Does being lean, young, muscular and insulin sensitive exempt you from cardiac disease? The answer to that is NO
In my role as the CEO of Iron Direct Primary Care I spend a portion of my day reading and studying the latest in anti-aging medicine. Since the development of AI I have been combining research with our real-world primary care population to see how it fits Iron DPC. This paper is important because it answers several questions our patients have every day and answers many of the commonly repeated myths found on the internet. Low Fasting Insulin Does Not Exclude Elevated Apolipoprotein B: A Real-World Primary Care Study- Please follow this link to download the full paper and watch the lecture I presented to AOSIM.
Does being lean, young, muscular and insulin sensitive exempt you from cardiac disease? The answer to that is NO considering how plaque lays down starting in young individuals (an old study found this as early in the Vietnam war when autopsies of young soldiers who died from war were often found with plaque). And also modern studies like the REACT which I discuss again in this lecture.
Does low insulin level correlate with low Apo B? Again, no
As women age, do their Apo B levels rise? Yes. We can infer then that treating women to lower Apo B levels is Anti-Aging Medicine. If we do that with optimally dosed estradiol or conventional lipid lowering medicine remains to be seen what effect those may have.
This is all especially relevant to Iron DPC. When I formulated this paper two physician friends of mine Dr. Halasa and Dr. Alo challenged me on how to ask the questions and what to include. One of the first requests they had was to see if Iron DPC patients with an A1C >7 had higher Apo B levels. I said this is impossible since Iron DPC’s has an extremely healthy user bias. I can count on one hand the amount of patients I have with an A1C>7. This typically leads to incredulous looks and shock from physicians in the conventional system. The average primary care panel out there in the world is much sicker than ours. However we still get patients here with cardiac disease despite not being diabetic.
Unfortunately many guidelines and internet arguments point out the fact that many studies on lipid lowering therapies are on patients with cardiac risk factors. The greatest being diabetic patients.
That has left me scratching my head since I started Iron DPC back in 2021 and even before that when I started asking the question for myself. I am lean, muscular, an insulin level of 2, and a1c of 5.3 but my apo B has been averaging between 90-120. For years I believed that “eating clean” i.e avoiding seed oils (and other leaps of imagination promoted by big personality influencers on social media) would exempt me from cardiac disease. Ordering the Lipid NMR, homocysteine, oxidized LDL, hs-CRP, LPLA2, never provided me much reassurance since they were normal or transiently elevated from some random environmental factor like a common cold. My Lp(a) was also negative. Family history does have vague vascular problems and dementia. We now know that elevated LDL/apo B are associated with dementia. But I could discount the family history as “I am healthier” than them.
But relying on my fitness as an exemption from cardiac disease has lost a lot of ground just in the past 1-2 years with new studies coming out on PCSK9 mutations and insights into estrogen exposure also influencing PCSK9 and lowering apo B. Then also my own patient population who I’ve followed over the years and finding that even with their great metabolic health they develop plaque in the arteries.
There are enough signs now for me to champion that lowering Apo B is Anti-Aging Medicine. I keep my Apo B at around 50 which Ezetimibe 10mg alone achieves. Adding in Rosuvastatin 5mg daily lowered it to about 44. This is a practical and cheaper way of finding out if I am a high gut cholesterol reabsorber (ezetimibe) or a high hepatic producer (rosuvastatin). There is a Cholesterol Balance test 835084 with our Labcorp pricing for $79 that supposedly can tell me which type I am. But it’s not necessary. I am happy with my Apo B level and my hs-CRP is also the lowest it has ever been with this low apo B.
Also stay tuned for another newsletter next month as we migrate out of the Elation EHR and into the Hint EHR. You all are familiar with Hint as it serves as our membership portal. We will be moving out the Elation portal some time next month.
The Iron Direct Primary Care Podcast is available on
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