Expert Answer
How do you lower ApoB?
Quick Answer
In a fixed order, not as a choice between diet and drugs. Attia works nutrition and insulin resistance first, then adds pharmacotherapy, and says that once you want ApoB in the 30-60 mg/dL range medication is usually required. Hyman stays food-first and talks in LDL rather than ApoB. Every target here is a decision to make with your own physician.
Strong Consensus
on ApoB overall
What Researchers Say
Runs it as a sequence rather than a either/or. Nutrition and insulin resistance first, then drugs, and he is explicit that the low end of the range is not reachable on food alone. He also treats elevated triglycerides as an ApoB lever, because triglyceride cargo crowds the particles and you need more of them.
“so yeah usually once you want to start getting down into the 30 to 60 range you're going to require pharmacotherapy um but you know usually we want to see how far we can get with nutrition”
Peter Attia, on the record @ 1:01:26
Food-first, and he frames the target as LDL cholesterol rather than ApoB - a real difference from Attia in what is being counted. His named lever here is plant sterols blocking reabsorption in the gut.
“we know that that two grams of plant sterols a day can lower ldl cholesterol by 10”
Mark Hyman, on the record @ 53:24
Has covered ApoB lowering on her channel, but with Attia as the guest making the argument, so what is on the tape is his position rather than hers. No independent protocol of her own in the videos we index.
Raises the question directly - what can somebody do to bring the number down, and is it always prescription medication - and hands it to Attia. He states no lowering protocol of his own.
No ApoB-lowering coverage in the videos we index.
Detailed Answer
The framing that gets argued about online - diet versus drugs - is not the one the panel uses. Attia's order is nutrition first, then pharmacology, with the split decided by how low the number needs to go.
He puts the boundary at a specific place. Asked on Huberman's show what someone with an ApoB of 130 can do, he answers that you usually want to see how far nutrition gets you, and that getting down into the 30 to 60 mg/dL range usually requires pharmacotherapy. Both halves matter. The first is why he does not lead with a prescription; the second is why he does not pretend food alone reaches every target.
His first nutrition lever is not the one people expect. Rather than starting with saturated fat, he starts with insulin resistance, because triglycerides ride in the same particles as cholesterol. If triglycerides are high, cargo space is used up and more particles are needed to carry the same load, which pushes ApoB up. He treats anything over 100 mg/dL as elevated, on the same tape, while noting most labs call normal anything up to 150.
On saturated fat he is more specific than the general advice. In his practice, among people whose ApoB is highly responsive to saturated fat, he says roughly half see the problem resolve when they are shifted isocalorically to monounsaturated fat - same calories, different fat. He is also candid that he is not one of those responders himself: on a ketogenic diet at 80% of calories from fat, about half of it saturated, he saw no meaningful rise in his own ApoB or LDL-C. That individual variation is the argument for measuring rather than assuming.
Hyman is on the same side of the question and a different side of the metric. He stays food-first and talks about LDL cholesterol rather than particle count, and his named mechanism is plant sterols binding cholesterol in the gut so it leaves in the stool. It is worth noticing that this is not the same target Attia is aiming at - one is counting particles, the other is measuring the cholesterol they carry - and the panel has an open disagreement about which number to chase.
On medication, what is on the record is disclosure rather than prescription. Attia says he has taken a PCSK9 inhibitor since around 2015, injected every two weeks, and explains the mechanism: block the protein, get more LDL receptors, pull more ApoB out of circulation. He is describing his own regimen on a podcast, not writing anyone else a plan.
Huberman and Patrick both host these conversations rather than hold positions in them, and Johnson has not covered ApoB lowering in the videos we index. So this is not five experts agreeing. It is Attia making the detailed case, Hyman arguing a food-first version aimed at a different marker, and three channels that have not independently weighed in.
None of this is medical advice, and every number here is a threshold an expert stated on a podcast rather than a target set for you. ApoB targets and any decision about lipid-lowering medication are decisions for you and your own physician.
Related Questions
Can you lower ApoB without medication?
Partly, and how far depends on where you are starting. Attia's approach is to see how far nutrition gets you first, but he says on the record that getting into the 30 to 60 mg/dL range usually requires pharmacotherapy. Diet moves the number; it does not always move it far enough.
What foods lower ApoB?
The panel's named levers are swapping saturated fat for monounsaturated fat at the same calories, which Attia says resolves the problem in roughly half of the people whose ApoB responds strongly to saturated fat, and fixing insulin resistance to bring triglycerides down. Hyman names plant sterols, though he measures the result as LDL cholesterol rather than ApoB.
Does everyone's ApoB go up on a high saturated fat diet?
No, and Attia uses himself as the counterexample. He says he ate a ketogenic diet at 80% of calories from fat, roughly half of that saturated, without a meaningful rise in his own ApoB or LDL-C. Some people are strong responders and some are not, which is the case for measuring instead of assuming.
Why do triglycerides matter for ApoB?
Because triglycerides travel in the same particles. Attia's explanation is that triglyceride cargo uses up space that would otherwise carry cholesterol, so more particles are needed - and ApoB counts particles. He treats anything over 100 mg/dL as elevated, while noting most labs flag only above 150.
What medications lower ApoB?
The ones named on these tapes are statins, ezetimibe and PCSK9 inhibitors. Attia discloses that he has taken a PCSK9 inhibitor himself since around 2015, injected every two weeks, and describes the mechanism as blocking the protein so more LDL receptors pull ApoB out of circulation. That is a disclosure of his own regimen, not a recommendation - starting or changing any of these is a decision for your physician.
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