A rebuttal to Peter Attia's claim that lowering ApoB prevents heart disease. The speaker argues that causality alone doesn't make something worth treating, comparing it to how you could theoretically prevent fire by removing oxygen, but that's not the right intervention.
Causality is an obsession of mine. Most of the day, on some level, I sit around thinking about causality.
A clip of Dr. Peter Attia on the Huberman Lab podcast discussing LDL cholesterol, ApoB, and heart disease and causality has been making the rounds, and I recently offered a respectful rebuttal. That was, I think, thus far pretty well received. Here's the 1-minute version. Peter argues that ApoB and LDL are causal in cardiovascular disease, and therefore should be lowered within reason. His logic is that if a variable causes disease, reducing that variable reduces disease, just like reducing smoking reduces risk of lung cancer. It sounds compelling on its surface, but that claim and that analogy, I think they're a little misleading. We could deconstruct the analogy and apply it to other causal variables and outcomes like oxygen and fire. Yes, oxygen causes fire. So, reducing oxygen in the environment will prevent fire, all else being equal. It technically holds up. But personally, I'd rather risk spontaneous combustion than suffocate. And yeah, that's an extreme opposition analogy, but it hints at a bigger point. Causality is a powerful concept, it is, but it's often misused. Just because a biomarker, like ApoB, is causal doesn't automatically mean it needs to be treated. It doesn't mean it's sufficient to cause disease. The TL;DR version: causality does not equal importance, and it certainly doesn't necessitate treatment. Of course, this is a short and doesn't represent the full scope of either Peter Attia or my own position. But if this got you thinking, please check out the slightly longer rebuttal. I think you'll find it direct, but respectful and reasonable, but I'll let you be the judge of that. Let's open up a conversation. Check the notes.
