What to eat and what to avoid to lower the cardiovascular disease risk factor lipoprotein(a).
How to Lower Lp(a) with Diet
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.
- Enas EA, Varkey B, Dharmarajan TS, Pare G, Bahl VK. Lipoprotein(a): An independent, genetic, and causal factor for cardiovascular disease and acute myocardial infarction. Indian Heart J. 2019;71(2):99-112.
- Le bras A. Lipoprotein(a) is an independent predictor of CVD. Nat Rev Cardiol. 2018;15(12):727.
- Angelin B. Fifty years of lipoprotein(a) -- the magical mystery tour continues. J Intern Med. 2013;273(1):3-5.
- Kostner KM, Kostner GM, Wierzbicki AS. Is Lp(a) ready for prime time use in the clinic? A pros-and-cons debate. Atherosclerosis. 2018;274:16-22.
- Gencer B, Kronenberg F, Stroes ES, Mach F. Lipoprotein(a): the revenant. Eur Heart J. 2017;38(20):1553-1560.
- 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.
- Stender S. In equal amounts, the major ruminant trans fatty acid is as bad for LDL cholesterol as industrially produced trans fatty acids, but the latter are easier to remove from foods. Am J Clin Nutr. 2015;102(6):1301-2.
- Gebauer SK, Destaillats F, Dionisi F, Krauss RM, Baer DJ. Vaccenic acid and trans fatty acid isomers from partially hydrogenated oil both adversely affect LDL cholesterol: a double-blind, randomized controlled trial. Am J Clin Nutr. 2015;102(6):1339-46.
- Masarei JR, Rouse IL, Lynch WJ, Robertson K, Vandongen R, Beilin LJ. Effects of a lacto-ovo vegetarian diet on serum concentrations of cholesterol, triglyceride, HDL-C, HDL2-C, HDL3-C, apoprotein-B, and Lp(a). Am J Clin Nutr. 1984;40(3):468-78.
- Corsetti JP, Sterry JA, Sparks JD, Sparks CE, Weintraub M. Effect of weight loss on serum lipoprotein(a) concentrations in an obese population. Clin Chem. 1991;37(7):1191-5.
- De biase SG, Fernandes SF, Gianini RJ, Duarte JL. Vegetarian diet and cholesterol and triglycerides levels. Arq Bras Cardiol. 2007;88(1):35-9.
- Chiavaroli L, Nishi SK, Khan TA, et al. Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Prog Cardiovasc Dis. 2018;61(1):43-53.
- Canadian Cardiovascular Society. Portfolio Diet infographic. 2020.
- Jenkins DJ, Kendall CW, Marchie A, et al. Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation. 2002;106(11):1327-32.
- Damasceno NR, Pérez-heras A, Serra M, et al. Crossover study of diets enriched with virgin olive oil, walnuts or almonds. Effects on lipids and other cardiovascular risk markers. Nutr Metab Cardiovasc Dis. 2011;21 Suppl 1:S14-20.
- Jalali-khanabadi BA, Mozaffari-khosravi H, Parsaeyan N. Effects of almond dietary supplementation on coronary heart disease lipid risk factors and serum lipid oxidation parameters in men with mild hyperlipidemia. J Altern Complement Med. 2010;16(12):1279-83.
- Ruisinger JF, Gibson CA, Backes JM, et al. Statins and almonds to lower lipoproteins (the STALL Study). J Clin Lipidol. 2015;9(1):58-64.
- Biswas TK, Chakrabarti S, Pandit S, Jana U, Dey SK. Pilot study evaluating the use of Emblica officinalis standardized fruit extract in cardio-respiratory improvement and antioxidant status of volunteers with smoking history. J Herb Med. 2014;4(4):188-94.
- Najjar RS, Moore CE, Montgomery BD. A defined, plant-based diet utilized in an outpatient cardiovascular clinic effectively treats hypercholesterolemia and hypertension and reduces medications. Clin Cardiol. 2018;41(3):307-313.
Video production by Glass Entertainment
Motion graphics by Avocado Video
- almonds
- amla
- animal products
- antioxidants
- beans
- berries
- brain health
- C-reactive protein
- cardiovascular disease
- cholesterol
- dairy
- DNA damage
- fruit
- heart disease
- heart health
- junk food
- LDL cholesterol
- meat
- mood
- nuts
- oatmeal
- oils
- Plant-Based Diets
- processed foods
- protein
- sleep
- smoking
- stroke
- supplements
- trans fats
- vegans
- vegetarians
- weight loss
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.
- Enas EA, Varkey B, Dharmarajan TS, Pare G, Bahl VK. Lipoprotein(a): An independent, genetic, and causal factor for cardiovascular disease and acute myocardial infarction. Indian Heart J. 2019;71(2):99-112.
- Le bras A. Lipoprotein(a) is an independent predictor of CVD. Nat Rev Cardiol. 2018;15(12):727.
- Angelin B. Fifty years of lipoprotein(a) -- the magical mystery tour continues. J Intern Med. 2013;273(1):3-5.
- Kostner KM, Kostner GM, Wierzbicki AS. Is Lp(a) ready for prime time use in the clinic? A pros-and-cons debate. Atherosclerosis. 2018;274:16-22.
- Gencer B, Kronenberg F, Stroes ES, Mach F. Lipoprotein(a): the revenant. Eur Heart J. 2017;38(20):1553-1560.
- 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.
- Stender S. In equal amounts, the major ruminant trans fatty acid is as bad for LDL cholesterol as industrially produced trans fatty acids, but the latter are easier to remove from foods. Am J Clin Nutr. 2015;102(6):1301-2.
- Gebauer SK, Destaillats F, Dionisi F, Krauss RM, Baer DJ. Vaccenic acid and trans fatty acid isomers from partially hydrogenated oil both adversely affect LDL cholesterol: a double-blind, randomized controlled trial. Am J Clin Nutr. 2015;102(6):1339-46.
- Masarei JR, Rouse IL, Lynch WJ, Robertson K, Vandongen R, Beilin LJ. Effects of a lacto-ovo vegetarian diet on serum concentrations of cholesterol, triglyceride, HDL-C, HDL2-C, HDL3-C, apoprotein-B, and Lp(a). Am J Clin Nutr. 1984;40(3):468-78.
- Corsetti JP, Sterry JA, Sparks JD, Sparks CE, Weintraub M. Effect of weight loss on serum lipoprotein(a) concentrations in an obese population. Clin Chem. 1991;37(7):1191-5.
- De biase SG, Fernandes SF, Gianini RJ, Duarte JL. Vegetarian diet and cholesterol and triglycerides levels. Arq Bras Cardiol. 2007;88(1):35-9.
- Chiavaroli L, Nishi SK, Khan TA, et al. Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Prog Cardiovasc Dis. 2018;61(1):43-53.
- Canadian Cardiovascular Society. Portfolio Diet infographic. 2020.
- Jenkins DJ, Kendall CW, Marchie A, et al. Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation. 2002;106(11):1327-32.
- Damasceno NR, Pérez-heras A, Serra M, et al. Crossover study of diets enriched with virgin olive oil, walnuts or almonds. Effects on lipids and other cardiovascular risk markers. Nutr Metab Cardiovasc Dis. 2011;21 Suppl 1:S14-20.
- Jalali-khanabadi BA, Mozaffari-khosravi H, Parsaeyan N. Effects of almond dietary supplementation on coronary heart disease lipid risk factors and serum lipid oxidation parameters in men with mild hyperlipidemia. J Altern Complement Med. 2010;16(12):1279-83.
- Ruisinger JF, Gibson CA, Backes JM, et al. Statins and almonds to lower lipoproteins (the STALL Study). J Clin Lipidol. 2015;9(1):58-64.
- Biswas TK, Chakrabarti S, Pandit S, Jana U, Dey SK. Pilot study evaluating the use of Emblica officinalis standardized fruit extract in cardio-respiratory improvement and antioxidant status of volunteers with smoking history. J Herb Med. 2014;4(4):188-94.
- Najjar RS, Moore CE, Montgomery BD. A defined, plant-based diet utilized in an outpatient cardiovascular clinic effectively treats hypercholesterolemia and hypertension and reduces medications. Clin Cardiol. 2018;41(3):307-313.
Video production by Glass Entertainment
Motion graphics by Avocado Video
- almonds
- amla
- animal products
- antioxidants
- beans
- berries
- brain health
- C-reactive protein
- cardiovascular disease
- cholesterol
- dairy
- DNA damage
- fruit
- heart disease
- heart health
- junk food
- LDL cholesterol
- meat
- mood
- nuts
- oatmeal
- oils
- Plant-Based Diets
- processed foods
- protein
- sleep
- smoking
- stroke
- supplements
- trans fats
- vegans
- vegetarians
- weight loss
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How to Lower Lp(a) with Diet
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Content URLDoctor'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:
- Amla vs. Cancer Cell Growth
- Amla vs. Cancer Cell Invasion
- Amla vs. Diabetes
- The Best Food for High Cholesterol
- The Best Diet for Upset Stomach
If you missed the previous video on Lp(a), watch Treating High Lp(a) – A Risk Factor for Atherosclerosis.
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