Managing patients with high Lp(a) | Peter Attia, M.D. & Benoît Arsenault, Ph.D.

Ғылым және технология

Watch the full episode and view show notes here: bit.ly/39jbCfb
Become a member to receive exclusive content: bit.ly/3xsqqjA
Sign up to receive Peter's email newsletter: bit.ly/39hgCRu
--------
About:
The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 40 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.
Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).
Learn More: bit.ly/3MNN2B1
Connect with Peter on:
Facebook: bit.ly/PeterAttiaMDFB
Twitter: bit.ly/PeterAttiaMDTW
Instagram: bit.ly/PeterAttiaMDIG
Subscribe to The Drive:
Apple Podcast: bit.ly/TheDriveApplePodcasts
Overcast: bit.ly/TheDriveOvercast
Spotify: bit.ly/TheDriveSpotify
Google Podcasts: bit.ly/TheDriveGoogle
Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website where I keep an up-to-date and active list of such companies.

Пікірлер: 128

  • @BossNerd
    @BossNerd Жыл бұрын

    I did a little self experiment. I get a blood test every two months and check hormones and cholesterol (including Lp(a)). My numbers were approaching the point where I would be put on cholesterol meds. I wanted to lose weight and went on a low carb diet - 60g carbs per day with no calorie restrictions - just eat as much of anything I want - just not carbs. I lost weight pretty rapidly(3lbs./week) but over seven months my Lp(a) went from 34 to 3 - sorry, I don't remember the units. Also, my hormone profile went from someone in the mid-50s to a 30 year old - not perfect but really good. I am sure there is a genetic component here but in my case it was a resounding success.

  • @tinhatrancher904

    @tinhatrancher904

    Жыл бұрын

    Interesting. Your self study shows LP(a) is not just genetic in nature (if too high for example) but connected to carb intake, lifestyle and diet in general. Keto, fasting, and low carb, like your self test can help lowering LP(a). I just got an invite from my doctor through access care. This is a research company looking to experiment with prescription drugs to lower LP(a) specifically. May not need to participate and possibly take an experimental treatment with unknown side effects to solve this issue. Thank you.

  • @Joseph1NJ

    @Joseph1NJ

    Жыл бұрын

    If that's true, your LP(a) went from 34 to 3, (you didn't mention the unit of measurement) assuming both were the same unit of measurement, you'd be in the medical journals as I don't believe that's possible.

  • @BossNerd

    @BossNerd

    Жыл бұрын

    @@Joseph1NJ I think /i still have the blood test results. Same lab over that period.

  • @Joseph1NJ

    @Joseph1NJ

    Жыл бұрын

    @@BossNerd Amazing!

  • @BossNerd

    @BossNerd

    Жыл бұрын

    @@tinhatrancher904 If you do this please respond with your results since there seem to be some skeptics. Of course genetics may be playing a factor here but there is a lot of new research dealing with epigenetics in this area.

  • @petercoderch589
    @petercoderch589 Жыл бұрын

    I am LP(a) null. I have the C>T mutation at rs41259144 (chr6:160601075) that substitutes Arginine for Glycine at that position, and causes the protein to truncate and stay immature and inactive. Less than 1 in 1,000 people have this SNV. My blood tests confirm non-detectable LP(a). The drawback is that I have a tendency towards infection. But it doesn't seem to hurt much. 4 people in my family have lived to be over 100.

  • @margots.3720
    @margots.37207 ай бұрын

    Im on liberal keto diet my second LP (a) test was 9. On my first ever Lp(a)test it was 15. I was 62. With keto diet i want to lower my Insulin which is improving, but the biggest gain was my Lp(a).

  • @stanleysokolow
    @stanleysokolow3 ай бұрын

    But what if you have high Lp(a) in your blood? Lp(a) is a modified LDL particle that has a "tail" protein attached to it. The tail has a sequence of atoms which interfere with the anti-clotting effect of plasminogen, so it promotes clotting. It is estimated that 20% of the world population has Lp(a) particles, which are genetically determined. Statins actually increase the amount of Lp(a), so they're no help with this. But 81mg aspirin counteracts the Lp(a) thrombogenic effect. The tricky thing is to get the aspirin dose and frequency correct for a particular concentration of Lp(a). Maybe a blood test, like the prothrombin time, could help the doctor titrate the aspirin dosage. Lp(a) is known to increase the risk of ischemic strokes and heart attacks, especially in elderly men, but doctors rarely test for it. You can find articles about this in PubMed.

  • @DrProfX
    @DrProfX3 ай бұрын

    The problem with statins is that they either do nothing to Lp(a) or increase it by up to 5%…

  • @BeachLifeLove
    @BeachLifeLove2 ай бұрын

    Have to say I'm a bit shocked at the recommendation of taking Statins (with all the side affects) ... So far I've found zero proof statins do anything for Lp(a), even the American Heart Association says they don't do anything for Lp(a). And, just from my Personal experience, My dr wanted to put me on them too because my Lp(a) was high, I said no. He then said lets get a CT scan and then talk. So I did the CT scan and all clean ... so my dr said, well no calcium so no need to go on them then (and 5 years later did just another one and still clean). And trust me, if there was proof statins helped with Lp(a), I would take them, even with the potential side affects. Anyway, just offering a different view.

  • @HA-kw7vq

    @HA-kw7vq

    2 ай бұрын

    I too have genetically high lipo protein - over 1500!! my cholesterol is also at overall 6.4 -- Drs begging me to go on a statin as i have RA too which can impact the heart. Feeling overwhelmed with it all - i am slim, eat heathy don't smoke or drink -I did ask what longevity of life would the statin provide? Btw i was told to do a Mri scan to check for calcium deposits £1600! It makes you wonder just let the body do what it needs too

  • @__7878
    @__78784 ай бұрын

    any comments on the unit of measure for Lp(a) ? nmol/L vs. mg/dL

  • @acke26
    @acke265 ай бұрын

    Why wait three months to test your cholesterol? HyperResponders reacts on dietary intakes and can detect changes within 3-4 days. Everyone that are concerned about their cholesterol levels should get a cholesterol tester. I've tested all kinds of supplements that are said to lower cholesterol and also different diets. I know it's individual but I can see changes within a week.

  • @JanZamani
    @JanZamani2 жыл бұрын

    Can we get the SNPs for the LPA gene that are of concern?

  • @TheShumoby

    @TheShumoby

    Жыл бұрын

    23&me and Ancestry DNA has LPa snps rs3798220 (T/T) and rs10455872 (A/A). I have both typical snps and my LP(a) was less than 8.4nmol/L, and my husband has the same typical snps and his LP(a) was 20.1nmol/L.

  • @kram21
    @kram212 ай бұрын

    Niaspan dropped my Lpa from 55 to 26-30 range would be great to have the new antisense agents when and if they become available

  • @salyx6687
    @salyx66876 ай бұрын

    i am 22 and have hypothyroidsm. On a regular blood work my lipoprotein a was checked. It was 245 which shocked me. Currently I have heart burns that feel like a radio tgat is not working and is making the rough sounds. Could tgat be from lipoprotein a?

  • @williamli7477

    @williamli7477

    2 ай бұрын

    Try iodine 12 - 25 mg. Start from 6 mg forna few days. Natural factors has liquid kelp that is 0.8 mg per drops. Also vit d3 10,000- 20,000 iu plus k2. Zinc magnesium, and activated vit B complex life extensions is very good

  • @Joseph1NJ
    @Joseph1NJ Жыл бұрын

    "Liberal with PCSK9" drugs... of course, he only has wealthy patients. The rest of us will just have to rely on luck.

  • @cherylh4688

    @cherylh4688

    9 ай бұрын

    Not his fault, tho'. It's the insurance companies, which won't cover the cost...yet.

  • @Joseph1NJ

    @Joseph1NJ

    9 ай бұрын

    @@cherylh4688 I understand they're very expensive.

  • @brevanth3976
    @brevanth3976 Жыл бұрын

    what about niacin?

  • @dsmill
    @dsmill6 ай бұрын

    I'm 55 years old, had an ischemic stroke 2 years ago and a stent placed in my left Coronary Artery for 75% blockage a month ago. I'm on blood pressure medication, baby l aspirin, 80mg statin and now blood thinners after the stent placement. My recent Aug 2023 lipid panel my LDL was 47 HDL 44 and triglycerides were 136 this is with use of the statin last 2 years. My cardiologist just had me do a LP(a) test which came back 160. In the last 6 months I've even become more aggressive with my diet cutting out most meat and reduce alcohol to almost zero and lowered my sugar and salt intake. I lost 35 pounds from 215 to 180 in the last 6 months through this approach and through a new job where I walk about 35,000 steps a day. I've worked out with weights all my life but did not really pay much attention to cardio or diet eating junk food quite often. Any thoughts on what else I can do to increase my chances with preventing further cardiovascular disease.

  • @SA-vw6rr

    @SA-vw6rr

    5 ай бұрын

    Look up the Linus Pauling protocol. They have a lot of information about reversing heart disease. It's hopeful. Also, there are some drugs coming out soon that target lp(a).

  • @DK-pr9ny

    @DK-pr9ny

    4 ай бұрын

    Low carb diet helped me a lot. Your triglycerides are way too high. Try keeping your carbs below 30/day. How is your A1C, Fasting insulin and C-Reactive protein?

  • @genomedia44

    @genomedia44

    4 ай бұрын

    Taking the msg and reply into consideration; 1. If you reduced meat, was that to avoid "saturated fat", or protein or both? What do you do, if at all to, for protein intake? 2. Reply says to reduce carbs; after protein and carbs reduction, what is left to eat? Veg?

  • @comeinhandynow

    @comeinhandynow

    2 ай бұрын

    @@genomedia44 fat, it’s good for you. Statistically less strokes..ex virgin olive oil best.

  • @genomedia44

    @genomedia44

    2 ай бұрын

    @@comeinhandynow I'm guessing this is a reply to my 2nd point?

  • @daviddelguercio8458
    @daviddelguercio8458 Жыл бұрын

    I’m so confused. So many people say a keto diet reduced all risks for heart disease. So many people say how bad statins are. I’m very confused. Been on a keto diet for months. Blood pressure went to perfect 110 over 77. My LDL 181, Hdl 56, tryg 102, vldl 18, waiting on Apo b results. I am 37 years old 6’2 188 pounds. Trying to do eveytning I can for optimal health. I don’t know which way to go though.

  • @SpookyScarecrow

    @SpookyScarecrow

    11 ай бұрын

    If you do a keto diet that is low in saturated fat you will likely see your LDL come down while retaining all of the other benefits

  • @prateekpawanpaharia8687

    @prateekpawanpaharia8687

    9 ай бұрын

    Can you please mention the units too? Like ldl is 181 'mg/dl'?

  • @cherylh4688

    @cherylh4688

    9 ай бұрын

    ​@@andrebiehl6837 Besides knowing your APoB number, the most important number is your ratio of triglycerides to HDL (T/H), as that is a measure of your likelihood of getting CVD, I believe. And yours is borderline too high. The closer it is to 1, the better, and ideal if less than 1, whereas yours is closer to 2. And another important ratio is TTL Cholesterol to HDL (TC/H). So to decrease your triglycerides and increase HDL (very important), you need to lower your carbs, and esp sugars. So I would definitely stick with the keto diet, since it has already proven to benefit you because of your improved blood pressure. And on keto (or carnivore), your LDL is expected to go up, but there are many types of LDL, most of which are not harmful. So you only need to be concerned if your ApoB proves to be high in relation to LDL-C. And if that is high, then you can just substitute the monosaturated fats from avocado and olive oil for some of the saturated fat in your diet and that should help a lot. That's what Dr. Attia has his patients do if their LDL is wayyy high. But yours is still pretty low for a keto diet. Check w any of the keto or carnivore docs on YT, esp Berg, Berry, Chaffee and Weston. And lastly, I would make sure to eliminate as much as possible ALL refined seed oils and trans fats (found in processed and fast foods) and all forms of sugar, incl natural and artificial (all the sweet tastes, as they only continue to cause a spike in insulin and cravings due to your unhealthy gut bacteria, which love the stuff). And you should probably get a Lipoprotein A score, as well, as that is also closely associated with cardiac events and will determine how urgently and aggressively you may want to lower your ApoB. But also reduce any insulin resistance and metabolic issues. Speaking of which, don't forget to ask for an HbA1C test as well, to see how you are doing insulin-wise over the previous 3 months. Ideal is 5 or below.

  • @sherryk0428

    @sherryk0428

    4 ай бұрын

    @daviddelguercio8458 Follow Dr Ken Berry and Dr Boz both of which do Keto and Carnivore. I trust them they have all the data to back up EVERYTHING - Do not listen to a bunch of crap...it does get confusing.

  • @snb310
    @snb3102 жыл бұрын

    We know statins reduce ldl but does ldl unquestionably cause cholesterol? If so, what's the increase in life expectancy from all cause mortality vs the side effect risk. Are there confounding studies that question the cholesterol cvd hypothesis? And is LPa cuasitive or indictive?

  • @Joseph1NJ

    @Joseph1NJ

    Жыл бұрын

    If you're asking how effective statins are, it depends on the age, as in the number needed to treat. It obviously declines with you age, but at the very least is just below 200 over 65 years old I believe. In other words, for every 200 patients on statins, you'll save one life. I would say that's fairly effective. As to the LDL question, ALL LDL particles are atherogenic, so reducing LDL makes good sense.

  • @snb310

    @snb310

    Жыл бұрын

    @@Joseph1NJ statins are effective at reducing cholesterol but is cholesterol really a factor in cvd and all cause mortality .

  • @Joseph1NJ

    @Joseph1NJ

    Жыл бұрын

    @@snb310 Yes.

  • @RHt09

    @RHt09

    Жыл бұрын

    @@snb310 I don't think you understand what cholesterol and a lipoprotein are. You should read more.

  • @snb310

    @snb310

    Жыл бұрын

    @@RHt09 I've read the clot thickens by Dr Kendrick among other things. Maybe you need you read things that aren't sponsored by pharma.

  • @milanpintar
    @milanpintar4 ай бұрын

    lowering lp(a) causes diabetes! what now?

  • @richakhattar2361
    @richakhattar23618 ай бұрын

    Hi Sir.. I am 37 year old. Last year suffered Carotid Dissection twice. My LPa levels are very high around 160. Doctor has put me on statins, blood thinners and niacin tablets. These medicines are ruining my body. Please suggest what should i take to lower my Lpa Naturally.

  • @Werebat

    @Werebat

    7 ай бұрын

    You don’t lower it naturally. You need the new antisense drugs to lower it, and the FDA plans on playing keepaway with those for the next several decades at least. Maybe they get a sick kick out of watching us twist in the wind, IDK.

  • @comeinhandynow

    @comeinhandynow

    2 ай бұрын

    Statins dont lower lpa

  • @supermills03
    @supermills0310 ай бұрын

    Thanks for the info on this. I recently got a cardio panel done and my LPa dropped from the last time I got it checked 2 years ago. it was at 143 and I was very obese and had high trigs and a1c as well, this year I dropped a lot of weight through low fat diet and exercise and my LPa was 85. APo B and Trigs plummeted as well. I did not use statins at the time but now I'm interested in them to further lower my levels. LPa is Still too high but trending in the right direction and I wonder if I redouble my efforts on diet and exercise I can get it down even further or if I should just ask to get on a PCSK9.

  • @BossNerd

    @BossNerd

    8 ай бұрын

    I would avoid Statins! I've met too many people with bad experiences on Statins. There is definetely and sub-group of people that Statins literally kill.

  • @forester057

    @forester057

    7 ай бұрын

    Do you want to be a test subject because PCSK9 inhibitors have not been human tested. You are the human trials if you decide to take experimental pharma products. Crazy how trusting people are when big pharma has not given any reason to trust them whatsoever.

  • @Davidj-il7fk
    @Davidj-il7fk4 ай бұрын

    I lowered lp(a) by more than half (240 > 115) on testosterone therapy, kind of interesting.

  • @nikos4677

    @nikos4677

    Ай бұрын

    Speculation propably what I am gonna say is wrong. It could be from the increase in estrogen.

  • @gammabyte5918
    @gammabyte59183 ай бұрын

    On keto, 10mg statin, 55 LDL but 300 lp(a)... crazy

  • @kimlim3275

    @kimlim3275

    25 күн бұрын

    LP(a) is genetic.

  • @pedrogonzalezsoto
    @pedrogonzalezsoto Жыл бұрын

    how do you bring down apoB aggressively ?

  • @TheShumoby

    @TheShumoby

    Жыл бұрын

    Decrease saturated fat consumption

  • @Kailokel

    @Kailokel

    Жыл бұрын

    Lose weight, exercise, decrease saturated fat, decrease trans fat (most Americans are getting that from beef), take statins, take ezetimibe, take PCSK9 inhibitors.

  • @RHt09

    @RHt09

    Жыл бұрын

    PCSK9 inhibitors #1, statins #2

  • @cherylh4688

    @cherylh4688

    9 ай бұрын

    #3 Substitute the monosaturated fats avocado and olive oil for some of your saturated fat. But still stay w a low carb, higher fat diet.

  • @cryptomando
    @cryptomando Жыл бұрын

    Statin increase LPa , substantially. Pcsk9 only work to lower.

  • @Joseph1NJ

    @Joseph1NJ

    Жыл бұрын

    It can by as much as 10% (?), but statins reduce your overall risk, or so it's been said.

  • @cryptomando

    @cryptomando

    Жыл бұрын

    @@Joseph1NJ for I started statin therapy I had a 75 LPA now I have 150 after 6 months

  • @Joseph1NJ

    @Joseph1NJ

    Жыл бұрын

    @@cryptomando Wow, raised by 100%!

  • @cryptomando

    @cryptomando

    Жыл бұрын

    @@Joseph1NJ next blood test is in a month. Trying the Pauling method to lower it. Lysine,proline, vitamin C for the last 3 months..

  • @vickistonehouse2218

    @vickistonehouse2218

    Жыл бұрын

    I would be very interested to learn how the Pauling protol works for you. I'm about to start that myself. I just test my Lp(a) and I guess I should be dead now! Going to discuss my own labs results with him/her soon. Do you think 3 months is long enough time to see a result hopefully a lowering in Lp(a) if indeed it needs to be lowered?

  • @kram21
    @kram2110 ай бұрын

    Niaspan puts my lpa in Nl. range

  • @vishalghorpade1023

    @vishalghorpade1023

    2 ай бұрын

    Hey, thanks for highlighting this. Could you please specify dose, and Lip a levels it dropped? TIA..

  • @tylero9568
    @tylero95682 жыл бұрын

    Wow, takin statin under 40 years old for prevention, interesting idea, there are many benefits.

  • @nancyd7441

    @nancyd7441

    11 ай бұрын

    Statins don't lower Lp(a) just the LDL to lower that risk ..

  • @hannocoetzer8763
    @hannocoetzer8763 Жыл бұрын

    I am using the Linus Pauling protocol, Vitamin C and Lysine. A few weeks ago I damaged my arteries around my right knee with a Kneeling Peroneal Stretch. My arteries above and below my knee were swollen to such an extent that I could feel them through my jeans. It was like this for about 3 weeks until I started the Pauling Protocol and then after about 3 weeks I could feel a significant reduction. Maybe it is placebo and/or my body repaired itself miraculously, or it actually worked. I wanted to post this testimony here.

  • @jillmorton3096

    @jillmorton3096

    Жыл бұрын

    Hello. Do you know if there is a book out on that study. I have increased my vitamin c so far Thank you

  • @thanasis_k

    @thanasis_k

    5 ай бұрын

    ​@jillmorton3096 there plenty linus pauling book about vit c

  • @godsend2529

    @godsend2529

    3 ай бұрын

    drjust put me on the same with a high lipoprotein a- do you have that as well?

  • @fordharrison2649
    @fordharrison264910 ай бұрын

    did you try Amla (Goose Berry) Indian ?

  • @sharonillenye8036
    @sharonillenye80364 күн бұрын

    40mg of rosuvastatin brought my LDL down to 89 and I thought I was going to die so I had to quit them. dr that says 30 is fine, has not taken a statin to see.

  • @randigarcia5307
    @randigarcia53074 ай бұрын

    Reading so much anecdotal data/stories on people lowering their Lp(a) by going carnivore or keto, low carb and it working and now I am listening to a doctor not even 40 years old taking a statin and going vegetarian????? Make it make sense.

  • @NA_Hemi
    @NA_Hemi Жыл бұрын

    I am 67 and recently had a TH CT Angio Chest CT which was normal and had a Calcium Score test which scored 111. Then last week during blood work I find out my Lpa(a) is 100mg. If I have had this for 67 years should I not be completely blocked at this point or dead ?

  • @NA_Hemi

    @NA_Hemi

    Жыл бұрын

    @Bladerunner2049 My diet has not been real good most of my life....high carb but then my A1c went to 61 so for almost all last year I was on the keto diet which dropped the A1c to 54 but my ldl went to 180. So now for the last 2 or 3 months I have been able to keep my saturated fat consumption to under 20g per day so I am expecting good results next labs

  • @Joseph1NJ

    @Joseph1NJ

    Жыл бұрын

    @@NA_Hemi A CAC score of 111, AND an LDL of 180, and your cardiologist knows you eat a keto diet and he didn't throw a bunch drugs at you? Today, sad to say, MDs treat numbers and symptoms, not patients, and always practice defensive medicine.

  • @NA_Hemi

    @NA_Hemi

    Жыл бұрын

    @@Joseph1NJ I have never seen a cardiologist, almost all my life my Cholesterol levels have been good, it mostly got high doing keto and trying to get the A1c down which I did. Then I got diagnosed with Osteoporosis. Then the doctor was like I want you to take a statin for Cholesterol and Fosomax for Osteoporosis. They weren't really caring too much to find the cause so I had to find a doctor that would and that's when the extensive testing started.

  • @mjoh090

    @mjoh090

    10 ай бұрын

    What was the actual concentration of your Lp(a)? Was it 100mg/dL or 100mg/L? There is an order of magnitude difference. The former would be very high, the latter would be normal.

  • @NA_Hemi

    @NA_Hemi

    10 ай бұрын

    @@mjoh090 This is how it was on the report 251 nmol/L

  • @jamesalles139
    @jamesalles1392 ай бұрын

    donate blood - a Win-Win

  • @mikeydiker
    @mikeydiker8 ай бұрын

    I was under the impression that LDL was not a concern. New studies have shown that somewhat higher. LDL has been found to be beneficial. Also vegetarian diet I have been reading are not ideal. Also, don't do statins increase calcifications and has a slew of other side effects, including early on dementia, along with joint pain and muscle or deterioration

  • @JoshuaSamuel309
    @JoshuaSamuel3097 ай бұрын

    I have low LDL and apoB. I actually have really good levels but my lp(a) is sky high at 67 mg/dl or 168 nmol/dl. Very frustrating and confusing how all my cholesterol levels are perfect and then the lp(a) was really bad..

  • @sidbista1715

    @sidbista1715

    Ай бұрын

    ..do you train heavy load or for endurance sports??

  • @cubalkan
    @cubalkan8 ай бұрын

    Why eliminating something which evolution created for a reason...thats nonsense...his pharma bias is insane 😂

  • @graemeedwards3064

    @graemeedwards3064

    7 ай бұрын

    Agree, my LPA is super high due to genetics but otherwise very healthy so I had a CTCA rather than try to lower LPA.. All arteries totally clean, my liver has been pumping out LPa for 40 years with zero negative impact on cardiovascular health

  • @tanitasara5919

    @tanitasara5919

    4 ай бұрын

    Me alegro😂

Келесі