I read @TC_Luoma’s great article about lipoprotein (a) and didn’t think much about it at the time. My mom recently had a heart attack though (age 71), which prompted me to get a more detailed lipid and heart risk panel done in preparation for my annual physical. All my numbers are great EXCEPT my lipoprotein (a), which is 84 mg/dl.
I’m wondering if anyone has had success lowering their lipoprotein (a) levels with a supplement strategy of some sort. I’ll talk to my primary care doctor about this too, but I’m not sure he’s going to know that much.
Thanks! I’m happy for the help, though my understanding was neither diet nor exercise move the needle on lipoprotein a. If that’s wrong, awesome!
A typical day of eating looks like this for me:
Breakfast: One of (a) rolled oat, banana and whey shake; (b) museli and protein shake; (c) two eggs, bunch of egg whites and 1-2 slices of Ezekiel bread.
Lunch: Chicken or fish (mostly chicken breast), plus some type of carb (rice, potatoes or infrequently pasta) and varying vegetables (whatever came in the farm box we get). I’ll usually eat an apple and sometimes some peanuts afterwards.
Snack: I don’t usually snack, but if I do it is usually greek yogurt with berries and some honey or made into protein pudding.
Dinner: Pretty much whatever my wife makes. She’s pescatarian, so it is usually a vegetarian dish that I add chicken to. So almost always plant forward and then I’ll typically add chicken breast to it. There is also usually rice, sweet potato or less frequently pasta.
I try to aim to get ~50 grams of protein or so in each of my three meals.
I used to eat quite a bit of red meat but don’t any longer. When I do, it is usually bison. Occasional sweets, which are typically limited to the weekend.
This is what I’ve been doing for about the last 6-8 months I’d say. My overall lipid numbers are good (Total Chol: 168, HDL: 68, LDL: 92, Trig: 34) it is just this stupid lipoprotein a that’s out of whack.
Well, it is tough but I have had some clients that have been able to shift it. Also, if you bring your total cholesterol down, there’s potential for a ratio change too. No guarantees, but I’ve seen it happen a few times and can give you a few suggestions that might help!
Some folks are super sensitive to carbs/sugar, so here I would say if you’re going to have oats, don’t also have a banana, and instead add a healthy fat - walnuts, almonds, etc.; I’m not sure what’s all in your museli, but I’m guessing there’s some sugar and some possibly some dried fruit - so again fairly carb/sugar heavy; the eggs + Ezekiel bread breakfast is good, but maybe do 1 slice of toast and add 1/2 of an avocado.
Here I would switch the carbs to something like brown rice or sweet potatoes; if you do regular white potatoes - keep the skin on them. You’ve got carbs here already, so maybe look at taking the apple out and instead adding a healthy fat choice - again avocado or olives, olive oil, and nuts that aren’t peanuts.
Here ditch the honey and add some (2 TBS or so) nuts. Get those healthy fats in.
Dinner, much the same as lunch with your starch choices and add some healthy fat there too.
Generally speaking, the most effective ways to switch the ratio via nutrition are:
Limit sugars and high amounts of carbs in general - try to keep them in and around your workouts if at all possible.
Fat choices - limit saturated and high amounts of polyunsaturated fats and instead focus on the monos. Choose olive or avocado oil; avocados; walnuts, almonds, etc. instead of peanuts.
Increase fiber intake via vegetables/whole grains. Fiber helps clear cholesterol from the body.
Incorporate fatty fish into your diet 3+ times per week or add an omega-3 supplement.
I hope there’s something helpful in all of that and please keep us posted!
Thank you for all these suggestions! I’m going to bug you with some specific questions…hopefully that’s ok.
I’m curious how much your clients were able to drop their lipoprotein (a) – I’m looking for hope! I don’t think I want to drive my total cholesterol down much further since it is already at 168 but if I can reduce the lipoprotein (a) that’d be great. If I did that and total cholesterol didn’t drop, then I think that means I’d have more non lipoprotein (a) LDL; I think this is the ratio shift you’re talking about.
It’s this one: Old Country Style Muesli Cereal | Bob's Red Mill. So some dates and raisins but actually fewer carbs per serving than the oats. I take your point though about the generally carb heavy breakfast.
Lots of arsenic in brown rice though, right? That’s one of the reasons I’ve generally stuck with well washed white rice. I like sweet potatoes so I’ll probably bump those up a lot.
I have tried this before and have struggled with it. I’m going to try it again though. Where do you see legumes fitting into this? I love beans and to a lesser extent lentils and so am thinking those would be good carb and fiber sources.
Any idea how long dietary changes like this might take to move the needle on my lipoprotein (a) if the needle is going to move?
Okay, here’s my “better late than never” response!
It only happened 3 times - so again, not the rule, but the exception and the amount was varied, for one of them it was roughly a 20 point drop and for the other two it was smaller in the 10 area. The 20 pointer had high total cholesterol and high triglycerides to begin with, so he had further to fall, the other two where in the 180’s for total cholesterol and had normal TGs. Your cholesterol and TG levels are lower, so there may not be a huge or any change. For the record, not a lot of folks get the cholesterol sub-type tests run, so having that data is rare. If you’re super concerned about your lipoprotein (a) level and overall cardiovascular/heart health, another test to have done would be a C-reactive protein - if this level is high it can be indicate a high risk for heart disease. It is also an indicator for other conditions - but it would give you another data point.
This is a good one! No added sugars at all, but yes still a carb heavy breakfast.
Brown rice does have a higher arsenic content than does white but it also has overall more fiber and nutrients. Honestly though, rice in general isn’t a super nutrition powerhouse. There are better carb choices. If you need/want a grain oats and quinoa would be my top recs for easy to source options.
These are great - definitely a more solid choice than a grain based carb!
I usually say give it 6 months to a year. I’m not sure on the exact timeline, but I would assume that longer is better.
Thanks, I had the C-reactive protein test done and it was very, very low. I’m not going to worry too much about the LP(a) level (or perhaps I should say I’m going to stop obsessively worrying about it like I have been ) – my primary care doctor didn’t seem too terribly worried about it given my overall risk. I have started on a low dose statin though to see if we can get my LDL down a good bit lower; since there’s no real way to treat the high LP(a) right now knocking out LDL seems to be the accepted approach. That plus the diet changes will hopefully do the trick until the LP(a) reducing drugs are out of their phase III clinical trials which I understand might be sometime in 2025 or so.
Thanks! I like both and so will start using these more.
I have not had them re-tested yet. I probably will in the coming months. I’m not expecting them to move much if at all – everything I’ve read suggests diet and exercise has no impact on LP(a). Treatment for folks with high LP(a) levels seems to be to knock LDL down to low levels using statins. That’s what I ended up doing after talking things over with my doctor. Apparently there are some drugs that are targeted at lowering LP(a) that are in clinical trials still so hopefully there will be more options in the near future.
One side effect of the changes I’ve made to my diet seems to have been some additional weight loss. I say seems since I’m also doing more cardio than I was so it is hard to say it has all been the diet.
You too. Peter Attia has some good stuff on high LP(a) levels. I’m not sure I totally buy into his approach – he seems to be very, very aggressive with the statins – but listening to some excerpts from his podcast was part of what got me comfortable making the decision to go on a low dose statin. Of course, the big parts that got me comfortable were talking with my doctor and my father in law, who is a cardiologist.
Just read this recently and I am currently battling this so I will offer my 2 cents.
Original number 165
total cholesterol 190 with day on day off of Lipitor 20 mg all other metrics associated with cholesterol were within normal limits
Cardiologist put me on 80 mg Lipitor ED
235
total cholesterol 105
All other metrics were at low end of normal
•••fyi libido and erections went massively down••••
Took myself off Lipitor, began regime of regular niacin starting at 500 mg and over several weeks went up to current amount of 2000mg
Total cholesterol 188
My lipo number went down to 127
Other metrics were in vey upper limit of normal
••• libido and erections strength came back massively•••
All during this I eat fairly clean mostly adhering to the Velocity Diet with IF (14 hours fasting 10 hours feeding) every other day
Training now is gymnastic rings (beginner workouts) resistant bands, and lighter weights
59 years old, old man that no longer dies martial arts and powerlifting
TRT for 18 years
Test cyp 20 mg SQ ED x 2 years
Waiting for most recent numbers to come in but it usually is around 900-1100
FT usually 25 to 30
Estradiol (sensitive assay) 40-50
So, imho, niacin (flushing) was most beneficial just had to get used to flushing for about 45 min and Lipitor really does nothing positively for lipo a AND it killed my libido and boners
) – my primary care doctor didn’t seem too terribly worried about it given my overall risk. I have started on a low dose statin though to see if we can get my LDL down a good bit lower; since there’s no real way to treat the high LP(a) right now knocking out LDL seems to be the accepted approach. That plus the diet changes will hopefully do the trick until the LP(a) reducing drugs are out of their phase III clinical trials which I understand might be sometime in 2025 or so.