How to lower ApoB

The numbers below come from meta-analyses and large trials, so they are averages; individual responses vary.

• Oral PCSK9 inhibitors lowered ApoB by 49.5 percent versus placebo in five trials of people on background therapy [2].
• PCSK9 antibodies used alone lowered ApoB by 43.3 percent, compared with 32.8 percent for high-intensity statins [1].
• Statins across common doses lowered ApoB by 33.1 percent on average [3].
• Ezetimibe added to simvastatin lowered ApoB by a further 15 percent in IMPROVE-IT [7].
• Bempedoic acid lowered ApoB by 14.3 percent versus placebo [8].
• Inclisiran, a twice-yearly injection, lowered LDL-C by about 50 percent in pooled phase 3 trials, with ApoB falling too [9].

To put diet effects on the same scale: at the median US ApoB of 90 mg/dL [7], a 33 percent statin effect is about 30 mg/dL, while psyllium's 5 mg/dL is about 6 percent. Food changes stack, though, and they act on everyone at no prescription cost.

• Psyllium. A median of about 10.2 g a day lowered ApoB by 5 mg/dL (0.05 g/L)0.05 g/L (5 mg/dL) across 28 trials, rated high-quality evidence [4].
• Oats. About 3.5 g a day of oat beta-glucan lowered ApoB by 3 mg/dL (0.03 g/L)0.03 g/L (3 mg/dL) across 58 trials [10].
• Walnuts. Walnut-enriched diets lowered ApoB by 3.7 mg/dL across 26 trials [11].
• Mediterranean pattern. A traditional Mediterranean diet with virgin olive oil lowered ApoB by 2.9 mg/dL compared with a low-fat diet over 3 months [12].
• Portfolio diet. Combining nuts, plant protein, viscous fiber and plant sterols lowered LDL-C by about 17 percent and also lowered ApoB [13].
• Beans and lentils alone. About one serving a day lowered LDL-C but did not change ApoB significantly in pooled trials [14], so count them as part of a pattern rather than a standalone fix.

AumniVIDA's longevity focus protocol scores soluble fiber (at least 5 g a day) and saturated fat from your logged meals, and the Mediterranean pattern and whole-food plant-based protocols track the foods above.

In a controlled feeding trial, 113 healthy adults ate high or low saturated fat diets with red meat, white meat or plant protein for four weeks each. High saturated fat raised LDL-C and ApoB regardless of protein source, and both red and white meat produced higher ApoB than plant protein [5]. Much of the increase came from large LDL particles.

The practical lever is swapping butter, fatty meat and coconut oil for olive oil, nuts and plant protein, which is also what the Mediterranean trial above tested [12].

The pooled analysis also found LDL-C rose by about 42 mg/dL (1.08 mmol/L)1.08 mmol/L (about 42 mg/dL), with higher HDL-C and no clear change in triglycerides [6]. It included only three trials, so treat the size of the effect as uncertain.

Some low-carb advocates argue that a diet-driven ApoB rise in lean, metabolically healthy people carries less risk. The most cited study for that view, a 2025 paper on plaque progression in people with keto-induced high LDL-C, was retracted in 2026 at the request of the authors and editors over methodological errors [15]. Genetic and trial evidence links ApoB to risk whatever raised it [16].

If you eat low-carb, AumniVIDA's keto and low-carb protocol keeps your lipid trend in view so you and your clinician can see what the diet does for you.

The 2025 ESC/EAS focused update says there is no compelling evidence that dietary supplements reduce cardiovascular risk [17]. Its specific points:

• Plant sterols at up to 2 g a day lower LDL-C by about 10 percent, but no study shows fewer heart attacks or strokes [17].
• Red yeast rice can lower cholesterol in purified high-dose forms, but convincing evidence of clinical benefit is missing, and the EU restricted products with 3 mg a day or more of monacolins in 2022 [17].
• Omega-3 fish oil does not lower LDL-C [17].

Psyllium, a fiber supplement, has pooled trial data showing a 5 mg/dL ApoB reduction [4]. Talk to your clinician before combining supplements with prescription lipid drugs.

• Statins cut cholesterol production in the liver. They lower ApoB by about 33 percent, while LDL-C falls about 42 percent, so ApoB often lags LDL-C on treatment [3].
• Ezetimibe blocks cholesterol absorption in the gut and added about 15 percent ApoB lowering to a statin in IMPROVE-IT, reaching a median ApoB of 67 mg/dL [7].
• Bempedoic acid acts upstream of statins in the liver. It lowered ApoB by about 14 percent [8] and cut major cardiovascular events (hazard ratio 0.87) in the CLEAR Outcomes trial [17].
• PCSK9 antibodies (evolocumab, alirocumab) and inclisiran keep more LDL receptors on liver cells. Antibodies alone lowered ApoB by 43 percent [1]; with a statin, FOURIER patients reached a median ApoB of 38 mg/dL [7]. Inclisiran lowered LDL-C by about 50 percent [9].
• Oral PCSK9 inhibitors are newer and lowered ApoB by about 50 percent in short trials [2].

Canada's guideline uses ApoB of 0.7 g/L or higher on a maximal statin as a threshold to add ezetimibe or a PCSK9 inhibitor in people with heart disease [18]. For what your number means, see what a high ApoB means.

In a clip from his podcast The Drive, Attia describes lowering ApoB well below guideline goals, combining a statin and a PCSK9 inhibitor in his own case, and starting earlier in life. His reasoning leans on genetic evidence that lifelong lower LDL tracks lower risk [19]. Guidelines are more conservative: the lowest ApoB goal in the ESC/EAS guideline is under 65 mg/dL, and only for very high risk [20].

AumniVIDA's Attia-style longevity protocol is community-compiled from his published frameworks; he has not reviewed or endorsed it. His summary is in the perspectives section of the ApoB hub.