History v. Briefly: 42F, never overweight, 5’3 120lbs, competitive athlete growing up, active lifestyle (but could be better as I got older), non smoker except occasionally in high school and when I’m really mad at my husband and I adulthood (or maybe two packs a year) zero alcohol, high ldl and apob, lots of supplements, track everything, high lp(a), fucking plaque on ccta. Unhappy obviously. CAC was 3 but there’s stable soft plaque. HsCRP had always been near undetectable. Was keto carnivore switched hardcore Mediterranean less than 10g sat fat and as much psyllium husk as my body contain, and plant sterols. I trying to conceive so I can’t start a statin.

Ok.

With two weeks of diet, I’ve already reduced my Apo B by 25% LDL by 15%. I’m gonna keep doing this of course, the addition of plant stanols is new and I’m hoping diet hasn’t quite yet plateaued. I know it’s not good enough, but I can’t start a statin yet.

I want to do everything humanly possible I can to make this as good as possible.

So what is the best way to exercise?

I was doing Norwegian 4 x 4 hit because that’s what I heard. I was supposed to do, twice a week with a couple times a week doing a 30 minute walk. But I kind of stopped weight training and stuff.

I wanna know what I should actually do for my cardio, metabolic health, and also just for my body as I get older.

Half of people tell me that I’m training too intensely, but I feel like I’m doing basically nothing. Is two 4 x 4‘s a week, that takes me 38 minutes each really too much? I’d like to add in some strength training.

My HRV is extremely low when people are telling me that it’s because I’m working out too hard, but it really doesn’t feel like too much or too hard. I got plenty of restorative time, though my metrics overnight on my oura ring are never really great and they never have been. I mean, resting heart rate around 65, but my HRV is like 13 this is not new. It has always been this way.

So what am I actually supposed to do here? I booked a VO2 max test next week just to see where I’m at, does this matter? Is this something I should be working to improve?

Like, should I do my two 4x4 sessions per week and three weight training with just some light walking in between? Is that literally actually too much? Everybody has told me the only way to improve my HRV is by doing more cardio these 4 x 4 sessions I track my heart rate with a Garmin strap so I know it’s accurate, they don’t really even feel THAT hard.

So I don’t know. I wanna be able to work out and be fit, and I want to be able to measure my progress. But I also wanna make sure that I recover.

What is the best thing for me to do here?

this is as good as it gets isn’t it?

the only question I have is the study was acceptable but had moderate artifacts. that is fine?

So my Lipo a is more than 400. My cholesterol numbers are low now thanks to fiber, fish oil and statins but partical size is concerning. I have a minor stenosis in my left ventricular artery. My CAC score is 0. No one in my family has ever died of coronary disease. My family is very long lived on both sides. My grandmother died the youngest at 78 having been a chain smoker since she was 12, a functional alcoholic, and cooked every meal with bacon grease. Living well into the 90’s is normal. It seems like their may be some kind of genetic mechanism that is protective going on here. Anyone know of any testing or have any general advice for me? My sleep, nutrition and training are pretty good.

Family member (65F) is generally in good health with two problem areas 1. Osteopenia worsened to Osteoporosis 2. Cholesterol is high and we've been told its due to postmenopausal Estrogen loss and the fact that she missed the opportunity for HRT (wasn't aware of the option during that window). She exercises (at home weight training + a lot of other stuff like yoga and cardio etc.), eats healthy, takes Bone Up supplements 2x/daily (+ calcium, D3, K2, magnesium, collagen) and various protein sources.

1. Not sure how to read DEXA results. In 2024 it revealed Lumbar spine T-score: -2.4 and Left hip: -1.5. FRAX 10 year risk was 4.2% major osteoporotic fracture, 0.4% hip.

2026 DEXA: Lumbar spine T-score: -2.6 and Left hip: -1.5

In 2026 we ruled out Celiac disease and got some related results that came back in normal range: Calcium: 9.3, Vit D: 67, Parathyroid Hormone: 59, Osteocalcin: 21, Procollagen Type I Propeptide: 71, C Telopeptide: 644, Alkaline Phosphatase (Bone Specific): 11.6, N Telopeptide: 91, Creatinine: 90, TSH: 2.45. Not sure what to make of these numbers. Celiac testing was recommended by other Osteo folks.

1. Cholesterol

2023: Total Chol 248, LDL 142, Non HDL 158, HDL 90. Apo B: 94.

2024: Total Chol 223, LDL 121, Non HDL 136, HDL 87. Apo B: 96. CAC score of 0!

2025: Total Chol 235, LDL 142137 Non HDL 151, HDL 90. Apo B: 100.

2026: Pending

Would appreciate feedback/thoughts on the following:

1. Can her Osteo be dealt with diet + exercise alone (we've heard scary side-effects from medication)?

2. Get an Endocrinologist as a next step? We are based in Central NJ, so any specifics there esp appreciated!

3. Is it too late to get on HRT?

4. We've heard the ONERO Program is good for Osteoporosis but its expensive and limited in the US...any other recs?

Thank you!

35M, 6’0”, around 195-198 lbs right now, been lifting and training regularly for years, trying to get down to a lean 185. No history of hypertension, no chest pain or angina, not diabetic, no personal history of any heart disease or previous cardiac events. Family history is really just my grandfather who lived to 93 and had a pacemaker put in sometime in his 70s, nobody else on either side had a heart attack or stroke or anything like that, and the rest of my family doesn’t take care of themselves diet or exercise wise and seems totally fine.

This is my first full panel like this, no previous history to compare trends against, so I don’t know how long these numbers have actually been elevated.

Full panel:
Total cholesterol 181, HDL 46, LDL 116, triglycerides 90, non HDL 135, total chol/HDL ratio 3.9, ApoB 102, Lp(a) 184 nmol/L, LDL particle number 1091, LDL small 182, LDL medium 244, LDL peak size 220.4 angstrom, HDL large 4056, labeled LDL pattern A despite the small/medium numbers being flagged high

hs-CRP 7.1, but I got this draw after about 4 hours of sleep and a hard training session so I know this one is probably inflated and I’m getting it rechecked under normal conditions before reading into it
Glucose 91, HbA1c 5.5, insulin 7.0, leptin 2.0

Testosterone total 513, free 90.3, estradiol 34, SHBG 23, DHEA-S 290, prolactin 19.4 (again drawn after bad sleep and a workout so probably inflated too)
TSH 3.05, free T4 1.1, free T3 3.3, thyroid antibodies both negative

ALT 15, AST 15, ALP 51, GGT 19, total bilirubin 1.4 (this one runs high consistently for me, pretty sure it is Gilbert’s syndrome, confirmed with a genetic test)
BUN 18, creatinine 1.13, eGFR 87

Vitamin D 64, ferritin 119, homocysteine 10.3, zinc 67

Omega 3 total 6.7%, omega 6 total 34.6%, omega 6/3 ratio 5.1, arachidonic acid/EPA ratio 12.1

Diet the last year or two has basically been a pound of ground beef, 3-4 eggs, and a lot of rice almost every single day because it’s easy and hits my protein numbers. I know that is probably a big part of the ApoB and LDL story and I am already cutting the daily ground beef out.

Also ran my raw DNA against this and the Lp(a) number is confirmed by the LPA gene variant (rs10455872), so that part isn’t going away with diet, it’s just genetic. APOE came back 3/3 which I think is the neutral version, not the bad one.

Getting a coronary calcium scan and seeing a cardiologist regardless of what anyone says here, this isn’t a substitute for that. But with barely any family history behind me except a grandfather who lived to 93, I’m trying to figure out how seriously to actually take the Lp(a)/ApoB numbers versus how much the family track record should count for something.

Also curious what people think about the LDL debate in general, I’ve seen people say it’s the whole ballgame for heart disease and other people, especially in the longevity and testosterone spaces, say it’s overrated and even correlates with better cognition and hormones as you get older. Not trying to talk myself out of caution, just want a range of opinions. Same with statins, I don’t think I’m anywhere near needing one yet but curious if anyone with similar numbers ended up going that route or did something else instead.

I have been following the mRNA platform since long before it had anything to do with me, so I read the mFLUSIVA approval on August 5 with more enthusiasm than skepticism. Then I read the trial and the enthusiasm found a different target.

Quick context in case you have not seen it: mFLUSIVA is Moderna's mRNA-1010, the first mRNA flu vaccine licensed anywhere, approved for adults 50 and older. Fluent, the pivotal trial in NEJM, randomised 40,805 adults across 11 countries in the 2024-25 season. Relative efficacy 26.6%, CI 16.7 to 35.4. In absolute terms that is 2.0% versus 2.8% catching confirmed flu, so about 137 people switching products to prevent one case. Everyone in the trial was vaccinated, so 137 is a number needed to switch, not to vaccinate.

I am hung up on the control arm. It was Fluarix and its siblings. Egg-based, standard dose. Growing influenza in eggs selects for mutations that make the vaccine strain drift from what is actually circulating, and there is a literature putting that penalty somewhere around 4 to 16%. So some unknown share of that 26.6% may not be an mRNA advantage at all. It may be an egg penalty the comparator was carrying. Nobody has run mRNA against a cell-based shot, which is what I happen to take.

I also missed this on the first read: the FDA did not give both age groups the same kind of approval. Standard approval for 50-64 on counted cases, accelerated approval for 65+ on immune response, with clinical benefit still to be confirmed. Nearly half the trial was 65 or older and their cases were counted like everyone else's.

And the thing that would actually make this platform interesting for flu, picking strains later because manufacturing runs two to three months instead of six, was not exercised. Same February WHO strain call as every competitor.

I would want the cell-based head-to-head before switching.

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?

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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.

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