In this video, Steve Goldring, a hormone pharmacist, discusses the importance of evaluating one’s heart disease risk and introduces a biomarker called Apolipoprotein B (ApoB) as a more accurate predictor of blocked arteries and heart attacks than traditional cholesterol measures. He shares his personal journey of reducing his ApoB levels by making dietary changes, including reducing saturated fat, decreasing carbohydrate intake, increasing fiber and healthy fats, and optimizing his insulin levels. While he acknowledges that individual responses to diet vary, he suggests these steps as potential ways to reduce overall health risks and emphasizes the importance of hormone optimization for long-term health.
Key Insights:
- Heart disease is the leading cause of death for both men and women.
- Heart risk should be evaluated by a qualified healthcare practitioner.
- Apolipoprotein B (ApoB) is a better predictor of heart disease risk than LDL cholesterol.
- Lowering ApoB levels can reduce the risk of heart disease.
- Many drugs can lower ApoB levels, but they may come with side effects.
- Dietary changes, such as reducing saturated fat and carbohydrates, can help lower ApoB levels.
- Optimizing hormone levels, such as insulin and testosterone, can contribute to overall health.
- Every person may respond differently to different dietary approaches, so individual experimentation is important.
- Optimal hormone levels can help prevent heart disease, diabetes, osteoporosis, and Alzheimer’s.
- Hormone optimization providers may be able to help with optimizing hormone levels
Transcript
What is the thing that’s most likely to kill you? More men and women die of heart disease than of any other cause, by far. I’m Steve Goldring, The Hormone Pharmacist. It sort of goes without saying, but I’ll say it anyway… heart risk is absolutely something you need help from a qualified healthcare practitioner for. I’m not your physician, and this video is only for education and information purposes. You absolutely must NOT take anything I say as medical advice.
All of us, me included, need to have our heart risk evaluated by a qualified practitioner. Well, we’ve been told for decades that we need to watch out for one single thing in order to avoid a heart attack, and that thing is cholesterol. Of course, your doctor’s talked about your „bad cholesterol,“ or sometimes referred to as LDL-cholesterol or LDL-C. Over the past few years, though, it’s clear that the term „bad cholesterol“ is really a bad oversimplification. There’s another biomarker that’s way better than LDL cholesterol at predicting whether you’ll get blocked arteries and eventually have a heart attack or a stroke. That biomarker is called Apolipoprotein B or ApoB for short. Your ApoB level is a very good indicator of your heart disease risk. The higher your ApoB, the more likely it is that your arteries are going to get clogged and it’s going to cause a heart attack down the line.
In the past 12 months, I’ve been able to lower my ApoB, that most important biomarker for heart disease, by 34%, and I did NOT take any drugs. In this video, I’m going to cover 3 important aspects of reducing your risk for heart disease. First, I’ll let you know what specific steps I took to lower my ApoB. Second, I’ll talk about how these steps fit in with optimizing my hormones, especially optimizing my insulin. Third, we’ll talk about some ways that you might be able to lower your heart risk by applying some of the same principles that I use to sort of chip away at my risks.
Last June, I asked my hormone optimization doctor to order an ApoB test along with all my other labs. ApoB tests aren’t so commonly ordered by doctors, so you may need to ask for it specifically, and it may not be covered on your insurance. The cost, I don’t know, something like $45 to $110 – somewhere in that range. The reference range for ApoB is listed as desirable <90mg/dl, borderline high 90-99, high is 100-130, and very high is >130mg/dl. Well, my ApoB test came back at 161mg/dl. I’m at very high risk for a heart attack. A second doctor I see up in Oregon told me he was also concerned about my heart risk. I decided I was going to make some changes and see if I could reduce my ApoB.
Several drugs are effective at reducing ApoB. Statins are probably the most common ApoB-lowering drugs. I’m not really sure if statins might cause me to go into insulin resistance. It doesn’t happen with everybody on statins, but it is a major concern. So, for me, statins seem to be out of the question. The second set of drugs or medications that lower ApoB are called PCSK9 inhibitors. They work, but they’re probably $500 a month. So, PCSK9s seem to be out as well. There are some other drugs that might help with ApoB levels, but the side effects versus effectiveness kind of weighing those out, it just didn’t seem all that appealing to me.
I typed in „diet and heart risk“ into Google. Almost every site that came up said something about reducing your saturated fat, and I’ve seen these recommendations about reducing saturated fat to affect ApoB. There are a lot of respected doctors and researchers that say we should emphasize a „plant-based diet,“ avoiding meat and dairy and reducing saturated fat, mainly to decrease our heart risk. There are other well-respected doctors who say the concerns about saturated fat are maybe overblown, and they advocate a high-fat, low-carbohydrate diet. Some people even go so far as to say a carnivore diet – all meat – is healthy. All meat means a lot more saturated fat. My main concern has been avoiding too many carbohydrates, especially sugar and grains. I’m trying to optimize my insulin levels by maintaining a stable blood glucose level.
I decided to do an experiment though. For about 8 months, I limited my saturated fat. I decreased grass-fed beef; I didn’t eliminate it but ate it maybe once a month instead of 2 or 3 times a month. I cut back on the charcuterie boards that we like with all the salami and processed meats and prosciutto and cheese. I substituted chicken breast for chicken thighs, and that has less saturated fat. We ate more salmon, even though we already eat it a few times a week. We cut back on the number of eggs we were eating every day, a little less half and half in my coffee in the morning. I drizzled olive oil on vegetables instead of butter. We added a blueberry smoothie with whey protein to our breakfast every day.
At the same time, I was making some small changes to my dietary supplements. I had been taking 2gm of fish oil capsules every day. Those are a great source of healthy fats; they’re called omega-3 fatty acids. But I doubled those fish oil capsules to 4gm a day. I added more fiber, more nuts, and I added some flaxmeal to those smoothies I mentioned. I added some berberine to my supplement list. There’s solid evidence that shows berberine can help maintain steady blood glucose levels and help me avoid that insulin resistance.
Well, I wasn’t really convinced that diet changes alone would really make that much of a difference in my ApoB. But I was pretty consistent with them. My level of daily exercise stayed roughly the same as it had been in the last year or 2. I had my blood drawn in April of this year, and that was about 10 months after my last labs. My ApoB showed 106mg/dl. I was shocked. I had dropped my ApoB by a whopping 34%. My LDL cholesterol also went down from 173 to 126, that’s 27%. My fasting insulin, blood glucose, and hemoglobin A1c – those are all indicators of insulin resistance – those all stayed right about the same.
Because insulin resistance is so common in men my age, and because it’s such a huge risk factor for heart disease and even Alzheimer’s, the ultimate goal of optimizing my blood glucose and my insulin levels is avoiding insulin resistance or, saying it another way, „maintaining my insulin sensitivity.“
My experiment turned out to be a surprising success. I was able to drop my ApoB and maintain my insulin sensitivity by making adjustments to my diet alone. Well, I’m not ready to eliminate saturated fat completely from my diet, and because everybody responds differently to different ways of eating, I’m not going to tell you that there’s one particular diet that you really need to stick to. What I will suggest, though, are a few steps to think about in reducing your overall health risks:
1. You can reduce your saturated fat intake to optimize your ApoB.
2. Reduce your carbohydrates to try and optimize your insulin.
3. Increase fiber with salads, green leafy vegetables, flaxseed, nuts.
4. Increase healthy fats – olive oil, avocado oil, fish oil, and fish.
My little experiment is called an N=1, that’s a study with just one participant. The results of an N=1 study can’t really apply to every other person, but they can give us some hints and ideas about changes that could have an impact on our long-term health risks. One thing I know for sure is that optimizing your hormones – insulin, testosterone, and cortisol for men like me, for women, it’s all about estradiol, progesterone, and other hormones – can go a long way toward helping you stay healthy for the long haul. They help you avoid heart disease, diabetes, osteoporosis, even Alzheimer’s.
Well, I know hundreds of hormone optimization providers who might be able to help you with all that stuff. If you send me a referral request, I’ll see if I can find somebody in your area – no guarantees, but I’ll give it my best shot. If this video has been helpful at all, click the „Like“ and „Subscribe“ buttons. Click the little bell to get notified anytime I post a new one. Thanks so much for watching, and I’ll look forward to talking to you again soon.
