Which is more important: LDL-P or LDL Size

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Which is more important: LDL-P or LDL Size


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Old 09-12-2015, 02:47   #1
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Default Which is more important: LDL-P or LDL Size

A little refresher about me.
I was diagnosed T2 one year ago and initially
prescribed glipizide and metformin.

I have been LCHF since Jan 1 of this year when I also stopped
glipizide. I stopped metformin about 5 months ago
but hope to restart sometime in future.

My A1C a few weeks ago was 5.7 and I think the next will be much
lower as my BG measurements seemed to have gone down in the last
couple of weeks.

This post is in regards to LDL cholesterol.

Date Cholesterol Trig HDL VLDL LDL
Total
--------------------------------------------------
11/04/14 193 120 63 24 106
11/20/14 202 94 62 19 121
05/05/15 300 113 89 23 188
08/21/15 193 84 73 16 191

NMR Lipid Profile
08/21/15 Ref:
LDL -P 1909 1600-2000 High (Bad)
LDL -C 191 > 189 Very High (Bad)
HDL-C 73 > 39 (Good)
HDL-P 36.9 > 30.5 (Good)
Small LDL-P 502 25% (117-527) (Good)
LDL Size 21.3 Large (23.0-20.6) (Good)

A number of sources say that the most important number from the
NMR Lipid Profile is LDL-P (particle number) and that mine is very bad.
These sources include Dr. Peter Attia of The Eating Academy, Dr. T Dayspring of LecturePad.

Several people on this forum have disagreed with the above assessment
and said that Small LDL-P and LDL Size are more important.

Dr. Bernstein does not seem to address the issue of cholesterol as far as I can tell.

My questions:
1) Can anyone who holds that Small LDL-P and LDL Size are more important point me to a reference that supports this.
2) What have been your experience with these numbers the longer
you have been LCHF.

Let me thank you in advance for any insight you can offer on this.

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Old 09-12-2015, 06:08   #2
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Google "hd labs high risk heart disease markers", that lists several sites. Also check Thomas Dayspring and Tara Dall.

Health Diagnostic Labs was my source and who did my tests. They list out what their tests mean somewhere on their site, but it may be available in the registered users accessible area. Did you have any other "high risk" or "inflammation" test results? I tend to believe all of them combined tell you something.

My LDL-P was higher (2700) and had other indications that were getting bigger. I was found to have 70-80% blockages in an angiogram leading to my recent quad by-pass. I've read that metformin can help lower LDL-P, needless to say, I am taking it again. Don't remember the source of that though.

Not sure of my cause, but guessing inflammation drives these numbers up as the body is reacting to the inflammation. I am also guessing that being sleep deprived has been a big part of my problem. Nothing definite from the cardiologist or surgeons other than a lot of it is genetics.

I am still LCHF, although have moved to more fats from EVOO, avocados, fish and nuts and fewer saturated fats.

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Think I've had this since 2003. Told I was Type 2 lean on 2/13/12.
a1c 8.8 (8/2011) 5.2 (02/2020)
TC 183 LDL 102 HDL 65 TG 52 (02/20/2020)
Supplemental vitamins and electrolytes
65 YY Love the LCHF diet. The cheese goes well with my whine

updated 10/12/2020
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Old 09-12-2015, 08:38   #3
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Quote:
Originally Posted by mbuster View Post
Did you have any other "high risk" or "inflammation" test results? I tend to believe all of them combined tell you something.
Your question is a tough one to answer with any certainty. Attia being Dayspring's follower, there's no surprise that he concurs with what Dr Dayspring says. Their thoughts on LDL-P take root from the concentration gradient concept. Some cardiologists (sometimes Dayspring too) say that HDL, TG & HDL/TG are the only numbers to look at.

Personally, I'd agree with Mark. Cholesterol in isolation may not tell you much. What do other markers say. Is there an "environment" in which high cholesterol can cause damage ?

I'm curious to know, what you did differently between May - Aug 2015 for that sudden drop ? Or is the total 293 not 193.

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Old 09-12-2015, 09:43   #4
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SKB

Yes there is a typo.
It should read
08/21/15 293 84 73 16 191

I have not had the other markers (CRP , CIMT, Coronary Calcium Score, fibrogen, homocystein) done yet and probably wont until next year. I had an ESR (which shows inflammation) which was quite low (good).

Sorry about the formatting of the data. It looked good when I typed it in.

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Old 09-12-2015, 10:42   #5
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Some people report higher cholesterol on LCHF. A figure of 20% of population has been suggested but I don't know where that came from. I'm one of them. The likely cause for that according to Paul Jaminet is thyroid issues, which turned out to be true in my case. The T3/T4 help in clearance of LDL in the liver. With these out of order, you see a rise in LDL & hence Total. Have you had thyroid ruled out ?

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Old 09-12-2015, 11:00   #6
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SKB
Yes, I have had my thyroid test done recently and they came back within the reference range. Unfortunately, I know very little about thyroid issues and what these numbers mean and will have to do some research.

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Old 09-12-2015, 15:24   #7
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SKB, any particular thyroid testing? That may be something I need to look into, pretty sure I'm not FH (genetically high cholesterol).

Good catch on the typo, I was reading this and trying to respond before getting any sleepier last night. I was thinking only 'nice drop in total'.

Any individual markers are really meaningless in cholesterol. The LDL-P is newer and is by far better than LDL-C as a risk marker, though not proven to be the holy grail of indicators. LDL-P can be discordant with LDL-C, one high and one low instead of concordant, both high, both low. It may explain why 50% or more of people coming to the ER with a cardiac event are in the normal range of typical lipid testing. LDL-P should be studied further, IMO, more so than just saying we need to lower the levels at which statins are recommended.

Most markers aren't good as stand alone values. Triglycerides are offset by HDL, APO-b is offset by APO-a1, i.e.. The inverse is also true good things can be offset by the bad ones. Also particle size is not a total solution, they say large LDL can can get in the artery cell walls, as well as small ones. I don't think there is any one smoking gun, as much info as you can get needs to be used. I thought I was protected with an HDL/trig ratio of 1 or less.

Hindsight is wonderful, ain't it.

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Think I've had this since 2003. Told I was Type 2 lean on 2/13/12.
a1c 8.8 (8/2011) 5.2 (02/2020)
TC 183 LDL 102 HDL 65 TG 52 (02/20/2020)
Supplemental vitamins and electrolytes
65 YY Love the LCHF diet. The cheese goes well with my whine

updated 10/12/2020

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Old 09-13-2015, 14:09   #8
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SKB, any particular thyroid testing?
The full thyroid panel. It consists of 6 tests. The T3, T4 and their Free cousins, TSH and the antibodies tests. You can also add the anti globulin antibodies to these if you like. With diabetes the autoimmune system takes a hit & a +ve score on the antibodies seems pretty common.

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Old 09-13-2015, 16:31   #9
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I am 65 and overweight! I have had the same questions and never really found a definitive answer. Did find a number of conflicting opinions. But my main question was do I have any form of heart disease or vascular disease? My Dad had his first heart attack at 65, his Dad had his first and last heart attack at 65....so you see my concern.

So my wife and I went in and had a 'health scan' ($130 ea.) no prescription necessary.

They scanned our hearts, did ultrasounds on our neck arteries and descending aorta. My ultrasounds were normal, my heart scan showed some potential calcium build up in my heart. Which then required my doctor to order a stress test! My wife's tests were 100% clear and good!

Surprisingly, my stress test, which was paid for by my insurance, came back 100% clear with no chance of current heart disease!

Now I worry much less about my blood work, but I will go back in maybe 3-5 years and have another scan done....so much better then relying on blood chemistry.

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Old 09-13-2015, 19:01   #10
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Quote:
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The full thyroid panel. It consists of 6 tests. The T3, T4 and their Free cousins, TSH and the antibodies tests. You can also add the anti globulin antibodies to these if you like. With diabetes the autoimmune system takes a hit & a +ve score on the antibodies seems pretty common.
Thanks, I'll see if they will add them.

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Think I've had this since 2003. Told I was Type 2 lean on 2/13/12.
a1c 8.8 (8/2011) 5.2 (02/2020)
TC 183 LDL 102 HDL 65 TG 52 (02/20/2020)
Supplemental vitamins and electrolytes
65 YY Love the LCHF diet. The cheese goes well with my whine

updated 10/12/2020
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