Prototypical Lipoprotein(a)

25. February 2010 William Davis (23)
Here's the prototypical male with lipoprotein(a):



Several features stand out in the majority of men with lipoprotein(a), Lp(a):

Slender--Sometimes absurdly so: BMIs of 21-23 are not uncommon. These are the people who claim they can't gain weight.

Intelligent--Above average to way above average intelligence is the rule.

Gravitate to technical work--Plenty of engineers, scientists, accountants, and other people who work with numbers and/or technical details are more likely to have Lp(a).

Enjoy high levels of aerobic performance--I tell my Lp(a) patients that, if they want to see a bunch of other people with Lp(a), go to a marathon or triathlon. They'll see plenty of people with the pattern among the aerobically-elite.

Are rabid fans of Star Trek.


Okay, I made the last one up. But the rest are uncannilly true, shared by the majority (though not all) men with Lp(a).

Why? I can only speculate that the gene(s) for Lp(a) are closely linked to gene(s) for intelligence of a quantitative kind and some factor that enhances aerobic performance or yields a desirable emotional state with exercise.

Oddly, the same patterns tend not to occur in women in Lp(a). I have yet to discern a personality or body configuration phenotype among the ladies.
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Comments (23) -

  • Anonymous

    2/24/2010 8:24:18 PM |

    arthur ashe and steve larsen (the cyclist who recently died at age 39) seem to fit the profile...

  • Jolly

    2/24/2010 8:57:16 PM |

    Great, I fit most of this risk profile.  (BMI is 17), although I prefer rock climbing to aerobic work.  

    Maybe I should get my Lp(a) levels tested.

  • Bob

    2/24/2010 9:41:58 PM |

    Dr. Davis,

    Thanks for sharing this, very interesting. Are these your personal observations or do you know of any studies indicating any of the above?

  • Anonymous

    2/24/2010 11:44:25 PM |

    Doctor Davis,

    While many people are sensitive to profiling, I think you are on to something and it should be investigated. The rate of how a person ages definitely seems to be indicative of how healthy their heart. I look at pictures of John Ritter in his younger years and compare them to just before he died. Yikes, he looks like a mess! How our chins droop and stomachs grow shows something. Being pruney is one thing. Looking old is another.

    -- Boris

  • Onschedule

    2/24/2010 11:56:56 PM |

    The profile you outline for your typical lp(a) patient describes me perfectly. I'll even admit to liking Star Trek...

    My lp(a) = 88 mg/dl (prior to treatment). I've lowered it significantly, in part, by following the advice on your blog.

    Many thanks for all of the time you spend sharing your wisdom and experience with the world!

  • Dr. William Davis

    2/25/2010 12:16:44 AM |

    Hi, Bob--

    Pure, unadulterated anecdote. No data whatsoever.

    Nonetheless, I marvel at how often it holds true. I see several people a week who fit the description.

  • ramon25

    2/25/2010 1:03:09 AM |

    Hello doctor, I know this is a little off topic and for that I apologize. I ask because I am a little desperate for an answer. I hope it would not be an inconvenience to answer. I take a vitamin k supplement from the LEF brand, this one-http://www.lef.org/Vitamins-Supplements/Item01224/Super-K-with-Advanced-K2-Complex.html
    It has a lot of K. I wanted to know If that high amount of k would require me to take HIGHER levels of vitamin D? Or would the regular 6000- 8000 iu would suffice, I ask that knowing that Vitamin D status is an individual thing ( I am an avid reader of your blog) But as a general rule for how they interact, I cant find any info on this. Thank you very much for your time, and keep up the good work!

  • Stan (Heretic)

    2/25/2010 3:00:32 AM |

    Dr. Davis,

    Thank you for very thought-provoking posts, but I have to say I have a slightly different slant on this:  the type of people you show have so little body fat that our (yes, I am one too) metabolism runs exclusively on what we put on our plate rather than using our body fat (intermittently) for ketogenic cycling in between meals. We lack ketone bodies.

       If we consume a high carbohydrate diet then our body has to use glucose for energy 100% of the time.   Our abnormal (on high carb) lipid profile may be (probably) a consequence of that rather than of some genetical differences.  This is the simplest explanation and may be sufficient to explain the entire plethora of observations.

    That is why I used to have hypoglycemia (and beginning of angina) at the age of 42 on a  low fat vegetarian diet, 11 years ago.  That's probably why you were developing diabetes on Ornish diet.  That's why many if not most low fat vegetarians are not doing particularly well especially after a couple of years once they loose their body fat.

    Regards,
    Stan (Heretic)

    Refs:

    Carbohydrates and Diabetes

    Snacking and glucose/ketogenic cycling

    Very-Low-Fat Diets: What Are the Benefits?

    Diabetes, liver, fructose and omega-3

    It's the glucose, stupid!

    Food Choices and Coronary Heart Disease

  • Dr. William Davis

    2/25/2010 3:13:28 AM |

    Hi, Ramon--

    To my knowledge, there is no interaction. Many of my patients are on the combination and I've not noticed any shift in dose requirements. I DO believe, however, that there is an important synergy between the two in both prevention/reversal of coronary disease and bone health.

  • Dr. William Davis

    2/25/2010 3:15:52 AM |

    Hi, Stan--

    Not so fast.

    Recall that Lp(a) is "activated" by the presence of small LDL. Small LDL particles are spectacularly created by  . . . carbohydrates!

    So I wouldn't be so eager to live on carbohydrates if you are a super skinny Lp(a) person.

    With small LDL and Lp(a), the basic theme is fat, fat, and more fat.

  • ramon25

    2/25/2010 4:12:36 AM |

    Dr. Davis, thank you so much for your response! But even with such a high level of K? the dosage I am taking is over 2500% of the DV. Do you think that amount has health benefits?
    thanks Dr. Davis I really appreciate you help.

  • Anonymous

    2/25/2010 4:29:36 AM |

    Dr. Davis,

    What of someone who initially fit the profile but then managed to add a fair amount of muscle tissue through hard training and enough calories and nutrients? Does this change anything?

    I'm not advocating going hog wild, but do you feel that a formerly golden fit for this profile who now has more muscle mass and is quite active has a bit more of a buffer zone in terms of carbohydrate consumption?

    I ask because in my work in gyms, I have known many men who would initially be carbon copies of the profile you proposed, but after 6 months to 2 years or somewhere in that range, people who just met them would never guess they had fit the profile at some point in the past.

    -Steve Janzek

  • Mat

    2/25/2010 5:25:03 AM |

    I am not sure of HeartHawk's BMI but he sure looks like has this problem.  From his blog:

    "I have high Lp(a) with an otherwise world-class lipid panel."

    "I am proactively fighting my extraordinarily high Lp(a)"

  • Dr. William Davis

    2/25/2010 3:46:54 PM |

    Hi, Mat--

    Yes, indeed. Our beloved Track Your Plaque Heart Hawk does indeed have Lp(a). He also fits the physical/mental pattern, including the Star Trek part.

    Anonymous--

    Lp(a) is genetically-determined. Muscle mass has no effect, unfortunately.

  • Kent

    2/25/2010 4:26:16 PM |

    Dr Davis,

    I've received mixed messages concerning LP(a) and LDL. Many have said that lowering one's LDL will not lower LP(a), yet I'm a little curious as to what happened with my LP(a).

    LP(a) started at 198 nmol/l, with LDL at 105 or so. I started 2000mg Niaspan, 4800mg fish oil, Pauling therapy, no wheat and a few other things you reccomended in your book for LP(a). In 3 months LP(a) was down to 109 nmol/l. In 9 months my LP(a) was down to 45 nmol/l! But my LDL was down to 26! My liver enzymes had gone from 20 to 60, my Testosterone had dropped sigmicantly and my energy was zapped.  

    Therefore, I went from 2000mg Niaspan to 2000mg Niacin IR because I was told it was easier on the liver and wouldn't shoot the LDL so low while keeping HDL high. Well next test LDL was back up to 89, and felt better, but LP(a) had jumped back up to 150 nmol/l. That would lead me to believe it is tied to LDL. Would you agree?

    Thanks,
    Kent

  • StephenB

    2/25/2010 7:01:44 PM |

    It's quite funny how well I fit the criteria: 46, electrical engineer, BMI of 22, and a marathon runner. I have eliminated wheat, have 62 mg/dl 25-H levels, and enjoy extra saturated fat with my saturated fat. I may have to spring for LpInnocent testing next time around.

  • jd

    2/25/2010 7:49:54 PM |

    I am getting mine tested shortly, once LEF puts their blood tests on sale.   I fit that profile very closely although I can gain weight if I pig out over a period of days.  I do stay away from all empty carbs but do get carbs from fruit and veggies like butternut squash & sweet potatoes.  I always eat my carbs with a protein and/or fat source to slow the assimilation into the bloodstream.

  • Drs. Cynthia and David

    2/25/2010 9:25:18 PM |

    Very interesting observations!  It might explain why some healthy-looking people have heart attacks anyway.  I am curious whether the observation will hold up as you gather more info, and what other insights it might bring.

    @ramon25, take a look at Chris Masterjohn's post about D, A, K1 and K2. Apparently D increases the use of and need for K, but is somewhat modulated by A. It's really interesting stuff. http://blog.cholesterol-and-health.com/2009/04/tufts-university-confirms-that-vitamin.html

    Cynthia

  • zach

    2/26/2010 3:34:21 PM |

    Wow. I just realized that all of myteachers of higher math and physics were all really, really skinny guys. You're right!

    @Stan

    That makes a lot of sense.

  • shelley

    5/21/2010 8:04:17 PM |

    Interesting stuff.  I am a 46 year old woman, runner, fit, low weight/body fat, good cholesterol levels, but have Lp(a) levels of 62mg/dl.  Huge family history of early death from sudden cardiac arrest.  I'd say add women to the profile. Smile

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    11/2/2010 7:35:48 PM |

    Enjoy high levels of aerobic performance--I tell my Lp(a) patients that, if they want to see a bunch of other people with Lp(a), go to a marathon or triathlon. They'll see plenty of people with the pattern among the aerobically-elite.

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