What is Apo B?

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Apolipoprotein B, or “Apo B” as the cool kids call it, is a relatively new test for cardiovascular risk. Unfortunately “relatively new” often translates to “insurance doesn’t cover it”, but it’s a pretty affordable test that gives a much more accurate prediction of risk (and how aggressively you might need to approach treatment), as compared to the standard testing for cholesterol and triglycerides.

So what is Apo B? As the full name indicates, it’s a protein, and what it does is carry lipid particles through the bloodstream. Each Apo B protein carries one particle of cholesterol, and similar lipids. It’s that one to one ratio, and the fact that Apo B molecules are uniform in size, that makes it important.

You see, standard tests for cholesterol and triglycerides measure the mass of lipids in your blood, but not all lipid particles are the same size, and not all are as likely to cause atherosclerotic plaqueing in your blood vessels. Smaller particles are much more likely to get trapped in the folds and recesses of the artery walls and cause plaques.

So, for a simplified view of it (other than the total cholesterol, the following are not actual numbers that would exist in a real person) let’s say you have a total cholesterol mass of 200 mg. That could be 200 one mg particles, or 100 two mg particles, or 50 four mg particles, etc., but if you only check the total mass, you don’t know the number of lipid particles, and therefore you don’t have any idea of the average size of them.

And size matters – at least when it comes to lipid particles!

Again, having a high number of small particles is a higher risk for atherosclerosis. Each Apo B protein (which again, are themselves uniform in size) carries a single particle. So, counting the Apo Bs will give you an indication of the average size of the lipid particles relative to the total mass. The higher the Apo B, the more, smaller particles.

A “good” Apo B number is around 80 – assuming you don’t have other significant cardiovascular risk factors – such as smoking, diabetes, etc.. In many cases, these other risk factors act by means of increasing inflammation, which in turn causes the blood vessels to have more “nooks and crannies” for plaqueing to stick to. Here again, it’s not so much the amount of lipids in the blood, but the conditions that favor plaque formation.

Because of the influence of inflammation, your doctor may also test for inflammatory markers to further analyze your cardiovascular risk. If those markers are high, it would be best to shoot for as low of an Apo B level as possible, as well as taking steps to manage the inflammatory conditions (stop smoking, manage your blood sugar, etc.).

So, how do you lower Apo B? If it’s really high, or high in combination with high inflammation, you may need to consider medication, but there are some natural ways to bring your Apo B down, and they often simultaneously reduce inflammation.

In terms of diet, one important step is to reduce carbohydrate intake, especially sugar and refined carbs. This will normally reduce triglycerides, which in turn reduces the Apo B required to carry them.

It also helps to reduce saturated fat intake – mostly animal fats such as found in beef, pork, and dairy products. Most of the cholesterol circulating in your blood is not from eating cholesterol – it is actually produced by the liver and this production is increased by saturated fat intake.

There are a few supplements that seem to help lower blood lipids and Apo B. These include plant sterols and psyllium husk, but generally speaking, minimizing refined carb and saturated fat intake is probably more important than the supplements.

If you want to have your Apo B tested, don’t be surprised if your doctor is not very familiar with it. Although it’s been around for several years, the fact that it’s usually not covered by insurance tends to keep it “off the radar” for some doctors. You can actually get the test done on your own, if need be, through various labs (Google “Apo B testing”). It might be a good idea to shop around a bit though, because the cost of the test varies widely – I’ve seen prices ranging from around $30 to well over $100.

Until next time…

George F. Best, D.C.