Dr Jeremy London
Heart disease remains the world’s leading cause of death for both men and women. To reduce risk, learn how to manage cholesterol through diet.
Among the key risk factors for heart disease — smoking, high blood pressure, insulin resistance — elevated cholesterol, specifically Apolipoprotein B (ApoB) or atherogenic particles, stands out as one you can meaningfully influence through diet. Two specific dietary levers do most of the work.
Saturated fat is a significant lever
When you eat excess saturated fat, your liver senses the influx and responds defensively by assuming ‘we have enough cholesterol, stop importing more.’ The liver reduces the number of low-density lipoprotein (LDL) receptors responsible for clearing LDL particles out of the bloodstream, essentially closing the door to limit how much more fat gets pulled in.
With fewer receptors doing that clearance work, LDL particles stay in circulation longer, and your numbers climb. The reverse is also true: cut back on saturated fat, and the liver restores healthy receptor activity, actively pulling LDL out of the bloodstream rather than letting it accumulate.
This is a major reason poorly controlled blood sugar and
insulin resistance correlate so strongly with heart disease risk
Triglycerides are the second major driver
Triglycerides are closely tied to metabolic health. High triglyceride levels increase the number of atherogenic particles circulating in your blood. The liver packages triglycerides for transport in very-low-density lipoprotein (VLDL) particles that carry an attached ApoB marker. Once these particles deliver their cargo to tissue, they’re converted into intermediate particles, which are then either cleared by the liver or further broken down into mostly small LDL particles.
More triglycerides means more of these conversions and more circulating LDL and ApoB as a result. This is a major reason poorly controlled blood sugar and insulin resistance correlate so strongly with heart disease risk. The biggest dietary drivers of elevated triglycerides are refined carbohydrates, added sugars, excess calorie
intake, visceral fat and alcohol — all of which are directly modifiable.
Cleaning up saturated fat and triglycerides
If, after cleaning up both saturated fat and triglycerides, your ApoB levels still aren’t optimal, genetics is likely the dominant factor. This is when you’ll want to loop in a medical professional for further guidance.
