What Causes Elevated LDL Particle Number? | Chris Kresser
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What Causes Elevated LDL Particle Number?

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

In the last article in this series, I explained that LDL particle number (LDL-P) is a much more accurate predictor of cardiovascular disease risk than either LDL or total cholesterol. In this article, I’m going to briefly outline the five primary causes of elevated LDL-P.

Conventional medicine is primarily focused on suppressing symptoms. If your blood pressure is high, you take a medication to lower it. If your blood sugar is high, you take a medication to lower it. If your cholesterol is high, you take a medication to lower it. In most cases there is rarely any investigation into why these markers are high in the first place, with the possible exception of some basic (but often incorrect) counseling on diet and exercise.

On the other hand, Functional Medicine—which is what I practice—focuses on treating the underlying cause of health problems instead of just suppressing symptoms. If your blood sugar, blood pressure or cholesterol are high, the first question a Functional Medicine practitioner will ask is “why?” If we can identify the root cause of the heart health problem, and address it at that level, medication is often unnecessary.

To use a simple analogy, if you have weeds in your garden, what happens if you just cut the weeds from the top? They grow right back—and sometimes faster than before! If you really want to get rid of them once and for all, you have to pull them up by their roots.

With this in mind, let’s look at some of the potential causes of elevated LDL particle number. If your LDL-P is high, it makes sense to test for and treat any of the conditions below (with the exception of the last, which is genetic and thus can’t be treated) before—or at least along with—taking pharmaceutical drugs.

5 common causes of elevated LDL particle number that can increase your risk of heart disease.Tweet This

Insulin Resistance and Metabolic Syndrome

LDL particles don’t just carry cholesterol; they also carry triglycerides, fat-soluble vitamins and antioxidants. You can think of LDL as a taxi service that delivers important nutrients to the cells and tissues of the body.

As you might expect, there’s a limit to how much “stuff” that each LDL particle can carry. Each LDL particle has a certain number of cholesterol molecules and a certain number of triglycerides. As the number of triglycerides increases, the amount of cholesterol it can carry decreases, and the liver will have to make more LDL particles to carry a given amount of cholesterol around the body. This person will end up with a higher number of LDL particles.

Consider two hypothetical people. Both have an LDL cholesterol level of 130 mg/dL, but one has high triglycerides and the other has low triglycerides. The one with the high triglyceride level will need more LDL particles to transport that same amount of cholesterol around the body than the one with a low triglyceride level.

Numerous studies have found an association between increased LDL particle number, and metabolic syndrome. One study measured ApoB, a marker for LDL particle number, in a group of 1,400 young Finns with no established disease. The participants with the highest LDL particle number were 2.8 times more likely to have metabolic syndrome than those with the lowest levels of LDL-P. (1) A much larger study of over 300,000 men also found a strong association between LDL-P and metabolic syndrome and its components (i.e. insulin resistance, abdominal obesity, high blood pressure, etc.). (2)

Poor Thyroid Function

Poor thyroid function is another potential cause of elevated particle number. Thyroid hormone has multiple effects on the regulation of lipid production, absorption, and metabolism. It stimulates the expression of HMG-CoA reductase, which is an enzyme in the liver involved in the production of cholesterol. (As a side note, one way that statins work is by inhibiting the HMG-CoA reductase enzyme.) Thyroid hormone also increases the expression of LDL receptors on the surface of cells in the liver and in other tissues. In hypothyroidism, the number of receptors for LDL on cells will be decreased. This leads to reduced clearance of LDL from the blood and thus higher LDL levels. Hypothyroidism may also lead to higher cholesterol by acting on Niemann-Pick C1-like 1 protein, which plays a critical role in the intestinal absorption of cholesterol. (3, 4)

Studies show that LDL particle number is higher even in subclinical hypothyroidism (high TSH with normal T4 and T3), and that LDL particle number will decrease after treatment with thyroid hormone. (5)

Infections

Another cause of high cholesterol profile is infection. Multiple studies have shown associations between bacterial infections like Chlamydia pneumoniae and H. pylori, which is the bacterium causes duodenal ulcers, and viral infections like herpes and cytomegalovirus and elevated lipids. (6) For example, H. pylori leads to elevated levels of total cholesterol, LDL cholesterol, lipoprotein (a), ApoB or LDL particle number, and triglyceride concentrations as well as decreased levels of HDL. (7)

Several mechanisms have been proposed to explain the association between infections and elevated blood lipids. Some evidence suggests that viral and bacterial infections directly alter the lipid metabolism of infected cells, and other evidence suggests that lipids increase as a result of the body’s attempt to fight off infection. Other evidence suggests that LDL has antimicrobial properties and is directly involved in inactivating microbial pathogens. This has been confirmed by studies showing that mice with defective LDL receptors—and thus very high levels of LDL—are protected against infection by gram-negative bacteria like H. pylori. (8)

Leaky Gut

One of the primary functions of the intestinal barrier is to make sure that stuff that belongs in the gut stays in the gut. When this barrier fails, endotoxins such as lipopolysaccharide (LPS) produced by certain species of gut bacteria can enter the bloodstream and provoke an immune response. Part of that immune response involves LDL particles, which as I mentioned above, have an anti-microbial effect. A protein called LPS-binding protein, which circulates with LDL particles, has been shown to reduce the toxic properties of LPS by directly binding to it and removing it from the circulation. (9) Studies have also shown significant increases in LPS-binding protein (and thus LDL particles) in cases of endotoxemia—a condition caused by large amounts of circulating endotoxins. (10)

Though more research is needed in this area, the studies above suggest that a leaky gut could increase the level of LPS and other endotoxins in the blood, and thus increase LDL particle number as a result. I have seen this in my practice. I recently had a patient with high LDL-P and no other risk factors. I tested his gut and discovered H. pylori and small intestine bacterial overgrowth (SIBO). After treating his gut, his LDL-P came down to normal levels.

Genetics

The final cause of elevated LDL-P is genetics. Familial hypercholesterolemia, or FH, involves a mutation of a gene that codes for the LDL receptor or the gene that codes for apolipoprotein B (ApoB). The LDL receptor sits on the outside of cells; the LDL particle has to attach to the LDL receptor in order to deliver the nutrients it’s carrying and be removed from the circulation. ApoB is the part of the LDL particle that binds to the receptor. If we use a door lock as an analogy, apolipoprotein B would be the key, and the LDL receptor is the lock. They both need to be working properly for LDL to deliver its cargo and to be removed from the bloodstream.

Homozygous carriers of FH have two copies of the mutated gene. This condition is very rare. It affects approximately 1 in a million people. And people that are homozygous for this mutation have extremely high total cholesterol levels, often as high as 1000 mg/dL. And unfortunately they usually die from severe atherosclerosis and heart disease before the age of 25.

Heterozygous carriers, however, only have a single copy of the mutated gene, and the other copy is functioning normally. This is much more common. The prevalence is between 1 in 300 to 1 in 500 people, depending on which study you look at. These heterozygous carriers of FH have total cholesterol levels that often range between 350 and 550 mg/dL, along with very high LDL particle number. They have about three times higher risk of death from heart disease than people without FH if it goes untreated.

It’s important to note that people with FH have primarily large, buoyant LDL particles, and yet are still at much higher risk for cardiovascular disease. While it’s true that small, dense, oxidized LDL particles are more likely to cause atherosclerosis, large, buoyant particles can also be harmful when their concentration is high enough. This is one reason why LDL particle number is a superior marker to LDL particle size.

In the next article in this series, I will debunk the myth that statins extend lifespan in healthy people with no pre-existing heart disease.

240 Comments

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  1. For the past three months I have been on a strict Ketogenic diet, consuming less than 20g carbs per day. Before I began the keto lifestyle, in August, my total Cholesterol was 216 with 97 triglycerides, 76 HDL and 121 LDL; 2.8 Ratio.

    Now, after eating no more processed foods, no added sugar, very low carbs, I have 227 total cholesterol, 61 HDL, 149 LDL, 87 triglycerides: 3.7 ratio.

    At your suggestion, I got NMR test with these alarming results:

    LDL-P: 2024
    LDL-C: 156
    HDL-C: 59
    Triglycerides: 92
    Total Cholesterol: 233
    HDL-P (Total) 28
    Small LDL-P: 948
    LDL Size 21.2
    Insulin Resistance Score: LP-IR: 25

    What do I do?!!! Like I said, for over 3 months I’ve been eating very low carb, with sugars only from occasional berries. I don’t know what to do or how to avoid taking medicine. Please help!

    • What you want to avoid is damage to your blood vessels from oxidation/ inflammation. Of course, massive sugar intake (i.e., many Americans) damages the blood vessel linings, but there are other aspects to this. Overall good nutrition is key. I am on the ketogenic diet, have been for many years, and I can say that you have to work hard to make it a healthy diet. There are other things that can be tested. Your C reactive protein (marker of inflammation), glutathione levels, etc. Trace minerals can serve as antioxidants as well–a good nutritional doc might help.

    • Check out the Mcdougall diet. After feeling terrible on a paleo-ish diet for several years with some initial weight loss but then gradual weight gain I went to this 10 day program. Day 1 my cholesterol was 153. Day 8 my cholesterol was 113. A 40 point drop in 7 days. Many people had the same results. The ones that didn’t instead lost a lot of weight i.e. 10-15 pounds! I try not to advocate things anymore, just putting this out there.

      • Maggie, one of the discoveries from the Framingham study was that a too low total cholesterol number showed an increase in sudden cardiac death with some patients.

    • I’m with you, as our numbers are very similar, and am searching all over for suggestions. I don’t want to take meds either. But despite being LCHF for 2.5 years, it seems that everything is getting worse. Not sure what else to try.

      Pre-LCHF (2.5 years ago):
      LDL-P: 2185
      LDL-C: 156
      HDL-C: 45
      Triglycerides: 126
      Total Cholesterol: 226
      HDL-P (Total) 29.9
      Small LDL-P: 1439
      LDL Size 20.1
      Insulin Resistance Score: LP-IR: 62

      My numbers all improved quite a bit (with my LDL-P going to 1517) per the last couple of years with LCHF and I thought I found my solution. But my numbers started worsening again and after taking niacin for the past 3 months they are…

      Present:
      LDL-P: 2250
      LDL-C: 148
      HDL-C: 53
      Triglycerides: 102
      Total Cholesterol: 221
      HDL-P (Total) 31.6
      Small LDL-P: 1361
      LDL Size 20.5
      Insulin Resistance Score: LP-IR: 33

      Would love to know if you’ve found any other helpful suggestions. Thanks!

      • So your numbers went UP with Niacin!!! Yikes!! I have been taking Niacin for 3 months and just had blood drawn Tuesday of this week. Was really hoping for improved results!!

        • They did indeed go up! However, I don’t think this is typical. I’d be very curious to hear if any others have had their particle number increase (or decrease) for that matter.

          • My LDL-P decreased from 1247 to 1014 with 2 months of 1000mg Niacin. And the 1247 was after 44# loss and was a great improvement at that time.

    • Hi. My labs look almost identical, and I am wondering if you have gotten some treatment, and if so, what is it? Am anxious about these numbers!

      • I have not gotten treatment yet. I haven’t had my numbers checked since last reporting them here. I was told that dairy could be the cholesterol culprit. I cannot imagine being able to stick with this ketogenic diet without dairy! I would feel so deprived that I would binge!!! Since January I have lost 30 lbs. I am mostly at my goal weight, at 133 lbs (I am a 40 yr old woman, 5’5.5″). But I feel like I am all fat and sagging skin. So now I need to focus on changing not my weight but my body composition: trying to build muscle and lose fat– keto diet seems ideal for what I want to achieve, no? As for the cholesterol, I figured I would wait until I was finished losing weight to check it again because I read that when you test in the process of losing weight, test can reflect fat that’s on its way out of your body! So that is my plan, to check again next month. I truly hope I needn’t give up dairy (not that I binge on it, but carbonara over zucchini noodles, fresh whipped cream over summer berries, loaded baked cauliflower w sour cream, smoked salmon rolled with creme fraiche… I would be so depressed).

        • I totally agree with you on the dairy front! I have given up bread and most carbs for 2.5 years, which I never thought possible. I can’t give it all up! Cheese is my saving grace. 🙂

          • Okay, got tested again. I’m down 34 lbs, and I’ve lost no muscle according to my doctor’s scale.

            LDL-P went from 2024 –> 1498
            LDL-C went from 156 –> 147
            HDL-C went from 59 –> 59
            Triglycerides went from 92 –> 85
            NMR Total Cholesterol went from 233 –> 223
            HDL-P total went from 28 –> 27.4
            Small LDL-P went from 948 –> 369 mol/L
            LP-IR Score below 25

            Standard Cholesterol Test
            Triglyceride went from 87 –>81
            Cholesterol went from 227 –> 213
            HDL went from 61 –>60
            LDL went from 149 –> 137
            Total/HDL Ratio: 3.6

            Look at that gorgeous drop in small particles! I did nothing different! I was just dropping weight I guess.

            • This is amazing! So glad you saw improvements. I get re-tested in early November and by that time will have been strictly keto with absolutely no cheats. And have been doing HIIT treadmill 4-5 days a week. Continuing with the niacin as well. Will hope for the best at that time.

            • Stephanie, what kind of foods did you eliminate to obtain those lowered numbers and weight loss, and what supplements do you take? Congratulations on those numbers!!

    • OK I will tell you what I think. Please reject as you see fit…..

      1. I lost 8kgs and my LDL went up considerably. I then read that losing weight can cause LDL to rise. I then stopped being concerned

      2. Five weeks later had more blood tests. LDL fallen, trigs fallen loads. I’m on the right path

      3. For your results to be worrying you’re assuming nothing else has changed. No change in stress, sleep, exercise, quality of life. Is that likely?

      My advice is choose what you reckon is the right path but do ALL the lifestyle changes …yes all, especially diet and exercise. Stop worrying and keep researching. Stop testing for a while. Vastly improve quality of life and then…only then…re-test.

      There, my two pennyworth….

    • Sounds like you may be a hyper absorber of cholesterol. Sorry, just a genetic thing.
      Authority nutrition has a good article on ‘what to do if LDL goes up on ketogenicvs’

    • Eating loads of fats and being in ketosis raises LDL-P it should be less than 1000. your total cholesterol should be under 150, and your LDL should be around 50-70. The only way to get there is to follow a Macdougall or Esselstyn type of diet. It consists of whole plant foods : fruits, veggies, whole grains. Simple right? My numbers are exactly in these ranges although I don’t know for the LDL-p as I did not have the knowledge of it’s importance until now.

  2. So after reading the above article, what are us folks with large puffy ldl and high particle numbers supposed to do about this situation that may be family genetics. hdl and trigs are normal. History of paternal heart disease.

  3. have been doing the complete heart screen for several years now; 58 yr. old female, cholesterol is high. Height 5’6″, weight 125, healthy, don’t eat fatty foods, etc… but here are the #’s and this is how they’ve been for about 4 years or so: total Ch. 207; LDL C 145; HDL-C 67; Trigl 61; Non HDL-C 141; Apo B 96 and LDL-P 1747. So my dr. is concerned about the apo b and LDL particle. Wants to start me on one of the super-powered statins. I just don’t want to take it. Dad died at 63 of massive heart attack, but big difference is he was diabetic, obese and tobacco user. I am none of those. Thoughts? Thanks for article and research.

    • Research more before statins. Dr. Hyman a good resource as well as others. You seem to have a very healthy lifestyle unlike family members. Statins are highly dangerous in my opinion and many doctors receive handsome kickbacks for pushing them onto patients. I had open heart surgery for valve replacement but I have good lifestyle, but statins were prescribed 2010. I took them for a year, researched and got off of them. I juice, eat organic, good fats, veggies etc, walk but told virus attacked my heart and had a light stroke 2014. Statins prescribed again, scared, took for a year now off. Neurological damage a huge side effect–felt numbness on side of thighs. I took myself off and feel better. One has to decide. Functional Medicine doctor will help you decide not mainstream doctors.

      • I have never heard of a functional medicine doctor before reading this page. How would one go about finding one?

      • “many doctors receive handsome kickbacks for pushing them onto patients.”

        As an MD, I can tell you this is simply not true. This would be an illegal practice in the United States. MDs can be “speakers” for a pharmaceutical company and give drug dinner talks but they do not and can not receive a kick-back for each statin that they prescribe.

        • Please tell me why doctors give up paying patient time to pharmaceutical reps then please. Makes absolutely no sense for docs to waste time hearing about new drugs if they don’t plan on prescribing them.

        • Ins companies give bonuses for children to be fully vaccinated so kickbacks must not be illegal.

        • I beg to differ, dear doctor. What do you call those lavish trips all over the world, furnished to you by the pharmaceutical industry? Especially those in the cancer business and heart business.

    • Debbie, I am 60 and have similar but worse numbers than you. Small LDL elevates more each year. Trying to avoid statin, too. What did you end up doing? I am VLC but now wonder about eliminating saturated fat.

    • Instead of statins try red rice yeast, a natural statin like compound without the dire consequences.

      • If you buy it in the US it is useless because the FDA has banned the substance in Chinese red yeast rice that may be beneficial.

    • But have you increased your doage? And by that I mean ‘lifestyle dosage’ i.e. MORE exercise (eg yoga) better qulity sleep, more relaxation etc?

  4. I am a 49 year old female. Can an ulcer cause your LDL to rise? I have factor five and I’m concerned about blood clots as well. The ulcer I have has made me feel really sick and tired all the time. I hade blood drawn during that time so I was wo.dering if that could be the reason for the high LDL. It is 154 and it use to be 100 a year ago. Please help.

  5. i can’t seem to find anywhere recommended ranges of LDL-P. What is considered high, moderate, and low? What’s ultimately a good and bad LDL-P number?

      • My test results shows optimum levels to be under 1020, 1020-1359 is Intermediate risk range and above 1360 is high risk range. What lab can we believe???

    • I have a chart that shows high as over 1360, intermediate as 1020 to 1359, and optimal as under 1029.

  6. I am a carrier of the KIF6 Genotype (Trp/Arg) does that mean I am Homozygous or Heterozygous, or is it not related?

    LDL-C 140
    Apo B 97
    Lp(a)-P 240
    HDL-C 74, Tryglycerides 86

    Old doc put me on a statin (she never tested as thorough as my new doc). New (Paleo) doc took me off statins, I’ve been “primal” since 2012. Also now at 1000 mg Enduracin.
    I’m trying to understand this gene is my high LDL genetic and is a diet approach not an option?

    I’m from the Netherlands and have always eaten very healthy (no overweight). Gave up smoking 11 years ago.

  7. Hi Chris (and others), Just got some numbers and I’m not sure of a direction (I won’t take statins). Total Cholesterol 193; HDL 67; Triglycerides 61; LDL 114 (all these look great to me). Here are the rest: LDL-P 1575 (H), LDL Small 327 (H), LDL Medium 358 (H), HDL Large 5768 (L), Apolipoprotein B 98, Lp(a) 164 (H). The CBC and CMP show all tests within normal limits. Diet is mostly paleo and I exercise regularly (intervals and strength). Family hx is significant for cardiovascular disease. I take compounded T3/T4. I am a clinical psychologist and very proactive with regards to health. Any suggestions would be appreciated!

    • I would encourage you to continue to refuse statins.
      Your trigs/hdl ratio is less than 1 which is optimal.

      Have an a1c done.
      This will help you to measure your glycaed cells
      which can lead to plaque build up.

      I would also encourage you to eat a low carb high fat diet. Less than 100 total carbs per day and at least 70% percent of total calories from fatsg

  8. Hey Chris, just wanted to ask if you could include a link to the “next” article in this (and other) series. Not sure where to go/search next for the next article. Thanks!

  9. I’ve never had my total cholesterol higher than 205 but it recently came back at 246. My HDL is 83 and LDL 152. Trig Lvl is 58, Chol/HDL 3.0i, VLDL 11.6. I know that my HDL is good but my LDL & TC is a little high. What can I do to bring my LDL & TC down? Should I be concerned? I’m wondering if this is related to me taking vitamin D3 every day and if I should stop. I’m 50 yrs. old, 5’6, 115 pounds, and I try to eat good but don’t always succeed. Thank you!

  10. Chris, I have slightly elevated tpoab levels, but no symptoms of hypothyrodism. Are you saying that i should avoid foods that might increase cholesterol levels, like saturated fat and cholesterol rich foods? Please, respond.

  11. I was a vegan and even. I have question about my blood lipid profile. I do not have high triglycerides (109), my small LDL-P is high around 932 and LDL-P is 1400. HDL is 39. Inspite of being vegan (except 2 gm of Lovaza) and 20mg lipitor, I cannot make sense of the LDL-P. If high triglyceride is normal, what other reason can explain this high LDL-P. I do not think i have any infection or leaky gut. The thyroid function is normal. Since this test, I have changed my diet to low fat omni and now restricting carbs as well.

  12. From Nov 2014 to April 2015, my LDL P number dropped from 2321 to 1188 nmol/L. One year ago, before LCHF, my LDLP number was 1382 and I was on Zocor statin. I stopped taking that bad drug (and fired my doctor), lost 20 lbs of fat but my LDL P was only marker that was ‘bad’. (It was 2072 in Aug 2014; 1383 in April of 2014). The changes I made from Nov ’14 until today is taking 2.5 g Rugby Niacin and 2400 g of red yeast rice daily…and LCHF. I’m just sayin’. Lipoprotein(a) is less than 10nmol/L ! I’m very happy.

    • http://theskepticalcardiologist.com/
      “One has to ask, given this background, why would a patient choose to take a “natural” OTC supplement containing an unknown amount of both a). Effective cholesterol lowering chemicals and b)potentially toxic extraneous chemicals over the precisely formulated, carefully regulated, fully studied, pure statin drug available by prescription.

      It’s especially baffling to me when one considers that lovastatin comes from RYR (Red Rice Yeast). Thus it would have to be considered “natural.”

      Akira Endo spent decades carefully identifying the effective and safe chemical portion of RYR. It is now available as a generic costing pennies per pill.

      We know exactly how many milligrams you are consuming. We know what benefits to expect and what side effects can occur based on studies in hundreds of thousands of patients who have taken a similar dosage.

      You are much better off taking the prescribed statin drug than RYR.”

      • It is not beneficial to lower cholesterol with statins unless you are over 50, male and already have had at least one heart attack. In all other groups nosignificant benefits. The draw back if you decide to start or continue these “carefully regulated, fully studied…” drugs come out even in the studies sponsored by the makers themselves: Mortality risk increased in several subgroups ! The heart attack reduction was not based on hard end points but diagnosis by doctors employed by the study, making only the increased mortality solid evidence.
        Also the risk of diabetes can increases with up to 50% taking statins, from recent Finnish study Known from early trials but “toned down” as all other side effects.
        A class action suit against Pfizer is undeway as Pfizer knew about the diabetes risk increase. Taking statins as protection for diabetes when 70% of diabetics here die from heart disease, the very thing statins are taken to protect! against dose not make much sense! One becomes diabetic from statins through increased insulin resistance. Insulin resistance is also heavily involved in cancer via IGF-1 according to several studies. Seems to me that statins are really a silent killers or more wolves in sheep clothes as they are promoted by those that we believe protect us. Other immediate side effects of statins are muscle pains. In many studies one nowadays usually do “pre studies”, enabling exclusion of patients that not feel good from the tested drugs so that these do not have to suffer the whole test period. The side effects our doctors see in their reportas trying to diagnose the muscle pains are not listed as the ones that felt like we were excluded. If that’s not fraud and that FDA let crap like it pass approval is scandalous. The excluded people was simply excluded, not in the study at all after. Yet the study may be touted as a “random controlled trial” by its sponsors. The problem is that the study sponsoring drug makers/sellers are allowed to call studies like these “sciencetific trials” when it really is pure fraud to only present parts of studies when the withheld parts are damming.
        For ads it is ok, but not for ads touted as science.
        All the low fat advice we received for the last 50 years were never based on science, No independent RCTs where ever performed and published, and the ones that were not published and showed increased mortality from the low fat diet were silenced. I rest my case. Read the book” “The big Fat Surprise” to find out more about the science we have been fed with.

    • Hi Woodstocker,
      I am curious, what is LCHF?
      I am 57 year old female.
      I am taking 250 mg of Enduracin (dr, recommended NIACIN),
      100MCG of vit K2-M7
      1 baby aspirin every other day
      2000IU vit D3
      probiotic

      my LDL-P is 1313, LDL-C is 111, trig-228.

      I just started with a holistic cardiologist, and he has me shaking in my boots. I don’t know if I am doing everything right. He is VEGAN and I cant do 100% vegan! I am about 80% vegetarian though. I am also on an anti-yeast diet. would love your opinion, or anyone out there!!!
      THANKS!!!

  13. Would you please provide links to some research (recent, if possible) that supports the use of an LCHF diet (incorporating saturated fats) for lowering LDL cholesterol?

    My son has slightly raised LDL (3 mmol/l). He is only 22 and weighs 60kg, so is a little underweight. He is gluten intolerant (probably coeliac, but hasn’t been tested – his father has tested positive for CD). I believe I have Familial Hypercholestetolaemia. My total fasting cholesterol has been as high as 10.3 mmol/l. My father also had high cholesterol and had his first heart attack at 42. He died from a heart attack at 51. So, there is reason to take it seriously, especially as he will be starting hormone treatment soon which is likely to cause his cholesterol levels to go up.

    His doctor has advised my son to cut out saturated fats and to replace them with “good” fats, such as olive oil. He has basically recommended the usual diet given for high cholesterol these days. If this is unsuccessful, his doctor said he may need to go on statins.

    This concerns me a great deal, as I followed an LCHF way of eating for awhile, and not only did it improve my general health, energy and pain levels (I have Fibromyalgia), but my cholesterol levels also improved (after rising initially). A lot has been going on in my life recently, which made it extremely difficult to keep up with the diet, but I returned from a camping trip yesterday (in a great deal of pain), and will be going back to the LCHF woe as of tomorrow. Eating any other way is just not worth it for me!

    A big problem is that my diet and my son’s will be in complete conflict! I cannot cook two dinners every night and my husband won’t. It was hard enough adapting to gluten free, although now that I’m doing LCHF it’s much easier. But, apart from the shopping and cooking issues this will create, I don’t believe that the way of eating my son wishes to follow will be good for him or his cholesterol.

    My son, unfortunately, is very sceptical of anything he considers outside of mainstream medical or scientific opinion, and totally distrusts anecdotal evidence (even from me – he is an Aspie). He is a great believer in the placebo effect. The only thing he will consider is actual scientific research. He did look at links to research that you provided in another article I sent to him of yours about cholesterol, but he said the research only looked at impacts on total cholesterol, not on LDL, which is his main concern at this stage.

    I would very much appreciate it if you could provide some evidence for saturated fats being a good or better choice for health and particularly for LDL cholesterol levels, assuming such evidence exists. Or, is removing saturated fat from his diet the right way to go?

  14. Thank you so much for this article. I went ketogenic for a long time, over a year and when my doctor checked my cholesterol (using the complex method), we were both very scared by the LDL-P and I had tons and tons of small particles (not the happy kind). It also showed significant insulin resistance. So I think next visit I’ll ask for metformin because chromium picolinate isn’t doing the job. I think I need real drugs for the insulin resistance. I’d love to just trust that he’ll find this article by himself or the science it’s based on, but I can’t be sure. I think he just wants me to become a vegetarian because it’s “safer.” But I’m sure that would be a mistake, I was one for over 10 years and had the typical crash.

  15. Forgot to mention, I have ideopathic eosinophilia – and elevated levels that stay above 1200 almost all the time unless I take steroids, which I do every four years or so.

    • Kim Wooten: my lab values are VERY similar to yours. What have you learned so far? I am on a Statin but am considering taking myself off. I just lost 40 #’s and fortunately was able to get off the other 5 cholesterol meds I was on. My cholesterol is perfect. My LDL P is my biggest problem, and my small LDL-P is also elevated. My liver enzymes are also elevated (doubled from last lab draw). I am 50 yrs old and not overweight. I have dyslipidemia.

  16. I have high LDL-P at 1574 (down from almost 2,000 six months ago), normal triglicerides at 98, LDL-C at 105, and HDL at 51. Why are my LDL-P so high? I eat a healthy diet, probably don’t exercise enough but get some, and am a normal weight. What can I do to lower my LDL-P?

  17. This is so confusing. I read the studies that David posted. They seem to contradict all the low carb guys that say dietary cholesterol does not effect blood cholesterol.

    I had a cholesterol of 180 with a 80 HLD and a 105 LDL, Triglicerides of about 40. My diet was about an even 1/3 of protein, fat and carb. No flour, sugar, vegetable oils or transfats. I went three years on a high saturated fat, very low carb diet and recently checked my cholesterol levels. 385 total cholestrol, LDL-C is 283, HDL-C 87, Triglicerides – 64, ApoB – 184. I don’t see LDL-P anywhere, is the ApoB the same thing/

    According to the establishment docs, I am in trouble. But I can’t get an opinion from any of the low carb, high fat guys as to what constitutes dangerous numbers

    Inflammation is ‘borderline’ Fibrinogen – 380, hs-CRP – 2.4, IpPLa2 – 228.

    Does anyone know a low carb doc like Attia that does consults via internet or phone?

      • because I tried it for a short while and lost 4 inches off my waist in a month without trying, began sleeping better, could handle stress better and got stronger with a better libido – my testosterone nearly doubled

        • It also shows that “Good Numbers” do not necessarily equate to how well the body is feeling. and that Blood test etc. aren’t reliable enough indicators of whats happening in the body. Eg that one could lose 4″ off the waist is a very significant change and also is an indicator of an abnormal state to begin with. (? insulin resistance – the cause which needed to be located. is often stated that insulin resistance associates with an impact on other endocrine glands, which one would expect improvement as insulin levels normalise.)

          • Yes, I was in an abnormal state – I had gone on a crazy lark to see how low I could get my bodyfat. I drove it down to about 3% exercising hard and long twice a day and cutting my cals more and more. Eventually, while still starving and over-exercising, I began to gain fat and lose muscle. I quit the insane workout and diet and recovered in general but still had the extra fat (about 8 in on my waist which had been about 30, but in normal days, was 34.)
            I went on a high saturated fat, low carb diet , went back down to a 34 and reversed all the negatives in a short time. This likely biased me and i stayed on that diet too long – I am about to retest after a month on a low fat diet – and if my numbers shoot down, like I think they will, I will shoot for a balanced diet or maybe even a low carb diet (20% or so) but not a virtual zero carb diet like I was on. According to some (Masterjohn, Jaminet, and I think Kresser too, some carbs are necessary

      • I don’t have an LDL-P number but I read that the ApoB is a reliable marker for LDL-P. My ApoB is 181. It is flagged as high risk. Does anyone know how it translates to LDL-P?

        • 1. See “Calcium Paradox..”-Dr Kate Rheum-Bleue for the Vit K2 connection to Atherosclerosis which is the sign of CHD that all the focus on cholesterol (LDL incl.) is about.
          2. My Dutch friend is a carrier of the FH gene ( one study pointed to increased incidence in the Dutch Afrikaans population to be carriers of the FH gene) that puts her at increased risk for Atherosclerosis so maybe genetic reasons are behind the high values- which is not necessarily a “death sentence” but requires informed action to prevent the conditions for atherosclerosis. Genes are modifiable by environment conditions which themselves can be controlled.)
          3. There seems to be very good evidence presented by Rheum-Bleue for the low K2 theory for Atherosclerosis seen in CHD. (Vit D requires Vit K ‘2’ to properly direct calcium into bones and NOT into the fibrous tissues of the body (incl. veins and arteries) where it creates havoc with abnormal stiffening. Therefore query whether Supplements of Calcium and or Vit D are involved in the diet and if so whether there could be coincidental deficiency of K2 leading to higher levels of cholesterol to support their effects.

          4. If the theory of the marker for the ‘-p’ tester is correct and is therefore a sign of increasing Atherosclerosis then it may be that inflammatory factors are also being overlooked .

          5. It seems it is not the high cholesterol per se that causes problems but it is an indicator of a body need for it, which spurned the ‘Inflammation theory’ of heart disease. So the diet/environment may contain idiosyncratic elements causing issues in the body e.g. undiagnosed allergens /pathogens/infections, which then as inflammation takes it various effects is “requiring” the levels of chol. detected in testing which then are abnormally mixed with bone matrix due to K2 deficit. > causing increased stiffening of the arteries seen in CHD and the reason for statin treatment and adjunct (misplaced) dietary advice.

  18. I am 52 years old and I have had high LDL-P levels for a few years now. 2,600 was my last test result. All of my other factors are fine. I don’t have high blood pressure or anything else. I am fairly healthy, I think. My doctor just put me on Cholesterol medicine so I am not sure if this will help, but I’ve also heard there are side effects which I am not crazy about.

    Anyone else have any experience with ONLY high levels of LDL-P? Any input would be appreciated. Thanks!

    • Wow! Finally found someone with my situation. I just turned 53. All my numbers are pretty good except my LDL-P was 2640. I changed my diet and after 5 months it went down to 2100. Its still high but at least its down somewhat. You can call my cell and talk if you want 954-448-3061 (to much info to post) as i have researched many things and feel im now heading in the right direction.
      Johnny

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