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Effect of alirocumab and evolocumab on all-cause mortality and major cardiovascular events: A meta-analysis focusing on the number needed to treat

Death by lab work

Olivia writes:

Hey Robb and Nicki! Long time listener and strong endorser of the work y'all are doing. I wish more people and healthcare providers were on the same page, or hell even in the same book as this community! ANYWAY....I recently got my labs done and I have some concerns on the results I received. For context: I am a 30 y/o female, no kids, work out 3-4 x week (mostly weight training and average 8-10K steps per day) I work as a nurse, tend to focus my meals around 30g or more of protein (red meat, chicken, dairy, eggs, I eat it all), and drink plenty of water and LMNT :), avoid seed oils and other ultra processed garbage. I went through some hormone issues for 5-7 years (i.e very infrequent cycle due to too much exercising and under fueling). Since then, I have become so much more educated and I have recovered my cycle *naturally*; gaining probably 30-40 ish pounds from my low; currently sitting at 155 5'6. I feel great, but these lab results got me shook! Any and all advice welcome.

Total Cholesterol- 282

Triglycerides- 43

Non HDL- 169

HDL- 113

ApoA to ApoB- 0.41

ApoB- 113

Liver enzymes AST and ALT- slightly elevated

Total T3 - 68 all other thyroid values "normal"

Fasting BGL- 95

A1C- 5.0

Am I destined for an early death related to heart disease?? I've listened to Huberman on blood glucose control and will implement his ideas to lower my fasting number, but it's hard to eat my last meal 2-3 hours before bed on days I work since I get home at 8. I hope this isn't too long of question, feel free to cut out anything you'd rather not discuss and just give general guidelines. THANK YOU!!!

Stay salty,

Olivia

ApoB confusion

Marit writes:

Hi Robb and Nicki,

I've been listening to your podcast and following your work for many years and I've thrown some similar hard questions at you, which you were kind enough to try to answer (thanks!). I'm so frustrated that I can't understand statistics enough to draw my own conclusion based on the literature on ApoB and statins. I listened to a Peter Attia's podcast and he said (I heard it twice to confirm) that if ApoB were low in the population he "thinks" AS CVD would be dramatically reduced. His pushes alot for statin use. On the flip side, reading the breakdown of studies on statins on Chris Kresser's website, I just can't understand why Peter Attia takes this stance. It doesn't add up! My gut feeling is risk for any chronic disease is never calculated on just one lab value (that's just logical). but even if it was, why does Attia use statins when they don't seem to reduce deaths, strokes or heart attacks by very much, in people without CVD? Don't statins obliterate ApoB?

You're the absolute best if you answer this question for me. I'd be forever greatful!

Thanks guys for all the work you do. It's appreciated!

Cholesterol and Diet

Jay writes:

Hi Robb and Nicki,

One of your original six listeners here. (Can't be wrong!) Thanks for all the good work.

Recent bloodwork revealed high cholesterol and LDL numbers (216 and 123, respectively), as well as non-HDL cholesterol (137) and apolipoprotein B (94). (HDL is 79 and triglycerides are 50.) For what it's worth, my glucose is in the normal range, though slightly high considering my otherwise overall health, activity level, and diet.

My functional med practitioner has suggested the "Cardiometabolic Food Plan." (for reference: https://www.allinahealth.org/-/media/allina-health/files/business-units/penny-george-institute-of-health-and-healing/2_ifm_cardiometabolicfoodplan_comprehensiveguide.pdf)

I'm reticent, considering the plan's emphasis on soy protein, legumes generally, grains, and limiting saturated fat. I could modify it to eliminate those things, but then I'm back to basically what I do already. 

Quick background: male, 38, active (commute on a bike, strength train, chase kids), small business owner with two young kids (i.e., non-zero amount of stress, less-than-perfect sleep). I have a pretty good gluten intolerance (which is how I found your work right around when you published The Paleo Solution — thanks again!) and generally follow a paleo-primal-ish template, with some full-fat dairy and rice/corn, occasionally, mostly to coexist with my family without being a *complete* pain in the ass.

So: Would those lab numbers concern you? What do you think about the Cardiometabolic Food Plan, specifically? And generally, what would you suggest for diet or any other interventions to right the ship?

Thanks tons and keep up the good work!

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