Kitchen sink approach for Lp(a)

Lipoprotein(a), Lp(a), can be a tough nut to crack.

Having struggled and wrestled with this genetic pattern for the last 12 years or so in hundreds of patients, I have gained great respect for this difficult to control pattern.

I regard lipoprotein(a) as the number one most aggressive cause for heart disease and coronary plaque known. It can account for heart attacks in men in their 40s, women in their 50s. It can cause heart disease and heart attacks in even the ultra-fit like marathon runners. It accounts for both excessive coronary risk and misleading cholesterol values in slender, healthy-appearing people.

Niacin is the number one treatment choice for Lp(a), followed by testosterone for men, estrogens (preferably human, not horse or other non-human mammal) for women. I then often resort to DHEA, along with adjunctive nutritional agents like raw almonds, ground flaxseed, and others.

Our most recent addition to the Lp(a) treatment list is high-dose fish oil, which appears to exert a significant effect in about 40% of people with Lp(a).

Even with this multi-agent approach, not everybody gains control over Lp(a).

That makes me wonder if someone has Lp(a) at a substantial level of, say, 200 nmol/L or 70 mg/dl (values can differ tremendously, depending on the method of measurement), should we throw everything but the kitchen sink at Lp(a) from the start? Right now, by adding an agent one at a time, it often takes two years to gain control over Lp(a) (if we are going to get it at all).

While many people might find this unpalatable and overwhelming from the starting gate of their program, I do believe it may be a strategy we should consider adopting for full and more immediate plaque control in the Track Your Plaque program. Something to chew on.

Clearly, we need better answers for Lp(a). A "kitchen sink," full-frontal assault might be a way to gain faster control, though not necessarily a superior approach with regards to efficacy and potency.

There are a number of unique, potentially effective therapies for Lp(a) that are worth examining. Given the difficulty of performing clinical trials with non-drug agents (largely a lack of financial support, since nobody gets a financial return with non-patent-protectable agents), I am anxious to put these potential treatments to a test in the Track Your Plaque program Virtual Clinical Trail (VCT). The VCT gives us a quick and relatively easy method to test various potential treatments, with feedback generated in months, rather than years.

Any suggestions on promising agents to test? Of course, they must be widely available nutritional agents, not drugs.

Comments (12) -

  • Anonymous

    8/29/2008 4:45:00 PM |

    Dr. Davis, first, thanks for one of the best blogs on the net.

    I'd suggest testing krill oil to see if it offers an advantage over plain fish oil.

    I'd also consider testing the rather extreme diet followed by the guy who does the Hyperlipid blog.  (Extreme high fat, moderate protein, essentially zero carb.)

    (By the way, he has an interesting post where he argues that in the presence of dietary sugar and/or excess alcohol intake, that fish oil is actually very dangerous.

  • donny

    8/29/2008 7:18:00 PM |

    I got this from the Wikipedia page on Lp(a). Subjects were fed casein, safflower oil, and cornstarch, or the same but with soy replacing the casein. With soy, Lp(a) levels were slightly decreased, with casein, they were radically decreased. (By as much as 65 percent.)

    Those fish-eating Bantu Islanders from the Kitiva study--they weren't just eating more omega 3's, they were also eating a lot more protein, and better quality protein at that.

  • Anonymous

    8/31/2008 3:57:00 AM |

    Hi Dr. Davis,

    Doxycycline works to reduce Lp(a) in some patients...

    Doxycycline inhibits the production of Leukotrienes produced through the 5-Lipoxygenase inflammatory pathway.

    I think you've hit the nail on the head here with the question of whether it would be better to hit Lp(a) with every weapon in the arsenal right from the start...

    So, all the inhibitors of the 5-LO pathwy would be used from the start including High dose EPA/DHA, Boswellia, Curcumin, Pycnogenol, Resveratrol, Quercetin, etc.

    Hit it with everything right from the start...


  • Anonymous

    8/31/2008 4:06:00 AM |

    Forgot another possibly significant angle on this "kitchen sink" idea...

    Include the new software tools/devices in the Virtual Clinical Trial to increase Heart Rate Variability to reduce the inflammation that most likely drives Lp(a) level.

    Re: the concept of the kitchen sink...

    It can take years to cycle through all the potential supplement and other solutions to high Lp(a) in the difficult cases.

    Why not throw the kitchen sink right from the start for the TYP program "high risk" members?



  • Anonymous

    8/31/2008 4:10:00 AM |

    Regarding diet....

    I am increasingly more impressed with the essential argument of the PaleoDiet that G keeps bringing up...

    Why is it that study after study finds the "nuts, berries, leaves, bark, and meat" which are central to the paleo diet to reduce risk?

    It seems to me that the essential argument of the paleo diet makes scientific sense and that the detailed studies of the nuts, berries, bark, and meat are supportive as well.


  • JohnN

    9/1/2008 7:16:00 AM |

    Dr. Davis,
    My two-cent suggestion for a full-frontal assault would include the followings:
    1. Drastically lower basal and total insulin production through ketogenic diet (the anabolic hormone that promotes inflammation). In this context, intermittent fasting and/or a high-fat diet is a component of this approach.
    2. Promote cell membrane flexibility/suppleness with fish-oil and simultaneously cut back on omega-6 intake.
    3. L-Arginine and/or nasal-breathing aerobic/anaerobic physical activities to promote nitric oxide production by the endothelial cells - vasodilation
    4. Potassium supplement from spices, vegetables and fruits (low fructose) to help lower blood pressure.
    5. Correct other nutritional deficiencies (vitamins D, A, niacin, magnesium, etc.)
    6. Treating the root cause of Lp(a) production. I'm partial to the Pauling's hypothesis which asserts that (a) the small, dense and sticky Lp(a) is the body's first response to patch the cracked coronary arteries that break down due to constant high pumping pressure; and (b) Lp(a) production is unique to primates who have lost the ability to synthesize ascorbic acid. Therefore, high dose vitamin C to cure scurvy of the heart and Lysine and Proline to bind to and remove Lp(a) that forms plaque.

    If all of that fail to produce the desire outcome after 6 months or so then it's time to get naked and carry a sharpened stick to the woods to did up some tubers and kill your own meat.

  • Anonymous

    9/3/2008 3:06:00 AM |

    Dr. Davis, thanks for an a great blog.

    I'd suggest testing the following:

    After one year, arterial plaque decreased 30% for those patients who consumed 8oz Pomegranate Juice daily, compared to a 9% worsening for patients who drank a placebo:

    Blood flow to the heart improved approximately 17% for those patients who consumed 8oz Pomegranate Juice daily but worsened approximately 18% in the comparison group:  
    same as:

    Statin dosage may need to be reduced because pomegranate acts like grapefruit.

    Seaweed sushi wrap for increased iodine.

    Daily Japanese iodine consumption vary from 5,280 mcg to 13,800 mcg; by comparison the average U.S. daily consumption is 167 mcg. It has been hypothesized the amount of iodine in the Japanese diet has a protective effect for breast and thyroid disease:  
    same as:

    HeartHawk (blog) thinks his hypothyroidism has caused some of his Lp(a) problems.

    Matt W

  • scatman75

    9/11/2008 3:37:00 PM |

    Apparently some people in the Netherlands believe in Doxy as well, enough to warrant a trial.

    The effects of doxycycline treatment on inflammation and endothelial function in advanced atherosclerosis

    My mother-in-law has fibromyalgia and host of viral infections, one bacterial, along with Lpa around 240, and of course elevated CRP. She is starting on Doxy for the bacterial infection.  Maybe we can hit two birds???

    Thanks Dr Davis for an excellent blog.  Hopefully with info from you blog we can slow down her PAD (100% blocked carotid + 4 blocked arteries below the knee) and keep her legs!

  • Heather

    9/18/2009 3:08:11 AM |

    Matt made a mention of Iodine.

    Dr. Guy Abraham has been doing all sorts of studies with and Iodine/Iodide combination. It has proven to be very effective in treating fibrocystic breast/ovarian disease, which are also responsive to estrogen. From looking at many of the studies he's published ( he seems to like to collaborate with physicians with a clinical practice. Perhaps he would be interested in working with you to look at the Lp(a) problem and see if iodine/iodide has any affect.

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  • buy jeans

    11/3/2010 6:19:34 PM |

    While many people might find this unpalatable and overwhelming from the starting gate of their program, I do believe it may be a strategy we should consider adopting for full and more immediate plaque control in the Track Your Plaque program. Something to chew on.