I Wish I Had Lipoprotein(a)!

Why would I say such a thing? Well, a number of reasons. People with lipoprotein(a), or Lp(a), are, with only occasional exceptions:

--Very intelligent. I know many people with this genetic pattern with IQs of 130, 140, even 160+.
--Good at math--This is true more for the male expression of the pattern, only occasionally female. It means that men with Lp(a) gravitate towards careers in math, accounting, financial analysis, physics, and engineering.
--Athletic--Many are marathon runners, triathletes, long-distance bicyclists, and other endurance athletes. I tell my patients that, if they want to meet other people with Lp(a), go to a triathlon.
--Poor at hydrating. People with Lp(a) have a defective thirst mechanism and often go for many hours without drinking water. This is why many Lp(a) people experience the pain of kidney stones: Prolonged and repeated dehydration causes crystals to form in the kidneys, leading to stone formation over time.
--Tolerant to dehydration--Related to the previous item, people with Lp(a) can go for extended periods without even thinking about water.
--Tolerant to periods of food deprivation or starvation--More so than other people, those with Lp(a) are uncommonly tolerant to days without food, as would occur in a wild setting.

In short, people with Lp(a) are intelligent, athletic, with many other favorable characteristics that provide a survival advantage . . . in a primitive world.

So when did Lp(a) become a problem? When an individual with Lp(a) is exposed to carbohydrates, especially those from grains. When an evolutionarily-advantaged Lp(a) individual is exposed to carbohydrates, more than other people they develop:

--Excess quantities of small LDL particles--Recall that Lp(a) is a two-part molecule. One part: an apo(a) made by the liver. 2nd part: an LDL particle. When the LDL particle within the Lp(a) molecule is small, its overall behavior is worse or more atherogenic (plaque-causing).
--Hyperglycemia/hyperinsulinemia--which then leads to diabetes. Unlike non-Lp(a) people, these phenomena can develop with far less visceral fat. A Lp(a) male, for instance, standing 5 ft 10 inches tall and weighing 150 pounds, can have as much insulin resistance/hyperglycemia as a non-Lp(a) male of similar height weighing 50+ pounds more.

Key to gaining control over Lp(a) is strict carbohydrate limitation. Another way to look at this is to say that Lp(a) people do best with unlimited fat and protein intake.

Comments (33) -

  • Bill Davis

    8/8/2012 1:17:58 PM |

    I have Lp(a) and am working on reducing it.
    Have been off wheat for several years now and on a low-carb diet. Hope I find that diet as well as fish oil, thyroid treatment, niacin and DHEA will bring it down.
    Thanks for making me feel special with this article! I have cross posted it. Scan coming up next month to give me a look at how I'm doing.
    The other Bill Davis

  • Joe

    8/8/2012 5:05:52 PM |

    I know this is probably a stupid question: but who doesn't have Lp(a)? My last VAP said that I have a Lp(a) of 7.0 and that <10.0 is preferred. Do some people actually have zero Lp(a)?


  • randallbb

    8/9/2012 3:01:37 PM |

    I too am high Lp(a) and fit largely the profile Dr. Davis has outlined.  Am working on the Lp(a) with all guns blazing!  My new TYP lifestyle along with high amounts of fish oil and Niacin have brought it down markedly in just six months (from 61mg to 46mg on the NMR profile).  Am eating lots of cheese, nuts, etc, so am glad to hear that fats are a good thing!  Dr. Davis' post here reminds me to keep limited my carb intake!

  • Holly

    8/9/2012 10:44:08 PM |

    Any ideas why these traits would correlate with Lp(a)?

  • aerobic1

    8/11/2012 2:28:01 PM |


    Yes, some people do have "zero" Lp(a).  It is partly determined by your genetics which you have no control over.  But, as Dr. Davis suggests you gain gain control over your Lp(a) with dietary interventions such as elimination of wheat and other refined carbs, along with taking a few targeted supplements.  His interventions do not involve pharmaceutical drugs as there are no drugs that effectively treat Lp(a).

    Three years ago my first VAP test revealed a Lp(a) level of 22.  Three years of following Dr. Davi's advice my level is now 3.  For more information go to http://www.trackyourplaque.com/default.aspx.

  • Joe

    8/11/2012 4:59:41 PM |

    Thanks for the feedback!
    On the other hand, aren't you on the way to having no Lp(a)?  From 22 to 3?
    I'm still not sure why having "high" Lp(a) is a good thing. I'm still confused. Frown

  • jpatti

    8/11/2012 9:08:51 PM |

    We're also good-looking.  And very sexy.  And surprisingly modest!  ;)

    So why the heck would the thirst thing be going on?  I don't get it.  

    I have this issue; I have to carry drinks all the time or I completely forget about drinking.  I never go anywhere without carrying drinks cause I don't remember until I've got a killer headache.  I've got a giant mug of coffee and a liter of ice water flavored with lime shrub sitting next to me right now.  

    It's not that I'm not thirsty, if you ask me, I become aware of thirst.  It's just that "thirsty" is not something I am aware of at all.  I don't notice it unless I ASK myself if I'm thirsty.  

    I'm also ridiculously picky, I can have a drink sitting next to me, but if the ice has melted, I don't "want" it no matter how thirsty I am.  

    I don't understand why I'm like this.

  • aerobic1

    8/12/2012 2:48:06 AM |

    There is nothing good whatsoever about having any measurable level of Lp(a).  Zero Lp(a) level should be your goal.  The personality characteristics Dr. Davis pointed out are just some typical observations of Lp(a)er's but do not assume the higher your Lp(a) is that the more intelligent, better at math or athletics, etc. you will become.  Lp(a) offers no advantage in that regard.

    There is plenty of good reading and advice from Dr. Davis on this subject on this blog on what Lp(a) is and how to self-manage it.  http://blog.trackyourplaque.com/category/lipoproteina.  Most all doctors are not well informed on this subject and therefore do not know how to treat it.

  • aerobic1

    8/12/2012 4:52:33 AM |


    The sensation of thirst is governed by the Hypothalamus and Limbic System of the brain.  I do not have an understanding of why people with Lp(a) demonstrate this unusual thirst pattern that Dr. Davis has observed in people with Lp(a).  Here is a good explanation of how the typical thirst mechanism works.  http://www.enotes.com/thirst-reference/thirst.  

    Perhaps the normal brain hormone driven thirst mechanism in people with Lp(a) "malfunctions" and may not be producing enough arginine vasopressin to enhance thirst.  The relationship of renin, angiotensin II, and aldosterone also control water retension and thirst and may play a role too.

  • Joe

    8/12/2012 6:36:30 PM |

    Thanks again. I followed that link and it reiterated Dr. Davis' protocol, of: " i.e., wheat elimination followed by elimination of cornstarch, oats, and sugars; high-dose fish oil (total daily EPA + DHA of 6000 mg/day); vitamin D supplementation sufficient to achieve a 25-hydroxy vitamin D level of 60-70 ng/ml; iodine supplementation; and thyroid normalization which, in Ted’s case, required supplementation with the T3 thyroid hormone, liothyronine, at a small dose. "

    And I follow that protocol pretty closely (I don't take quite that much fish-oil).  My thyroid is fine. I have Pattern "A" LDL. Vitamin D of 90ng/ml. My TC is "high" but I have great trig and HDL numbers and ratios. My Lp(a) again is 7, which is well under the "reference range" of  <10 (according to VAP). But I'm unable to find anything anywhere that explains why having a zero Lp(a) is best, or what the mechanism is that makes it best. I'll keep looking around. Thanks for the help!

  • Joanna

    8/13/2012 8:16:28 PM |

    So we requested our doctor order an Lp(a) test along with several other blood tests that were being done - and later find out that our insurance company (Humana) will not cover the cost of the test, they gave some reason like it wasn't scientifically proven to be useful!!!  It's $65 so not sure if it would be worth fighting them on this one since they have been pretty good about covering most things.

  • Mark

    8/14/2012 2:59:56 AM |

    Hi Dr. Davis,
    I’m 47 yrs old. I’ve had migraines since I was a teen and I developed Athsma this past January (hate it). During the process of discovery the drs found I have a 50% blockage in one of the 5, non critical, arteries running along the back of my heart. Scared me, to say the least. I’ve always eaten quite healthfully (for what I knew), am thin @ 6′ 1″/155lbs (was 175lbs in Jan.). Had:
    Total Cholesterol of 200
    LDL of 146
    HDL of 50

    Drs wanted me to do Lipitor. Researched and said, “No, thanks.” Started exercising 5-6 days/wk (lifting + walk/run), taking red yeast rice, fish oils, fish, no meat, no dairy, no eggs, lots of veggies/fruit, etc., but still eat beans, oats (every AM), occasional wraps. After 6 wks my blood work (VAP) was as follows:
    TOT. CHOL=146
    Non-HDL (LDL+VLDL)=103.

    Seemed GREAT to me! The dr wasn’t impressed. Said my ‘particle size’ was small: LDL1(a)=8.1, LDL2(a)=0, LDL3(b)=39.5, LDL4(b)=24.9. Density Pattern=B.

    I’ve continued but don’t know how to elevate my HDL and reduce the particle size/change the pattern to the more favorable ‘A’. Getting down about this. Working hard but, seems like I can’t find answers that work, anywhere! What might you would work in my situation? Also, Is niacin ANDRed Yeast Rice a bad idea?
    I’ll hang up and listen. Thank you,

  • Will

    8/14/2012 3:03:09 PM |

    Dr. Davis,

    Do you have any comments or response to the study released yesterday at the University of Western Ontario, comparing the risk of regular consumption of egg yolks to smoking on the increase of arterial plaque?

  • JoAnne

    8/15/2012 1:08:25 AM |

    Dr Davis, I recently had had a NMR LipoProfile done, but I don’t understand the numbers. I think it’s saying my LDL particle size is pattern A (good), but the total LDL-P number of 1985 nmoI/L is bad. And the HDL at 79 mg is good, but the TC at 307 is bad…. I’m so confused. Can you please summarize? I’ve been looking at the TYP website and I’m ready to join.

    LDL-P    1985 nmoI/L  (LDL Particle number)

    LDL-C    212 mg/dL  (calculated)
    HDL-C  79 mg/dL
    Triglycerides  82 mg/dL
    Total Cholesterol  307 mg/dL

    LDL & HDL Particles
    HDL-P   40.8 μmoI/L  (total)
    Small LDL-P  106 nmoI/L
    LDL size  22.1 nm

    Lipoprotein markers assoc with insulin resistance & diabetes risk
    Large VLDL-P  0.7 nmoI/L
    Small LDL-P    106 nmoI/L
    Large HDL-P  15.8 μmoI/L
    VLDL size    32.9 nm
    LDL size    22.1 nm
    HDL size    9.9 nm

    Insulin resistance score  0-100
    LP-IR score    5

  • kimsuoil

    8/15/2012 2:15:14 AM |

    Dr. Davis, I have Lp(a) and all of the traits above. Don't really know my IQ, but I am a Petroleum Geologist, been a runner for over 32 years,  can go many hours without water (ran a marathon in 3 hrs and 3 minutes when I was 24 in New Orleans and only had a small cup of water at the halfway point).  I have no problem eliminating foods and have high willpower to food.

    Before joining your Track Your Plaque program 3 years ago, I was on the "low fat"  high carb Am. Heart Assoc. recommended diet for many years.  At 48 I discovered that I had massive heart disease and received 6 stents.
    I now have to limit my carbs to very low to keep my small LDL particles somewhat low.

    Good news is now at 53 years old my carotids are getting better flow since on the TYP diet when I got my last carotid echo.

  • Gene K

    8/15/2012 5:59:29 PM |

    We have coverage thru Blue Cross Blue Shield, and they require extensive review of why I would need an NMR or an Lp(a) test, after which they will decide whether to cover or not. I decided it was too much of a pain, so I order these tests thru privatemdlabs, and use their receipt to get reimbursed from my flexible spending account. If you have an FSA, you could do that, too.

  • Joanna

    8/15/2012 8:18:23 PM |

    Nope, no FSA account so that's not an option and they already have extensive records of why it would be warranted (if they even looked at medical expenses for the past year it would be obvious!)  Thanks for the tip though.

  • Dr. Davis

    8/17/2012 2:36:21 AM |

    Hey, Kim!

    Yes, we have to reverse this incredibly stupid tidal wave of low-fat that is enormously destructive.

    The proof is in the (carotid) pudding!

  • Dr. Davis

    8/17/2012 2:40:41 AM |

    There are a number of possibilities to explain this pattern, JoAnne.

    Among them:

    --Apo E4 genetic type
    --Other genetic patterns

    Unfortunately, this is a pattern that may be difficult to correct with diet. You might also consider an HDL Labs sterol absorption panel to decide what role diet plays.

  • Dr. Davis

    8/17/2012 2:43:50 AM |

    This is a pattern that is highly responsive to diet, such as the diet used in the Track Your Plaque program, the diet discussed in these pages, and the diet I articulate in my book, Wheat Belly.

    By the way, you are currently on a diet that makes this pattern worse. Your diet of avoiding meats and eggs with lots of fruits causes the small LDL pattern and heart disease. And it sounds like you have an intellectually challenged doctor who wants to prescribe drugs but doesn't understand that your diet is contributing or outright causing your pattern.

  • Dr. Davis

    8/17/2012 2:45:54 AM |

    Nobody does.

    It is likely that the gene for the apo(a) protein of Lp(a) is somehow linked to a gene for thirst triggering and nothing more.

    More of a curiosity than anything else.

  • steve

    8/19/2012 1:36:11 AM |

    Hi Dr. Davis:
    Can LDL-P level ever be to low? I have heard lower is better, but when you get below 500, most of that can be small LDL-P.

  • Dr. Davis

    8/23/2012 2:00:59 PM |

    Yes, it can.

    But it should be mostly, if not all, large particles if you are following the diet advised here.

  • steve

    8/26/2012 8:39:17 PM |

    i do follow the diet, but unfortunately generate much in the way of small LDL-P
    I eat no wheat, small amounts of rice and potatoes, no other grains or sugars.  TRGS  were 26 which i thought  is an indication of carb intake.  Am guessing it is just genetics.
    How low is low for LDL-P and do you have any studies you can point that indite small particles?  All research I have seen indite LDL-P and say size does not matter.  Would be interested in seeing studies that show otherwise

  • jpatti

    8/28/2012 7:46:26 PM |

    Yes, I knew the hypothalamus was involved with thirst and the adrenals involved with electrolyte balance.

    Except... just last week, I had a board-certified endocrinologist tell me that ONLY the heart, liver and kidneys are involved in fluid/electrolyte balance:  

  • Susan

    10/4/2012 9:59:33 PM |

    My pattern is very similar and I have had the sterol absorption panel, though I don't know what it means. Campesterol is optimal at 2.22, Campesterol ratio is Hypo at 63, Sitosterol is Hyper at 3.23, Sitosterol ratio is optimal at 88, Cholestanol is Hyper at 5.89 and Cholestanol ratio is Optimal at 172. What does this tell us?

  • Kindred

    10/31/2012 4:53:42 PM |

    My LP(a) was 167.  I got it down, in three months, to 22 using the strict vegan, Forks Over Knives approach coupled with 1500 mg of niacin before going to bed.  My math skills are deplorable as I have severe discalculia (the math version of dyslexia which I also have.)  I'm not competitive at all so, although very coordinated and active, I'm not athletic.  I drink lemon water or dandelion/chicory coffee frequently and frequently get up in the middle of the night for a glass of lemon water. I'm not diabetic and am tested for this annually.   I graze between  meals on celery sticks.   Also, I'm 1/8 Native American Indian. We are suppose to have low levels of LP(a.)

    I lightened up on the vegan diet using olive oil for cooking and my LP(a) rose in 3 months to 67 so it's back to Forks Over Knives again.

  • darin

    12/29/2012 5:47:33 PM |

    Confused, would this be the same thing as Lp(a) mass (mg/dl) i had on a recent Health diagnostics test?
    Mine is showing 44 and its supposed to be less than 30.

    There was also a Lp (a) cholesterol (mg/dl) and mine was 8- supposed to be <3


  • Fred Rutherford

    6/17/2013 5:00:36 AM |

    I have a lipid disorder. My doctor checks lpa once a month. Says thou I have minimal body fat I have to take cholesterol meds. Because my lpa is 14 times higher than what is considered high risk. This putting me at risk of blood clots. I under go quarterly ulta sounds of vascular system as well as annual Hart caths. A high price for being smarter than the average bear. Don't ya think?

  • Dr. Davis

    6/18/2013 1:29:29 AM |

    No, you have been misled.

    What you need are new doctors, plain and simple.

  • Mathieu Gagné

    6/18/2013 5:17:58 PM |

    That is very interesting! I never heard of this before, but it seems to fit to me pretty well. I have high IQ, I'm a physicist, don't drink enough water and would be fairly athletic if it wasn't for my crohn disease. The impact of giving up grains was huge on my health! A quick search and I've found this link between high Lipoprotein(a) and crohn disease:

    It would be interesting to ask my doctor about it!

  • Mary Ann Joyce

    2/15/2014 8:07:55 PM |

    I've the Berkley tests three or four times, and my Lp(a) was 217 in 2007; the latest test shows 80Lp(a).
    I have been on Crestor for a very long time, and now realize it does noting to lower the Lp(a).  On the latest test, my small particle was 21.2 and the large was 11.4.  What does this mean?
    I want to get off the Crestor and onto the niacin, etc., including pomegranate juice which, I understand, has properties that will lower the Lp(a).  I am aiming to cut carbohydrates out completely as well as reduce sugar to near zero.  Do any of you have suggestions for me?  Even though I am 70 years old, I am not ready for a stroke nor MI.  Thanks!

  • Sandra Tremulis- Founder Lipoprotein(a) Foundation

    5/7/2014 6:12:44 PM |

    For those of you interested there is now a foundation for high Lipoprotein(a)  www.lipoproteinafoundation.org