LDL-P

Counseling patients on the role of blood lipids (fats) and their association with the risk of cardiovascular disease (CVD) can be a difficult task.

There are many types of lipids, and most of them play a major role in bodily functions. Nonetheless, some lipid measurements may reflect an increased risk of heart disease.

What is LDL? Why is it important?Cholesterol is the type of fat that is most often associated with increased risk of heart disease. High blood levels of low-density lipoprotein cholesterol (LDL-C) in particular are believed to increase risk.

Still, it is important to understand that a correlation between different subtypes of fats or lipoproteins and the risk for heart disease does not have to imply a causal relationship. In other words, correlation does not prove causation.

Although disputed by many, it has been proposed that cholesterol may play a causative role in CVD. Lowering blood levels of LDL-C is usually recommended.


Small and Large Particles

Triglycerides are the largest category of lipids in the human body and our diet. About two percent of dietary lipids are phospholipids. Only a small percent of our dietary lipids are sterols. The most common animal sterol is cholesterol.

To be able to travel outside cells and in the circulation, cholesterol, and triglyceride molecules are tied to different types of proteins. The term lipoprotein describes these combinations of fats and protein.

Most people are aware that there are two types of cholesterol, depending on the types of proteins that carry the cholesterol molecules. High-density lipoprotein cholesterol (HDL-C) is often termed the “good” cholesterol while LDL-C is usually termed the “bad” cholesterol.

HDL and LDL are two of five major lipoproteins that enable transport of different fat molecules, including cholesterol. The other lipoproteins are chylomicrons, IDL (intermediate density lipoprotein) and VLDL (very low-density lipoprotein, mainly triglycerides).

LDL is the lipoprotein particle that is mostly involved in atherosclerosis. LDL particles exist in different sizes. On the one hand there are the large, fluffy, cotton-ball like molecules, and on the other hand the small dense molecules.

Many recent studies have looked into the importance of LDL-particle size. Studies show that people whose LDL particles are predominantly small and dense have a threefold greater risk of coronary heart disease. Furthermore, the large and fluffy type of LDL may be protective. However, it is possible that the association between small LDL and heart disease reflects an increased number of LDL particles in patients with small particles. Therefore, the number of LDL particles could be more significant in terms of risk than particle size in itself.

There is an inverse correlation between blood levels of triglycerides and LDL particle size. Thus, the higher your triglycerides, the greater the number of small LDL particles. Conversely, the lower your triglycerides, the higher the number of large, fluffy LDL particles.

What Is LDL-P and Why Is It Important?

LDL-C is usually calculated using the Friedewald equation. However, this measure can underestimate LDL-C level as triglycerides increase. Direct LDL-C measurements are also available and better reveal individual issues, but are less often promoted or done due to slightly higher costs.

LDL-C reflects the total content or concentration of cholesterol within LDL-C particles in mg/ml or mmol/L. Since the amount of cholesterol in each particle may vary, measuring LDL-C does not necessarily reflect the actual number of particles.

LDL-P (LDL particle number) measures the actual number of LDL particles (particle concentration, nmol/L). It appears that LDL-P may be a stronger predictor of cardiovascular events than LDL-C.

Low LDL-P is a much stronger predictor of low risk than low LDL-C. In fact, about 30 – 40% of those with low LDL-C may have elevated LDL-P. Therefore you can have low LDL-C but still be at risk for CVD, particularly if your LDL-P is elevated. Discordance is when LDL-C differs from LDL-P.

Lipoproteins play an essential role in the initiation and progression of atherosclerosis. Therefore it is crucial for us to understand what regulates the production and clearance of atherogenic lipoprotein particles and how these mechanisms may be influenced.

LDL-C is only a measure of the cholesterol mass within LDL-particles. Thus, LDL-C only indirectly reflects the atherogenic potential of LDL particles. Apolipoprotein B (apoB) and LDL-P, on the other hand, reflect the number of atherogenic particles, with no mention of cholesterol mass. Therefore apoB and LDL-P are believed to be better risk predictors than LDL-C.

In a consensus statement from 2008 on lipoprotein management in patients with cardiometabolic risk, the American College of Cardiology and the American Diabetes Association recommended more prominent roles of apoB and LDL-P as target of therapy

Some patients with low LDL-C may have elevated LDL-P and the other way around. This may explain why so many patients who suffer a heart attack do not have elevated levels of LDL-C.

Reference Range for LDL-P

LDL-P is measured by a so-called NMR lipid profile test. A value of less than 1.000 is considered ideal. Above 2.000 is considered very high.

  • Ideal: <1000
  • Moderate: 1000-1299
  • Borderline High: 1300-1599
  • High: >1600

How to Lower LDL-P

Much has been written about how to lower LDL-C. Most doctors will recommend eating less fat and cholesterol from meat and dairy products. Statin therapy usually lowers both LDL-C and LDL-P. However, some therapies may affect LDL-C and LDL-P differently.

Interventions that will lower LDL-C more than LDL-P include statins, estrogen replacement therapy, some antiretrovirals, and a low-fat, high-carbohydrate diet. Interventions that lower LDL-P more than LDL-C include fibrates, niacin, pioglitazone, omega-3 fatty acids, exercise, Mediterranean and low-carbohydrate diets. Although statins lower LDL-P, they may leave a significant number of patients above the LDL-P target.

Patients with high levels of triglycerides and low HDL-C  are likely to have high LDL-P despite normal or low LDL-C. Such a lipid profile is typical for individuals with metabolic syndrome. Studies indicate that these patients may benefit most from low-carbohydrate diets and that carbohydrate restriction reduces LDL-P.

advertisement



514
Leave a Reply

avatar
322 Comment threads
192 Thread replies
2 Followers
 
Most reacted comment
Hottest comment thread
132 Comment authors
Axel F SigurdssonJo-AnnLyrrKim MAxel F Sigurdsson Recent comment authors

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  Subscribe  
newest oldest most voted
Notify of
David Brown
Guest

LDL-C and total cholesterol have never been particularly good predictors of who will develop clogged arteries. However, total cholesterol strongly correlates with all cause mortality risk. For example, as total cholesterol rises above 240, there appears to be some increased risk for cardiovascular disease. As total cholesterol drops below 200 there is a steep rise in mortality from infections, parasites, and cancers and increased risk of violent death. Unfortunately, last I heard, the American Heart Association was still recommending that total cholesterol be artificially depressed below 200 to decrease risk of heart attack. https://www.theheart.org/article/1371059.do Yet researchers at Texas A&M university… Read more »

Mike
Guest
Mike

Are you seriously trying to imply that low cholesterol causes infections, parasites, cancer, and violent behavior? If you look at that graph, it’s obvious that the countries with low cholesterol are Third World Nations with poor sanitation, disease epidemics, civil war, etc. Do you think you could protect yourself from HIV by eating enough butter, sir?

Lucy
Guest
Lucy

It’s true. Low cholesterol is bad BAD news. People with high cholesterol live the longest. IN fact for women, really high cholesterol is associated with longevity, but also with increased a little increased risk of heart disease. IMO I think the particles and all that stuff doesn’t mean much either. (I saw only one study on that particle thing and it didn’t convince me) There was a recent study that oxidized LDL is actually the good guy in the process of heart disease. I think heart disease is really an infection in the lining of the artery, and people with… Read more »

Lilyrose
Guest
Lilyrose

butter and diet don’t do much to raise cholesterol. IT’s a myth. I think Sugar does cause a rise in Triglycerides which causes the ratio to get out of wack. I don’t think butter or cholesterol in food does much. I went on Google Scholar and saw that low cholesterol below 150 is associated with all cause mortality everywhere.

Sean O'Leary
Guest
Sean O'Leary

Bergamont (Bergamont), in combination with grape seed extract, Bioperine, and Artichoke make for an amazing combination. I take this combination from compoundednutrients.com but you can only get it through a practitioner.

RB
Guest
RB

Please expound. What makes it “amazing”? Has it changed your lipid numbers?

Jane Bateman
Guest
Jane Bateman

I found out 2 days ago I have High Small LDL-P levels 1455 High Triglycerides 160 Low HDL-C 36 Low HDL-P (Total)24.2 High Cholesterol,
Total 210. Im scard to death. Doctor wants to put me on Statin drug. Husband says its hype mother says eat oats. Im afraid of side effects . And afraid of CVD. Im 47 woman . Father died of CVD at age 35 . Mother says it was Lymes disease. I’m afraid to take statin and afraid not to. I dont know what to do. Help please

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi Jane. Thanks for your post. A TG/HDL ratio above 4 (in your case 4.6) may sometimes indicate high insulin levels (hyperinsulinemia). I don’t know if you are overweight, but if you are, a low carbohydrate, high fat diet may indeed increase your HDL-C and lower your triglycerides which is probably a good thing. Furthermore, it might improve particle size and particle number. Your lipid profile in general, with high TG and low HDL, is compatible with the metabolic syndrome. Therefore it is important to know whether you are overweight or not. Furthermore, it is important to look at your… Read more »

David Brown
Guest

Saturated fats, in conjunction with adequate supportive nutrition, can lower triglycerides and raise HDL-C. The important thing is to restrict added sugars.

Optimum total cholesterol seems to lie in the 200 to 240 range.comment image

jane bateman
Guest
jane bateman

Thanks for the reply I am 5’3 and 153 # I do smoke.

jane bateman
Guest
jane bateman

do you mean unsaturated fats and are you saying no sugar because it turns in carbohydrates. What about omega 3 oats nuts avacado fish oil walnuts fresh fruit vegtables oats . If i eat this diet do you think it will lower ldl-p?

David Brown
Guest

@ Jane Bateman, A person does not necessarily need to eliminate added sugars or omega-6s
from the diet. Just keep them to safe levels. A diet of whole, natural foods such as you listed will naturally limit added sugars and omega-6s without much effort but it may not lower LDL-P.

As for smoking, I suggest you read about the Kitava Study:
https://www.staffanlindeberg.com/TheKitavaStudy.html
https://wholehealthsource.blogspot.com/2008/08/cardiovascular-risk-factors-on-kitava_17.html

Maribeth
Guest
Maribeth

My doctor wants to put me on statins because of elevated LDL-P. In May, it was 1578. Now: LDL-P – 1348 LDL-C = 105 HDL-C = 44 Triglycerides = 73 Cholesterol Total = 164 LDL & HDL Particles HDL-P (total) = 29.7 Small LDL-P = 513 LDL Size = 21.6 I am 53, never smoked, both parents died from heart disease, I’m 141# (have lost 30 lbs this year). I had bile duct surgery a month ago with elevated liver enzymes and I hate to take medication that will bother my liver. For the last 3 months, I haven’t eaten… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Maribeth. Thanks for sharing your thoughts. It would be irresponsible of me to give advice on individual cases. This is certainly a situation where some doctors may want to prescribe statins and some would recommend against it. The decision to prescribe statin therapy in primary prevention is often quite difficult. The clinical guidelines generally recommend looking at total risk, taking into account all risk factors, not only lipids. In your case the total risk is propably rather low, considering that you have never smoked and don´t have hypertension or diabetes. One could certainly wonder, looking at your family history and… Read more »

Ed Cooper
Guest
Ed Cooper

If we reduce carbs in our diet, I think we can assume that food will be replaced with fats and proteins. The additional fats and proteins will increase LDL-C, right? Will it also increase LDL-P? I understand that LDL-P is what we need to be concerned about. Thanks.

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Ed. Some studies indicate that low carbohydrate diets may increase LDL-C as you suggest. However, HDL-C seems to increase as well and triglycerides usually go down, which is positive. Furthermore, LDL-particle size appears to increase on low carb, and LDL particle number (LDL-P) decreases. Thus, discordance (between LDL-C and LDL-P) appears to become more prominent.

Kristina
Guest
Kristina

Hi! I am 36 years old, 5’3, weigh 113lbs. I eat relatively healthy and excerise 6 days a week. I do not smoke. My dad died of congestive heart failure at 53, his identical twin died at 46 from a massive heart attack and their dad died at 53 from heart disease. All 3 smoked. Dad had his first heart at 37. I just had extensive blood work done and here are the results. My doctor wants me to take a baby aspirin daily and retest in 3 months. I would love your thoughts on this. I am not sure… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Krstina. I understand your family history is a cause for concern. Remember however that your dad, his brother and your grandad were all smoking males. You being a nonsmoking woman is quite different. The regular exercise, and I am assuming a normal blood pressure is also positive when assessing your total risk. I think your lipid numbers are indeed quite good as well, apart from the LDL-P. The goal for LDL-p is less than 1.000. 1300-1600 is generally considered moderate risk and above 1600 is high risk. However considering that all other measures are very good, I don´t think you… Read more »

Kristina
Guest
Kristina

Thank you do much for your quick response! The total cholesterol is 206. ( 3 little ones running circles around me while typing). Also, my Lp-PLA2 is 236. This has to do with inflammation? What are your thoughts regarding that number? I am told this is a high risk number for me. Thank you do much!

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Kristina. There is still some uncertainty about the value of Lp-PLA2 measurements. There seems to be a positive association between Lp-PLA2 levels and vascular and nonvascular outcomes in many studies, but these are observational studies and can´t establish causality. https://www.theheart.org/article/1071965.do

High sensitivity CRP (hs-CRP) is probably the most commonly used marker of inflammation. Some studies have raised the possibility that hs-CRP could be used to target high-risk patients who may benefit from statin use. https://ukpmc.ac.uk/abstract/MED/16442935

REBECCA
Guest
REBECCA

I just had my labs done due to feeling fatigued and tired all the time as well as headaches. My LDL-P was 2051, LDL-C 131, Triglycerides 147, Cholesterol 212. My small LDL-P is 787. Also, my LP-IR score is 50. I am so confused about all the information about diets and the fact that my LP-IR is high. Now I’m confused about diabetes and insulin resistance. I am overweight, 185 and 5’2″. My Vit D is also low at 27.1. I know I need to maintain a diet and decrease weight, but the proper diet, what to eat and what… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Rebecca. Please discuss your symptoms and lab results with your doctor and get his advice. What concerns me with your lab results is the elevated LDL-P and small LDL-P. Triglycverides are also borderline high. Total cholesterol and LDL-C are not that bad numbers. Your BMI is 33.8. Your LP-IR certainly indicates some insulin resistance. Lipid problems, including higher triglycerides, decreased HDL levels, and increased small, dense LDL particles, have been shown to be atherogenic. In obesity, these lipid disorders seem to be closely related to insulin resistance. Weight loss and exercise, even if they do not result in normalization of… Read more »

Dottie Parker
Guest
Dottie Parker

I went LCHF Paleo in 2011 and my cholesterol numbers have worsened considerably. I am worried that I might have familial hypercholesterolemia. I am a 49 year old female, non-smoker, low-normal blood pressure, low (but treated) thyroid, BMI of 23. Now (pre-Paleo) Total Chol. 298 (195) LDL-C 136 (98) HDL-C 134 (85) VLDL 28 (9) Trigl. 140 (61) CRP 0.9 (1.6) My doctor wants to prescribe statins and is unwilling to order an NMR (I’m in Massachusetts where it is illegal to get any blood tests without a doctor’s order – even online). I think I can, however, drive out… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Thanks for the post Dottie. I find your experience interesting. It surprises me a little bit that your Total Chol and LDL-C have gone up this much. It surprises me even more that your TG have gone up as well, which is uncommon on Paleo and other low carbohydrate diets. However, your HDL-C has gone up considerably which is very positive. Therefore, your TG/HDL-C ratio has only gone up a little bit. I see from the numbers that your LDL-C is calculated (not measured) using the Friedewald equation, but it should be reliable anyway in your case. There appears to… Read more »

Dave
Guest
Dave

Hello Doc, I have been watching your video and reading your articles, and I just received my results from an NMR and VAP cholesterol test. Below are my NMR results and I am very concerned and hoping you can give me some advice for area of my diet and exercise to explore. My results: LDL-C 217 HDL 68 VLDL 16 Cholesterol Total – 301 Trigs 66 LDL+VLDL 233 LDL-R (Real) 190 Lp(a) 16 LDL-P 1812 LDL Density Pattern: A I weigh 170 lbs, 5’10”, male. My diet is generally low carb, low grains. I eat eggs, steak, chicken a few… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi Dave. As you probably know genetic factors highly influence our blood lipid pattern. I presume you have a family history of high cholesterol, correct me if I am wrong. You seem to live a healthy lifestyle, BMI is normal, lots of exercise and a relatively healthy diet. Total Chol and LDL-C are quite high and so is LDL-P. The positives are a relatively high HDL for a male and relatively low levels of TG. TG/HDL-C is close to 1 which is fine. LDL density Pattern A suggests that large particles dominate which is positive. Lp (a) is not that… Read more »

Dave P
Guest
Dave P

Thank you, Doc, for your comment. Yes, I am healthy, have no risk factors and do not have a history of high cholesterol in my family. I am going to take your advice and add carbs to my diet, probably sweet potatoes and white rice, and more nuts, and then retest in a month, unless you think this is not enough time. Also, I was wondering what your thoughts are on low-carb eating and the effect of T3 or rT3. Could low thyroid function be the cause of high LDL-P? I was considering getting tested for thyroid function and testosterone… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Low thyroid function has been associated with elevated levels of blood cholesterol. Thyroid hormones seem to be involved in LDL and HDL metabolism, although the mechanisms are still a bit unclear. I agree that you should have your thyroid function tested. There is a recent publication indicating that hypothyroidism (TSH levels over 10 mIU/l) is associated with a significant reduction in LDL particle size and a higher prevalence of atherogenic pattern B. https://www.ncbi.nlm.nih.gov/pubmed/23039873 One month may be a little to short to evaluate the effects of diet changes on blood lipids, but you might see some trend. I often recommend… Read more »

David P
Guest
David P

Thanks, Doc. As it is easy to overdo these tests, which test do you recommend for Thyroid?

Here is a site I have been using: https://www.accesalabs.com/thyroid

Thanks.

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Measuring TSH is usually enough to test for hypothyroidism (low thyroid function). If hypothyroidism is present, TSH will be elevated. If hyperthyroidism (overactivity of the thyroid gland) is suspected Free T4 is ofte measured as well. Other tests are seldom needed.

cityboy
Guest

Yet, my wife is hypothyroid and despite taking 100mg of T4 daily, she still has symptoms such as brittle nails, hair loss, insomnia. After reading Sarah Gottfried’s book, the Hormone Cure, she had her free T3, free T4, reverse T3 and antibodies tested to determine if she had Hashimoto’s, which it looks like she most likely has. Most articles she has read would indicate that TSH alone doesn’t tell you squat and that the other tests are vital. I suspect she is a candidate for Armour, although her doctors are reluctant to prescribe “natural” products and have so far started… Read more »

Dottie Parker
Guest
Dottie Parker

Thank you, Doc, for your informative reply. Regarding FH, I tend to agree that it would likely have shown up earlier in life. Prior to Paleo, I had been on a SAD/ Weight Watchers diet for 10 years. My diet was chronically calorie-restricted, VLF, and nutrient sparse (I believe that may have caused the hypothyroid). I have read that FH can be hidden by a low-fat diet, so, I am going to find a way to get an NMR. On a positive note, I’ve just learned from 23andme that I don’t carry the ApoE ε4 variant. So, I’m now thinking… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Thanks for sharing your thoughts Dottie. I will be very happy to hear about your progress.

Mike
Guest
Mike

Just came across this site. I too have experienced the increase of TC and LDL. However as I consider the FH diagnosis, everything Ive read is that FH is almost never been able to be controlled by diet alone, which clearly is not the case in many Paleo eaters that encounter this sudden rise in TC and LDL.

Amanda
Guest
Amanda

Hi Doc! Went to the doc yesterday to talk about Cholesterol & labs and got scared out of mind!! Here are the results of my labs: Total Chol-209 LDL-C-148 HDL-C-37 TRIGLYCERIDES-60 NON HDL C-172 APO B-128 LDL-P-2430 LP MASS-20 HS-CRP-25.7 I am overweight but I am dieting right now and have been successfully for about a month. I have lost 13 lbs since these labs were drawn. At the same time these labs were drawn I was also being checked for a UTI that did come up positive. Was wondering if the UTI caused the high hs-CRP? I am 33… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

@ Amanada. UTI can definitively raise hs-CRP. Measuring hs-CRP when you have an active infection can therefore be misleading. There appears to be a lot you can do to reduce your risk for heart disease. Quitting smoking is extremely important. If you continue losing weight, your LDL-P and APO B will probably improve. You may have insulin resistance so limiting sugar and carbohydrates might be helpful. I think you should discuss with your doctor the possible advantages and disadvantages of medical therapy.

katie
Guest
katie

I am 31 yr old female. I weigh 120 lb and am 5’3 inches. I eat relatively healthy, including whole grains, fruits, vegetables, lean meats, and dairy into my diet. I don’t eat a lot of fat, but when I do I try to use healthy fats like olive oil or Smart Balance spread which is supposed to help maintain healthy cholesterol. I usually don’t eat a lot of junk, but I would usually bake something sweet about twice a month. My doctor did a full array of blood tests for me in February, where I had some parts of… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

@ Katie. This is a difficult situation as you seem to eat healthy, have no overweight and do a lot of exercise. Your genetic predisposition does not appear strong either. The TG/LDL ratio and the LP-IR score may indicate you have some insulin resistance. LDL-P and small LDL-P are high as you are aware of. If you look into the scientific literature, a low carb high fat diet is probably more likely than a low fat diet to raise your HDL and lower your TG, LDLP and small LDL-P.

Joe
Guest
Joe

I am told that LDL-P and ApoB measure the same thing. But how do the numbers translate. I don’t have a LDL-P number. I have 184 ApoB which the report says is high risk. But I see people posting LDL-P numbers in the 1000’s and 2000’s. What does a 184 ApoB translate to in LDL-P?

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Joe
You can’t directly translate ApoB to LDL-P. There is a strong correlation between ApoB and LDL-P which means that when ApoB is low, LDL-P tends to be low as well and when ApoB is high, LDL-P tends to be high.. However, sometimes there is discordance between ApoB and LDL-P. Thaht could mean a relatively high LDL-P despite a relatively low ApoB.
So it’s not always simple.
Don’t know whether you have access t this paper here but you may be able to see the abstract.

joe
Guest
joe

Doc, are there any innocent, non-dangerous conditions that can cause a spike in inflammation markers? I always had low crp. Went on a high fat/low carb diet a few years ago and my LDL went to 300. My crp was 2.4, a little higher than in the past (used to ranged from 0.3 to 2.0). I decided to go low fat for a month and recheck. My LDL went down to 120 but my crp went from 2.4 to 12.3. fribrimogen from 380 to 507 and LpPLA2 from 228 to 266. I had given up coffee and was having slight… Read more »

Axel F Sigurdsson
Guest
Axel F Sigurdsson

Joe
There are a number of factors that can elevate hs-CRP and other markers of inflammation. Infection is one of them. So if you had a cold and swollen glands, that may surely have played a role.
https://www.docsopinion.com/health-and-nutrition/hscrp/

joe
Guest
joe

Do any of these tests directly measure inflammation on the wall of the artery, or do they all just measure general inflammation? And if its just general inflammation, is it the case where elevated inflammation levels as measured by these tests (CRP, frbrimogen, LpPLA2) is only a problem if the inflammation detected happens to be from damage in the inside of the arteries that are inflamed, or does inflammation from other parts of the body (arthritis etc) cause damage to the arteries and raise risk of CVD?

Axel F Sigurdsson
Guest
Axel F Sigurdsson

Joe
Measurements of these markers reflects general inflammatory activity. We can’t differentiate between inflammation within the cardiovascular system or elsewhere in the body.
The other question is more difficult to answer. We know that people with some inflammatory disorders such as rheumatoid arthritis are at increased risk of cardiovascular disease suggesting that the inflammatory activity associated with these disorders may negatively affect the cardiovascular system.

joe
Guest
joe

So for someone to have ‘chronic inflammation’ those markers should be up all time? I have been trying to figure out why my inflammation went from low to med to sky high. I recently switched from a combo of traditional lifting and cardio to less frequent, shorter but more intense workouts. Part of that is ‘super-slow reps’. The negative, or eccentric part of the lift, lowering it, has long been claimed to cause more micro damage to the muscle. Doug McGuff says now that the concentric part of the lift done very slowly does even more ‘damage’. Usually it is… Read more »

Sean Daily
Guest

I’ve been a superslow guy for almost 20 years and am intrigued by this question.. especially b/c I’m doing it pretty intensely and now 3x/week up from previously 1x/week. My LDL-C and LDL-P is really high so would be interested in any possible correlation here as well.

Marcia
Guest
Marcia

Hi Doc! I’ve just got my results, and I’m a little concerned with the numbers. I never smoked, drink only socially, don’t exercise, love sweets (ice cream, chocolate, cakes, etc), a little overweight, but accumulate fat basically in my stomach. My energy levels change, my sleep pattern is crazy. Please, help me to figure out what I need to do. Today I tried not to eat sweet and I must tell you. It’s hard. My mouth waters when I see it, and I get a little upset because of that. AST(SGOT) high – 49; ALT (SGPT) high – 74; Vitamin… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi Marcia. The liver enzymes, AST (GOT) and ALT (GPT) are only marginally elevated. There appears do be a typical discordance between LDL-C and LDL-P; LDL-C is not that bad, but LDL-P is high. Triglycerides are high, so is small LDL-P. LP-IR score is elevated suggesting insulin resistance. This is a lipid profile you would expect to see in an individual with the metabolic syndrome. I would focus on two things, both important. 1) Try as much as you can to stop gaining weight. I know it sounds easy, but I have to emphasize it. I don´t know about your… Read more »

Sandy
Guest
Sandy

I am an almost 63 year old female, low blood pressure, get lots of exercise (walk almost every day at least 4-5+ miles and do Pilates 2-4+ times/week), eat a mostly plant –based diet w/lots of greens, onions, garlic, mushrooms, raw nuts, some fruit, etc. plus wild Alaska salmon almost every day. (Started eating fish regularly when I started taking my ldl seriously around June of this year.) Take one fish oil tablet usually every day (EPA 360mg/DHA 240 mg). I am about 5’ 1” and weigh about 116. (Have been bringing down my weight by strictly eating a high-density… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi Sandy. Your BMI, blood pressure, lots of exercise, no-smoking certainly indicates you are taking good care of your self. You do have family history of CAD and your blood lipids have caused some concern. However, considering the usual algoritms, your total risk is probably not very high. LP-IR score indicates no insulin resistance. Most doctors recommend statins if LDL-C is above 190, so I understand your doctor very well when he recommended drug therapy, when your LDL-C was >190. However, you managed to lower your LDL-C which is great. The high LDL-P worries me a little bit. You can… Read more »

Sandy
Guest
Sandy

PS I forgot to mention (at least) a few things. First, I very much want to avoid taking drugs, if at all possible, and have the discipline to do what is necessary, I believe, assuming it can be done. Second, I have Hashimoto’s, which last time measured at 1204. And, for what it’s worth, I have acquired angioedema triggered by NSAIDs.

John
Guest
John

Hi Doc, I am 51 6’2 203lb male. I was diagnosed with celiac disease 2 years ago and soon after my weight went up to 220 after plummeting to 190. Blood Pressure was controlled by norvasc 5mg and cardiologist insisted on taking simvastatin, to which I have resisted until now. Father and both grandfathers died from heart attacks. Mother’s side has history of diabetes and high cholesterol. NMR profile: LDL-P 2333 LDL-C 163 HDL-C 35 triglycerides: 116 Total Cholesterol: 220 HDL-P 23.2 Small LDL-P 1561 LDL size 20.1 LP-IR score 64 I do moderate cardio exercise with weight training. I… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi John. Thanks for the post. The high LDL-P certainly put you at higher risk. Considering your BMI and LP-IR score it is likely that you have insulin resistance. Losing weight is very important in this situation. I definitively agree that carbohydrate restriction is sensible. Under these circumstances, considering the lipoprofile, high blood pressure and family history of coronary artery disease, I usually recommend statin therapy unless there are contraindications for such treatment.

Anthony
Guest
Anthony

Dear Dr. Sigurdsson, I am a 71 yr. old male and have been lucky not to have hight blood pressure, and no Diabetes,but both of my parents did have it. I have total body weight of 146 lbs. On my recent visit to my Dr. My test Total cholesterol is 170. Triglycerides 55, Hdl 68, Ldl (direct)82, and vldl 11, also HDL risk factor is 2.5, which is low. Fasting Glucose is 91 and Hemoglobin A1C is 5.6 four months ago but as of this new test date is 5.9. The cause for my question to you is that I… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

@ Anthony. Thank you for your post and all the kind words. As you know I do have to be careful when it comes to individual recommendations. Your doctor will surely know much better than I what´s best for you. I can only reflect on what you have written in very general terms. In general, your risk profile appears to be low; no smoking, no hypertension, no obesity, no diabetes. There is family history of hight blood pressure and diabetes but no history, as it appears on premature coronary events. Your general lipid profile does not cause much concern, total… Read more »

Anthony
Guest
Anthony

Dear Doctor, Its Anthony again and a sincere Thank you for your response. What I will do is not take the Creastor as My Dr. suggested , but I will excirse more , Walk more and stop eating Cheese, and Potato chips that I adore. I have read and read about diets , and a question I ask you now is what diet helps to lower LDL-p and is the most Heart Healthy diet to live by. I eat chicken, fish, and red meat only once a week. I do drink 4 cups of coffee in the am with oat… Read more »

Charles
Guest
Charles

Greetings Doc – I have studied your previous responses but am still confused about my direction. I am 43, male, 5 ft. 10 in., non smoker, normal blood pressure and light exerciser (walking about 3 times per week). No family heart problems in the past. I started a Paleolithic diet after a lipid profile I received last year. I also began supplementation as follows: Vitamin D at 3000 IU daily (2011: 21.2 ng/mL 2012: 66.6 ng/mL) FISH OIL at about 2 grams daily Here’s the before and after: PRE- PALEO November 2011 1784 LDL-P 115 LDL-C 54 HDL-C 315 Triglycerides… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Thank´s for the post Charles. I understand your confusion. Your lipid profiles pre – and post Paleo show very well how difficult it is to predict how our lipid numbers react to different diets. The fact that your total cholesterol (TC) and LDL-cholesterol (LDL-C) go up on Paleo is not surprising. Generally, carbohydrate restriction with increased consumption of fat elevates TC and LDL-C. However, more than 50 percent elevation of LDL-C on Paleo is more than I usually see. The lowering of TG and insulin resistance (LP-IR score) is something you would expect on Paleo. However, I would have expected… Read more »

KevinF
Guest
KevinF

My personal anecdotal experience — starting as a prototypical metabolic syndrome case whose good numbers were all low and whose bad numbers were all high: Eating low-carb high-fat paleo significantly reduced my triglycerides and raised my HDL; and then going on a statin and naicin massively brought down the TC, LDL-C, and LDL-P. Those two approaches seem to be working great for me. I didn’t get a lipid profile done just prior to converting to a LCHF diet early this year (unfortunately!). Hadn’t had cholesterol checked in a couple years — so I can’t say for sure exactly what the… Read more »

Joe
Guest
Joe

Dr Sigurdsson, I would like to start by saying that I just came across your website and have been quite impressed. I too am one of those people on “lowish” carb Paleo with elevated LDL-C/P. It is quite difficult to find good data that combines the principles of a low carb approach to looking at lipids(i.e. high HDL, LDL size, low TG/HDL ratios) and the reality of LDL particle numbers. Some of the comments you have made above have been quite insightful and on the money. As a physician (anesthesiologist) I appreciate that. In my personal lipid situation I have… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Thank you for the post Joe. As carbohydrate restriction and Paleo is becoming so common these days, it is important to understand what happens to our blood lipids with these lifestyles. Although there are a number of short term studies looking at risk factors such as blood pressure, lipids and glucose metabolism, we still don´t know the long-term health effects. There seems to be a general pattern in the lipid response to low carb high fat (LCHF) diets, but there is a lot of individual variation. Most often, like in your case, total cholesterol (TC) and LDL-C will go up… Read more »

joe
Guest
joe

Doc, I wonder if you could comment on my situation. Years ago on a very low calorie (starvation diet) with excessive exercise, driving my bodyfat down to 3%, I had 145 total C, LDL-52 and HDL-C 87, trigs 37, glucose 90, crp 0.29. On heavy, but not excessive exercise program and a normal caloric intake evenly balanced between p, c and f, I had total C 185, LDL-C 107, HDL-C 69, trigs 47 and crp 2.0. Three years ago I went very high fat (75% – 3000 cals worth? ) 20% protein and less than 5% carb (leafy and cruciferous… Read more »

Richard
Guest
Richard

Just got some testing back, after a long period of weight loss and transition from strength athletics to endurance athletics, all the numbers were nicely in their reference range… except that LDL-P, which was obnoxiously high at ~2000. So we’re going back on the simvastatin; but in reading stuff on “metabolic syndrome” which the doc seemed concerned that I might be trying to develop, I see recommendations for a low carb approach. I figure while I’m still used to micromanaging my diet, if I could get a recommendation for ratios (carb/fat/protein) for a 3200kcal / day diet, it’d be easy… Read more »

Tom
Guest
Tom

I just got my first LDL-P test = 1755. My triglycerides = 48 and my LDL-C = 114. This does not see match the pattern described in the article in that my triglycerides are low and LDL-C not too high. I take 20 mg simvastatin. Take about 3 grams of fish oil per day. BMI around 24. Don’t seem to be a metabolic syndrome candidate. My diet tends toward high carb and my execise level is on the low end. Not sure of the best course of action in this situation. Maybe someone could comment on this general situation.

Nette
Guest
Nette

Total Cholesterol 365; LDL-C 214; Triglicerides 404; Apo B 189; LDL-P 3500 (yes 3500) What can I eat??? 5’6″, 130#, non smoker, female A little bit scared!

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Nette. I don´t know about your age or your family history. Looking at your lipid numbers there is a possibility that you have what is called familial combined hyperlipidemia. My suggestion is that you seek a specialist, either a cardiologist or a lipidologist. Have you done that?

John
Guest
John

John Male Age 42

Family History – Father had first HA at 46 and is a Diabetic

Ht – 6’3
Wt – 230 lbs (lost 15 lbs in 2 months)

TC 202
LDL-C 106
LDL-P 1667
HDL 57
TRiG 218
Blood Glou 107

After two months of Meditarian diet and 6x a week exercise I dropped 300 from my LDL-P. My NP still wants me to start statin therapy which scares me. I want to keep trying to lose weight. I’m afraid statins will push into diabetes.

Axel F Sigurdsson
Admin
Axel F Sigurdsson

John. Your lipid profile is not that bad really and does by itself not support statin therapy, considering that we are talking primary prevention. I agree with you that you should continue trying to lose weight. I think a Mediterranean type diet including exercise is definitively a good option in your situation. This will hopefully help lowering your TG. Indeed, a low carb version of the Mediterranean diet might be something to look at as well.

mpanttaja
Guest
mpanttaja

I have a problematic set of results on my NMR. At least I cannot figure what they mean. Story: obese most of my adult life; low carb 2.5 years; in first 18 months lost 25 pounds with work; discovered the T2D 1 year ago; added metformin and lost another 10 pounds; weight and BG stuck both still somewhat high; high FBG. In mild ketosis much of the time, with periodic breaks with added carbs. What does it mean if both LDL-P and HDL-P are off the charts high, IF I am on a long term low carb regimen with high… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

@ mpanttaja. As you probably know the high levels of HDL-C and HDL-P are good things in terms of risk. Considering your weight and diabetes I would suspect you fulfill criteria for the metabolic syndrome. So it is a bit surprising that your LP-IR score is this low. Actually, you can often get confused with all these numbers. Maybe you should look at your lifestyle in general and see what you can do to reduce your risk. The saturated fats will not help you lower LDL-C. I wonder whether switching to a more of a Mediterranean type diet, using more… Read more »

Tweet
Pin13
Share253
Share1