How to Lower ApoB with Nutrition

Using 2300 calories as our example, the practical steps to lower ApoB with diet and supplementation are as follows:

ApoB measures the concentration of apolipoprotein B (ApoB) molecules, a proxy for the number of atherogenic (plaque-promoting) lipoprotein particles, including LDL, VLDL, IDL, and Lp(a). Each of these major atherogenic particles carries one ApoB molecule. A higher ApoB level means that more particles are circulating that can enter and become retained in the artery wall, promoting plaque buildup and increasing the risk of heart attack and stroke.

LDL-C measures the total amount of cholesterol carried inside low-density lipoprotein particles, while ApoB reflects the number of atherogenic particles.

We'll use a cargo analogy to simplify the explanation:

Imagine two trucking companies each have 500 pounds of cargo in total to transport:

ApoB can provide additional insight into atherogenic risk because the same amount of LDL cholesterol can be transported by very different numbers of particles. This matters because it's the particles that can enter and become retained in the arterial wall.

LDL-C tells you how much cholesterol the trucks are carrying. ApoB tells you how many trucks are on the road. More trucks on the road means more opportunities for one to end up where it shouldn't.

This analogy left out other atherogenic particles for simplicity, but as mentioned earlier, ApoB isn't just an LDL particle count; it also reflects VLDL, IDL, and Lp(a).

First, it's important to acknowledge the role of genetics in high ApoB. Genetics absolutely matter, and for some people, dietary changes alone may not be enough to reach their target ApoB. However, eating healthy and eating to lower ApoB aren't necessarily the same, and it's worth understanding whether your diet is actually optimized to lower ApoB.

Most of us know that to improve heart health, we should keep treats like burgers, pizza, and ice cream as occasional indulgences. Even if you avoid ‘junk’ and processed foods, whole foods can hide dietary patterns that matter for ApoB. Reducing saturated fat and increasing soluble fiber are the most actionable dietary levers for improving ApoB, and a common problem is that most Americans don't meet their recommended fiber targets, while saturated fat often exceeds recommended limits. Nutrition is the highest-frequency health decision, and most of us are guessing.

‘Eating healthy’ for some people could mean lean red meat, fatty fish like salmon, leafy greens, fruits, nuts, oatmeal, eggs, etc. All of these foods could reasonably be considered ‘healthy’. However, you can eat a combination of these foods and exceed your saturated fat target while missing your fiber target.

The American Heart Association's recommendation for people trying to lower LDL cholesterol is less than 6% of calories from saturated fat. At roughly 2340 calories, 40g of saturated fat in this example day is about 15.4% of calories (more than 2.5 times the recommended limit). We're using LDL as a rough proxy for ApoB because the AHA currently has no ApoB-specific guidance.

The National Academies of Sciences, Engineering, and Medicine (NASEM) basis for adequate fiber intake is equivalent to approximately 14g per 1,000 calories (~33g), based on evidence related to coronary heart disease risk. The American Heart Association's guidance for adults is 25-34g/day. The 17g of fiber in the example is far below either recommendation.

There isn't a burger, pizza, or bowl of ice cream anywhere in this example. Nearly every food could reasonably be considered part of a healthy diet.

Yet the day can still significantly exceed a heart-health-focused saturated fat target while falling well short on fiber.

Limiting saturated fat to ~6% of calories, increasing fiber to 14g per 1000 calories (Measures recommends at least 10g of the total fiber come from viscous soluble sources), and eating this way consistently can meaningfully improve ApoB for many people.

This is what our original healthy diet optimized for improved ApoB looks like:

The reduction in saturated fat came largely from these changes:

The fiber increase came largely from:

This is just an example. The key point is that meeting the targets shouldn't require dramatic changes to what you already enjoy.

Putting it all together

Using 2300 calories as our example, the practical steps to lower ApoB with diet and supplementation are as follows:

Retest ApoB after ~60 days to see how your body actually responded.

Yes. You can, if you can fit these foods into a dietary pattern that keeps your average saturated-fat exposure where it needs to be.

This is my saturated fat intake over the past 90 days. You can clearly see that I have been a little more indulgent this month. Those red bars represent cheeseburgers, tacos, pizza, etc. Yet my average remains below my target.

Once one measures saturated fat intake, establishing a saturated fat budget becomes easy. Generic advice like ‘everything in moderation’ can become measurable and actionable.

If you know you're going to have a cheeseburger later in the day, perhaps breakfast isn't three eggs and a whole-milk latte. The goal isn't perfection. It's maintaining the dietary pattern that keeps your ApoB where you want it.

This was a typical day for me when I started tracking my meals. I thought I was eating ‘healthy,’ but I had never measured my nutritional intake. My meals typically looked like the one on the right: strips of steak, leafy greens, cherry tomatoes, apples, etc.

The screenshot is from an early version of Measures, and the fat content of this meal may have been overestimated. The product and our nutrition estimates have improved considerably since then.

Although I had recently started tracking my meals, this was how I had been eating for years.

If you were curious enough to open the detailed nutrient breakdowns earlier in this article, you can see how easy it is for seemingly healthy meals to quickly accumulate saturated fat totals that are no longer heart-healthy. While the breakdown makes it easy to see, keeping a running total in your head isn't realistic.

After I started measuring my nutrition, understanding my blind spots, and adjusting how I ate, my ApoB fell 29% in about two months and 40% within six months. My LDL-C fell 34% in about two months and 46% within six months.

To accomplish this, I began figuring out how to eat in a way that allowed me to end each day with all green nutrition tiles. Admittedly, it wasn't easy at first. Adopting new habits never is. But over time, those red and orange tiles started turning green more consistently. I still occasionally ate like my old self, but it was no longer my default. I had a new baseline, and after a while, I no longer missed how I used to eat.

Once I got the hang of turning all my tiles green, it became much easier to do consistently. After about 60 days, I retested my lipid markers and loved the numbers I saw staring back at me.

I had high cholesterol for years. High cholesterol runs in my family, and there have been early deaths because of it.

For the first time, I felt a real sense of agency over an issue that had plagued me for years. I had regained some control over my health trajectory. High cholesterol was no longer something that was simply happening to me. It was something I finally understood how to manage.