,500 people, diabetics had higher ApoB levels than non-diabetics. High ApoB levels were associated with higher HbA1c levels (a measure of 3-month average glucose levels) in an observational study of over 400 people.
Do we need to even worry about ApoB in the presence of good metabolic control of Blood glucose and insulin, in a study in 1996 in the New England Journal of Medicine,4 showed that if you have low fasting insulin, and high ApoB, the risk was low for heart disease, however if one had the presence of high insulin AND high ApoB the risk increased 5 fold! So it appears that insulin carries the greater risk of heart disease but more research is needed.
Other Factors Affecting ApoB Levels
- Sleep: In another study with over 8.5k people, sleeping less than 6 hours increased the odds of having high ApoB by 1.8 times in women. Sleep may affect ApoB by increasing insulin resistance.
- Smoking: Similarly, in 600 people, ApoB levels were higher in current cigarette smokers than non-smokers.
- Kidney Disease: In an observational study of 30 people, those with chronic kidney disease had 30% higher ApoB levels. Nephrotic syndrome is a kidney disorder that causes the body to release too much protein in the urine.
- Coffee: In an observational study of 77 people, drinking more than two cups a day of coffee was linked to higher ApoB levels. Further, in 180 men who drank coffee, ApoB increased in those who changed to decaf.
- Depression: People with depression often have issues with brain function including memory.
- Genetics: Familial hypercholesterolemia and hyperlipidemia are genetic disorders that result in high ApoB levels. Familial hypobetalipoproteinemia, familial combined hypolipidemia, and abetalipoproteinemia are genetic disorders that result in low or undetectable levels of ApoB.
When to Consider Medication
Consider medication if ApoB remains >120 mg/dL despite lifestyle changes, you have existing cardiovascular disease (target ApoB <80 mg/dL), or you have diabetes or multiple risk factors (target ApoB <100 mg/dL). Statins work by blocking HMG-CoA reductase, forcing your liver to produce less cholesterol and pull more cholesterol from your blood. Ezetimibe blocks cholesterol absorption in your small intestine, preventing dietary and biliary cholesterol from entering your bloodstream. PCSK9 inhibitors prevent the degradation of LDL receptors, allowing your liver to clear more ApoB particles from circulation.
Monitoring and Personalization
Once you’ve made these dietary and lifestyle changes, monitoring your ApoB levels to see if they are improving is important for a heart-healthy diet, staying active, managing stress, and making other positive lifestyle changes. ApoB responds to lifestyle changes within 6-12 weeks, though maximum benefits may take 3-6 months.
Personalized Insights for a Healthier Heart
Tools like Mito Health, helps you identify areas for improvement in your diet and lifestyle. By tracking your ApoB levels and other key health indicators, Mito Health helps you identify areas for improvement in your diet and lifestyle. Our science-backed recommendations provide the tools to lower your ApoB levels and optimize your heart health. Whether you're fine-tuning your nutrition, incorporating exercise into your routine, or making other lifestyle adjustments, Mito Health can help you achieve a healthier heart.