Why You Should NOT Measure Apoprotein B

Apoprotein B provides a virtual count of the lipoprotein particles in the bloodstream that cause coronary heart disease. It is often held up as superior to the widely used LDL cholesterol value. Is this true?

It is true, but it does not mean that measuring apoprotein B tells you much about health. Compare this to the enormous amount of insight provided by measuring the REAL cause of heart disease: small LDL particles that gives you an entire universe of insight into your overall health, as well as risk for heart disease. And it is wonderfully and completely manageable with some simple strategies. 

Chapters

• 0:00 What Coronary Disease Really Is
• 0:32 The Cholesterol Era And Its Flaws
• 2:41 Meet ApoB And The Actual Particles
• 4:10 Why Particle Size Changes The Story
• 5:22 Small LDL As A Metabolic Snapshot
• 6:23 Food Drives Small LDL And Resistance
• 7:12 Nutrient Gaps That Fuel Risk
• 8:21 Microbiome, Endotoxemia, And The Liver
• 9:50 Getting The College-Level Test
• 11:00 Drugs Versus Causes
• 12:10 Fixing Risk At Home

Transcript

William Davis, MD: 0:00

You know, having practiced cardiology for 30 years, many years of which we're practicing preventive cardiology, that is, ways to prevent coronary disease. So when we say heart disease, we're typically talking more about coronary disease and not all the other kinds of heart disease like cardiomyopathies and rhythm disorders. So let's focus on this idea of coronary disease. So traditionally, of course, LDL cholesterol, the so-called bad cholesterol, is used as a gauge of your cardiovascular risk as well as total cholesterol. These are absurd ideas that came about in the 1950s and 1960s when work at the National Institutes of Health, NIH, tried to develop a way to quantify, to actually count the number of particles in the various fractions of blood. So blood has many things in it, right? But it also has so-called lipoproteins, fat-carrying proteins. And it was thought back then that the low-density lipoprotein, this one group of lipoproteins, LDL lipoproteins, was the cause of heart disease. And so the researchers wanted to develop an easy way. This is back 70 years ago, when a lot of this technology had not been sorted out. So they wanted an easy way, say in a doctor's office or community hospital, to gauge LDL particles. So they chose a marker for LDL particles. In this case, they chose cholesterol. They could have chosen any number of other things: triglycerides, apoprotein C3, apoprotein B, because there are many things in these particles. They chose cholesterol, and cholesterol was used as an indirect marker for these particles. Well, it proved to be a very poor marker. There are many other better markers, but it became construed, misconstrued as the cause for coronary disease. It's not the cause. Now, one of the problems is LDL particles, for which LDL cholesterol was meant to be a marker. LDL particles are not one thing. They're many things. They differ in surface charge and protein content and triglyceride content, size, and how long they last in the blood. The whole family of particles. And to think that this one crude indirect marker, cholesterol, could serve as an indirect way to quantify and characterize LDL particles is absurd. And think of it. Cholesterol is this fat in your eyes, in your skin, in your tongue, in your heart, in your pancreas, in your spleen. In other words, it is ubiquitous. It's all throughout your body. Yet we're going to use this thing as a marker for particles that cause heart disease? It's an absurd concept. You know, understandable for the 1950s, 1960s, when things are pretty simple back then, right? But for today, it's ridiculously simple. Should have been discarded. Should have been discarded decades ago. And so there's been this idea that apoprotein B may be superior. What's apoprotein B? Well, all LDL particles and VLDL particles, very low density lipoprotein, so even lower density than LDL, low density lipoprotein particles, those are the two classes of particles in the bloodstream, lipoprotein particles, that are known to cause heart disease. Do you see the distinction? Not cholesterol is an indirect marker, but the actual particles themselves. So if you want to quantify VLDL particles and LDL particles that potentially cause coronary disease, heart attacks, sudden cardiac death, I mean nasty stuff, right? You can use apoprotein B because there's one apoprotein B molecule for every LDL particle and for every VLDL particle. So apoprotein B provides a virtual count of those two heart disease-causing blood. So what's the problem here? All right, let's think about this. Let's pretend we do a blood work, do some blood work, and your apoprotein B is 180 milligrams per deciliter, which is kind of high-ish compared to other people. What does that tell you about you? Well, it tells you that your LDL cholesterol is likely to be high because it's a count of LDL particles, or it might tell you that your VLDL particles are high. Does it really tell you much about you beyond that? Not really. And the reason for that is this whole idea of cholesterol and apoprotein B is deeply flawed and outdated. What if instead I used a superior marker and I use, for instance, a NMR, nuclear magnetic resonance method to actually count and characterize the lipoproteins? And what if we did that and I said to you that your total LDL particle number is, let's just say for simplicity, 2,500 nanomoles per liter particle count per volume. And of that 2,500 nanomoles per liter of total LDL particles, let's say 2,000 are small. 2,000 nanomoles per liter are small. That is, the majority are small. What can I tell you about you? Well, you're gonna have a very low HDL cholesterol, you're gonna have a very high triglycerides, thereby high VLDL, you're gonna have a high blood glucose, you're gonna have a high hemoglobin A1C, you're gonna have a high C reactive protein and other measures of inflammation, you're gonna have high blood pressure, you have too much abdominal visceral fat. In other words, knowing that one number, small LDL particle count of 2,000 nanomoles per liter, tells me a whole bunch about you because these causes for heart disease cluster together. Unlike, say, LDL cholesterol and epoprotein B, which tells you almost nothing. So knowing that you have this small LDL tells you a whole bunch. It also tells you, by the way, that you're overconsuming carbohydrates and sugars. Because those are the only things in your diet that cause small LDL particles. The amylopectin A of wheat and grains, and sugars, sucrose, fructose, glucose. 2,000 nanomoles per liter of small LDL also tells you that you have insulin resistance. Your body's not responding to insulin. The process that it causes you to have more abdominal visceral fat causes all those other problems, hypertension, risk for dementia, heart disease, breast cancer, other cancers. So once again, knowing your small LDL particle number tells you all kinds, a whole constellation, a whole universe of things wrong with your health that you can correct. Why don't you hear about this? Well, because the treatment, the way to manage it is diet and addressing common nutrient deficiencies that most of us have: vitamin D, magnesium, omega-3 fatty acids, iodine. That sounds like a random list. It's not. It's factors lacking, largely lacking in modern life. For instance, magnesium is not in food anymore. Modern produce has almost no magnesium because of depletion of the soil and mycroplastic contamination that binds, that prevents uh uptake of magnesium from the soil and produce. You drink filtered water, that removes all magnesium. So, in other words, we're addressing deficiencies that are common to almost everybody. But those four things, magnesium, omega-three fatty acids, iodine, and vitamin D, when put together, synergize to minimize insulin resistance. But having that high small LDL particle number tells you you have insulin resistance and inflammation. So, in other words, small LDL gives you an entire picture of the path that leads you down to heart disease, a coronary disease, unlike LDL cholesterol and apoprotein B that tell you almost nothing beyond you have a high LDL cholesterol and apoplein B. So knowing small LDL gives you incredible insight. There are 55, 55 human clinical trials now that show that measurement of small LDL is significantly superior to that silly outdated thing called LDL cholesterol. So why doesn't your doctor or healthcare system or whoever you're talking to tell you this? Sad to say, and this may sound cynical, there's no money in it. No one is hawking some drug to correct this pattern. It is wonderfully and magnificently and totally correctable with diet and addressing those nutrients. It also helps to address your microbiome. The gastrointestinal microbiome is a contributor, also, especially if you have colonization of the small intestine with fecal microbes, small intestinal bacterial overgrowth. That's because the small intestine is very permeable, and the invasion of fecal microbes that live and die rapidly, they only live for a few hours. They shed their toxic components, they get into the bloodstream. That's called endotoxemia. And the gastrointestinal tract empties into the so-called portal venous system, a very separate system, venous system than the systemic, the body-wide venous system. So that portal venous system empties the gastrointestinal tract directly to the liver. So your liver takes a beating and it's inflamed and damaged by this process, endotoxemia, portal vein endotoxemia, and one of its effects is to amplify insulin resistance and thereby the production of small LDL particles. Okay, so in other words, saying your cholesterol is high is like a kindergarten version of how heart disease is created. You want the college version, right? You want the more advanced version. So how do we correct this? The small LDL. Well, first of all, you can measure it. You can use NMR, nuclear magnetic resonance, lipoprotein analysis. There are other methods that have kind of fallen aside for uh over the past 30 or so years. That, by the way, is how long I've been doing lipoprotein testing, over 30 years. It's available, it's inexpensive. Why don't you hear about it? Well, it takes a little education for the doctor to understand what they're doing and how to interpret these numbers. And you know, your doctor is an amateur at health and nutrition. Unf sad to say, most. I'm generalizing, of course. There are some who have made it their mission to understand these kinds of things, but most do not. Most will just write you a prescription, say, for Lipitor or PCSK9 inhibitor or some other drug to reduce cholesterol that does very little to nothing to reduce your cardiovascular risk because they're not addressing the cause. If you take a drug like Lipitor, does it correct your endotoxemia from small intestinal bacterial overgrowth? Of course not. Does it address your vitamin D deficiency? Of course not. Does it address your magnesium deficiency? No. Does it address, does it completely suppress the small LDL particle provocation of the amylopectinae of grain and show? Of course not. And so you can see how absurdly simplistic the conventional approach to heart disease is. The tragedy here, as I've often said, you've been watching my videos, etc., is that this focus, this obsession with cholesterol and saturated fat-related issues, the tragedy is it took your everybody's attention off the real causes of heart disease, which are, in truth, easy to identify, easy to correct, but you can do it for almost free, almost no cost. That's the blessing, that's the curse. Because if a lot of money could be made by correcting the cause for heart disease, you bet there'd be a fancy salesperson hawking that treatment, right, to your doctor. Your doctor gets an all-expense paid week in Orlando, Florida, in order to encourage this doctor to prescribe these drugs. But of course, none of this is true. You can address cardiovascular risk at home with diet, a handful of nutrients, and a handful of other strategies, such as those to correct SIBO. And if you don't know what I'm talking about, see my other videos, my Defiant Health podcast, my books like Super Gut and Super Body, my most recent book, that tell you how to correct SIBO, small intestinal bacterial overgrowth, thereby removing the contribution of portal vein endotoxemia to that small LDL particle issue. Or if you need some guidance, some support, I do have a membership website where we talk two-way Zoom type conversations. That's my inner circle.dearDavesInfinate Health dot com.