Lipoprotein(a)

Summary:

• Liberal fat intakesome saturated fats from eggs, meats (non-cured and processed), dairy; monounsaturated; fish oil
• Completely avoid hydrogenated, “trans,” fats
• Wheat and cornstarch reduction or elimination

Scientific Summary of the Lp(a) experience
(adapted from Unique Strategies for Lipoprotein(a) Reduction)

Low-carbohydrate diets may reduce Lp(a) modestly. A carefully conducted University of Connecticut study in 29 overweight men showed that a diet of 13% carbohydrate, 60% fat (no controlled proportions of saturated, polyunsaturated, etc.), 27% protein, without restriction in calories resulted in an average of 11% reduction in Lp(a). Interestingly, the average weight loss was 16.5 lbs over the three-month period (Wood RJ et al, 2006).

On the other hand, fat restriction (low-fat, high-carbohydrate diet) raises Lp(a), as demonstrated by another study in 37 healthy women in which Lp(a) increased 7–9% by reducing total fat intake from 36% of calories to 31%, achieved by reducing saturated fat (Silaste M et al 2004). Another study in 140 men showed a similar effect (Shin MJ et al 2007).

With regards to fat composition of the diet, omega-3 fatty acids from fish oil capsules and eating fish (see above) have the potential for both reducing Lp(a) levels, as well as suppressing production of the most undesirable small apo(a) portion of the Lp(a) molecule. Saturated fats also reduce Lp(a). Saturated fat effects show great variation among different individuals, ranging from 5% to 30% lower Lp(a) with diet unrestricted in saturated fat. Interestingly, the stearic acid component of saturated fats stands out as the factor that raises Lp(a), unlike other saturated fatty acids palmitic, lauric, and myristic fatty acids, which do not (Müller H et al 2003; Sanders TAB et al 1997). Stearic acid is especially plentiful in the saturated fat from chocolate (43% of total fat) and red meats (14%). (There are no studies specifically examining the effects of dark chocolate or cocoa on Lp(a).) Nonetheless, the net effect of saturated fat is Lp(a) reduction.

Trans fatty acids (hydrogenated fats) raise Lp(a), generally around 5%, though some people show much greater increases (Clevidence BA et al 1997; Mensink RP et al 1992). Although monounsaturated fats (e.g, canola, olive) may be desirable from an insulin-sensitizing standpoint, they may also raise Lp(a) by 10–12% (Vessby B et al 2002). From a fat composition viewpoint, a diet rich in omega-3 fatty acids and saturated fats, and low in hydrogenated trans-fats and perhaps monounsaturates, is therefore most beneficial for Lp(a) reduction.

Weight loss may result in modest reduction of Lp(a) in obese or overweight people. In one small French experience in 62 overweight people, participants with Lp(a) >20 mg/dl experienced 17.6% reduction in Lp(a) with weight loss of approximately 15 lbs over 6 weeks, achieved through calorie restriction (Kiortsis DN et al 2001). 



Soy protein

Soy protein, while exerting a modest LDL-reducing effect, may also increase Lp(a) 15-20%, while the dairy protein, casein, may reduce Lp(a) (Nilausen K 1999; Teede HJ et al 2001). However, these observations have not been consistent; one small study in females suggested no Lp(a) effect (Merz-Demlow BE et al 2000), another larger study in 130 participants receiving 30 grams soy protein also showed no effect (Tonstad S et al 2002).



Alcohol

Alcohol, i.e., ethanol provided by alcoholic beverages, reduces Lp(a) in a dose-dependent manner: the more you drink, the more Lp(a) is reduced, up to 57% reduction, an observation confirmed in a number of studies (Fontana P et al 1999; Välimeli M et al 1991; Marth E et al). Unlike the apo(a)-size effects of omega-3 fatty acids, alcohol did not exert any beneficial effect on apo(a) profile, despite the reduction in Lp(a), according to one very well-conducted study (Fontana P et al 1999). Conversely, withdrawal of alcohol from chronic users triggers a rebound of Lp(a), an effect also confirmed in several studies (Huang CM et al 1992). 

Although deeply-pigmented red wines are suspected to provide benefits over and above their alcohol content (presumably due to flavonoid content), no such specific relationship with Lp(a) has been identified.

Of course, there are other effects of alcohol to consider, including beneficial rises in HDL at low quantities (up to two servings a day), but increasingly adverse effects, including increased triglycerides and blood pressure (more than four drinks per day), with greater amounts.

Flaxseed and almonds

Ground flaxseed (2 tbsp/day) and raw almonds (1/4 cup/day) achieves Lp(a) reductions of approximately 7% (Jenkins DJ et al 2002). Both foods not only reduce Lp(a), but also reduce LDL and may partly counteract the small LDL particle size tendency through their blood sugar-reducing effect.

Diabetes, pre-diabetes, and “hyper-metabolic syndrome” (including Apo E2 and E4)

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