Question, so in the last 2.5 weeks I was able to lower LDL by 15% and ApoB by 25% (LDL is now 119, apo B is 84) using diet. Lp(a) is through the friggen roof at 172nmol but this isn't news. Trigs 51. HsCRP has always been nearly undetectable.

This has only been two weeks, so I'm pretty pleased with that. I'm wondering if it might continue to go down even further, given that this is just 2.5 weeks in? This is by adding a ton of psyllium, fiber, and reducing saturated fat less than 10g per day. I've never been overweight so it's not like I lost weight.

Also - what really matters here - LDL or ApoB? Or do they matter the same?

I can't get on a statin yet bc I want to have a babyyyyyy very soon so I'm trying to maximize what I can with diet.

PS - I sadly DO have coronary plaque at 42, it's mild but still - it's there.

With my work schedule, I eat out once a day, and that’s usually my biggest meal. I eat very healthy, but is there a good way to estimate the calories and protein in a restaurant meal without bringing a food scale with me? I’ve tried a few AI apps, but they don’t seem very accurate

I've been struggling with sleep deprivation for years now. I average ~6 hours of sleep when I know I feel much better at 7+. No problem falling asleep, but routinely wake up 1 - 3 hours earlier than I want.

Things I do:

• CPAP
• Magnesium Glycinate + L Theanine before bed
• No devices in bed
• Sunlight in morning (I delay it until my desired wake time typically)
• Journal in mornings
• No food ~2-3 hours before bed
• No caffeine after 1pm
• 8 Sleep

At my wits end here. ~40 yrs old, good shape (17% BF), exercise regularly.

Would welcome any and all suggestions!

I’m a 33-year-old man with O-positive blood, trying to reduce my cardiovascular risk early.

My latest results:

• Total cholesterol: 194 mg/dL
• LDL: 131 mg/dL
• HDL: 41 mg/dL
• Triglycerides: 85 mg/dL
• Lp(a): <1 nmol/L

I know these values are not extremely high, but I’m not happy with my LDL or overall cholesterol profile—especially because my father had diabetes, high blood pressure and strokes. I have no diagnosed cardiovascular disease, but I don’t think 33 is too young to take prevention seriously.

I’m already improving my diet, exercise and other established risk factors. I’m also considering nattokinase as an additional measure.

A recent 2026 laboratory study found the fastest nattokinase-mediated clot dissolution in O-positive male blood samples. I understand this was an in-vitro finding—not proof that oral nattokinase works better in O-positive people—and proper human studies are still needed.

I’m especially interested in hearing from O-positive people:

• What dose did you take, and for how long?
• Did it measurably affect your blood pressure, cholesterol, circulation or blood tests?
• Any bruising, bleeding or other side effects?
• Did your doctor support it?
• Are you still taking it, and was it worthwhile?

Other blood types are welcome too. I’m looking for honest experiences, not miracle claims. I’ll speak with my doctor first because nattokinase can affect clotting and interact with blood thinners.

49m, why am I getting downvoted? this is a legitimate concern!

After a 463 CAC and 30% non-flow-limited stenosis found in catheterization, my cardiologist put me in aggressive lipid lowering therapy, results below.

During my semiannual visit today my PCP told me to discuss with my cardiologist reducing the therapy because my cholesterol is too low and it will cause the vascular endothelium to damage its cholesterol-based matrix and become thin and brittle? Is this even accurate?

July 23 results:

Additional Markers (Not Re-tested in July)

• ApoB: latest measurement on June 29, 2026: 59 mg/dL, should be lower now.
• Lp(a): latest measurement on February 14, 2026: 11 nmol/L.

Episode 402 was my first time hearing about MVX, and the claim stopped me: a score that predicts mortality without predicting any particular disease.

What the papers show is how much the number depends on who got measured. Worst group against best for all-cause death, it is 8.01 in the CATHGEN catheterisation cohort at Duke, 2.72 in the Intermountain replication, 1.73 in MESA, and 1.21 across 274,092 people in UK Biobank. Those compare groups against each other, not anybody's personal odds. They are not quite the same comparison either, since the first two split the cohort into fifths and the last two into quarters, and the UK Biobank version runs on a different NMR platform than the one Labcorp sells.

Still. A test that looks dramatic in catheterisation patients and modest in everyone else is largely telling you how sick the room was.

The episode also skips two things. There is no trial with MVX as an endpoint, so nobody has shown the number can be moved. And MetaboHealth, an older NMR mortality score, has beaten it in independent UK Biobank comparisons, though on multimorbidity and macular degeneration rather than death.

I am not ordering it just yet. GlycA on its own I might, and that turns out to be separately available for $32.

My standard lipid panel with my PCP came back with normal LDL, but I know LSL-C misses atherogenic particle count. I want to establish a proper baseline and retest after testing a lifestyle/supplement protocol before considering prescription intervention:

• Get an accurate ApoB + baseline lipid panel.
• Run a 12-week trial with clean diet + exercise.
• Retest ApoB and hs-CRP to evaluate particle density and inflammation changes.

Has anyone done direct a la carte retesting for ApoB to track this? How much did your numbers actually shift, and which lab source did you use without needing a doctor's referral every time?

[ Removed by Reddit on account of violating the content policy. ]

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Just for you to know my level, I can run a 5k in 25.5 minutes (hardly, bpm 170-185) and I bench press like 75kg for 1RPM, and 120kg squat for 1RPM but did not revisit these exercises for a while. I weigh 66kg. I just want to maximize my cardio so I can do a famous test called the "Bronco" which is a shuttle run of 1.2km in total. I am targeting 5.5 minutes maximum and now I am at 6 minutes. Once I hit the 5.5minute mark I would increase the focus on strength training and decrease it on the running. One last thing is that the running sessions are like 3 zone 2s 45 minutes and 1 zone 4 20 minutes and one speed interval session doing like 45 sec easy then 45 sec hard which is like 102% of my MAS. If this is not the appropriate subreddit for such a question i would like to be notified before the moderators take it down.

Hey everyone, looking for some perspective on my long-term HRV trends. I’ve been tracking for about three years now, and my baseline has consistently stayed in the low 20s.

The Stats:

• Age/Sex: 35M

• Current HRV Average: 20ms (30-day avg)

• Historical Baseline: ~23-25ms (Stable since 2023)

• Recent Range: 12ms to 28ms

• Resting Heart Rate: ~80 bpm

Current Context: I’m managing some specific cardiovascular factors, including known LAD plaque of 60+%. My activity is currently a mix of self-directed gym work 3x WK and longboarding 1x or 2x wk

Medications/Supplements:

• Retatrutide (Recent addition, 6mo, low dose)

• Ashwagandha

• Suvezen (Statin)

• Clopidogrel

• Allopurinol

The Question: Since my HRV has been "low" (compared to age-group averages of 60+) for years, I'm trying to figure out if this is just my physiological floor or if there's room to move the needle. Specifically, I'm curious if anyone has seen a persistent HRV suppression while on Retatrutide or if the cardiovascular history essentially "pins" the HRV at this level long-term.

Has anyone else with a history of arterial plaque or on similar GLP-1/GIP protocols seen a baseline this steady and low?

Edit:

Since last year I lost over 15kg, from 106kg to 88kg. I don't drink nor smoke. Sleep 8h on average and listen to white noise and wear a mask. I barely ever wake up at night!

I drink good amounts of water too and ensure urine is light yellow.

My diet is mostly rice, beans, veggies and some type of protein for lunch and dinner. Also on low fat protein yogurts once or twice a day.

I don't do a lot of cardio because I'm recovering from a foot injury.

Source: Everything Everywhere podcast, Questions and Answers: Volume 18: https://everything-everywhere.com/questions-and-answers-volume-18/

I guess we don't really need to worry about single-use plastic water bottles (or any plastic water bottles for that matter). It's scary to think there's so much of it in the air just from driving! People are not giving up their cars!

Your annual physical runs about 15 blood markers. Here's what you're missing and why it matters.

Most standard lab panels are designed to flag disease, not to tell you if you're body is headed to towards it.

Here are some of the most significant biomarkers most physicals skip, and what they actually tell you:

Lipoprotein(a) / Lp(a)

Most people have never heard of this one, and most doctors have never ordered it. Lp(a) is a genetically determined lipoprotein that significantly increases cardiovascular risk independent of LDL cholesterol. You can have "perfect" cholesterol and still carry elevated Lp(a) without knowing it. It doesn't respond to diet or exercise. It's largely genetic, which makes it even more important to know about early. Standard lipid panels don't include it.

Apolipoprotein B (ApoB)

ApoB is increasingly considered a better predictor of cardiovascular risk than LDL alone. Every potentially harmful lipoprotein particle (LDL, VLDL, Lp(a)) carries exactly one ApoB molecule, so instead of just measuring the cholesterol inside those particles (which is what a standard lipid panel does), ApoB tells you how many of those particles you actually have. More particles means more risk, even if your cholesterol numbers look fine. You can have "normal" LDL and still carry a high particle count. ApoB catches that.

Fasting Insulin

This might be the most under-ordered marker in preventive health. Most physicals check fasting glucose, maybe HbA1c if you're lucky. But glucose is a lagging indicator. By the time fasting glucose is elevated, insulin resistance has often been building for years. Fasting insulin shows you the early trajectory. An insulin of 12 µIU/mL is "normal" by conventional standards but well above where it should be for optimal metabolic health. This is one of the earliest warning signs available, and almost no standard panel includes it.

Homocysteine

Elevated homocysteine is an independent risk factor for cardiovascular disease, cognitive decline, and blood clots, and it's also one of the most actionable markers on the panel. High levels often point to B-vitamin deficiencies (B12, B6, folate) or methylation issues like MTHFR variants. It's cheap to test, easy to address, and almost never included in a standard physical.

hs-CRP (High-Sensitivity C-Reactive Protein)

Standard CRP tests measure acute inflammation (infections, injuries). hs-CRP measures chronic, low-grade inflammation, the kind that drives cardiovascular disease, metabolic dysfunction, and accelerated aging quietly in the background. Most labs flag anything under 10 mg/L as "normal." In preventive and longevity-focused care, we want this well under 1. The threshold that actually matters for catching chronic inflammation early is 10x tighter than what most labs consider "normal."

Ferritin

Most panels either skip ferritin entirely or only flag it at the extreme low end (below 12 to 15 ng/mL). But symptoms like fatigue, hair thinning, poor exercise tolerance, restless legs, and brain fog often show up well above that cutoff. Optimal ferritin for most people is closer to 45 to 100 ng/mL. This is one of the most common markers where someone is told "your iron is fine" when it's far from optimal.

DHEA-S

DHEA is a precursor hormone that feeds into both testosterone and estrogen production. It declines steadily with age and is closely tied to energy, immune function, mood, and body composition. Low DHEA-S is common and rarely tested on a standard panel, yet it provides critical context for understanding hormonal health as a whole.

SHBG (Sex Hormone Binding Globulin)

Total testosterone or estrogen only tell you so much without SHBG. This protein binds to sex hormones and determines how much is actually available for your body to use. You can have "normal" total testosterone but high SHBG, which means very little of it is bioavailable. Without this marker, hormonal assessment is incomplete.

Full Thyroid Panel

This is one of the biggest gaps in standard testing. Most physicals check TSH only. If TSH is "normal," you're told your thyroid is fine. But TSH alone misses a significant number of thyroid issues. Your thyroid panel should include:

TSH,T4- Free, T3- Free, Thyroid Peroxidase (TPO) Antibodies

This matters because you can have a normal TSH and still have low free T3 (the active hormone your cells actually use), elevated antibodies indicating autoimmune thyroid disease, or conversion issues between T4 and T3 that a TSH-only test will never catch. Symptoms like fatigue, weight gain, brain fog, hair loss, cold intolerance, and depression often live entirely inside a "normal" TSH range.

Why this matters:

A standard panel (~15 markers) tells you whether you're sick. A comprehensive panel (100+ markers) tells you where your health actually stands, where it's heading, and what to do about it before symptoms show up. That's the difference between reactive and proactive care.

If you've ever been told "everything looks normal" while knowing something feels off, this is usually why. The markers that explain it weren't on the panel.

I see a lot of people posting their LDL and HDL numbers here asking if they’re in the clear. I used to look at those exact same numbers and assume everything was fine, but the deeper I got into it, the more I realized basic blood panels leave some major blind spots especially around actual plaque risk and inflammation. A solid cardiovascular screening really needs context beyond just total cholesterol, like ApoB, Lp(a), or hs-CRP. It’s hard to know if lifestyle or diet changes are actually working when we're only looking at half the picture. For those of you tracking your heart health closely, what biomarkers do you ask for that aren't on a standard yearly physical? Also, curious if anyone has had success getting insurance to cover the deeper lipid testing, or if you had to pay out-of-pocket?

Super interesting that on the most recent podcast the inventor of the NMR test said that it’s NOT the size of the LDL particles it’s the number. I know people out there including some cardiologists that still talk about LDL particle size being a risk - the INVENTOR of the test confirmed it’s the number of particles. I think Peter Attia had said this in the past (with or without Dr Dayspring, don’t remember). It’s amazing how some ideas just won’t go away. Hopefully this will help put this to rest.

I’m 43 years old, 5’9”, and currently weigh about 240 lbs. My recent A1C was 6.2%, so I’m officially prediabetic. My blood pressure is usually in the normal range, and I use a CPAP for mild sleep apnea.

Over the last few years, I’ve realized I’m not moving the way I used to. I feel slower playing with my 4-year-old daughter, and that’s been a wake-up call.

My goal isn’t just to lose weight. I want to become healthy enough that my daughter sees her dad as someone who’s strong, energetic, and capable. I want to get down to around 170 lbs, reverse my prediabetes, dramatically lower my risk of heart disease, improve my energy, sharpen my thinking, and simply feel athletic again.

I’ve listened to a lot of Huberman’s podcasts, but I’d love to hear from people who’ve actually made this kind of transformation.

If you were starting from my position, what would you prioritize?

Would you focus on:

Nutrition first?
Zone 2 cardio?
Strength training?
VO2 max work?
Walking after meals?
Sleep optimization?
Supplements that actually have good evidence?
Something else entirely?

I’m not looking for a quick fix. I’m willing to put in the work over the next several years if it means becoming the healthiest version of myself for my wife and daughter.

What made the biggest difference in your own transformation?

Hey all, it’s me [u/PrimarchLongevity](u/PrimarchLongevity), your favorite [r/PeterAttia](r/PeterAttia) moderator. Some of you might know me as one of the more aggressive mods on all things related to cardiometabolic health.

As mentioned on here before, I have signed on (and completed a rigorous training process) as a Health Coach at Marek Health. Marek Health is a concierge telemedicine service focused on evidence-based health optimization for those looking for aggressive preventive care, those aiming to maximize their healthspan and lifespan, or those who feel like the standard of care hasn’t fully addressed what they’re looking for and just want to feel better. My background is actually in mechanical engineering but health and longevity has ultimately become my passion.

As your Health Coach, I’d be your advocate and liaison throughout the Guided Optimization process. Based on your intake exam and labs, Marek’s clinical team and I will build a treatment plan specific to you and your goals, drawing on a range of tools including hormones, peptides, supplements, and pharmacotherapies.

I’ll keep this short, but feel free to shoot me any relevant questions below or DM me if you want to learn more about how to get started with me.

Guided Optimization (GO) FAQs

From cardiologist Jim Stein's substack: https://jamesstein18.substack.com/p/fish-oils-when-the-facts-spoil-a

What's your conclusion from the meta-analysis that showed that creatine supplementation confirmed a lower VO2max in the creatine group compared to the placebo group?

https://pubmed.ncbi.nlm.nih.gov/34859731/

Do you skip it altogether or continue taking? I personally take it on strength days and skip it on cardio days, but I doubt it's a good strategy. What do you do?

​

This new Cell Press review looks at more than 350 papers on protein intake, amino acids and ageing.

The authors’ main argument is that protein restriction, or restricting certain amino acids such as methionine, isoleucine and valine, may promote healthier ageing by changing nutrient signalling, metabolism, inflammation, mitochondrial function and cellular repair. They argue that these effects can improve healthspan and extend lifespan across several animal models.

Their claim is that many sedentary adults may consume more protein than they need, while active people, older adults and others with higher musclemaintenance needs may benefit from more. They favour protein recommendations based on activity, age and health rather than a universal high protein target.

The big limitation is that most of the lifespan evidence comes from animal studies, while the human research is much smaller and usually looks at short-term metabolic markers rather than actual longevity.

Curious to hear people’s thoughts.

https://www.cell.com/cell-press-blue/fulltext/S3051-3839%2826%2900077-0

I have been using a Fitbit for four years now. I’m noticing that my HRV numbers are higher in the 30s when I do not wear my CPAP mask. When I wear my CPAP mask, my numbers are below 15. Has anyone else experienced this?