Apolipoprotein B (ApoB) has emerged in recent years as one of the most important biomarkers for cardiovascular health. However, it still remains relatively unknown to the general public. This article will provide an overview of ApoB, explain why keeping it in a healthy range matters, and offer science-backed, actionable strategies to lower your levels.
What is ApoB and Why Does it Matter?
ApoB is a protein found in lipoproteins – particles that transport fats around our bloodstream. Specifically, ApoB is a component of atherogenic lipoproteins – the ones that can accumulate in artery walls and lead to plaque buildup and atherosclerosis.
Higher ApoB levels indicate higher numbers of these dangerous lipoprotein particles circulating in your blood. In contrast, lower ApoB suggests lower amounts of atherogenic particles.
For many years, cholesterol metrics like total cholesterol, LDL cholesterol, and HDL cholesterol were considered the most important biomarkers for heart disease risk. However, large studies have now demonstrated that ApoB is superior to cholesterol for predicting cardiovascular events.
In fact, a 2022 study published in The Lancet showed that elevated ApoB levels not only predict heart disease risk, but also raise the likelihood of developing type 2 diabetes and shorten lifespan.
According to the authors:
“Higher ApoB is detrimental to lifespan and increases risk of coronary heart disease and type 2 diabetes…Different approaches to lowering ApoB should have widespread beneficial effects, including preventing common diseases and even prolonging life.”
Keeping ApoB in a healthy range below 90 mg/dL is crucial for protecting cardiovascular health. Levels below 70 mg/dL are ideal for those at very high risk of heart disease.
Top 3 Evidence-Based Ways to Lower ApoB
Dozens of studies have tested different lifestyle interventions and their impact on ApoB levels.
After reviewing the evidence, these three strategies emerge as the most powerful levers for lowering ApoB:
1. Losing Excess Body Fat
- Weight loss consistently lowers ApoB across studies when people lose 6-12% of their body weight.
- Shedding body fat reduces production of VLDL particles, which can convert into LDL particles. It also increases LDL breakdown.
- The end result is an overall reduction in circulating atherogenic particles, reflected in lower ApoB.
2. Increasing Unsaturated Fat Intake
- Both monounsaturated and polyunsaturated fats have robust ApoB-lowering effects.
- Good sources of monounsaturated fats: avocados, olive oil, canola oil.
- Good sources of polyunsaturated fats: walnuts, flaxseeds, chia seeds, fatty fish.
- Replacing saturated fats or carbohydrates with unsaturated fats appears optimal for lowering ApoB.
3. Eating More Soluble Fiber
- Foods high in soluble fiber including oats, okra, apples, berries, psyllium husk, help lower ApoB.
- Soluble fiber reduces cholesterol absorption in the gut, which lowers circulating lipoproteins.
- Adding psyllium to a statin lowers lipids as much as doubling the statin dose.
In addition to these top three interventions, some other foods and nutrients may also help optimize ApoB levels when consumed in the right amounts and context. Let’s review the evidence.
Other Potential Strategies to Reduce ApoB
Phytosterols
Some studies suggest phytosterols, concentrated in nuts and seeds, may modestly lower ApoB. However, the effect is not entirely clear yet and may require high supplemental doses beyond what most people consume through diet alone.
Fructose
Very high fructose intake from added sugars and sugary beverages can increase ApoB production. But the amounts used in these studies supplying 25% or more calories from liquid fructose exceeds typical intakes. Still, limiting sweetened beverages seems prudent.
Trans Fats
Trans fats increase ApoB, but are no longer as ubiquitous as they once were due to food reformulations. However, in places where trans fats are still common in processed foods, limiting intake may help lower ApoB.
Soy Protein
Several studies in people with high lipid levels found isolated soy protein supplementation lowered ApoB. It’s unclear if less processed forms of soy (e.g. tofu, tempeh) would have the same effect.
Dietary Patterns
The Mediterranean diet has the most evidence behind it for lowering ApoB, likely due to its emphasis on plant fats and soluble fibers. The DASH diet, Vegetarian diets, and Nordic diets may also be beneficial, although more research is needed.
Putting it All Into Practice
While drugs like statins or PCSK9 inhibitors can powerfully reduce ApoB when diet and lifestyle alone are insufficient, optimizing nutrition and other lifestyle factors should be the first line of defense.
Here are some practical tips for incorporating ApoB-lowering foods and behaviors into your daily routine:
- Replace butter and fatty meats with unsaturated fats like olive oil, avocado, nuts, seeds, and fatty fish.
- Eat more soluble fiber by enjoying oatmeal, okra, apples, berries, and supplementing with 5-10g psyllium husk per day.
- Lose excess body fat by reducing calorie intake and engaging in regular physical activity. Aim to lose 1-2 lbs per week.
- Limit sugary beverages and ultra-processed foods – these are linked to higher ApoB levels when consumed in excess.
- Consider an omega-3 supplement providing at least 2 grams combined EPA/DHA per day if not eating fatty fish regularly.
- Grind flaxseeds to maximize nutrient absorption, or keep them whole for a soluble fiber boost.
- Make cheese substitutes using soaked raw cashews for a vegan/plant-based take on creamy sauces and dips.
- Embrace Mediterranean diet principles: an abundance of fruits, vegetables, whole grains, beans, nuts, seeds, and olive oil, with modest amounts of fish, dairy, eggs, and poultry.
ApoB as Metrics for Gauging Cardiovascular Health
Apolipoprotein B is emerging as one of the most important metrics for gauging cardiovascular health. Chronically elevated ApoB indicates an excess of atherogenic lipoproteins that can promote plaque buildup in the arteries.
Thankfully, there are powerful nutrition and lifestyle strategies supported by clinical trials that can help lower ApoB. Losing excess body fat, increasing intake of unsaturated fats, and eating more soluble fiber represent the top three evidence-based levers for reducing ApoB.
Putting these tips into practice by making thoughtful food choices, adopting sustainable lifestyle habits, and working with your healthcare provider can help keep this crucial biomarker in a healthy range and promote long-term cardiovascular wellness.
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