How to Lower Lp(a) with Diet

How to Lower Lp(a) with Diet
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What to eat and what to avoid to lower the cardiovascular disease risk factor lipoprotein(a).

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Lipoprotein A, also known as Lp(a), is an independent, genetic, and causal factor for cardiovascular disease and heart attacks. At any level of LDL cholesterol, your risk of heart attacks and strokes is two to three-fold higher when Lp(a)is elevated. With a high enough level, atherosclerosis continues to progress, even if you get your LDL cholesterol way down, which may help explain why so many people continue to have heart attacks and strokes even under treatment for high cholesterol. So, it’s suggested that doctors check lipoprotein A levels in a patient who has suffered such an event if it can’t otherwise be easily explained. What’s the point of checking it, though, if there’s not much we can do about it? To date, no drug to reduce circulating Lp(a) levels has ever been approved for clinical use.

Some researchers blame our lack of knowledge on the fact that Lp(a)is not found in typical lab animals, like rats and mice. It’s only found two places in nature: primates…and hedgehogs. How strange is that? No wonder Lp(a)is an enigmatic protein that has mystified medical scientists ever since it was first discovered a half century ago. But, who needs mice when you have men? The level in our bloodstream is primarily determined by genetics, and for the longest time, Lp(a)was not thought to be much influenced by things such as diet. Given its similarity to LDL, though, one might assume a healthy lifestyle would help. However, the evidence has been lacking––but maybe that’s because they have not yet tried a plant-based diet.

We’ve known for years that the trans fats found in meat and dairy are just as bad as the industrially-produced trans fat found in partially-hydrogenated oil junk food when it came to raising LDL cholesterol. When it comes to lipoprotein A, the meat and dairy trans fat appears to be even worse. Just cutting out meat––putting people on a lacto-ovo-vegetarian diet––does not appear to help, but put people on a whole food plant-based diet packed with a dozen servings of fruits and vegetables a day, and within four weeks, Lipoprotein A levels dropped 16%. Of course, in those 30 days, they also lost 15 pounds. But weight loss does not appear to affect Lp(a)levels; so, you figure, it must have been due to the diet.

If you’re already eating a healthy plant-based diet, and your Lp(a)levels are still too high, are there any particular foods that can help? Like for cholesterol, even if the average total cholesterol of those eating strictly plant-based may be right on target at less than 150, with an LDL right on target at under 70, there’s a bell curve, with plus or minus 30 falling immediately on both sides. Enter, the “Portfolio Diet,” which is not just plant-based but adds specific cholesterol-lowing foods if that’s not enough. So, like nuts and beans, oatmeal, and berries to drag cholesterol down even further. What about LP(a)?

Nuts have been put to the test. Two and a half ounces of almonds every day dropped levels, but only about 8%. But that’s better than the other studies on nuts that found no effect at all, no effect at all, and… no effect at all. Ah, nuts.

There is one plant, though, that appears to drop Lp(a)levels 20%, enough to take people exceeding the U.S. cut-off down to a more optimum level. And that plant is a fruit: Emblica officinalis, otherwise known as amla––Indian gooseberries. A randomized, double-blind placebo-controlled study asking smokers before and after about their cough, their shortness of breath, loss of appetite and feelings of impending doom, palpitations, sleep deprivation, irritability, heart burn and tiredness, as well as objective measurements from their blood count, cholesterol, DNA damage, to antioxidant status and lung function, and…the amla extract they used showed a significant improvement compared to placebo in all the parameters tested, with no reports of side effects. That’s unbelievable! No, really, that’s unbelievable. And indeed, it’s completely not true.

Yes, subjective complaints got better in the amla group, but they got better in the placebo group too, with arbitrary scoring systems and no statistical analysis whatsoever. And of the two dozen objective measures, only half could be said to reach any kind of even before-and-after statistical significance, and only three were significant enough to account for the fact that if you measure two dozen things, a few things might pop up as positive, if only by chance. Any time you see this kind of spin in the abstract, which is sometimes the only part of a study people read, you suspect some kind of conflict of interest, but there were no conflicts of interest declared… But that’s bullshit, as the study was funded by the very company selling those amla supplements. *sigh*

Anyways, one of those three significant findings was the LP(a); so, it might be worth a try. I mean, in the context of a plant-based diet, which in addition to the weight loss, can dramatically improve blood pressures even as people cut down on their blood pressure medications, plus a 25-point drop in LDL bad cholesterol, plus a 30% drop in C-reactive protein, and significant reductions in other inflammatory markers for a systemic, cardio-protective effect, all thanks to this single dietary approach.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Lipoprotein A, also known as Lp(a), is an independent, genetic, and causal factor for cardiovascular disease and heart attacks. At any level of LDL cholesterol, your risk of heart attacks and strokes is two to three-fold higher when Lp(a)is elevated. With a high enough level, atherosclerosis continues to progress, even if you get your LDL cholesterol way down, which may help explain why so many people continue to have heart attacks and strokes even under treatment for high cholesterol. So, it’s suggested that doctors check lipoprotein A levels in a patient who has suffered such an event if it can’t otherwise be easily explained. What’s the point of checking it, though, if there’s not much we can do about it? To date, no drug to reduce circulating Lp(a) levels has ever been approved for clinical use.

Some researchers blame our lack of knowledge on the fact that Lp(a)is not found in typical lab animals, like rats and mice. It’s only found two places in nature: primates…and hedgehogs. How strange is that? No wonder Lp(a)is an enigmatic protein that has mystified medical scientists ever since it was first discovered a half century ago. But, who needs mice when you have men? The level in our bloodstream is primarily determined by genetics, and for the longest time, Lp(a)was not thought to be much influenced by things such as diet. Given its similarity to LDL, though, one might assume a healthy lifestyle would help. However, the evidence has been lacking––but maybe that’s because they have not yet tried a plant-based diet.

We’ve known for years that the trans fats found in meat and dairy are just as bad as the industrially-produced trans fat found in partially-hydrogenated oil junk food when it came to raising LDL cholesterol. When it comes to lipoprotein A, the meat and dairy trans fat appears to be even worse. Just cutting out meat––putting people on a lacto-ovo-vegetarian diet––does not appear to help, but put people on a whole food plant-based diet packed with a dozen servings of fruits and vegetables a day, and within four weeks, Lipoprotein A levels dropped 16%. Of course, in those 30 days, they also lost 15 pounds. But weight loss does not appear to affect Lp(a)levels; so, you figure, it must have been due to the diet.

If you’re already eating a healthy plant-based diet, and your Lp(a)levels are still too high, are there any particular foods that can help? Like for cholesterol, even if the average total cholesterol of those eating strictly plant-based may be right on target at less than 150, with an LDL right on target at under 70, there’s a bell curve, with plus or minus 30 falling immediately on both sides. Enter, the “Portfolio Diet,” which is not just plant-based but adds specific cholesterol-lowing foods if that’s not enough. So, like nuts and beans, oatmeal, and berries to drag cholesterol down even further. What about LP(a)?

Nuts have been put to the test. Two and a half ounces of almonds every day dropped levels, but only about 8%. But that’s better than the other studies on nuts that found no effect at all, no effect at all, and… no effect at all. Ah, nuts.

There is one plant, though, that appears to drop Lp(a)levels 20%, enough to take people exceeding the U.S. cut-off down to a more optimum level. And that plant is a fruit: Emblica officinalis, otherwise known as amla––Indian gooseberries. A randomized, double-blind placebo-controlled study asking smokers before and after about their cough, their shortness of breath, loss of appetite and feelings of impending doom, palpitations, sleep deprivation, irritability, heart burn and tiredness, as well as objective measurements from their blood count, cholesterol, DNA damage, to antioxidant status and lung function, and…the amla extract they used showed a significant improvement compared to placebo in all the parameters tested, with no reports of side effects. That’s unbelievable! No, really, that’s unbelievable. And indeed, it’s completely not true.

Yes, subjective complaints got better in the amla group, but they got better in the placebo group too, with arbitrary scoring systems and no statistical analysis whatsoever. And of the two dozen objective measures, only half could be said to reach any kind of even before-and-after statistical significance, and only three were significant enough to account for the fact that if you measure two dozen things, a few things might pop up as positive, if only by chance. Any time you see this kind of spin in the abstract, which is sometimes the only part of a study people read, you suspect some kind of conflict of interest, but there were no conflicts of interest declared… But that’s bullshit, as the study was funded by the very company selling those amla supplements. *sigh*

Anyways, one of those three significant findings was the LP(a); so, it might be worth a try. I mean, in the context of a plant-based diet, which in addition to the weight loss, can dramatically improve blood pressures even as people cut down on their blood pressure medications, plus a 25-point drop in LDL bad cholesterol, plus a 30% drop in C-reactive protein, and significant reductions in other inflammatory markers for a systemic, cardio-protective effect, all thanks to this single dietary approach.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Doctor's Note

For those of you unfamiliar, see my video on Trans Fat in Meat & Dairy. And animal products are exempted from the ban (Banning Trans Fat in Processed Foods but Not Animal Fat).

If amla sounds familiar I’ve got some older videos on what else it can do:

If you missed the previous video on Lp(a), watch Treating High Lp(a) – A Risk Factor for Atherosclerosis.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

134 responses to “How to Lower Lp(a) with Diet

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  1. Hi Doctor Gregor,

    I learned in my late 40’s that I have elevated Lp(a) after discovering an elevated score on a cardio scan. After doing months of research I came to the conclusion that a strictly vegan, plant based diet was my best option to avoid further calcification and possible cardiac events in my future. I was hopeful that you might have more specific details on how a plant-based diet can improve chance for a healthy future for those with this condition. It sounds like there still hasn’t been much accomplished in the effort to understand and find solutions to Lp(a)? I’m feeling a little discouraged after watching this video. I need some good news!

    1. Teresa, have you ever tried Amla? In spite of the “conflict of Interest” compromise of the study in this video, maybe… just maybe it might help you out.

      Have you seen the other Amla videos listed in the Notes section up there?

      If I knew I had elevated Lp(a) and my strict WFPB diet didn’t reduce it where I wanted it to be, I’d at least try the Amla.

      Also, if I know Dr. G, he’s not done with this topic yet. I’m guessing future installments will give you some hope. We’ll see.

      1. dr cobalt, being in Teresa’s situation, I did try amla to no effect, and in my experimentation and research since, two things came to light. The first was, initially changing to Dr Greger’s Daily Dozen did show great improvement in cholesterol numbers….while losing weight. (and I was
        bmi 20 to start with). When weight stabilized, the cholesterol did a slow climb back up.

        The second thing was that I found studies that said it’s the vit c impacts cholesterol levels. Amla is very expensive here, and I found my trials with inexpensive vit c had the same effect. Few specific foods have made a difference for me while eating Dr Greger’s Daily Dozen which tells me that we’re already getting what we need.

        1. Barb,

          That is interesting about Vitamin C.

          I am taking Vitamin C now. I bought the ascorbic acid after reading a study that it spiked C…. I think it was faster than IV C…. Other types didn’t.

          I may get enough from food, but I know that I am still overweight, so I feel that shoring things up during a pandemic makes sense.

          It is interesting.

          Here is a new Vitamin D study analysis that I found interesting today.

          https://www.youtube.com/watch?v=ApEl7k45-yc

            1. Julot,

              I don’t keep track of food nutrition.

              Maybe I do get enough.

              Maybe I don’t always get enough.

              How much Vitamin C is in hummus and kale?

              1. The studies I looked at used more than 200 mg, so I guess I am just shoring things up.

                Three controlled studies recorded a reduction of at least 80% in the incidence of pneumonia in the vitamin C group, and one randomised trial reported substantial treatment benefit from vitamin C in elderly UK patients hospitalized with pneumonia or bronchitis.

                1. The fact that I started eating more processed food several weeks into this and can’t go to the gym.

                  I would say that my “normal” WFPB diet probably magically has enough of everything, but I have never checked and don’t want to do food journals.

                  But my pandemic, stressed-out essential worker puts Amy’s burritos in the microwave and some other Amy’s product for dinner version may not get enough Vitamin C and the thing is, I don’t “identify” with the Amy’s eater version anymore so it is easy to not have a sense of what I am eating. (Today, it was back to the salad, but I didn’t have my pomegranate seeds or mushrooms or any other vegetable with it. Just microgreens. Mixed microgreens because that was all they had.)

                  Nope, I am not likely to look at all the different microgreens in the container and figure out the Vitamin C.

              2. If you eat a significant amount of fruits(especially citrus, various kiwi, berries, melons, pineapple, mangoes, red bell pepper) and/or raw and steamed green vegetables, raw kale contains around 100mg for 100gr, hummous dont contains much, thats very easy to get 200mg, lately i have been eating one big gold wiki a day which should give me at least 150mg of Vit.C, they are delicious.

            2. Andrew Saul and Dr. Mercola both recommend getting 3000 to 4000 mg of vitamin C daily. 200 mg may prevent scurvy but that is about it. You need much more C to maintain a healthy immune system.

              1. Neither Saul nor Mercola are reputable or reliable sources of information. Saul has a worthless mail order ‘doctorate’ and Mercola is an osteopath. Both make their living promoting this kind of stuff and therefore have substantial conflicts of interest which makes their assertions questionable.

                The US National Institutes of Health observe

                ‘ Plasma and tissue concentrations of vitamin C are tightly controlled in humans. At daily intakes of 100 mg or higher, cells appear to be saturated and at intakes of at least 200 mg, plasma concentrations increase only marginally [2,10,24,33,39]. If subjects’ vitamin C levels were already close to saturation at study entry, supplementation would be expected to have made little or no difference on measured outcomes [24,25,43,44].’
                https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/

                That said, people with disease and trauma may have higher needs for vitamin C. Much higher fruit and vegetable intake is probably the preferable source where this is practicable.

                Note that increasing vitamin C intake in people with haemochromatosis (iron overload) can be dangerous.

              2. Your body cant absorb significantly more than this amount a day, thats the problem but your toilet will get the excess which may be healthy for the septic tank.

                Mercola is quack selling supplement, they says a lot of things but more reliable and not industry funded science is on NF.org, this doesnt make sense to take several grams of vit.C, the amount to avoid full blown scurvy is only around 10mg iirc long term.

                Pauling gave nice information about vit.C back in time but a lot of these are outdated nowadays with technologies, back in time he was only measuring kidney excess vit.C but not excess flushed with the stools which is important once you reach 200mg a day.

        2. Barb: Linus Pauling in his book explains how vitamin C lowers cholesterol, by inhibiting the same enzyme as is inhibited by cholesterol-lowering drugs. The book was written, if I remember right, in the seventies, so the ability of vitamin C has been known for a while.

          1. Thanks George! I remember being so disappointed with the amla results, but when I looked into the vit c trials I thought perhaps I was already getting lots of vit c in the many fruit and veg I consume daily so I was already doing the best I could do.

        3. Barb: I’m similar. Just getting my BMI from 18.9 to 17.8 finally did it for me! I’d already gone plant based but tended to have a lot of almond butter. A small amount is great but too much may not be. Anyway, Dr. Joel Furhman suggested I juice and lose five pounds, going from 115- 117 to between 110 and 112. Also to have two tablespoons of walnuts, 1 T flax and 1 T chia. Juicing was too much trouble but I started having a lot more veggies. My cholesterol initially was 297 and came down to 202 but to get to 189 I had to do the final steps outlined here.

          1. Thank you Joy! We are very much alike! I don’t buy almond butter or any nut butters though since I would be eating more than I should if I did. I do use the flax, sometimes chia, and maybe a walnut. I touched down at 185 once but it tends to creep back up. Interesting though that Dr Furhman suggested juicing. I wonder if even 2 or 3 days per month might help keep levels in check? I have all but given up on the numbers and try to concentrate on staying motivated with good food and lots of exercise.

      2. Hi Dr. Cobalt & Dr. Greger,
        Thank you for addressing this topic, but I am confused.
        HOW MUCH Amla?? Tablet or powder? What kind of extract?
        Please, can we have more information to help implement this?
        I eat a strict WFPB diet that sounds a lot like the Portfolio diet but have very high Lp(a).
        Desperately seeking some way to lower it since I have early symptoms of CVD.
        Thank you.

        1. I like this video: https://nutritionfacts.org/video/amla-versus-diabetes/ because it shows the wide range of different forms you can get the berries in a store – whole, mixed in a preparation, or dry powder. As far as how much, I seem to recall that Dr. G puts about a quarter teaspoon of powder in his breakfast smoothie to give it an off-the-chart slug of anti-oxidants.

          Maybe he’ll have more on the Amla/Lp(a) connection later in this series.

      3. Thank you dr cobalt. I have used amla powder and will continue. I hope you are right I would love to see more about this topic! There just isn’t much available on the subject but at least it’s beginning to come to light. I will revisit dr g’s amla videos for a refresh.

      4. Hi,

        I started Amla January 18, 2020. It works great for me. I had a physical last year and then again last week. My cholesterol is high, but now it’s slightly high. From taking Amla, my LDL went down 42 mgs from 167 mg to 125 mg. Yay!!!

        2019 2020
        Total Cholesterol 258 mg Total Cholesterol 220 mg
        Triglycerides 87 mg Triglycerides 70 mg
        HDL Cholesterol 74 mg HDL Cholesterol 81 mg
        LDL Cholesterol 167 mg LDL Cholesterol 125 mg

    2. I’m hoping this is the beginning of a series on Lp(a). I remember a study that showed turmeric as an effective way to lower Lp(a). I hope the results held up in other studies. I am assuming I have elevated Lp(a) as my father did. My doctor won’t test for it since I don’t have high cholesterol or other cardiac indicators. I’m taking turmeric and amla already for other reasons and will hope that they do some good in this area.

      1. Anne, you can test Lp(a) through Requestatest for $60. https://requestatest.com/lipoprotein-a-testing . You need to have access to a Quest or Labcorp lab for the blood draw. No doctor’s order is required.

        I too was hoping for more info since I have an elevated Lp(a) level and a family history of cardiovascular disease along with problematic gene variants related to risk of cardiovascular disease. I was expecting Dr.Greger to mention this study, which found a decrease of around 20% in Lp(a) after just four weeks on a raw vegan diet, probably like what the Williams (tennis star) sisters were on. https://doi.org/10.1002/clc.23027 Researchers in this 2018 study fed the study participants a raw whole foods plant based diet with a whopping 11.8 servings of fruits and 16 servings of vegetables daily. The article says that weight loss and exercise do not seem to have an effect on Lp(a) but the diet had a significant impact, and in a very short period of time. The blood markers looked at in addition to Lp(a) were hs‐CRP, IL‐6, Lp‐PLA2, fibrinogen, white blood cells, sdLDL‐C, LDL‐P, and Apo‐B, so you should perhaps test some of these inflammation markers through your doctor or through Requestatest along with the Lp(a) level. Quest also has some very interesting blood tests developed by Cleveland Heart Lab, which Quest recently acquired. My cardiologist did agree to write an order for those, so my insurance paid the cost. Full price for each is in the $100 range. The result that was problematic for me was omega-3.

        Here is another suggestion for you, in case you are wondering what health issues you actually did inherit from your father. Test with one of the major DNA testing companies (My Heritage, 23andme, or Ancestry). Watch for sale prices if you are cost conscious. MyHeritage uses cheek swabs, the others have you fill a vial with spit. Mail back your swabs/vials. Then download your raw data file after results are back, and upload to promethease.com. They will give you a comprehensive list of your gene variants as well as an estimate of how serious a health problem is involved and how often the variant occurs in the general population. You will receive interesting genealogy information from the DNA testing company as well.

        From the journal article “Participants were instructed to consume a defined, plant‐based diet for 4 weeks ad‐libitum which included the consumption of foods within a food classification system.15 These foods fell within food levels 0 to 4b of the food classification system (Table S1, Supporting information). Briefly, excluded were animal products, cooked foods, free oils, soda, alcohol, and coffee. Allowed for consumption were raw fruits, vegetables, seeds, and avocado. Small amounts of raw buckwheat and oats were also permitted. Vitamin, herbal, and mineral supplements were to be discontinued unless otherwise clinically indicated….Significant reductions were observed for serum Lp(a) (−32.0 ± 52.3 nmol/L, P = 0.003), apolipoprotein B (−13.2 ± 18.3 mg/dL, P < 0.0005), low‐density lipoprotein (LDL) particles (−304.8 ± 363.0 nmol/L, P < 0.0005) and small‐dense LDL cholesterol (−10.0 ± 9.2 mg/dL, P < 0.0005). Additionally, serum interleukin‐6 (IL‐6), total white blood cells, lipoprotein‐associated phospholipase A2 (Lp‐PLA2), high‐sensitivity c‐reactive protein (hs‐CRP), and fibrinogen were significantly reduced (P ≤ 0.004)."

        1. Thanks, Caroline, especially for the testing information. I actually do have my 23andMe raw data uploaded in a couple of places and know several risk factors, but as I understand it, the genetics for Lp(a) are not simple or a single gene. I have other major cardiovascular risk factors, though, and eat accordingly. I’ve been concentrating on my genetics and my dietary changes, but I do think it’s time to start tracking some things with tests. I’d prefer to supplement what I actually know I need.

          Funny you should mention raw. I normally try to keep a minimum of a 50/50 raw/cooked ratio, but the past few weeks have had a lot of cooked comfort foods. Partly by necessity, but with my CSA starting up, I have easier access to more fresh salad vegetables. Working on it…

        2. Not only is the Lp(a) test inexpensive even if your doctor refuses to order it, but the genetic health analysis analysis from Promethease is an incredible bargain at $12. And you can find the DNA analysis from 23andme, MyHeritage or Ancestry for well under $100 if you wait for a sale. Promethease will tell you if you have hereditary thrombophilia or other gene variants increasing the risk for stroke or cardiovascular disease. I found that I have elevated Lp(a) as well as hereditary thrombophilia, inherited low HDL, and gene variants for increased risk of stroke. So I need to be careful to manage lifestyle factors related to blood clots, stroke risk and cardiovascular events. And if, heaven forbid, I should be hospitalized for COVID-19 (you are hospitalized if your test is positive and you have a hard time breathing) I would need to be put on blood thinners as soon as possible to offset the increased risk of clotting and stroke for patients seriously ill with COVID-19.

    3. I was in same boat, checked out Dr. Esselstyn’s video on youtube “Treating the Cause…” and found he’s got 100 percent results in 2 studies over 30 years, with ongoing research into this…only one who has it. good luck, but you won’t need it, just works.

      1. I’m 74 been on the diet 4 years, who ‘nother world for me, amazing stable and healthful results all the way. Takes work to get kitchen set up and habits down, but dive into this and I bet you win big. Do it half-heart (joke) and you may not get as much. I’ve done both by parts and full bore, go full bore would be my advice. Esselstyn, Caldwell. MD amazing research.

    4. I just found out in Jan. that I have an extremely high lp(a) level and likely blockage via a failed stress test and am wanting some hope also. I did go on vegan WFPB no oil diet and have lost 20 pounds and have gone off my blood pressure medication, and doing what I can to help what I can, but would love to get some good news also about what further can be done to alleviate the damage the lp(a) causes.

      1. Well, the Lp(a) stuff bears watching, but if you look at the other markers of heart disease with a strict WFPB diet, I think once you get weight down where it needs to be (under BMI of 24 or so…), your other heart parameters will be where they should be…total cholsterol about 150 of lower and LDL about 70. I don’t know whether there is any research suggesting that high Lp(a) levels occur and produce blockages when these other numbers are where they need to be. It might take some level of exercise in addition to diet, IDK. What I am looking at is the Framingham Heart Study, where over years of followup on thousands of people, “no one has every died of heart disease with a total cholesterol under 150.” Surely some of these people had high Lp(a), right? Once you get to this point, you could look at some heart imaging (non-invasive) and if you are male, like me, look at whether you ED has receeded as a clue. I am wary of thinking that this Lp(a) thing is an independent genetic risk factor, as I don’t think that has been proven. I haven’t seen reports that folks on a really good WFPB diet with optimal BMI and good cholesterol numbers have had nexplicable heart attacks.

        1. I think that it is a very good point you make Roy.

          There have been studies which suggest that lp(a) may not be a huge threat if we get everything else right eg

          ‘A 1998 study of healthy centenarian individuals initiated a debate about the potential association between Lp(a) and longevity following the report that up to one-quarter of that population had high Lp(a) levels in the absence of any atherosclerotic CVD.6 Another study of patients with documented coronary heart disease found no evidence of an association between high Lp(a) levels and all-cause mortality.7’

          And last year’s Mendelian analysis found

          ‘In 18 720 participants from EPIC-Norfolk (5686 cases), the mortality risk for those with Lp(a) levels equal to or above the 95th percentile was equivalent to being 1.5 years older in chronologic age (β coefficient [SE], 0.194 [0.064]).’
          https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2762018

          Just 1.5 years for those in the 95th percentile compared to those with the lowest levels? That doesn’t sound much especially as Dr Mirkin notes in his 17 May 2020 newsletter

          ‘In North America, the average man lives to age 76, and the average woman to age 81. Harvard researchers found that adopting five healthy habits could extend life expectancy by 14 years for women and by 12 years for men (Circulation, 2018;345:345):
          • eating a diet high in plants and low in fats,
          • exercising at a moderate to vigorous level for several hours a week,
          • maintaining a healthy body weight,
          • not smoking, and
          • consuming no more than one alcoholic drink a day for women and two for men.’

          Get everything else right and lp(a) might not a big threat. It certainly didn’t seem to do those Italian centenarians much harm

          https://www.fasebj.org/doi/full/10.1096/fasebj.12.6.433

      2. Carol,
        I have extensive atherosclerosis from extremely high ldl levels and off the charts ldl particles. Also elevated Lp(a). After trying max statins etc…my disease progressed. I finally tried a PCSK9 inhibitor and a WFPD. My ldl, ldl particles lowered nicely and also my Lp(a) levels dropped. Since I started the drug and WFPD together, it’s a mystery which one lowered the Lp(a). Have been feeling great with no symptoms for a while now. Won’t go back to typical American diet.

    5. Dr Greger,
      Can you please get to the point….. you have the attention of your viewers , however you pontificate on and on.., constantly side tracking and then your loose us on your train of thought…But too the point, it sounds like blah blah blah…. kind of like the school teacher in the cartoon Peanuts ….Any way, (annoying isn’t it)
      If your objective is to save as many lives as you can then speak to the masses… kind of like Ronald Reagan did. The you will increase your viewership, (and their attention) and save more lives.

    1. And, no, even though I am not fully vegan, I don’t kill mice.

      At least on purpose.

      I have found that they tend to climb into our wastebaskets at work and can’t get back out and sometimes that leads to their demise.

      Keep no food around is the best way to not ever have to think about it.

      Everything in glass jars = mice going to the neighbors house.

      1. Deb,

        I had mice in the attic of an old house; there were pull down stairs, I could only stand in the center, and I rarely went up there. No food at all, just a few items in storage. And no mice anywhere else in the house. Perhaps having two cats helped. (They were never in the attic; even I rarely went up there.)

        But I did trap them; I’ve read too many stories of mice chewing on electric wires, and possibly even causing house fires, to want to take that chance. Also, who wants an attic full of mice poop? And pee everywhere; mice don’t hold their urine, but dribble it out every where they travel.

      2. Deb, regarding your comment: “Everything in glass jars = mice going to the neighbors house.”

        Hey, I thought we were all in this together! No fair protecting yourself and sending those pesky mice to my house ;-)

        1. Laughing.

          Yes, well, I will prevent my neighbor’s mosquitos from breeding and give them a walk the plank mouse trap and 5-gallon bucket and they can take the mice a few miles away.

          I wonder how many miles mice travel to get back home.

          Dr. J.,

          We used to have a mice issue.

          The glass jars really have helped, but I did also heavily insulate my attic and I put insulation in the windows in the basement. I no longer have my dog dropping dog food.

          I have decided to do the 5-gallon bucket mice check now and then. A ramp up to the top of the bucket and some food on the bottom of the bucket with a little walk-the-plank contraption captures them nice and then I can bring them to the woods in the next state.

          Darwin, I really do try to not have them go next door. I like my neighbors very much.

          1. You don’t really need the walk the plank gadget or the bucket.

            Food at the bottom of any old wastebasket and they will jump in and not be able to jump out.

            The gadget just makes the trip to the bottom faster.

            1. Deb, I was just joking, of course. I’m sure you are as kind to your neighbors as you are to the commenters here :-)

              Actually, I haven’t had a mice problem at my house for years. Don’t know where they all went.

    2. Interesting. I’m glad he took care of them after their traumatic, unguinous overnight trial.

      When I was in Jr. High I was involved in a “Rocket Club” at my school. We had a “space mouse” named Igor, who frequently took rides in the payload compartment of our Estes model rockets. On his last mission the the rocket took off, rotated sideways, and flew parallel to the ground for 150 yards before smacking into a tree.

      We buried poor Igor in a jar of formaldehyde.

      Mice always seem to get a bad deal – in the name of scientific research.

      1. Dr. Cobalt,

        What a story! Poor guy for smacking into the tree.

        You buried him in a jar of formaldehyde?!?!

        Some day, he may be unearthed and someone will be wondering what the story of that mouse was.

  2. I like the name “The Portfolio Diet.”

    Enigmatic.

    Here, we try to get people to understand what Whole Food Plant-Based means.

    Something tells me that people who go on The Portfolio Diet will say, “Nope, I am not going to tell you.”

    1. The Portfolio Diet was an intervention by Dr. David Jenkins at the University of Toronto, effective for reducing risk factors for heart disease. He is highly respected within the scientific plant-based community, and was a co-author of Dr. Neal Barnard’s 2006 study on diabetes.

    1. hello, Rami,

      I found your research article just this past year and appreciate that you are working on lowering Lp(a) with diet. Are you working on follow up research? Also, I wondered…. was there any follow up a year later to see whether the Lp(a) levels increased? It’s been my experience that we may lower the levels, but not sustain the lower level. I’ve experienced that myself.

      Thanks, Cindy

      1. Hi Cindy,

        No follow up research at the moment, although it’s certainly on the radar. Right now heart failure is the focus. Perhaps some investigations in the future will examine Lp(a). I have some ideas and the gears are always turning.

        Thanks,
        Rami

    2. Rami! (Toxins)

      look at you…this is great. It’s amazing all you have done since the beginning when you would educate us with interesting banter in support of a WFPB way of life.

      I see you are still climbing.

      Beyond happy for you.

      Best
      Gale

  3. I adopted oil-free plant-pure WFPB nutrition several years ago.When my labs were checked earlier this year my LP(a) was at 397. Heart disease runs rampant in my family. What can I do?

    1. I congratulate you, Lori, on the proactive steps you’ve taken when you adopted oil-free WFPB nutrition. You did not mention if you are working with a cardiologist who is working with you on this condition (and understands the value of a nutritional approach). That is definitely recommended, because medications along with diet and certainly regular monitoring may be needed. . Of course you have concerns and it’s important you feel confident you and your doctor are doing everything you can to manage your LP(a) and overall health. You did not mention if you are also exercising, but that’s also recommended. I’ll include this link just for you to go over all that’s recommended in managing this challenging diagnosis. https://www.atherosclerosis-journal.com/article/S0021-9150(18)31171-7/fulltext Knowing you are doing all you can do is a good focus and will be another positive step to keep the stress at bay. Best of health to you.

  4. I’ve been eating a low fat, no oil WFPB incorporating the Portfolio recommendations for the last ten years. My Lp(a) is 180, my total cholesterol is 200 and climbing (over 50 yr old female), ldl is 111. I’ve always been slim and fit. I even called Dr. Esselstyn, he had no suggestions other than to not eat anything that would hurt my arteries. Now what? Don’t worry about the numbers?

    1. He has another video that talks abput dosage which was 1/4 – 1/2 tsp amla powder. Sorry I cant remember which video but I had written the dosage down as I have elevated Lp(a) and have not had my cholesterol checked since going WFPB.

    2. Sharon if you do a search on his sight you will find he has several videos on amla. I believe it’s 1/4 tsp per day of the powder.

    1. Fish oil supplements do seem to raise LDL cholesterol but fish itself may lower LDL cholesterol
      https://www.nature.com/articles/s41387-017-0007-8

      Note that fish oil normally contains more than just EPA. It usually also contains eg DHA. You can however get special EPA supplements. Unlike DHA, EPA alone has not been shown to raise LDL cholesterol levels.

      it’s always best to discuss these things with a licensed medical professional before self-medicating though.

  5. What is suggested for people with elevated lpa and Sitosterolemia? A low plant sterol diet is recommended for that condition but then that means no plant oils or fats such as nuts, seeds, oils and avocadoes. Quite a boring lifelong diet. Is a vegan diet truly beneficial then?

    1. Uliana- I can understand why you might get discouraged thinking that you have that rare sterol-storage disease makes eating some of the more indulgent foods in a whole food plant based diet not advisable. However, please don’t give up on eating whole food plant based (notice I did not say “vegan” because just eating vegan, cutting out the animal products, will not be as healthy as doing that plus minimizing processed foods (includuing oils)–and for you eating the healthiest is especially important. You probably know that already but just in case you haven’t reviewed information on Sitosterolemia here’s a good article with some words stressing the importance of not simply giving your efforts at a cholesterol and sterol-free diet:
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835564/ Sitosterolemia: a review and update of psychophysiology, clinical spectrum, diagnosis, and management “…Hypercholesterolemia in patients with sitosterolemia is dramatically responsive to low cholesterol diet.”a sterol-free diet”

      If it’s any consolation, folks with known heart disease are also encouraged to have such a diet (not only low cholesterol, but also no or minimal nuts, avocado etc. My husband is on such a diet and while he cheats occasionally, we manage to do just fine, eating lots of wonderful varied meals without those foods. It’s possible to enjoy eating while minimizing cholesterol and sterol,. Yes, it’s more challenging but it is possible, so don’t give up. Best of health to you as you face this challenge.

  6. After transitioning to a WFPB way of eating roughly 3 years ago, I recently had my custom cardiac panel done and my LPa result was 17nmol/L . I do consume Amla powder on occasion, but mostly it’s just plants and regular exercise, making sure I get some high intensity training into my exercise mix. I am also consuming a considerable amount of Arugula…..

  7. Interesting, and one thing Dr. Greger didn’t mention (or I didn’t catch; he can go close to the speed of light) is that in a previous video he did on the antioxidant content of various foods, that amla was, off the charts, higher than anything else tested. Despite that he wasn’t sure he wanted to recommend it, given that the primary sources were companies that sold Ayurvedic products, with many of those products known to contain large amounts of heavy metals. I looked around and found a source of triphala powder (a mix of amla and a couple of other high antioxidant berries) that claimed it’s organic designation also meant free of heavy metals (who knows… I figured my odds were at least a little better).
    So, I guess if one can find a “clean” source of amla (or triphala) the antioxidant content could perhaps provide a little value added re. giving it a shot at helping with Lp(a),

    1. Uliana de Shannon, that is basically the diets Drs McDougall and Esselstyn promote ie without oils, fat in any soup base products etc, avocados, nuts. Same with Dr Ornish and the diet he recommends for people with heart issues.. no oils/fatty foods and nuts limited in the extreme. (eg 6 peanuts per day or 1 walnut).

    2. Karl, I buy dried amla berries from Rose Mountain Herbs. When possible, I buy herbs/berries in recognizable form rather than powder – hoping to reduce the chances of contamination. Not that I have any proof that it works –

      1. Anne – yes getting the berries certainly sounds like it provided a bit more quality control than getting powder (though I guess the berries could still have been grown in soul that contained heavy metals). I didn’t find any source for amla berries (though admittedly didn’t look very hard )

      1. George – yes, I thought that was the case and that was why I asked the source of the organic triphala about heavy metal content – perhaps I misstated what they told me; they did say that the product was free of heavy metals but I can’t recall if they said that that was just the case for their product or a result of the organic designation – in any case I agree that any such claim needs to be taken with a grain of salt (if not lead !)

  8. Thanks Dr. G for the video. I had elevated Lp(a). I consistently take Niacin and monitor my ast/alt (liver function)I also eat oat bran but not as consistently. The “flush’ from Niacin doesn’t come I think because I’ve been taking it for so long. My Lpa dropped from the hundreds to between 50-70. I typically eat WFPB. I do sometimes mess up. I read a book years ago by Kowalski called the Cholesterol Cure in which he advocated oat bran and niacin not only helps cholesterol but also Lpa. I think consistency is important. So with much prayer and consistency i was able t bring mine down. I also have an independent lab like Quest (i pay out of pocket for) do my test so i don’t have to wait for a doctor’s appointment and can do more self monitoring. I haven’t been lately because of Covid19. Hope my experience helps someone else.

    1. Deb,

      Thanks for sharing your experience. I, too, have elevated Lp(a) and take 2G Niacin daily for almost 20 years. I agree with you about the importance of consistency. What units is your Lp(a) measured in? How often do you monitor it? Have you ever had the NMR blood testing done?

      I saw an interesting article on the Lp(a) Foundation page where they recommend anyone who has elevated Lp(a) be sure to tell a doctor should you have to be hospitalized because of the way elevated Lp(a) tends to make the blood clot and COVID-19 often creates thromboses.

      Cindy

    2. What form of Niacin do you take Deb? Is it a prescription? My Lp(a) is in the hundreds. My cardiologist has talked about putting me on niacin but hasn’t so far. Just a statin to keep LDL as low as possible.

  9. Very interesting article by Dr Gregor, but I am confused. Everything else that I’ve read recently talks about Apo b as the component that has health implications above and beyond just HDL/LDL.

    I have been on a vegan WFPB diet for over 2 years, and was recently tested for Apo b. The test came back over 100, with the Doctor suggesting I start Statins. I Declined.

    I wish Dr Gregor would talk about the difference between the two different types, and the implications. An interesting study was cited in one article, the Interheart study, which indicated that the ratio between Apo b/Apo a-1 was the best indicator of health risk.

    Thank you

    1. Roger,

      I found this — https://www.ahajournals.org/doi/10.1161/JAHA.117.007160

      When I was tested for Lp(a) at the Phila Heart Institute almost 20 years ago, they also tested for APO-A and B. It looks like there is an independent correlation with aortic disease.

      It’s frustrating that we never see this research until someone has heart disease. What would a pro-active preventative approach look like?

      Cindy

      1. Hi, Cindy R! Thanks for sharing that article with us. A proactive, preventative approach to cardiovascular disease looks like a whole food, plant-based, oil-free diet, along with sleep and regular, moderate exercise as you are able. Apolipoproteins A and B are of interest because they are transporters for LDL and other artery-clogging lipids. Although they have not yet specifically been covered here on NutritionFacts, there is a lot of material on heart disease. You can find all of it here: https://nutritionfacts.org/topics/heart-disease/ This video may be of particular interest to you: https://nutritionfacts.org/video/how-not-to-die-from-heart-disease/ I hope that helps!

        1. Thanks, Christine, for your reply.

          I do know the videos and Dr. G’s books, etc. I’ve had the privilege and opportunity to work closely with the Philadelphia Heart Institute lipid researchers and a lipid cardiologist here in SC while tweaking my diet and lifestyle to minimize the negative effects of elevated Lp(a). It’s been an interesting journey. And so far, it’s been successful. While the Lp(a) remains elevated, all other markers are in healthy range.

          Thanks again, Cindy

    2. Hi, Roger F Peters! I think that there are many factors contributing to cardiovascular disease risk, rather than just one or two. Apolipoproteins such as apoA1 and apoB are of interest because they are transporter molecules for LDL and other potentially atherogenic lipids. As you have pointed out, that is a topic that has not yet been covered here on NutritionFacts. I will pass along your request, but it may be awhile before Dr. Greger gets to it, as we receive many requests daily, and it is a lot of work to cover all of them. Thanks for bringing this up!

  10. I left this comment about six months ago and was told it would be answered sometime but never received an answer so I am repeating it here.
    Unless I am misunderstanding some facts, maybe Dr. Greger should have added his recommended Amla powder to the list of Oxalate foods to avoid. (My references are listed in parenthesis at the end of each statement and links listed at the end).
    Dr. Greger warned us that other high-oxalate foods that have been associated with kidney problems at high enough doses include a single dose of about a cup and a quarter of star fruit juice, or just 4-6 fruit (1). In his video on star fruit he said, star fruit, which you can often find in the tropical produce section at large supermarkets is harmful enough to shut down our kidneys. Acute oxalate nephropathy, caused by the extraordinarily high oxalate content (2).
    Dr. Greger said he takes a tsp of Amla powder in his smoothies for breakfast (3).
    An article I found on the internet stated that very high levels of total oxalates were measured in 2 imported fruits, Indian gooseberry (Phyllanthus emblica L.) and carambola (Averrhoa carambola L., star fruit), at 7566.5, and 436.1 mg/100 g FW, respectively, and their soluble oxalates were also the highest measured of all the fruits (4). That showed that Indian goose berries had over 17 times as much oxalates as star fruit and since it applied to whole fruit I don’t know if the powdered forms were worse, much worse, or better, I also read that in another report that the reported oxalate content of foods varies by a very wide margin (5), so I don’t know how that would affect any result/conclusion/advice/danger. I leave the whole analysis up to the experts like Dr. Greger and his staff, but I do think the whole subject of the safety of Amla powder should be addressed unless I am misunderstanding something.
    References:
    1. https://youtu.be/Eg5ksHXQavk
    2. https://youtu.be/19jF5eNi2tk
    3. https://youtu.be/N0QbVYoKe5g
    4. https://www.sciencedirect.com/science/article/pii/S0889157513000732
    5. https://www.ncbi.nlm.nih.gov/pubmed/25168533
    Oxalate content of food: a tangled web.
    CONCLUSION:
    Wide variations exist in the reported oxalate content of foods across several Web-based sources and smartphone applications, several of which are substantial and can have a sizable impact on the construction of a low oxalate diet. As dietary counseling has proven benefits, patients and caregivers should be aware of the heterogeneity that exists in the reported oxalate content of foods.

    1. Hi, Paul Rubin! I am sorry you did not get an answer to your question yet. Dietary oxalate is complicated because it varies a great deal depending growing conditions. To make matters more confusing, the amount of oxalate in a food appears to be less significant than the amount we absorb, which also varies greatly. It is interesting to note that, despite an apparently high oxalate content in amla, a quick PubMed search turned up nothing about amla and kidney stones or kidney damage. It may be that it is not an issue due to low absorption, or it may be that it has not yet been put to the test. If an when research is available on this topic, I am sure it will be reported here on NutritionFacts.

  11. The list of foods permitted in the study of a diet that reduced Lp(a) mentioned in footnotes to this video (Najjar RS, Moore CE, Montgomery BD. Consumption of a defined, plant-based diet reduces lipoprotein(a), inflammation, and other atherogenic lipoproteins and particles within 4 weeks. Clin Cardiol. 2018;41(8):1062-1068) is in the supplementary notes to the journal article. The researchers also listed the foods permitted in their earlier 2017 study https://onlinelibrary.wiley.com/doi/pdf/10.1002/clc.22863:
    TABLE 2 The food classification system

    0 Liquids including water, tea, unpasteurized fruit and vegetable juices, and blended fruit and vegetable smoothies. These foods
    would be consumed raw, except for tea, which can be steeped in hot water.
    1 Raw fruits and vegetables with a low glycemic index (70)
    4A Plant foods that are raw with a high fat content (≥20% of caloric content from fat), such as raw seeds and avocados
    4B Plant foods that are dehydrated to temperatures ≤160F

      1. There is some debate over how effective masks are in curbing the spread of aerosolized particles and that level of efficaciousness will depend on a bunch of factors: what the mask is constructed of, how it’s worn, etc, but there is no serious debate that there is some effectiveness.
        It doesn’t matter whether masks slow the spread of virus particles by 80 percent or 20 percent, because masks are a low-cost way to reduce the broadcast of aerosolized saliva droplets which carry virus particles.
        It’s basically a freebie, in the grand scheme of economic expense and behavior modification, wearing a mask costs us next to nothing.
        Research shows masks aren’t necessary while taking a run outside or going for a walk, because they’re low-risk events, and they’re probably not necessary if proper social distancing is observed.
        What we’re thinking about is reducing large-spread events. The big-ticket items are places where you spend significant amounts of time face-to-face with multiple people in closed spaces: Riding mass transit, in the work place, in a school setting, at social gatherings. You should not be in a movie theater, for instance, without a mask. Or a bar. Or sitting in a doctor’s office or any place that is indoors and has a waiting room.
        There are NO valid arguments that masks are unhelpful, at best, or harmful at worst. This is BS on the order of magnitude of anti-vaccine and flat-earth theories. There is not merit to both sides here.
        Any risks involved in wearing a mask can be easily mitigated by washing them occasionally or disinfecting them between uses.
        These ought to be no-brainers for everyone while the outbreak is still operating at a large scale. Being smart about masks is one of the ways we can keep pushing on the virus.

  12. EGADS!! I haven’t watched a NutritionFacts.org video in awhile. I have to say I really find having Dr. G’s animated arm-waving presence on the screen to be very distracting and frankly unappealing. I like to read the script on the screen and even have closed captions on when watching a video. I found myself having to freeze the video to stop all the hand waving and just focused on reading the closed captions and looking at the charts/graphs, etc. Just one viewers perspective but please Dr. G. consider returning to the earlier formats.

  13. So is Amala good or not for LP(a)? Also, no one has mentioned aspirin. From what I found, this is effective at reducing LP(a).

  14. Niacin in large doses dramatically lowers Lpa. Need physician to monitor liver enzymes. Prescribed pharmaceutical grade niacin should be used

  15. Hey everybody,

    this isn’t really related to the video, but I am reading „How not to die“ at the moment, and in the chapter about kidney diseases, dr Greger talks about how animal protein has a negative impact on kidney function and health.
    Does anybody know whether Whey Protein also has the same effect?

    I have been eating a relatively healthy diet for some time now, but I like to eat my morning oatmeal with ~30g of whey protein mixed in. So if whey protein is also bad for your health then I would have to get a different protein powder soon :)

    Thank you for your replies!

    Raphael

    1. RaphaelS,

      In Dr. Greger’s video on which type of protein is better for us, they tested dairy protein versus soy protein and dairy protein caused an increase in pressure on the kidneys which they believe is due to an inflammatory response triggered by the animal protein.

      They didn’t specifically mention whey. Just animal protein from dairy versus plant-protein.

  16. That was a bit of a let down. I was expecting something more encouraging regarding a means to reduce Lp(a) and was hoping my cardiologist was simply not tuned into the most current plant based news on this topic. Even if amla has some impact, it seems pretty minor. I’ll keep using it in my diet, maintain a focus on WFPB strategy, continue to exercise regularly, practice my meditation, do occasional yoga, and update my will.

    1. “….update my will.”
      – – – – – –

      Not a bad idea anyway, every few years. :-) So they tell us. But I’d suggest doing yoga every day, not just occasionally. It’s good for what ails us.

      I always learn new words over at this joint –whether I really care to or not. I just now googled both “amia” and “Lp(a).” To think I lived all these years never having heard of those words.

      https://www.quora.com/Why-does-Google-track-us

  17. Lp(a)
    What’s a doctor to say?
    Eat fruits and vegetables
    12 servings per day
    Lower Lp(a) with diet
    By eating WFPB till full

    1. Lp(a)
      What’s a doctor to say?
      Eat fruits and vegetables
      Twelve servings per day
      Lower Lp(a) with diet
      By eating WFPB, little oil
      Eat some amla
      If you’re willing to try it

  18. ‘My new book, Lipoprotein(a): The Hearts Quiet Killer, spent all of March at #1 on Amazon for heart books. The feedback has been great. The recipes have been getting strong and favorable reviews.’
    –Dr.Joel K. Kahn

  19. Dr. Greger appears to be incorrect when he says there are no clinically approved drugs to lower the levels. There are 2 drugs that lower Lp(a) levels. Both are approved for clinical use. One is Repatha. I costs about $5 / month, I think, with a discount from the manufacturer…

      1. They used the word disappointing, but John, Peter, you are right that there is a small difference, just not enough and not statistically significant, so I don’t think it qualifies as Dr Greger being wrong.

      2. Deb in the link you list, Dr. Stroes says the studies show 27% reduction in lpa. Here is the study I think he is talking about:

        https://pubmed.ncbi.nlm.nih.gov/30586750/

        So the drug definetely lowered lpa. And it showed a reduction in primary end point – death, cardiovascular events etc.

        Your reference about Stroes was someone reporting from a conference. 3rd hand news. Accurate? According to the notes, Stroes says the people in this study had normal or slightly elevated lpa. I could not find any papers published by Stroes or the ANITSCHKOW study. If you find one, please list it.

  20. The USA is splitting in half in logic.

    COVID-19 is being woe-fully over-reported and woe-fully under-reported, depending on which channel you watch.

    And YouTube keeps taking down MedCram videos.

    I honestly feel like the logic could rip my brain in half.

    On top of that, my friend with lupus was already so mad about them using Hydroxychloroquine And now Trump is taking it prophylactically.

    I am a middle child peacemaker but something is going to give.

    Information and control of information is the next civil war and there is not going to be anything civil about it.

    YouTube censoring MedCram scares me most of all.

    1. I very much doubt that YouTube is ‘censoring’ MedCram. It’s more likely that MedCram demands that YouTube takes down pirated copies of its videos.

      MedCram is a paid subscription service although they may make some eg covid 19 videos free to view on YouTube

  21. Amla ‘might be worth a try’ sounds very much like drinking Clorox ‘might be worth a try’. Heck drinking exactly 112 oz of water a day ‘might be worth a try’ as it won’t hurt, right?

    When I started at this website I was impressed at the meta-analysis and demand for research before promoting anything. Now it appears as not much different than Dr Oz.

  22. And, no, I wasn’t trying to put down Trump. He is under a doctor’s care and is probably taking it with zinc and he is doing it early enough that it may make sense.

    It is just that we really have every topic:

    It will kill you. It will save your life.

    Psychopath culture

  23. I am 67, WFPB for 8 years. I have familial hypercholesterolemia and Lp a of 200 mg/DL. And this is with cholesterol medication and WFPB daily dozen program. However – and here’s the important part – my calcium artery scan is 0. So maybe there is more happening here than the numbers. Even if WFPB diet leaves the numbers unchanged it may be protecting in another way.

  24. One caveat about the plant-based diet study here (Najjar et al, 2018). The defined diet excluded “animal products, cooked foods, free oils, soda, alcohol, and coffee. Allowed for consumption were raw fruits, vegetables, seeds, and avocado. Small amounts of raw buckwheat and oats were also permitted.” In other words, it was a raw vegan diet, which poses considerable issues with compliance and sustainability.

    When I did my own research on the topic after Friday’s teaser video, I came across most of the sources cited here, but I thought a couple of others were of considerable interest. A meta-analysis points to potential benefits of filtered (but not boiled) coffee:

    Penson et al, 2018. Does coffee consumption alter plasma lipoprotein (a) concentrations? A systematic review. Critical reviews in food science and nutrition, 58(10), pp.1706-1714.

    “In short-term controlled studies, consumption of coffee, or coffee diterpenes was associated with either a reduction in serum Lp(a) of ≤11 mg/dL (6 trials, 275 participants), or no effect (2 trials, 56 participants). Conversely, one cross-sectional study with 309 participants showed serum Lp(a) was elevated in chronic consumers of boiled coffee who had a median Lp(a) of 13.0 mg/dL (range 0–130) compared with consumers of filtered coffee who had median Lp(a) 7.9 mg/dL (range 0–144).”

    Davies et al, 2003. Black tea consumption reduces total and LDL cholesterol in mildly hypercholesterolemic adults. The Journal of nutrition, 133(10), pp.3298S-3302S.

    “Five servings/d of tea reduced total cholesterol 6.5%, LDL cholesterol 11.1%, apolipoprotein B 5% and lipoprotein(a) 16.4% compared with the placebo with added caffeine.”

    Sharpe et al, 1995. Effect of red wine consumption on lipoprotein (a) and other risk factors for atherosclerosis. QJM: An International Journal of Medicine, 88(2), pp.101-108.

    “Volunteers (n=20) were given 200 ml of red wine per day for 10 days… Potential anti-atherogenic changes specific to red wine were reduction in lipoprotein (a) (p< 0.001) and increased membrane fluidity (p<0.01)."

    The studies on black tea and coffee are also

  25. Enjoy the Memorial Day weekend! I’ll post this message on the 25 May NF video site and on this second Lp(a) article.

    On the recent very helpful subject of Lipoprotein a (Lp(a), I had the $49 test done by “Lab Tests Online,” rather than wait till the end of July and have my Medicare insurance cover the cost before I see my cardiologist and my family physician for periodic health appointments. I have been a healthy-eating vegan since 2003, at age 67, after participating in Dr. McDougall’s 10-day “TOTAL HEALTH SOLUTION CLINIC”. At age 79, I had a stent put in the widow-maker heart artery. at age 83 (March 2019) I got trapped into a four bypass heart operation. I am doing OK now, but wondered if I had high Lp(a) running in the family genes!

    Test Name Result Flag Reference Range

    LIPOPROTEIN (a) 159 HIGH <75 nmol/L

    Reference Range Risk:
    Optimal 125

    Dr. Greger’s two Lp(a) articles did not find significant help from particular foods in lowering this risk factor. Many comments from viewers were very helpful regarding gooseberries, oxalates, and the drug Repatha. That drug is a real ripoff! My gathering of info and my comments are as follows:

    ###################
    “What Is Repatha®?
    = evolocumab
    For adults with heart disease, Repatha® is a treatment that dramatically lowers LDL bad cholesterol and [ NOT DRAMATICALLY: ] reduces the risk of heart attack and stroke. If you’re taking a statin, but you are still struggling to lower your LDL, it’s time for a different approach.”

    =============
    [ Insert by WJK: Risk of heart attack:

    (4.6% – 3.4%) / 4.6% = 26% relative risk reduction

    4.6 – 3.4 = 1.2 % absolute risk reduction

    Also, I think that I read somewhere that “all-cause mortality” did not go down for patients that took REPATHA? Meaning “No increase in lifespan.”

    COST:
    “The list price for Repatha is $450 per month. Most patients do not pay the list price. Your actual cost will vary and will depend on your insurance coverage.”
    ===========
    “Repatha
    Repatha® helps the liver clear LDL bad cholesterol by limiting the actions of a protein called PCSK9—and less PCSK9 means less LDL in your blood.

    Statins
    Statins help stop your liver from making as much cholesterol, including LDL.
    They also increase the liver’s ability to break down cholesterol that’s already in your blood.

    Dramatically Lower LDL
    Taken together, Repatha® with a statin is proven to dramatically lower your LDL.

    – – – – – – [ Give me a break! K. ]
    Take Every Two Weeks
    SureClick® Autoinjector
    Single-use prefilled autoinjector*
    15-second at-home self-injection with hand-held device

    – – – – – [ Give me a break! K. ]
    Take Once a Month
    Pushtronex® System
    Single-use on-body infusor with prefilled cartridge†
    9-minute at-home self-injection with hands-free device

    – – – – – – –
    Repatha® Side Effects
    In clinical trials with more than 26,000 patients, Repatha® demonstrated a consistent safety profile.
    Repatha® can cause serious side effects, including serious allergic reactions. Stop taking Repatha® and call your healthcare provider or seek emergency help right away if you have any of these symptoms: trouble breathing or swallowing, raised bumps (hives), rash or itching, swelling of the face, lips, tongue, throat or arms.

    The most common side effects of Repatha® include
    Runny nose
    Sore throat
    Symptoms of the common cold
    Flu or flu-like symptoms
    Back pain
    High blood sugar levels (diabetes)
    Redness, pain, or bruising at the injection site

    Tell your doctor if you have any side effect that bothers you or that does not go away.
    These are not all the possible side effects of Repatha®. Ask your doctor or pharmacist for more information. Call your doctor for medical advice about side effects.

    27% Reduced risk of Heart Attack
    In a study, patients not treated with Repatha® had more heart attacks (4.6%) compared to those treated with Repatha® (3.4%). 
 In adults with heart disease 


    [ 4.6 – 3.4 = 1.2 % absolute risk reduction.
    BUT NO INCREASE IN LIFESPAN? ]

    63% Reduction in LDL Cholesterol 
 By adding Repatha® to a statin, patients are able to achieve a 63% mean reduction in LDL-C levels at week 12. 


    [ a? – b? = c? % absolute reduction ? ]

    21% Reduced risk of Stroke 
 In a study, patients not treated with Repatha® had more strokes (1.9%) compared to those treated with Repatha® (1.5%). 


    [ 1.9 – 1.5 = 0.4 % absolute risk reduction. WOOHOO!! ]

    Worked within 4 weeks:
 Most people experienced their greatest drop in LDL bad cholesterol with Repatha® in as little as 4 weeks; this drop was maintained with treatment.
    [ For the rest of your life! WJK ]

    Reduces certain types of heart surgery:
    Repatha® is also proven to reduce the need for a stent or open-heart bypass surgery.

    ###################
    As you can tell, I reject this Repatha drug completely!

    What I do take is a baby aspirin, finally – after the CABG event in March 2019 – I take a 40 mg Crestor statin (I asked to go to this water-based statin rather than the lipid-based Lipitor that the cardiologist started me on), and 300 mg Co-Enzyme Q10. I periodically take an iron pill and a B-12 pill. The statin dropped my forever-230-ish total cholesterol down to the 124 level. I hear that you may gain four or five days more life from statins! Woohoo!!

    I’ll post this on the Lp(a) video comments, too.

    Bill Kleinbauer https://TinyURL.com/HealthyLifestyle-Ks-Mar2020 & https://TinyURL.com/HealthiestNutrition/course-2019

    1. Hi Bill

      Well that must be terribly disappointing. I too have a high Lipoprotein(a). 167.

      I had a scan as recommended by Dr. Kahn with a score of zero. My cholesterol has always hovered around 150 total and 75 ish LDL. I’ve been WFPB vegan with very little salt, oil, sugar. I have run most of my adult life.

      However I do have a family history of heart disease so all of this can be a bit daunting.

      Bit frustrating. Physicians Committee for Responsible Medicine had a really interesting podcast on this recently.

      https://podcasts.apple.com/us/podcast/the-exam-room-by-the-physicians-committee/id1312957138?i=1000473624479

  26. As a long time follower, I remember amla being touted as the number one antioxidant. Is this stuff still good for me or was the data used for this video made by the manufacturer of amla.

    1. Hi Mike Mair,

      I am a volunteer for Dr. Greger. Thank you so much for your question!

      There has not been much clinical research done on amla to date. What has been done are primarily uncontrolled or poorly done studies. However, they don’t seem to have a negative effect on health and in many cases, they seem to have a beneficial effect on cholesterol and blood sugar control. These studies showing benefits that I looked at were not funded by any type of amla manufacturer. All of this being said, consult with your doctor before taking anything in which we are uncertain as to the effects of it.

      I hope this helps answer your question!

      1. Cody the reason for my question is because Dr. Greger in an old video said in antioxidant study amla was shown to be the best antioxidant even over cloves.

        Thanks

  27. Is it safe to take about a teaspoon of amla powder a day while pregnant/breastfeeding? I have been wanting to incorporate it into my daily smoothie! Thank you!

  28. I love your videos, Dr. Greger! You are so funny and entertaining. I like that we can see you in the newer videos, because your expressive face makes them even more delightful to watch. Thanks for everything you do and please keep up the great work.

  29. Not a very encouraging video especially compared to prior videos where amla was praised? Does this change the view of prior videos?

  30. I purchased a bag of organic Amla powder from you know who. The taste is disgusting. Had to use warm water to mix it up with small whisk. The nutrition label says 1 tsp has 3 grams of fiber. That’s as much as Benefiber and almost as much as psyllium (4.5 g in a teaspoon) So wondering if the mechanism whereby cholesterol is lowered is simply from the fiber. Claims for Amla also say it helps with regularity and fiber could again be the reason.

  31. Hi, Ronda! With plants, it is seldom just one constituent that is responsible for benefits. While amla may have a high fiber content, it also has a high antioxidant content. When we try to identify the “active compound” in a plant and extract it, it often does not work as well as the whole plant, or it may have side effects that the whole plant does not have. This is because multiple compounds in plants work together in a synergistic way to benefit us when we consume them. While it is true that certain types of dietary fiber can help to reduce cholesterol, it is likely that amla has multiple constituents that work together to achieve this. I hope that helps!

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