Why You Should NOT Meaure Apoprotein B

Main Ideas

• The speaker distinguishes coronary artery disease from other forms of heart disease. He focuses on coronary disease and questions the use of total cholesterol and LDL cholesterol as measures of its causes.
• LDL cholesterol is an indirect marker, not a count of LDL particles. The speaker says it was adopted as a convenient proxy decades ago, but argues that cholesterol levels do not adequately describe the varied particles that carry it.
• ApoB estimates the number of certain lipoprotein particles, but gives limited detail. In his account, each LDL and VLDL particle carries one ApoB molecule, so an ApoB result approximates their combined number. However, it does not distinguish LDL from VLDL or describe particle characteristics.
• He argues that small LDL particle count offers more insight. Using NMR lipoprotein analysis as an example, he says a high small-LDL count can point to a cluster of issues, including insulin resistance, inflammation, high triglycerides, low HDL, elevated blood pressure, and abdominal fat. He presents this as more informative than LDL cholesterol or ApoB alone.
• Diet and metabolic factors are central to his explanation. The speaker links small LDL to insulin resistance and says that, in his view, excess carbohydrates and sugars promote it. He also discusses SIBO and endotoxemia as possible contributors to liver inflammation and insulin resistance.
• He criticizes a medication-centered approach. He argues that cholesterol-lowering drugs do not address the dietary, nutrient, or gut-related factors he considers underlying causes. He also claims that financial incentives help explain why these factors receive less attention.
• The speaker presents small LDL as manageable. He describes lifestyle and nutrition changes—notably reducing relevant dietary triggers, addressing nutrient deficiencies, and managing SIBO—as ways to reduce the factors he associates with small LDL. These are his claims and recommendations, not independent medical guidance.

Method and Recommendations Described

1. Measure lipoproteins directly, if assessing particle patterns. The speaker recommends NMR lipoprotein analysis to count and characterize particles, especially small LDL, rather than relying only on LDL cholesterol or ApoB.
2. Interpret small LDL in context. He says a high small-LDL result may signal broader metabolic and inflammatory concerns rather than being an isolated cholesterol finding.
3. Address factors he associates with insulin resistance. He recommends changing dietary patterns he believes promote small LDL and considering common nutrient deficiencies, naming vitamin D, magnesium, omega-3 fatty acids, and iodine.
4. Consider gut health. He identifies SIBO and endotoxemia as possible contributors and refers viewers to his other materials for approaches to SIBO.
5. Seek informed interpretation. He notes that interpreting particle testing requires familiarity with the measurements and cautions that many clinicians may not have that training.

Speakers and Sources Mentioned

• Speaker: William Davis, MD, the sole narrator; no other speakers are heard.
• Sources and resources mentioned: The National Institutes of Health (in a historical discussion), NMR lipoprotein analysis, unspecified human clinical trials, Lipitor, PCSK9 inhibitors, his Defined Health podcast, his books Super Gut and Super Body, and his Inner Circle membership website.