Dear Member,

In the December 27 e-Alert, we wrote to you about a new way to assess your risk of heart disease. It’s the ratio between apolipoprotein B (apo B) and apolipoprotein A-1 (apo A-1), and studies have shown it can be even more meaningful than the HDL/LDL ratio. In fact, in the study I wrote about last month, men with the highest levels of apo B and the lowest levels of apo A-1 were nearly FOUR TIMES as likely to have a fatal heart attack than those with opposite values. (You can view this e-Alert on our website,, on the “Current e-Alerts” page.)

Since that e-Alert, many of you have written to thank us for this information – and to ask what you can do to improve your apo ratio. We took that question to our medical advisor, Dr. Martin Milner, who routinely monitors his patients’ apo levels. So today I’ll turn it over to Dr. Milner, who will tell you what you can start doing TODAY to improve your ratio – and reduce your risk of a heart attack.

Three-pronged approach offers comprehensive protection

When my patients need help improving their apo ratio, I recommend concentration on three areas: diet, lifestyle, and a supplement program. The first two include many of the same basic steps you would take to address overall heart health. But the third gets into more specific therapies that can help lower apo B levels and increase apo A-1 levels.

Anyone concerned with heart health should start with a nutritional approach. Here are some dietary changes I recommend to my patients:

  • Overall, aim for a diet that consists of 30 percent protein, 50 percent carbohydrate, and 20 percent fat. (Percentages reflect percent of total calorie intake.) On days when you eat a lot of fish, you can consume up to 30 percent fat and reduce your carbohydrate intake to 40 percent.
  • Avoid foods high in saturated animal fat and cholesterol, such as red meat and dairy products. Lean chicken and turkey without skin and fish are fine.
  • Add more vegetables to your diet. Eat three to five servings daily.
  • Choose carbohydrates that are low in their glycemic index, like apples, yams, legumes, beans, whole grains, nuts and seeds. Avoid all refined carbohydrates.
  • Eat three meals and three snacks daily to maintain steady blood sugar.
  • Add more fiber to your diet. Try adding two to four tablespoons of psyllium or organic ground flax seeds to your meals daily. The goal is to widen your stool volume; make a circle by touching your index finger to your thumb and you’ll see the stool circumference you’re shooting for.
  • Eat plenty of garlic, onions, and shallots, and season your foods with ginger. They’ll all been found to lower cholesterol and inflammation.

As far as lifestyle changes, I recommend getting some sort of exercise every day. Shoot for 30 minutes of aerobic exercise at your target heart rate every other day, with some sort of resistance exercise (push-ups, sit-ups, leg lifts, etc.) on the alternate days.

I also recommend findings way to reduce stress. Exercise is a great way to do this, but if you find you need more help try meditation, deep breathing, hiking in the woods, taking a bath by candlelight – anything that helps you relax and unwind. You may also want to try the “Freeze-Frame” program, an impressive self-relaxation method which has been proven to lower blood pressure and reduce anxiety.

Targeted supplements to reduce your risk

There are also some specific supplements that I recommend to lower apo B and increase apo A-1:

  • 200 mcg of chromium each day.
  • 1 to 5 mcg of vanadium three times a day.
  • 50 to 200 mg of alpha lipoic acid three times a day.
  • 2 to 6 grams of fish oil each day.
  • 300 mg l-carnitine two to three times or day (or try a medicated food like UltraGlycemX (Note: you can find more information about UltraGlycemX in the May 2000 issue of the HSI Members Alert newsletter.)

Remember, apo B and apo A-1 are subsets of cholesterol; apo B is the protein component of LDL, and apo A-1 is the protein component of HDL. So many of the recommendations are similar. But the test provides a unique way to assess your risk, so that you have the opportunity to address your heart health more aggressively if needed. With my patients, I have seen impressive results from this approach.

Martin Milner, N.D.
HSI Medical Advisor