LDL Particle Sizes: Why Everyone Should Know Their No.? | Chris Kresser
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The Diet-Heart Myth: Why Everyone Should Know Their LDL Particle Number

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To read more about heart disease and cholesterol, check out this eBook on the Diet–Heart Myth.

Cardiovascular disease is one of the most misdiagnosed and mistreated conditions in medicine. In the first article in this series, I explained the evidence suggesting that eating cholesterol and saturated fat does not increase cholesterol levels in the blood for the majority of the population.

In this article, I will debunk the myth that high cholesterol in the blood is the cause of heart disease.

Myth #2: High Cholesterol Is the Cause of Heart Disease

Part of the confusion about cholesterol and its role in heart disease is caused by imprecise terminology. So, before I explain why high cholesterol is not the underlying cause of heart disease, we have to cover some basics.

Cholesterol is not technically a fat; rather, it’s classified as a sterol, which is a combination of a steroid and alcohol. It’s crucial to understand that you don’t have a cholesterol level in your blood. Cholesterol is fat-soluble, and blood is mostly water.

In order for cholesterol to be transported around the body in the blood, it has to be carried by special proteins called lipoproteins. These lipoproteins are classified according to their density; two of the most important in heart health and cardiovascular disease are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

I know this can get confusing quickly, so let me use an analogy to make this more clear. Imagine your bloodstream is like a highway. The lipoproteins are like cars that carry the cholesterol and fats around your body, and the cholesterol and fats are like passengers in the cars. Scientists used to believe that the number of passengers in the car (i.e. concentration of cholesterol in the LDL particle) is the driving factor in the development of heart disease. More recent studies, however, suggest that it’s the number of cars on the road (i.e. LDL particles) that matters most.

The crucial test for heart disease risk you’ve probably never heard of.Tweet This

Coronary arteries are essentially hollow tubes, and the endothelium (lining) of the artery is very thin—only one cell deep. The blood, which carries lipoproteins like LDL, is in constant contact with the endothelial lining. So why does the LDL particle leave the blood, penetrate the endothelium and enter the artery wall? The answer is that it’s a gradient-driven process. Going back to our analogy, the more cars there are on the road at one time, the more likely it is that some of them will “crash” into the fragile lining of the artery. It’s not the number of passengers (cholesterol) the cars are carrying that is the determining factor, but the number of cars on the highway.

The significance of this in terms of determining your risk of heart disease is profound. When you go to the doctor to get your cholesterol tested, chances are he or she will measure your total, LDL and HDL cholesterol. This tells you the concentration of cholesterol (passengers) inside of the lipoproteins (cars), which is not the driving factor behind plaque formation and heart disease. Instead, what should be measured is the number of LDL particles in your blood.

LDL cholesterol levels and LDL particle number are often concordant (i.e. when one is high, the other is high, and vice versa), and this is probably why there is an association between LDL cholesterol and heart disease in observational studies. The elevated LDL cholesterol was more of a proxy marker for elevated LDL particle number in these cases. But here’s the kicker: they can also be discordant. In layperson’s terms, it’s possible to have normal or even low cholesterol, but a high number of LDL particles. (1) If this person only has their cholesterol measured, and not their particle number, they will be falsely led to believe they’re at low risk for heart disease. Even worse, the patients that are the most likely to present with this pattern are among the highest risk patients: those with metabolic syndrome or full-fledged type 2 diabetes.

The more components of the metabolic syndrome that are present—such as abdominal obesity, hypertension, insulin resistance, high triglycerides and low HDL—the more likely it is that LDL particle number will be elevated. (2)

On the other hand, patients with high LDL cholesterol (LDL-C) and low LDL particle number (LDL-P) are not at high risk of heart disease. In fact, studies suggest they’re at even lower risk than patients with low LDL-C and low LDL-P. (3) Yet they will often be treated with statin drugs or other cholesterol lowering medications, because the clinician only looked at LDL-C and failed to measure LDL particle number. This is a concern for two reasons. First, statin drugs aren’t harmless. (I’ll go into more detail on this in the third post of the series.) Second, studies suggest that low cholesterol can increase the risk of death, especially in women and the elderly.

In one study of over 52,000 Norwegians, researchers found that women with total cholesterol levels below 195 mg/dL had a higher risk of death than women with cholesterol levels above that cut-off. (4) And a study published in the American Journal of Medicine found that people over 70 years of age with total cholesterol levels below 160 mg/dL had twice the risk of death than those with cholesterol levels between 160-199 mg/dL. (5) Low cholesterol is also associated with increased risk of disease—especially mental health and brain disorders. For example:

  • A study in the Journal of Psychiatric Research found that men with low total cholesterol levels were 7 times more likely to die prematurely from unnatural causes such as suicide and accidents than other men in the study. (6)
  • A 1993 study published in The Lancet found that depression was 3 times more likely in men over 70 with low cholesterol than in those with normal or high cholesterol. (7)
  • A Swedish study found that women with the lowest cholesterol suffered significantly more depressive symptoms than other women in the study. (8)
  • A study in the journal Neurology showed that low cholesterol is associated with increased risk of dementia. (9)
  • A paper published in the European Journal of Internal Medicine linked low cholesterol levels with Alzheimer’s disease. (10)

It’s important to note that all of these studies were observational, which means that they don’t prove that low cholesterol was the cause of the increased risk of death or disease that was observed. It’s possible, for example, that these patients had another disease that caused both the lower cholesterol and increase in disease or mortality. However, given what we know about the important roles of cholesterol in the body, it’s certainly plausible that low cholesterol is capable of contributing to these problems directly.

Wrapping Up: The Map Is Not the Territory!

Before concluding, I’d like to point out that although LDL particle number is superior to LDL cholesterol as a marker for heart disease, it’s still just that—a marker. A marker is not a disease. It’s a risk factor for a disease. Having a risk factor for a disease does not guarantee that you will get that disease—it just increases the chance that you will. There are still several gaps in our knowledge about LDL-P and its usefulness in a clinical setting. For example:

  • Imagine two people with an LDL-P above 2,000, which puts them in the highest risk group. Person A follows a Paleo diet and lifestyle, gets plenty of sleep, manages stress and has no other significant risk factors for heart disease. Person B eats a Standard American Diet, doesn’t exercise, doesn’t get enough sleep, is stressed out and has several other risk factors for heart disease. Logic would dictate that Person A would be at much lower risk for heart disease than Person B, but there isn’t any comparative data to quantify the difference in risk and it’s unlikely such a study will ever be done. (Who would pay for it?)
  • Imagine two people following a healthy Paleo-type diet and lifestyle. Person C has no conventional risk factors for heart disease. Person D has no conventional risk factors either, but does have an LDL-P of 2,000. Logic here would dictate that Person D is at higher risk than Person C, but again, we don’t have actual data to quantify the difference in risk.

Heart disease is a complex, multifactorial process. The likelihood that we’ll have a heart attack depends on numerous factors, including genetics, diet, lifestyle and living environment. The purpose of this article is not to suggest that LDL-P is the only risk factor that matters, or that other risk factors shouldn’t be taken into consideration. It is simply to point out that existing evidence suggests that LDL-P is a much better predictor of heart disease risk than LDL or total cholesterol, and that it appears to be one of the better markers available to us now.

Want to learn more? Check out my next article in the series “What Causes Elevated LDL Particle Number?“, followed by “Statins Don’t Save Lives in People Without Heart Disease.”

Note: if you’re interested in a much more thorough discussion of how to determine your risk of heart disease and how to use diet, supplements and lifestyle changes to protect yourself and those you love, check out the High Cholesterol Action Plan.

148 Comments

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  1. Is it possible that naturally low LDL can be a problem? My doc just informed me mine is 1.9 (I live in Canada: I think that works out to around 73 in the States). My HDL is “very healthy”, but I don’t know the actual number. He said he’d never seen such a low LDL in someone not on statins. After I left his office, it occurred to me that anything outside a normal range might be a cause for concern. I am 58 and I don’t take any medication.

  2. I have been Paleo for 3 years now. I am 61, 5’5″, and weigh 110. My cholesterol is always between 250-300 and my LDL-C 130-190 but my concern is my particle number is 1675 (<1000) and my HS-CRP has gone from <0.3 to 2.6 (<1.0) with no known reason. My new PCP wants to put me on statins which I have refused. My Lp(a) is also elevated 38 (<30). My labs were done at Cleveland Heart Lab. Everything else is very normal and I am pretty healthy and play tennis daily. What should I do and how can I get these numbers down, especially my particle number.

  3. Hi Chris, just as your ending comment re a future article “what increases LDL-P” would be interesting, so, I think the opposite “what natural foods /supplements reduce LDL-P” would be even more interesting.
    Did you post anything on this?
    Thanks Robert

  4. Hello,

    Apart from LDL-P number, my research shows that LPA – Lipoprotein test is an extremely important one.

    My recent test showed a result of over 30 and am wondering what you think about this test specially since there seems to be no cure for this. Seems more genetic than anything else.

    One of the sources that I looked at is:
    http://www.lipoproteinafoundation.org

    Thank you again for the wonderful site.

    • Some evidence that Vit C can effect it. For what its worth mine was OK on 1,000 Vit C daily, came off it and it went above 30. Back on again and it returned to the normal range. Most sub mammals do not produce this Lipoprotein which tallies with their ability to produce Vit C.

  5. I’m 27, weigh about 127 lbs and I’m trying to get off of carbs, a lot of sugar and instead put my focus on whole, fatty meats, less fruit (sugar) and more vegetables, niacin (flush kind, not sustained release) and omega 3 fish oil (I don’t use krill for environmental reasons, overfishing, seeing how we’ve driven some species to extinction, etc).

    I have familial hypercholesterolemia. Mom is concerned about something called lipoprotein A (lpa). I don’t want those levels to get too low, nor my other cholesterol levels! I’m MUCH more afraid of too little cholesterol, not an excess.

    I haven’t got my lpa checked, but I have my other cholesterol numbers. do not have the total cholesterol, good cholesterol or triglycerides.

    On my first check up my LDL was around 240 (which I’ve heard is fine and even optimum for women) but this last time it was around 150. my doctor wants me to keep it at 150 and wants me to lower it BELOW 150 as I get older, which worries me. Why? Because I’ve read where we need MORE cholesterol as we age, NOT less, including LDL!

    Strangely enough, I’ve heard that in studies, people with FH actually have a much higher resistance to certain illnesses, cancer and actually live lengthy lives, as seen this these following articles.

    http://jeffreydachmd.com/2013/07/familial-hypercholesterolemia-statin-drugs/

    This next one has the familial hypercholesterolemia benefits and experiments and documentation from Dutch researchers. it starts on “animal experiments and continues on.

    http://www.regenerativenutrition.com/natural-supplements-cure-cholesterol.asp

    I’d really like to know your thoughts on this. My mom is really concered about me having too much cholesterol, but from my experiences with red yeast rice, I’m much, much more concerned with the opposite. Not having enough! However, mom doesn’t see to be taking it as seriously as I am and might still peruse “the lower the better”.

    Before i start on with my question, I would like to share my experience with red yeast rice.

    I tried red yeast rice (1800 to 2400 mg) but had some frightening side effects, pain in my knuckles (I actually had the idea i might have had arthritis of all things!) and others.

    Some of the other side effects were anxiety, mild, paranoid hallucinations (but enough to worry me), violent irritability (not violent to people, but furniture, it was getting closer to actual violence against my cat and family), sitting in my room with the lights off and the windows closed (creepy isn’t it?) and the worst? Death wishes. Not quite suicide, but it was heading in that direction. I did actually, genuinely think after a while it might be the “right” thing to do. Luckily a nightmare literally gave me a rude awakening and steered me away from that, but the thoughts did continue until about 7 days after I stopped the red yeast rice.

    I’m concerned that if even I do start on a low dosage of red yeast rice (I’m NOT doing statins, period!) I might get the same thing, except either so slow I don’t realize it’s the RYR and mistake for something else or it suddenly catches up with me one day. I’m also concerned that if I got my LDL down without statins OR red yeast rice (I was using fish oil, beta sitosterols, exercise, high fat, high cholesterol dieting, and niacin when it fell) that I could end up getting it TOO low despite NOT using ANY statin or RYR!

    I do not take suicide lightly and even the slightest suspicion that I may be heading in that direction is enough to make me drop everything I’m doing and question my sanity.

    So finally on to the question. What the f**k should I do about this???

    • Take a statin! These medicines should be given under doctors supervision. They won’t just give it to you and say “see you next year”. Any side effects will be monitored closely and labs monitored in the beginning. It sounds like you’ve done everything you can. Familial hypercholesterolemia is a tough thing to treat with just over the counter remedies/diet/exercise… heart disease can occur at any age.. minimizing your risk is key to prevention.

    • Wendi,
      I understand what a struggle it can be, so instead of making yourself a patient, I would suggest to read the book “The Truth About Statins: Risks and Alternatives to Cholesterol Lowering Drugs” by Dr Barbara Roberts MD, a Cardiologist of 30+ years who specialized in Womens cardiology. She does discuss FH in detail…

  6. Dear sir
    My total cholesterol is 398 mg/dl, hdl 59, ldl 307, serum Vldl 32,
    Tryglyceride 160 mg/ dl. What you suggestfosuggest for me, am 48 years old .

    With thanks
    Abhijit

    • Hi Your triglycerides and your Total cholesterol to HDL ratio look a bit high and if I was you I would take some dietary measures to lower them especially the Tri’s before the Statin police get hold of you.

    • To lower your Triglycerides you can try treat with Omega -3 suppl. Studies show they can decrease Triglys up to 30%. You should stay under 130. You can also try LowCarbHighFat (LCHF) diet. A link to: dietdoctor.com Tells you more about that diet.

    • The calculator you recommend was alarmed at my numbers.

      LDL 104 (Oh no!)
      HDL 51 (didn’t ask gender)
      Tri (Too high!)

      I’d say overall my numbers are just fine, but your calculator would like me to worry.

        • A level of Triglycerides to be 66 is just perfect and healthy!
          Women does not have a risk factor at all if cholesterol levels are high. Recent studies suggested the complete opposite. They live longer!!

    • Couple of issues with that study. First, they were using an NMR method to classify LDL particle size. This method is ‘black box’ and was started by one individual on that study (Jim Otvos); also, he has since changed the algorithm that he uses to assign LDL subclasses. Finally, using a cross sectional association of LDL subclass with IMT (a measure that itself is prone to measurement error) while adjusting for other subclasses is pretty suspect.

      Ultimately, there are numerous studies showing that small LDL are atherogenic (even after normalizing for LDL level) using hard endpoints such as CHD or angiographic determined CAD–here two, but the references are pretty comprehensive:

      http://www.ncbi.nlm.nih.gov/pubmed/21262005
      http://www.ncbi.nlm.nih.gov/pubmed/24233487

  7. We had family history of CV disease, I had high blood pressure at times and my doctor advise for me to have a lipid profile test. We had been engaged in routine exercise, we’ve also been taking Omega 3 supplements (http://visiongroupcorp.com/omega3.html), our diet is more of a Paleo diet kind and was advise by our dietician to see if we can try vegan diet to reduce cholesterol intake – its going to be a struggle 🙂

    There are numerous posts, articles and even in the commercial that call LDL cholesterol as “bad cholesterol”… it scare people off without properly understanding how it affects over all heart health. Though this article did not affirm or deny the studies on how LDL cholesterol is linked to heart health but it did provide us a clear understanding on how cholesterol, LDL-P, HDL, etc may cause heart risks. Thanks Chris!

    • No need to stop eating meat! I buy from Blackwing.com!
      The Piedmontese cattle has HIGH CLA-s (cancer fighters) and contains medium chain triglycerides! THIS BEEF contains LOWER SAT FAT THAN (your GMO) chicken. Its not only grass fed, but ORGANIC healthy grain finished- so its NOT gamey tasting or sinue-ey.

      • What’s your deal with saturated fat? Saturated fat is the most preferred fat for the heart, and secondly, grass fed beef has a higher saturated fat in percentage of fat than not fully grass fed beef

  8. I’m 73. As far back as I can remember my total cholesterol has been between 250 and 300 with proportionately high LDL numbers. When I turned 65 I was having pains around my heart prompting a series of cardiovascular test including a stint in a Gamma Ray camera, which revealed totally open arteries. This result prompted the cardiologist to recruit me as a control patient in a heart study by General Electric. It turns out that the pain around my heart was from many years of using Theophyline (asthma Drug). Once I abandoned that drug the pain disappeared. This process, however, left me wondering why the results were so positive … the cardiologist couldn’t explain it.

    20 years ago I started taking on a regular basis a very powerful antioxidant called Pycnogenol, which contained Oligomeric Proanthocyanidins (OPC). A few years later Grape Seed Extract became available and I switched to that as it is a more potent form of OPC and less expensive. It turns out that Oxidation of the LDL is a major contributor to the buildup of arterial plaque. I’ve also changed much of my diet concentrating much more on fruits and Veggies …………

  9. Dear Chris
    I’m 71, 5’10” @ 170lbs, Triple by-pass 5 years ago, and Diabetic.
    Fro breakfast I have one apple, one pear, 2 slices of turkey bacon, quarter size turkey sausage 5 ea. Noon meal is cottage cheese with almond slivers with red grapes or blue berries
    Thought I was eating healthy till read that all this fruit is not good?
    MY latest blood run—A1c-5.0, choles.-154, Triglyceride..-96. HDL-57, LDL- 78 & VEDL ? 19. nO LDLP given but will ask for that info. next time.
    Thanks

    benny

  10. I find this all very interesting. I’m 68 years of age, have had several heart attacks, had a quad bypass in 1996 and have 19 stents. I’ve been reading that inflammation is the largest cause of artery disease and I’m basically going back to basics as far as eating is concerned, trying to eliminate as many processed foods as I can. I had my blood tested 0n 7/14/14 and here are my numbers:
    HgbA1C: 5.2
    Cholesterol: 100
    HDL: 33
    LDL: 42
    Triglycerides: 127
    Blood Sugar: 110

    I am on Atorvastatin and Fenofibrate

    I’ve decided to not eat light, low-fat or no fat foods and it is one heck of a struggle to eat “regular” food with all the fat content.

    I wonder if I am doing myself more harm than good with all my past history. Your comments are welcomed. Thanks.

      • Though, fwiw, zebra’s (and stress-free humans) may or may not get ulcers, since we now know that stress isn’t the leading cause of them, bacterial infections are 🙂

    • Why is eating more fat a struggle, Chuck? Did you have your gall bladder removed? Does food taste strange? What’s the issue?

      Regardless of your food choices, I think MikeTO has good advice. Stress brings on a heart attack as it kicks in the sympathetic nervous system.

      If you read this, you’ll see though why a stress attack can only result in damage to the heart if your parasympathetic nervous system has been brought down in functionality:

      http://articles.mercola.com/sites/articles/archive/2014/12/17/real-cause-heart-attacks.aspx

      This all may sound strange, but once you understand it, you’ll see how it is important. Your diet is still important. Very important. And fats that you choose to eat are a critical part of that. So is your intake of heart-important minerals.

    • well if you’ve continued to read Chris’s information I’m sure you’ve gathered that you cholesterol is really too low; should be around 200; I’d recommend reading why cholesterol is so important from Chris, Dr Joseph Mercola, and Dr Stephanie Seneff, a senior research scientist at MIT. Best wishes, Chuck!

  11. My wife dealt with many bouts of sinus infections and was given may doses of antibiotics. She then began having serious gut issues. She switched to a pure paleo eating meats, veggies, butter, coconut oil, etc. things got worse and she eventually was diagnosed with ulcerative colitis earlier this year. They wanted to start here on steroids but she decided to go with a GERD diet with bone broth, cooked carrots and broccoli coconut oils and other GERD foods. She has stopped all grains, sugar, hi carb foods. Trying to stick with It’s been 3-4 months and she has improved greatly. Also her achy hands and feet have stopped aching. Her allergies were gone too. She lost weight and overall the colitis symptoms (mucus and runny stools) and began having regular stools and everything seems to be working right. She has always had higher cholesterol thinking it’s due to FH. Like above the 200’s. she is 49 years old 5’2 120 lbs her BP is like 100/60 and pulse is usually in the 60’s. she is in great shape. She recently had here blood work done so we could see if she had the big fluffy partials. We got the results back and we were very shock.
    Here are the results
    Lipids
    Total 398
    LDL-C 290
    HDL-C 104
    TRI 58
    Non-HDL-C 294

    Particle
    Apo B 198
    LDL-p 3150
    sdLDL-C 65
    SDldl-c 23
    Apo A-1 170
    HDL-P 48.4
    HDL2-C 50
    Apo B:Apo A-1 ratio 1:16
    Lp (a) 22

    Inflamation
    Hs-CRP 0.4
    Lp-PLA 303

    Metabolis
    All were optimal except
    Her free fatty acids were 1.40

    Thyroids
    TSH 1.96
    T4 7.1
    T4 free 1.27
    T3 88

    Were kinda super concerned now.
    I read this article and were thinking its FH and leaky gut
    Could it also be SIBO and or H. pylori.???
    I know you cant answer personal questions but we need some help here and be directed to who we can talk to in the Portland Oregon area.
    HELP!

    • What does your wife eat in an average day? What are the percentages of fat, carbs and protein?

      http://www.bhlinc.com/clinicians/clinical-references/reference-manual/chapter16.
      Lipoprotein(a)[Lp(a)]

      http://www.bhlinc.com/clinicians/clinical-references/reference-manual/chapter6
      Apolipoprotein B (apoB), Low Density Lipoprotein Cholesterol (LDL-C) and Atherogenic Risk

      http://www.lecturepad.org/dayspring/lipidaholics/pdf/LipidaholicsCase291.pdf
      “My goodness! If a new healthy looking, normal weight patient showed up with an LDL-C ~ 230 mg/dL, we are all presuming that familial hypercholesterolemia is present. At the age of 54 we would be searching for arcus senilis, a sternotomy scar or xanthomata. Although there is no premature CHD, there are certainly cholesterol issues in her family. Although we do not have a baseline LDL-P or apoB, how can one go from a perfect lipid profile to a seeming very high risk one in a very short period of time? Can CV lipid/lipoprotein-related risk be worsened by the weight loss? Or perhaps the question is – does it matter what one consumes to lose weight? Is there a danger too low carbs/high fat in some people? Or how about this absurd question – can an LDL-P of ~2600 nmol/L not be associated with atherothrombotic risk? It has been reported for years that diets high in saturated fat raise TC and LDL-C and diets with reduced saturated fat lowers them (Evidence Level IA in NCEP ATP-III). MUFA and PUFA can be neutral or lower LDL-C. MUFA may raise HDL-C. Of course we now know what any therapy does to CV outcomes likely has little if any relationship to what that therapy does to HDL-C but the story that raising LDL-C is associated with or causal of atherosclerosis is widely accepted. I, other lipidologists, and many patients themselves, are starting to see that the above lipid response to a high fat diet as not being very rare response in people who abandon carbs and replace it with saturated fat, especially in those doing extreme carb restriction to achieve nutritional ketosis.”

      ““Let’s get rid of the nonsense seen all over the internet that atherosclerosis is an inflammatory disease, not a cholesterol disease. That is baloney-with the reality being that it is both. One cannot have atherosclerosis without sterols, predominantly cholesterol being in the artery wall: No cholesterol in arteries – no atherosclerosis. Plenty of folks have no systemic vascular inflammation and have atherosclerotic plaque. However clinicians have no test that measures cholesterol within the plaque – it is measured in the plasma. It is assumed, that if total or LDL-C or non-HDL-C levels are elevated the odds are good that some of that cholesterol will find its way into the arteries, and for sure there, are many studies correlating those measurements with CHD risk. Yet, we have lots of patients with very low TC and LDL-C who get horrific atherosclerosis. We now recognize that the cholesterol usually gains arterial entry as a passenger inside of an apoB-containing lipoprotein (the vast majority of which are LDLs) and the primary factor driving LDL entry into the artery is particle number (LDL-P), not particle cholesterol content (LDL-C). Because the core lipid content of each and every LDL differs (how many cholesterol molecules it traffics) it takes different numbers of LDLs to traffic a given number of cholesterol molecules: the more depleted an LDL is of cholesterol, the more particles (LDL-P) it will take to carry a given cholesterol mass (LDL-C). The usual causes of cholesterol depleted particles are that the particles are small or they are TG-rich and thus have less room to carry cholesterol molecules. Who has small LDLs or TG-rich LDL’s? – insulin resistant patients! After particle number endothelial integrity is certainly related to atherogenic particle entry: inflamed endothelia have inter-cellular gaps and express receptors that facilitate apoB-particle entry. So the worse scenario is to have both high apoB andan inflamed dysfunctional endothelium. Is it better to have no inflammation in the endothelium – of course! But make no mistake the driving force of atherogenesis is entry of apoB particles and that force is driven primarily by particle number not arterial wall inflammation.”

  12. Chris – crazy question – but do you have this article in Spanish. We have a family history of Atherosclerosis and I just found out my LPL-P is 1511, and I would like to send your writings to my brother in Argentina.

  13. My previous cardiologist who now heads the Heart Transplant Center at a Medical Center in Northern California told me “it’s not just what you eat but how much you eat. You can eat all the healthy foods you want but if you are consuming more calories than you are burning, you are going to gain weight and accumulate fat.” There is one piece of advice told me and it still remains with me. She said “i don’t put my patients on diets because diets don’t work. Have a cookie just don’t have the whole bag at once.” Makes alot of sense. I have followed her advice and lost 25 pounds in less than a year and have kept it off. I still enjoy a cookie now and then.

  14. I recently had bloodwork done. Everything was completely normal except high LDL of 207; HDL was 71. My weight is normal, I exercise, and have a good (but not perfect) diet. BP was 92/62 and pulse 48. Dr. is recommending statins. Any suggestions on what the cause of high HDL may be and what I should do about it?

    • Hi

      Try Krill oil tablets, it worked for me bringing my LDL down by 30%. I would be interested to hear if anyone else gets the same results. I use Krill Oil tabs from Healthspan (make sure they contain astaxathin if you use another brand). Let me know how you get on

  15. Let’s say we assume that high cholesterol does not cause heart disease, my question is whether there are other health problems/concerns one should be worried about instead?

    I’m a 33 year old male and have been on a low-carb ( 394
    HDL 59 -> 59
    LDL 153 -> 208
    TG 116 -> 166

    Would love to hear thoughts from people with similar experiences to mine. I’ll also provide more details on my blog if you want to follow along at http://www.chinabiohacker.com

    • @Randy

      Is the 394 number your TC?
      Are the other numbers showing results before and after starting the LC diet?
      How long were you on the LC diet before you got the new blood work done?
      What were you eating before and what are you eating now?

      As to your question – have you had your biomarkers of inflammation measured? such as hsCRP?
      Have you had your A1C measured?

      If your TC is 394 and your HDL is 59 your TC/HDL ratio is 6.68!

      3.5 is considered ideal and anything over 5 is cause for concern so I would be very concerned!

      • For some reason my initial post got cut off. I have been on a low-carb ( May
        CHOL 252 -> 394
        HDL 59 -> 59
        LDL 153 -> 208
        TG 116 -> 166

        I haven’t measured any of the biomarkers you mentioned.

        • I’ve been on a low carb diet for 4 months now. I eat lots of eggs, butter and saturated fat, but my diet overall can be summed up by eating clean, natural foods and avoiding sugars, grains and starches. After going on this diet, I’m now at 10% body fat, and I’ve never felt better in my life. Given the positive impact on my life, I hope to continue this way of eating long-term, but after getting a blood test, I am now concerned as my total cholesterol is “off the charts”. HDL did not change while my LDL and triglycerides increased significantly.

          The figures are from Dec 2013 -> May 6, 2014.

          • Can you get an ApoB test in your neck of the woods? That would give you a rough ides of your particle count.

            Did you get your VLDL measured?

            Your non-HDL-C is now 335 (394-59) so I’m guessing that your LDL-P is probably >3000.

            Very, very dangerous – IMHO.

            Here’s my suggestion – cut back on the saturated fat, eggs, butter, etc. for a month or 2 and then get retested – if your lipids improve you will know what the problem is.

            Question – how many carbs do you eat in a day?

  16. What’s a *lower* bound for the optimal LDL-P?

    As an example, my doc shifted me from simvastatin 20mg to atorvatstatin 20mg (plus 2×500 mg immediate-release niacin) and my LDL-P came down to 622 – but, it has kept declining, and now the HealthDiagnosticsLab test shows total cholersterol 117, LDL-C 53, Tri 49 with LDL-P of 400. So, he’s cutting the atorvastatin to 10mg.

    But I’m not clear on what the target is, what counts as “overshoot” in lowering LDL-P. Is it based on having just enough particles to get the correct amount of cholesterol and triglycerides delivered, so it’s some three-way balance between those 3 numbers?

    • Consider yourself lucky. Its been a year since my heart attack and my doctor/cardio has not subjected me to a single blood test or even blood pressure test. Its been a case of take these tablets and go away

      • @Mark

        Have you asked your doctor to run blood tests? I get blood tested every 6 months or so – if my doctor puts up any resistance I remind him that he works for me!

        • No I have not asked him, I have taken matter into my own hands and run private blood tests where I can get some useful data like Apo B levels which can give an approximation to number of LDL particles. If you have a blood test with you doctor you only get HDL LDL and if you ask for it CRP, thats pretty much it. We are way behind here in the UK. I went to see my doc last week to check a small lump on my shoulder (just a cyst from a blocked follicle) he did not even ask me how I was with regard to my heart.

      • Since a *heart attack* and not taking BP, watching for damage?? That’s …unusual!

        But even by common good-care standard, yeah, we’re way lucky with our doc – he’s deeply caring, excellent conversationalist/listener, skillfully puts us at the center of our care (matches to our lives), and is a board-cert lipidologist as well as a family GP. Great staff, too.

        So I’ll certainly follow his advice to cut back on the atorvatstatin, but I forgot to ask about actual optimal targets for LDL-P, and now I’m curious …

        • I am taking my own BP Wayne and have just forked out £250 for a comprehensive set of blood testing. I think the problem is that I ask too many questions and put forward ideas that they are not in agreement with. For example I state that cholesterol levels are not really the most important thing to measure. I also ask about nutrition and they know little about this subject and what they do eg dont eat saturated fat, is out of date and inaccurate

  17. Hi Chris, I enjoyed your article. My cholesterol LDL has been around 7 for the last 2 years. My Doctor insists that I start taking medication to reduce it.
    Let me start by saying that I’m 46 years old, very fit for my age, I do Crossfit 4-5 times/week, weigh 80kg, 186cm tall, body fat around 10%, I eat about 80% paleo meaning that I do eat some dairy (milk in coffee, on muesli) and some grains (oats, muesli, legumes) I do not eat any of the foods that are said to cause high cholesterol, cakes, biscuits, fried foods, processed foods etc. yet my LDL cholesterol remains high.
    I have read that the particle size of LDL is the most important factor in deciding whether to start medication and to know whether you are at risk of further health complications. My question is how do you get a test to measure your LDL particle size? Is it part of a regular blood test? Or does it have to be specially requested by your Doctor?
    Thanks, Darren

        • I am a healthy 59 year old male living in the DC area. On my last physical my doctor chose to do a LDL-P test and it showed that my overall cholesterol was good, but that my particle count was off the charts…over 2,000. He immediately put me on Crestor, which has brought that count down to under a 1,000. I just ask for the particle count test every time I take a blood test now.

          My doctor has now put me on Simvastatin, a more generic brand of the drug. I don’t know the differences and would like to know if one is better than the other in reducing particle count.

    • Hi Mark,
      What kind of cholesterol test did you have done in UK?
      I am looking for a lab which can do a detailed cholesterol
      check in UK. I am based in Birmingham

      • Hi Kevin
        My test is with BlueHorizon. I have had their comprehensive test done a couple of times which gives you lots of useful stuff you dont get from a standard doctors test eg APO A and APO B amongst others (see my blog). They have however just introduced a test that checks for particles size and count and I had this done last week and await results. The first test is done local to you at say a Spire hospital but the latter one means a trip to London to give the blood.

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