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Cholesterol - LDL Particle Size

Bigtex

Bigtex

VIP Member
Aug 14, 2012
913
1,351
I taught an older adult class on healthy eating and got into a lesson and discussion over lipid metabolism, cholesterol levels and statins. Many of them have high cholesterol and are taking statins.


Measurements of lipids levels in blood are frequently used to assess the risk of future heart disease. The most commonly used measurements are total cholesterol, triglycerides and high density lipoprotein cholesterol (HDL-C). These numbers are then used to calculate low density lipoprotein cholesterol (LDL-C),which has been found to be strongly correlated with the risk of heart disease.

In the past doctors tested:
Total cholesterol = triglycerides + HDL + LDL

Now doctors should test
Atherogenic lipoprotein particles = LDL-P (LDL particle number),apolipoprotein B (apoB) and lipoprotein(a)
This has shown to be a much stronger predictor or cardiac risks

Particle sizes = LDL small density (LDL-B) and LDL large density (LDL-A)

Studies show that people whose LDL particles are predominantly small and dense (LDL-B),have a threefold greater risk of coronary heart disease. Furthermore, the large and fluffy type of LDL (LDL-A) may be protective.

LDL-Particles.jpg


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014286/


LDL Particle Sizes


In the class I mentioned atherogenic lipoprotein particles or particle sizes in relationship to LDL. Fat large particles (LDL-A) were good and in fact increase HDL, small dense particles (LDL-B) are known to increase cardiac risk factors. In fact, studies show that people whose LDL particles are predominantly small and dense, have a threefold greater risk of coronary heart disease. The large and fluffy type of LDL may be protective.

In view of the strong relationship between elevated plasma triglycerides and the small dense LDL-B particles, triglyceride lowering therapies could be expected to have a greater impact on LDL size and density than predominantly cholesterol lowering therapies using fibrates. Fibrates are a class of medication that lowers blood triglyceride levels in particular, small dense particle (LDL -B). Statins have little effect on particle size when tested in patients with the small dense LDL phenotype.

The following generic formulation medications are commonly given which have been shown to reduce LDL-B and increase LDL-A:

Fibrates

Gemfibrozil - Lopid
Fenofibrate - Antara, Triglide, Fibricor, Lipofen, Trilipix, and Fenoglide
Bezafibrate
Ciprofibrate

• To test for LDL particle sizes your doctor will need to do a test called Low-Density Lipoprotein Sub-fraction Profile. This will require a blood sample.

Diet Strategies

Strict low-fat diets (less than 20% of calories from fat) lower HDL and push LDL to the undesirable smaller size (LDL-B). Low-fat diets are therefore not advised when total HDL is low or when large HDL is deficient. People with low HDL do better by adding dietary sources of plentiful monounsaturated fatty acids (especially raw nuts, flaxseed products, and olive and canola oils),eating unprocessed foods with a low glycemic index, and increasing lean protein intake. Omega-3 fatty acids from fish oil have a modest effect in raising total HDL and increasing large HDL. Ketogenic diets have also been show to help.

The Ketogenic Diet:

• Increases LDL particle size to the less oxidation-prone state - a shift to LDL-A
• It increases the amount of HDL available to recycle LDL from the blood before it has a chance to become oxidized
• It improves the LDL to HDL ratio
• Lowers triglycerides and improves triglyceride to HDL ratio

1) Dietary carbohydrates increase levels of small, dense LDL cholesterol (LDL-B).
2) Dietary saturated fat increases levels of both HDL cholesterol (which is inversely correlated with cardiovascular disease) and large buoyant LDL cholesterol (LDL-A).

For many years doctors and nutritionists have been unwittingly giving incorrect advice to their patients about cutting fats – for example from the 70’s onwards we have been telling them to cut down on eggs and other cholesterol rich foods (it has now been known for many years that dietary cholesterol does in fact reduce levels of LDL-B ); and in replacement, they should eat margarine instead of butter. Now we know that margarine was full of trans fats.

1. Levels of small, dense LDL particles are closely correlated with carbohydrate intake.
2. Saturated fat increases levels of HDL (good) cholesterol.
3. Saturated fat increases levels of large buoyant LDL-A (good) cholesterol.
4. We need to include a diet rich in omega 6 fatty acids and omega 3 fatty acids with a ratio of 3:1
5. Reduce the amount of sugars especially fructose and high fructose corn syrup you take in.

Include Coconut Oil

Coconut oil contains a high amount of saturated fats called medium chain triglycerides (MCT). Your cells burn MCTs for energy while storing very little as fat, boosting your metabolism and supporting your immune system. While eating more MTC’s will cause your cholesterol levels to rise, it is not considered to be a negative thing and will not increase our chance of cardiac problems.

Researchers found that the saturated fat from coconuts does not negatively impact the cholesterol profile. Instead, the coconut oil’s overall effect raised HDL while lowering triglycerides and small LDL cholesterol particles (LDL-B),which is definitely a good thing.


Reference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014286/
 
R

rawdeal

TID Board Of Directors
Nov 29, 2013
3,608
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Crap. So, after reading the post, and the link, I naturally ran on over to PrivateMD to see if they offered the Low-Density Lipoprotein Sub-fraction Profile test, and ...... they do not. I like to do as much of my own health monitoring sans doctor as possible, gonna have to think on this.
 
Bigtex

Bigtex

VIP Member
Aug 14, 2012
913
1,351
Crap. So, after reading the post, and the link, I naturally ran on over to PrivateMD to see if they offered the Low-Density Lipoprotein Sub-fraction Profile test, and ...... they do not. I like to do as much of my own health monitoring sans doctor as possible, gonna have to think on this.

LabCorp and Quest both do them.
 
R

rawdeal

TID Board Of Directors
Nov 29, 2013
3,608
2,571
Not sure if we're speaking the same language here or not. LabCorp IS who I go to, but I'm scripted to there by PMD. No experience with Quest, but it wouldn't surprise me if both labs did this test you mentioned ..... IF a f2f Doc wrote the script.

When I checked PMD's site, however, I didn't see that test as worded in your post. Poked around a little among all the tests they listed that look at the blood itself, didn't see any that seemed to be your recommended test under a different name. THEN, I poked around among the various "Lipid" tests, still didn't see one that exactly matched the wording you used for the one you recommended, but I have a hunch in it's in there, just worded differently enough to stymie this layman.

Help an ignorant brother out?
 
Bigtex

Bigtex

VIP Member
Aug 14, 2012
913
1,351
Not sure if we're speaking the same language here or not. LabCorp IS who I go to, but I'm scripted to there by PMD. No experience with Quest, but it wouldn't surprise me if both labs did this test you mentioned ..... IF a f2f Doc wrote the script.

When I checked PMD's site, however, I didn't see that test as worded in your post. Poked around a little among all the tests they listed that look at the blood itself, didn't see any that seemed to be your recommended test under a different name. THEN, I poked around among the various "Lipid" tests, still didn't see one that exactly matched the wording you used for the one you recommended, but I have a hunch in it's in there, just worded differently enough to stymie this layman.

Help an ignorant brother out?


Here is a link to LabCorp
https://www.labcorp.com/help/patient-test-info/ldl-particle-testing-ldl-p#

You may have to call PMD and ask for the test. Not familiar with PMD but it looks like they are a middle man. You can go to the LabCorp web site and make an appointment
 
R

rawdeal

TID Board Of Directors
Nov 29, 2013
3,608
2,571
Thanks Bigtex. PMD is an online middleman, and my preferred method of accessing bloodwork. Disadvantage is you pay 100% outta pocket, no insurance gets involved. Advantage is you schedule bloodwork, urinalysis too if you order, when you want, and exactly what you, not the Minor Deity you may have on retainer, wants. Totally private, your regular doctor and all the other doctors you may have seen do not get to see this in your records. Why so sneaky? Best example I can think of is a trt patient who blasts on and off who wants to confirm he got his serum Test number down before the next time he's due for doc-ordered bloodwork. That said, suspicious, cynical, cranky old farts like me prefer to minimize doctors in my life unless I'm involved in the occasional train wreck, drive-by shooting, or airplane crash.

Your link indicates that, yeah, LabCorp does seem to offer that test you mentioned earlier. Now, I gotta use PMD's toll-free # to match that test with the sorta similar - sorta differently worded tests PMD has on their menu.

MANY thanks for the time you put into this, Bigtex. My only complaint is you don't post enough, yours usually (always?) have substance . :)
 
Bigtex

Bigtex

VIP Member
Aug 14, 2012
913
1,351
Thanks Bigtex. PMD is an online middleman, and my preferred method of accessing bloodwork. Disadvantage is you pay 100% outta pocket, no insurance gets involved. Advantage is you schedule bloodwork, urinalysis too if you order, when you want, and exactly what you, not the Minor Deity you may have on retainer, wants. Totally private, your regular doctor and all the other doctors you may have seen do not get to see this in your records. Why so sneaky? Best example I can think of is a trt patient who blasts on and off who wants to confirm he got his serum Test number down before the next time he's due for doc-ordered bloodwork. That said, suspicious, cynical, cranky old farts like me prefer to minimize doctors in my life unless I'm involved in the occasional train wreck, drive-by shooting, or airplane crash.

Your link indicates that, yeah, LabCorp does seem to offer that test you mentioned earlier. Now, I gotta use PMD's toll-free # to match that test with the sorta similar - sorta differently worded tests PMD has on their menu.

MANY thanks for the time you put into this, Bigtex. My only complaint is you don't post enough, yours usually (always?) have substance . :)

I understand. I got lucky with my doctor, he is from South America so he is much more liberal in his treatment. He will not put anything I am taking on my records to keep it from my insurance company. Of course I also end up paying out of pocket for all of my medication and testing. Quest labs has an room in his offices where they draw the blood.

Looks like PMD caters to athletes, I was looking at their testing. If you can't get it done through PMD, just make an appointment at LabCorp and pay cash.

Thanks kind words rawdeal, I am going to start posting more here.
 
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