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Apolipoprotein B: High & Low Levels + 7 Ways to Improve

Written by Will Hunter, BA (Psychology) | Reviewed by Biljana Novkovic, PhD | Last updated:
Medically reviewed by
Jonathan Ritter, PharmD, PhD (Pharmacology) | Written by Will Hunter, BA (Psychology) | Reviewed by Biljana Novkovic, PhD | Last updated:

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Cardiogram

Apolipoprotein B is a large protein that serves as the backbone of LDL and other lipoproteins. It can help determine your risk of heart disease and is even a better predictor than the commonly-measured LDL cholesterol (the “bad” cholesterol). Read on to learn more about apolipoprotein B, what causes abnormal levels, and how to improve your levels.

What is Apolipoprotein B?

Apolipoproteins are the building blocks of lipoproteins, such as high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Lipoproteins bind fats and cholesterols and shuttle them around the blood. Apolipoprotein B (ApoB) serves as the structural backbone of three important lipoproteins [1]:

  • Very-low-density lipoprotein (VLDL)
  • Intermediate-density lipoprotein (IDL)
  • Low-density lipoprotein (LDL)

There are two types of apoB. One (ApoB48) is made in the gut as part of compounds called chylomicrons. The other (ApoB100) is made by the liver and released into the blood in the form of VLDL. VLDL loses fats called triglycerides to form IDL and eventually turns into LDL as it loses more triglycerides [2, 3].

Each molecule of VLDL, IDL, and LDL contains exactly one molecule of apoB. This makes apoB a measure of total non-HDL lipoproteins in circulation [2, 3].

Apolipoprotein B helps LDL bind to receptors on cells and deliver cholesterol. It’s also necessary for liver cells to bind LDL and remove it from the blood [1].

ApoB-containing lipoproteins are the main contributors to hardening of the arteries (atherosclerosis) and heart disease [1].

ApoB is used to determine your risk of heart disease if you have a family history of heart disease or elevated heart disease risk factors (i.e. high cholesterol and triglycerides). It is also used to diagnose genetic diseases that cause extremely low or high ApoB levels.

Role in the Immune System

ApoB helps defend the body against bad bacteria such as Staphylococcus aureus by interfering with a process called quorum sensing. Quorum sensing is how bacteria “talk” to each other to coordinate the necessary actions for survival [4].

Normal Apolipoprotein B levels

The normal range for apolipoprotein B is 52 – 120 mg/dL (milligrams per deciliter), or 0.52 – 1.2 g/L (grams per liter).

Some labs may report a slightly different range for men and women. Men have slightly higher levels on average [5].

ApoB levels are normally increased during pregnancy [6].

Causes of Low Apolipoprotein B Levels

1) Hyperthyroidism

People with hyperthyroidism often have lower apoB levels. That happens because of an increased breakdown of LDL particles [7].

Two studies show lower ApoB levels with a total of 48 hyperthyroid patients, that increased as their thyroid function improved after therapy [8, 9].

2) Liver Disease

Most of ApoB is produced in the liver. That’s why apoB levels decrease in liver disease [10].

ApoB levels were reduced by 25% in 74 patients with chronic liver failure compared to 82 healthy subjects [11].

Liver malfunction induced by hepatitis B virus infection decreased apoB levels in 148 chronic HBV patients [12].

In a study of 213 people, 25% of people with chronic hepatitis C had low ApoB levels. Only 5% of healthy controls had low levels. Lower apoB levels were also linked to a higher viral load [13].

3) Genetic Disorders

Familial hypobetalipoproteinemia is a disease in which low ApoB levels are caused by mutations in the ApoB gene and other related genes. There are over 60 mutations that can cause this disease [14, 15, 16, 17].

Abetalipoproteinemia is another disease in which ApoB levels are undetectable [18].

Although deficiency of apoB may lower the risk of heart disease, it can result in debilitating neurological complications, fatty liver, and liver cancer. That’s why early discovery and appropriate treatment and follow up are essential [18].

Effects of Low Apolipoprotein B Levels

May Increase The Risk of Infections

Apolipoprotein B helps defend the body against microbes [4]. Lower levels may, therefore, increase the risk of infections.

Among 40 people with severe trauma, those with low ApoB levels had an increased risk of infection compared to those with higher levels [19].

Ways to Increase Apolipoprotein B Levels

1) Reduce Alcohol Consumption

Alcohol decreases your ApoB levels. Reducing alcohol consumption may help raise your ApoB levels. In a study of 16 people, those who drank alcohol saw a decrease in their LDL-apoB levels [20].

In a study of 18 alcoholics, ApoB levels increased by 24% after they stopped drinking [21].

2) Drink Coffee

In an observational study of 77 people, ApoB levels increased with increasing coffee consumption [22].

3) Increase Saturated Fat Consumption

A study of 53 people found that increasing calories from saturated fat from 8% to 18% increased ApoB levels by 9.5% [23].

In a study of 40 people, those who ate more saturated fat had higher ApoB levels than those who ate less (15% vs 5% of calories) [24].

4) Increase Cholesterol Consumption

Eggs are rich in cholesterol, with a single large egg containing around 215 mg of cholesterol. In a study of 13 people who ate up to 3 large eggs a day, ApoB levels increased 0.93 mg/dL per 100 mg of cholesterol consumed [25].

Causes of High Apolipoprotein B Levels

1) Insulin Resistance and Diabetes

Insulin resistance is when the body no longer responds to the hormone insulin. This causes glucose to stay in the blood, raising blood sugar levels.

Insulin decreases ApoB production by promoting apoB breakdown and clearance in the liver. However, when cells become insulin resistant, ApoB is cleared less efficiently and blood levels increase [26].

In an observational study of 15 people, those with insulin resistance had 35% higher ApoB levels than those without the condition [27].

An observational study of more than 700 people found that ApoB levels were 15% higher in people with diabetes than in healthy people [28].

In another observational study of 1,500 people, diabetics had higher ApoB levels than non-diabetics. ApoB levels were then tested again after three months. Increases in ApoB levels were directly linked to increases in blood sugar levels [29].

2) Diets High in Saturated Fats, Fructose, and Cholesterol

A study of 53 people found that increasing calories from saturated fat from 8% to 18% increased ApoB levels by 9.5% [23].

Similarly, in a study of 40 people, those who ate more saturated fat had higher ApoB levels than those who ate less (15% vs 5% of calories) [24].

Data suggests that over 13% of the U.S. population consumes 25% or more of energy from added sugars. A study showed that eating 25% calories from fructose and high-fructose corn syrup increased ApoB levels in 48 people after only 2 weeks [30].

In almost 25,000 people, those who had higher intakes of sucrose and food products containing added sugar (such as pastries, sweets, chocolate, jam/sugar, and sugar-sweetened beverages) had higher ApoB levels [31].

In a study of 13 people who ate up to 3 large eggs a day, ApoB levels increased 0.93 mg/dL per 100 mg of cholesterol consumed [25].

3) Smoking

In an observational study of over 24,000 men and 35,000 women, current smokers had higher levels of ApoB than non-smokers [32].

In almost 25,000 people, ApoB was linked to smoking [31].

Similarly, in 600 people, ApoB levels were higher in current cigarette smokers than non-smokers. The association was significant for men but not women [33].

In addition, in over 250 men, those who smoked over 20 cigarettes/day had about 12 mg/dL higher ApoB levels than non-smokers [34].

However, a study of over 10,000 adolescents and adults failed to show any significant effect of smoking on ApoB levels [35].

4) Drinking Coffee

In an observational study of 77 people, drinking more than two cups a day of coffee was linked to higher ApoB levels. Less than two cups day showed no association with ApoB levels [22].

In 42 people with high cholesterol, 8 cups a day of boiled coffee, but not filtered coffee or tea, increased ApoB levels [36].

Further, in 180 men who drank coffee, ApoB increased in those who changed to decaf. This suggests that a coffee component other than caffeine is responsible for the effect [37].

However, in a study of 119 healthy students, neither filtered nor decaffeinated coffee had an effect on ApoB [38].

5) Lack of Sleep

In an observational study of 7,300 people, sleeping less than 6 hours a night was associated with a 75% increased risk of high ApoB levels compared to sleeping seven to eight hours [39].

In another study with over 8,500 people, sleeping less than 6 hours increased the odds of having high ApoB by 1.8 times in women. The association was not significant in men [40].

6) Sleep Apnea

In 570 women with suspected obstructive sleep apnea, ApoB levels increased with apnea severity, but only in non-obese subjects and those < 55 years of age [41].

7) Being Overweight/Obese

Higher ApoB was linked to higher BMI in an observational study of almost 25,000 people [31].

Similarly, in 298 people with diabetes, higher BMI was associated with higher ApoB levels [42].

The same was shown in a study of 76 men and 115 women [43].

However, one study failed to find a link between ApoB and BMI in young Cherokee adults [44].

A study of 35 obese people found that a 12% weight loss resulted in 17% lower ApoB levels over 16 weeks [45].

8) Hypothyroidism

In an observational study of more than 200 people, those with hypothyroidism had 35% higher ApoB levels than those with normal thyroid function [46].

Another observational study of more than 400 people found that hypothyroid patients had elevated ApoB levels [47].

ApoB levels decreased by 27% in 19 people with hypothyroidism after treatment improved their thyroid function [9].

9) Menopause

Sex hormones influence ApoB levels.

In an observational study of 1,600 women, ApoB levels were higher in postmenopausal than in premenopausal women [5].

In another observational study of 37 women, postmenopausal women had higher ApoB levels than premenopausal women [48].

10) Kidney Disease

In an observational study of 30 people, those with chronic kidney disease had 30% higher ApoB levels. This was due to less ApoB being removed from circulation [49].

Nephrotic syndrome is a kidney disorder that causes the body to release too much protein in the urine. Nephrotic syndrome causes more apoB to be made by the liver and less removed from circulation [50].

11) Non-Alcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is the liver manifestation of obesity and metabolic syndrome.

In an observational study of 22k people, those with non-alcoholic fatty liver disease (NAFLD) had 18% higher ApoB levels [51].

Higher ApoB levels were linked with NAFLD in over 8k people, both normal-weight and obese [52].

In 25 obese subjects, higher liver fat content was associated with higher ApoB levels [53].

12) Growth Hormone Deficiency

In an observational study of 25 people, individuals with growth hormone deficiency had 25% higher ApoB levels than healthy controls [54].

Treatment of growth hormone deficiency increases the removal of ApoB from circulation [55].

13) Genetic Disorders

ApoB levels are high in inherited genetic disorders such as familial hypercholesterolemia and hyperlipidemia [56, 57].

Effects of High Apolipoprotein B Levels

1) Increase The Risk of Heart Disease

VLDL, IDL, and LDL molecules contribute to the hardening of the arteries and heart disease because they can lodge in blood vessels walls and cause plaques. Because ApoB levels are a marker of how many of these molecules are in the blood, they can reveal your risk of heart disease [1].

Many observational studies show that high apoB levels are strongly linked to an increased risk of heart disease. ApoB is even a better measure of heart disease risk than traditional risk factors LDL-C, total cholesterol, and triglycerides [58, 59, 60, 61, 62, 63, 64, 65].

2) Increase The Risk of Diabetes

One observational study tested apoB and blood sugar levels of more than 600 healthy people at baseline and then 10 years later. High ApoB levels increased the risk of developing type 2 diabetes over the 10-year period [66].

High ApoB levels were associated with higher HbA1c levels (a measure of 3-month average glucose levels) in an observational study of over 400 people. Women with high ApoB levels at baseline had increased HbA1c levels after 1 to 2 years [67].

3) Cancer Risk

Higher ApoB levels were linked to an increased risk of lung and colorectal cancer in an observational study of 5,200 people. However, higher apoB levels were associated with a decreased risk of breast cancer in women [68].

4) Linked to Higher Ferritin Levels

High ferritin (a marker of iron levels) levels are linked to high ApoB levels in women [69].

5) Linked to Memory Decline and Alzheimer’s

People with depression often have issues with brain function including memory. In an observational study of 180 people, higher ApoB levels were associated with worse memory scores in those with depression [70].

An observational study of 56 people found that those with Alzheimer’s disease had 26% higher ApoB levels than those without the disease [71].

In animals, too much ApoB promotes memory decline and brain cell damage [72].

Ways to Decrease Apolipoprotein B Levels

1) Eat a Healthy, Balanced Diet

Mediterranean Diet

A Mediterranean diet is high in olive oil, leafy greens, legumes, and nuts and fruits. Foods eaten in moderation include fish, meat, and dairy.

A study of 70 people found that eating a Mediterranean diet for 4 weeks decreased ApoB levels by 10% [73].

Another study of 551 people at high risk of heart disease found that the Mediterranean diet reduced ApoB levels by 4.4% compared to a low-fat diet [74].

More Fish

Eating oily fish (2.8 oz, or 80 g, a day) such as salmon and herring for 8 weeks reduced ApoB levels in 126 people [75].

In a study of 20 people, a diet that included fish at least two times a week reduced ApoB levels by 23% over 24 weeks compared to a typical Western diet [76].

More Nuts

A meta-analysis of 61 studies and 2,500 people concluded that eating nuts decreased ApoB levels by an average of 3.7 mg/dL [77].

A study of nearly 200 people found that eating 43 g of walnuts a day for 8 weeks decreased ApoB by nearly 7 mg/dL [78].

In an observational study of 9,600 people, those who ate nuts more than 4 times a week had half the risk of having high ApoB levels compared to those who never ate nuts [79].

A meta-analysis of six studies and 250 people found that hazelnuts decreased ApoB levels in three studies [80].

More Soluble Fiber

A diet high in soluble fiber decreased ApoB levels over 6 weeks in a study of 44 people [81].

Less Fructose

Eating > 25% calories from fructose and high-fructose corn syrup increased ApoB levels in 48 people [30].

In almost 25,000 people, those who had higher intakes of sucrose and food products containing added sugar (such as pastries, sweets, chocolate, jam/sugar, and sugar-sweetened beverages) had higher ApoB levels [31].

Less Fried and Roasted Food Consumption

Compounds in fried and roasted foods called advanced glycation endproducts (AGEs) are able to raise ApoB levels. When 26 people consumed diets low in AGEs, their ApoB levels decreased by 25% [82].

Alternatives to frying and roasting include boiling, poaching, stewing, or steaming your food.

Less Saturated Fats

Consuming 18% of calories from saturated increased ApoB levels by 9.5% compared to eating 8% of calories from saturated fat (53 total people) [23].

People who ate 15% of calories from saturated fat had higher ApoB levels after three weeks than those who ate 5% of calories from saturated fat (40 total people) [24].

Less Cholesterol

In a study of 13 people who ate up to 3 large eggs a day, ApoB levels increased 0.93 mg/dL per 100 mg of cholesterol consumed [25].

Remove Trans Fats

A meta-analysis of 51 studies found that substituting palm oil for trans fats resulted in lower ApoB levels [83].

Vegetable Oils

An 8-week study of 16 men found that eating 39% of calories as fat from diets rich in safflower and canola oils reduced ApoB levels by as much as 24% compared to a typical American diet [84].

2) Exercise

Resistance exercise decreased ApoB levels by 50 mg/dL over 3 months in 52 people with type 2 diabetes [85].

Another study of over 300 obese people found that five months of resistance training decreased ApoB levels [86].

One study found that performing endurance exercise three times a week for a year reduced ApoB levels in 188 people [87].

An observational study of over 100 people found that those who engaged in 30 – 60 minutes of moderate exercise five days per week had 14% lower ApoB levels than those who didn’t exercise at all [88].

Circuit training combines resistance training and aerobic exercise. High-intensity circuit training reduced ApoB levels more than endurance exercise in a study of 58 people [89].

3) Lose Weight

A study of 35 obese people found that a 12% weight loss resulted in 17% lower ApoB levels over 16 weeks [45+].

In 9 people with non-alcoholic fatty liver disease, a low-fat diet caused weight loss and decreased ApoB levels [53].

4) Get Enough Sleep

Sleeping less than 6 hours a night is associated with higher ApoB levels [39, 40].

5) Drink Less Coffee

Drinking coffee (over 2 cups/day) is linked to higher ApoB levels [22].

The same effect is observed with decaf [37].

6) Don’t Smoke

Several studies found higher ApoB levels in smokers [32, 31, 33, 34].

7) Supplements

Omega-3s Fatty Acids

A study of 20 people found that 4 grams of omega-3 fatty acids a day for eight weeks reduced ApoB levels by 8% [90].

Niacin (Vitamin B3)

Niacin increases the rate at which ApoB is cleared from the blood. In a study of 5 men, 2 grams of niacin a day for 12 weeks reduced ApoB levels [91].

Beta-glucans

Beta-glucans are long chains of sugars that stimulate the immune system. A study of 59 people found that supplementing 3 grams of beta-glucans for eight weeks reduced ApoB levels [92].

Probiotics

Taking L. reuteri (2 billion colony forming units, or CFUs) for nine weeks reduced ApoB levels by 8% in a study of 127 people with high cholesterol [93].

Another study of 114 people with high cholesterol levels found that taking L. reuteri (1 billion CFUs) twice a day for six weeks reduced ApoB by 7 mg/dL [94].

Resveratrol

Resveratrol reduces the production of ApoB in the liver. In a study of 75 people, supplementing with resveratrol and grape extract for six months lowered apoB levels by 10%. Supplementing with grape extract alone had no effect on ApoB levels [95].

Berberine

In a study of 40 people, taking 500 mg berberine HCL resulted in 15% lower ApoB levels over the course of four weeks [96].

Astaxanthin

In a 12-week study of 27 people, 20 mg of astaxanthin lowered ApoB levels by 8% [97].

Phytosterols

Phytosterols are compounds found in the cell membranes of plants that are similar to cholesterol. They actually decrease the absorption of cholesterol from food.

Consuming a spread enriched with 12 grams of phytosterols a day for three weeks reduced ApoB levels in a study of 53 people [98].

Plant sterols are found in wheat germ, vegetable oils (corn, sesame, canola, and olive oil), peanuts, almonds, and fortified foods.

L-Carnitine

In a study of 84 people, two grams of L-carnitine for 30 days lowered ApoB by 30 mg/dL [99].

Vitamin C

A study of 68 people found that supplementing with 500 mg vitamin C daily for 10 weeks decreased ApoB by 20 mg/dL [100].

Supplementing with 2g of vitamin C daily for one month reduced ApoB levels by 6% in women and 8% in men in a study of 124 people [101].

Konjac Glucomannan

Glucomannan is a type of fiber found in the root of the konjac plant.

A study of 22 people with high cholesterol levels found that 3.6 grams of konjac glucomannan a day for 28 days reduced ApoB levels by 13% [102].

Red Yeast Rice and Olive Extract

A combination of red yeast rice and olive extract reduced ApoB levels by 15% over eight weeks in a study of 50 people [103].

Red Ginseng and Cheonggukjang

Cheonggukjang is a fermented soybean paste from Korea. Supplementing with a combination of red ginseng and cheonggukjang decreased ApoB levels by 37.7 mg/mL in a study of 45 people [104].

Fish Oil

Rats fed a diet rich in fish oil produced less ApoB in the liver and gut [105].

Coconut oil

Incorporating coconut oil into the milk of young calves reduced the production of ApoB in the liver [106].

Maritime Pine Oil

Mice given maritime pine oil had reduced ApoB levels after two weeks [107].

Citrus Flavonoids

A cell study found that flavonoids found in citrus fruits blocked the release of ApoB in liver cells [108].

Effect of Drugs on Apolipoprotein B Levels

Drugs that increase Apolipoprotein B

  • Androgens/anabolic steroids [109]
  • Chemotherapy drugs including doxorubicin (Adriamycin, Doxil, Lipodox) and paclitaxel (Taxol, Abraxane) [110]
  • Carbamazepine (Tegretol, Carbatrol, Epitol), used to treat seizures and nerve pain [111, 112]
  • Cyclosporine (Neoral, Sandimmune, Gengraf) and tacrolimus (Prograf, Protopic, Astagraf XL), drugs used to suppress the immune system and prevent organ rejection after transplants [113]
  • Infliximab (Remicade), a drug used to treat autoimmune disease [114]
  • Protease inhibitors used to treat HIV [115]

Drugs that decrease Apolipoprotein B

  • Statins (Lipitor and Zocor), used to reduce high cholesterol levels [116]
  • Fibrates such as gemfibrozil (Lopid), used to reduce high cholesterol and triglyceride levels [117]
  • Bile acid sequestrants such as cholestyramine (Questran) and colestipol (Colestid), used to lower high cholesterol levels [118, 119]
  • Ezetimibe (Zetia), used to lower cholesterol levels by decreasing how much cholesterol is absorbed in the gut [119]
  • PCSK9 monoclonal antibodies such as alirocumab (Praluent) and evolocumab (Repatha), used to reduce high cholesterol levels [120]
  • Selective estrogen receptor modulator (SERMS) such as raloxifene (Evista), used to treat and prevent osteoporosis in postmenopausal women [121]
  • Dabigatran (Pradaxa), a blood thinner used to treat and prevent blood clots and reduce the risk of stroke [122]
  • Mipomersen (Kynamro), used to treat familial hypercholesterolemia [123]

Genetics of Apolipoprotein B

Low ApoB Levels

Familial hypobetalipoproteinemia, familial combined hypolipidemia, and abetalipoproteinemia are genetic disorders that result in low or undetectable levels of ApoB. Mutations in the following genes can cause these disorders [124, 15, 16]:

The following SNPs are associated with decreased ApoB levels [125]:

High ApoB Levels

Familial hypercholesterolemia and hyperlipidemia are genetic disorders that result in high ApoB levels. Mutations in the following genes can cause these disorders [56, 57]:

The following SNPs are associated with increased ApoB levels [126, 125, 127]:

Irregular ApoB Levels?

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About the Author

Will Hunter

BA (Psychology)
Will received his BA in Psychology from the University of California, Los Angeles. 
Will's main passion is learning how to optimize physical and mental performance through diet, supplement, and lifestyle interventions. He focuses on systems thinking to leverage technology and information and help you get the most out of your body and brain.

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