Heart and metabolism · Hopkins, Minnesota
Lp(a) and ApoB: The Cholesterol Numbers Worth Knowing
Your cholesterol panel came back fine, but heart disease runs in your family. Maybe you've wondered why no one has checked your Lp(a) or ApoB. In a two-hour first visit, Dr. Jacob Panka looks at both through a functional lens, alongside your family history and current labs, then helps you sort out what you can change.
Lp(a) and ApoB are two cholesterol markers a standard panel usually skips. Lp(a) is set mostly by your genes, so lipid experts recommend testing it at least once as an adult. ApoB counts the particles that build plaque, and it can run high even when LDL looks normal. Food and exercise can lower ApoB but barely change Lp(a), so the rest of your risk matters more.
How we approach this at Panka Natural Health
Dr. Jacob Panka, ND, MS, focuses on heart and metabolic health, and he weighs every test against the research. Your first visit runs two full hours. He reads the lipid panels you already have through a functional lens, looking at patterns and trends rather than one flagged number. He asks about your family history, blood pressure, blood sugar, sleep, stress, training, and an ordinary week of eating. If Lp(a) or ApoB has never been measured, he'll talk with you about adding them. Then he sorts out which numbers you can move and how hard to push. You see the same two doctors at every visit, and secure messaging through the Charm portal is included, with no membership.
Lp(a): the inherited number worth checking once
Lipoprotein(a), or Lp(a), is an LDL-like particle with an extra protein attached. More than 90% of the difference in Lp(a) between people comes from genes, and your level is set early in life. That's why European and U.S. lipid experts recommend checking it at least once as an adult. About one in five people have elevated Lp(a), which is linked to heart attack, stroke, and narrowing of the aortic valve. For example, a result of 125 nmol/L (about 50 mg/dL) or higher falls in the range the National Lipid Association calls high risk. Dr. Jacob reads it alongside your other risk factors. If yours is high, your parents, siblings, and children may want testing too.
ApoB vs. LDL cholesterol: cargo vs. trucks
LDL cholesterol measures how much cholesterol your LDL particles carry. Every plaque-forming particle carries exactly one ApoB protein, so ApoB counts the particles. Think of LDL cholesterol as the cargo and ApoB as the number of trucks. The two usually move together, but when they don't, heart risk tends to follow ApoB. That mismatch is more common with high triglycerides, extra weight, or insulin resistance. These make smaller particles that each carry less cholesterol, so LDL can look fine while the particle count is high. It's one reason Dr. Jacob doesn't stop at whether your LDL is flagged. ApoB barely changes after eating, so it can be drawn with a standard lipid panel. Insurance coverage varies.
Lp(a) and ApoB: what food and fitness can and can't change
Food and exercise barely move Lp(a). That's not a reason to give up. When Lp(a) is high, the National Lipid Association recommends earlier, more intensive work on your other risks, mainly LDL cholesterol, which does respond to what you do. Nutrition changes can lower LDL cholesterol and ApoB. The National Heart, Lung, and Blood Institute's heart-healthy pattern is built on vegetables, fruit, whole grains, and beans, with less saturated fat. Its DASH eating plan has been proven to lower blood pressure and LDL cholesterol. Dr. Jacob also looks at blood sugar, sleep, alcohol, and training, then picks the few changes that fit your week. Sustainable beats perfect.
Medication decisions stay with your prescribing physician
Minnesota naturopathic doctors don't prescribe statins or other prescription cholesterol medicines. For some people with high Lp(a) or ApoB, those medicines belong in the plan. The National Lipid Association recommends them for people at high risk. Whether you hope to avoid a statin, reduce one, or get the most from the one you take, Dr. Jacob coordinates with your prescribing physician, helps you bring clear questions, and checks every supplement against your medications. We never ask you to stop or change a medication on your own. New medicines aimed at Lp(a) are being studied. Ask your physician or a lipid specialist whether any could fit you.
This visit may fit if…
Your cholesterol looks normal, but heart disease or stroke runs in your family.
You've never had Lp(a) or ApoB measured, or you aren't sure what your results mean.
Your LDL looks fine, but triglycerides are high or blood sugar is creeping up.
You're discussing a statin and want a nutrition and fitness plan alongside it.
See someone else first if…
Chest pain, pressure, or discomfort, with or without arm, jaw, or back pain, shortness of breath, or a cold sweat: call 911.
Sudden face, arm, or leg weakness on one side, trouble speaking, vision loss, or loss of balance can mean a stroke: call 911 and don't drive yourself.
Chest discomfort that's getting worse, comes at rest, or doesn't ease after a few minutes of rest: call 911. New chest discomfort with exertion that eases with rest: see your physician the same day if you can.
Fainting, dizzy spells, or unusual breathlessness with exertion, a very high LDL, or yellowish cholesterol deposits on your eyelids or tendons: see your physician first.
Bring a clearer picture to your visit
Every lipid panel you can find, plus any Lp(a) or ApoB results and their units.
Your medications and supplements with doses, including any cholesterol medicine.
Family history: who had a heart attack, stroke, stent, or valve problem, and at what age.
Notes on a typical week of eating, activity, sleep, and alcohol.
Common questions
Do I need to repeat my Lp(a) test?
Usually not. Because Lp(a) is mostly genetic, the European consensus found that repeat testing generally doesn't improve risk prediction. Exceptions, where your clinician may recheck, include a test taken during an acute illness, kidney or liver disease, or a test done in childhood.
Can supplements lower Lp(a)?
We don't count on any supplement to lower Lp(a), so be wary of products that promise it. The European consensus advises against niacin for Lp(a), since two outcome studies showed no benefit. Dr. Jacob focuses on what you can move, like ApoB, LDL, and blood pressure.
Do you take insurance, and what does it cost?
We're direct-pay and out-of-network with all insurers. We provide a superbill for possible out-of-network reimbursement and accept HSA and FSA. Medicare and Medicaid don't reimburse naturopathic services in Minnesota. Your other providers may be able to order some tests through insurance, or you can pay cash for testing through us. Current fees are on the scheduling page.
Can I do this by telehealth?
Yes, if you're physically located in Minnesota or Wisconsin at the time of the visit. In-person visits are at our downtown Hopkins clinic.
Real doctors. Real time with you.
Panka Natural Health is a family-owned clinic in downtown Hopkins, led by Drs. Haley and Jacob Panka since 2018. You see the same doctor at every visit.
Your first visit
1. Book a visit or a free 10-minute intro call. The intro call is a short conversation about fit, not a medical visit.
2. Time for your whole story. Adult first visits run two full hours; children's visits are shorter. Bring prior labs and the bottles or photos of what you take.
3. A written plan. What to try, what to test if anything, and when to reassess. We coordinate with your other clinicians.
4. Support between visits. Messaging with your doctor is included between visits, with no membership. If a message turns into clinical work, like reviewing new labs or changing your plan, it's billed according to our messaging policy.
Direct-pay practice: out-of-network with all insurers, superbills for possible reimbursement, HSA and FSA accepted. Medicare and Medicaid do not reimburse naturopathic services in Minnesota. Current fees are on our scheduling page. Telehealth for patients located in Minnesota or Wisconsin at the time of the visit (virtual only in Wisconsin). Ample parking in front of and behind the building; the entrance is up four steps with handrails; the office is not wheelchair accessible, and virtual visits are an alternative.
Dr. Haley Panka, ND: Women's health and hormones, pediatrics, holistic diabetes care, and supportive care for breast cancer patients and survivors.
Dr. Jacob Panka, ND, MS: Brain and neuroendocrine health, cardiovascular and metabolic health, gut–brain physiology, and men's health.
Sources and further reading
General education, not a diagnosis. We work alongside your primary care clinician and specialists, not instead of them. Care and testing depend on your history and clinical needs.
Your questions are a good place to start.
Book a visit, or begin with a free 10-minute call to see whether we're the right fit.