It is not measured by a standard lipid panel, and can be treated with statins and niacin. Second, in patients at high risk based on the presence of documented vascular disease, diabetes or a strong family history, I initiate therapy based on the standard lipid panel with intended goals of: non-HDL-C under , LDL under 70, HDL over 40 and triglycerides under In about three months I check LDL-P to assess for residual risk and determine if additional therapy is needed.
Methods for lowering LDL-P levels include more aggressive lifestyle changes diet, exercise and weight loss , niacin, fibrates and fish oil. Higher doses lower LDL-P in a linear manner. I eat eggs everyday for breakfast. So I improved in certain areas and reduced my insulin resistance, but did I increase my risk for heart problems?
Might a further reduction in carbs make a difference? DOes high dose fish oil affect the results? 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. Indeed HDL-P goes up a little bit. However, studies have shown and I have also seen in my practice, that a small percentage of people who eat a lot of eggs elevate their TC and LDL-C quite much although this is not the general rule.
Maybe you are just one of those individuals. I have seen a lipid response like yours a few times among people on low carb high fat diets. I am not ready to ignore LDL-C as a risk factor. Clinical guidelines recommend LDL-C as the main target for treatment with lipid lowering drugs.
An LDL-C above is something that most cardiologists want to treat with a statin drug, no matter what. Remember that your LDL-P is also very high. When I see a lipid response like yours I always recommend my patients to reduce the consumption of cholesterol and saturated fat. This involves eating less eggs and animal and less dairy fat.
I usually urge them to eat mono-and unsaturated fats including fish oils and Omega In my opinion a Mediterranean type diet is very sensible under these circumstances. 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. But the good was that my HDL had increased to 40 from 32 two years ago and TG was down to from nearly two years ago … even 20 years ago in my mids, I had tested in the s on TG. So my Doc put me on simvastatin and Niaspan.
He advised that low-carb was OK but I should minimize red meat and saturated fat ie, a low-carb Mediterranean or South Beach kind of diet.
I took the drugs and ignored his diet advice, kept eating all the bacon, eggs, cheese, and beef I wanted, with whipping cream in my coffee, all 5 cups a day. HDL up to 45 and TG down to But have to say the drugs clearly had quite an impact. I personally suspect that if I did anything other than a low-carb high fat diet my triglycerides would explode again, and probably the LDL-P along with it.
I would like to start by saying that I just came across your website and have been quite impressed. It is quite difficult to find good data that combines the principles of a low carb approach to looking at lipids i.
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 spoken with many physicians and frankly the majority had never even heard of LDL-P. From my reading of low carb and Paleo blogs, I believe my situation is fairly common and we all could use your insight.
I would truly love to hear your opinion on my situation. I am not asking for specific medical recommendations but more of a way to look at the situation or any suggestions about specific reading.
In age 40 I had a cholesterol of and an LDL Calcium Score Obtained result: zero Statins stopped due to side effects libido, muscle soreness mild , multiple colds and memory issues per wife. Anyway since stopping the statins I feel great. I think I am doing most of the right things with watching my sleep and stress, exercising taking vitamin D and fish oil. Because of my previous side effects I am a little leery about starting statins again without really thinking about it.
From my limited knowledge it is obvious that my particle number is too high but I can't find any data about patients with similar overall lipid profile.
Niacin might be an option but it also has issues and is not often considered a first line agent. Any comments would be greatly appreciated. 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. 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.
However, this will probably depend on what types of fat are consumed. What will the be the net result? Studies are definitively lacking when it comes to hard clinical endpoints.
Therefore the debate is ongoing. I agree with you that your situation is indeed very common. Furthermore, the side effects appear very clear in your case, indicating that the negative effects of statin drugs on your health will be much larger than the positive effects.
Again, looking at your lipid profile, here are a number of positive things. You probably would want to see all thes numbers a bit lower. Your healthy lifestyle, absence of hypertension, diabetes and smoking certainly make your total risk quite low indeed. Familial hypercholesterolemia FH appears unlikely in your case. The zero calcium score is certainly a positive thing. However, looking at the available science on the importance of LDL-C, most cardiologists would probably recommend cutting down on saturated fats and cholesterol.
You might try to select more mono and polyunsaturated fats instead. You can still stick with Paleo and carbohydrate restriction if you want to. Doc, I wonder if you could comment on my situation. The hard core low carb guys say the whole cholesterol thing is a scam ie take the insulin resistant patients out of the high LDL population and LDL becomes a non-factor and that total under is nothing, but some say high LDL and totals are ok, but within limits — ie total under To be sure it was diet, I am finishing a month on a low fat diet and expect the numbers to plumet.
I was thinking of going low carb-high fat but with all monounsaturates, then the same thing but with only coconut oil as my sat fat to see what it does. The problem is what if it is a scam? I went on a high fat diet three years ago.
I suffered bronchitis and bad chest colds all winter for years — two years ago I added cod liver oil to my diet with the high fat and went two years without a cold some say that LDL fights infection?
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 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.
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? My NP still wants me to start statin therapy which scares me. I want to keep trying to lose weight. 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. Story: obese most of my adult life; low carb 2. In mild ketosis much of the time, with periodic breaks with added carbs. Also LP a is very high Where do I look for what this means? Is the risk real? Can it be managed without drugs? It almost feels as if this is two problems, not one. Or the risk factors have not been vetted against my scenario. 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 monounsaturated and omega 3 fats, might help you. It is a good diet for type-2 diabetes and for weight loss. I am worried due to my weight and LDL-P ratings.
Should I be and what should I do. My overal Cholesterol has dropped from when I was 28 to this number now that I am I take Lipator 10mg. Considering that you are overweight, weight loss probably reduces your risk. Cutting down on sugar and refined carbohydrates often helps lowering LDL-P. Thank you for your thoughts. I believe the IR is under control because of 2. I control post prandial glucose rigorously by eating very few if any carbs. Obviously, there are some things we do not understand yet.
Thanks again for considering. Thank you for you very enlightening blog. In Dr. A body with low inflammation, there should be no arterial damage from glycation. Therefore, the LDL-P has no injury to deposit its load of cholesterol for repair, thus no plaque. Hi Peter. Sorry for my late response. I read Dr. Patels article.
Very interesting. I think you are right. We often tend to treat laboratory values. We have to see the whole picture. We know that inflammation plays a role in atherosclerosis, and we know that lipids do as well. There are ongoing clinical trials on the effects of anti-inflammatory drugs in patients with heart disease. They might actually provide some answers to the role of inflammation in cardiovascular disease.
It is a pro-inflammatory state. Lowering lipids is important and will affect risk. Affecting other risk factors is important as well, and will help reduce risk of heart disease.
The importance of lipids as a risk factor becomes less if you can reduce the role of other risk factors. I am a 42 year old female. Good morning Doc. There are a lot of FLAGs on the results, so trying to decide if I should see a cardiologist or regular doctor.
Your thoughts?? She had a stent implanted and no other occurances. Also exercising at least 5 days a week for 30 min. Here are my numbers:. LDL Size Thank you for your post and for sharing your numbers. However, I understand that some studies have shown that statins may be effective for prevention when the KIF6 polymorphism is present, while this was not confirmed by rosuvastatin in the JUPITER trial. Carbohydrate restriction, Mediterranean diet and Omega -3 fatty acids may all be helpful.
Avoiding sugars, eating healthy natural fats and exercising are probably helpful. I believe you are on the right track by eating healthier; steel cut oatmeal, fish, etc. Good luck. Would love you to get your thoughts on my numbers. I started going to a cardiologist about a year go as I was having some random chest pains, he attributed this to stress after a battery of tests — EKG, Stress test, Echo, Echo stress, CIMT but I did discover I had a leaky aortic heart value, mild to moderate leak.
During my visits there I got my blood work done a few times and was shocked to learn my LDL-P was ! Since then, 8 months ago, I have dropped 20 lbs, starting running 4 times a week and removed all sugary drinks from my diet.
During my last visit, my Dr mentioned going on a statin, would love to get your thoughts on this. LP-a 13 hs-CRP 0. Hi Mike. Well done, congratulations. Total cholesterol, triglycerides, HDL-C all quite acceptable. ApoB is fine and so is Lp a. HsCRP is ok. No diabetes. Considering the absence of other risk factors such as family history, hypertension and smoking, the risk of cardiovascular disease in the near future should be quite low.
She is focused on the LDL-P number and says none of the other numbers matter. No one told me. Should I continue very low carbing? Should I take the statin? My most recent A1C is 5. Thank you for any clarity you can provide. Total cholesterol is a bit high, so is LDL-choleseterol. However, when considering risk and potential benefits of statin therapy you have to look at other risk factors as well, such as family history, smoking and blood pressure.
You will also have to keep in mind potential side effects of such therapy. Some specialists have claimed that the efficacy of statin therapy in primary prevention may be less in women than men. Barbara Roberts has written a wonderful book The truth about statins where she discusses the pros and cons of statin therapy and suggests that such treatment may be less influential in women than in men.
I agree with your doctor that there are studies indicating that statin therapy may lower your risk of hart attack and stroke. The important thing however, is that you understand the magnitude of benefit, in relation to the risk of side effects. That is something you should be able to discuss with your doctor. It might be, if you are overweight or have signs of the metabolic syndrome. If we look at cardiovascular risk in general, a Mediterranean type diet may be helpful.
Any physician pushing this class of drugs for women is ignoring the evidence, or lack thereof. At the least, you should ask for a coronary calcium test to get a picture of the degree of blockage if any in one of your major blood vessels. In a conversation with Dr. Tom Dayspring, a prominent U. Dayspring admitted that there are no good studies of very-low-carbers, and that a different standard might be appropriate. Hello Doc.
Thank you for all this information and for helping all of us. His father had a major stroke at age 55 and now lives in an assisted care facility. This has obviously been a difficult thing for his family and so this whole cholesterol issue is quite emotional and scarey for my hiusband. We started with low carb but have increased them in the last few months.
It seems his LDL is increasing rapidlyof late. My limited understanding is that apoB predicts particle do you know what this apoB number would translate to in LDL-P? We drink freshly pressed green juice most mornings spinach, carrot parsley ginger apple lemon. Sorry for the excessively long message. Just frustrated after putting so much care and effort into making good choices and getting results like this.
Any feedback on which direction to turn would be helpful. Thank you so much for your time. Hi Tami. Thanks for your post. Although Paleo and low carb diets have many health benefits they are certainly not the best diets to lower total cholesterol and LDL-cholesterol.
In a normal weight person with LDL-levels this high, I would rather go for a Mediterranean type diet as you suggest, as it might lower cardiovascular risk. If he had, you would certainly have to wonder whether he has familial hypercholesterolemia FH. Maybe he should discuss with his doctor about genetic testing for FH. Lipid guidelines usually recommend statins if LDL-C is above 4. Thank you for your reply. I really appreciate your feedback.
There is no family history of coronary artery disease, just the stroke as I mentioned above. We will still rule out FH. The interesting thing about this situation is that for the first year plus of paleo his cholesterol rose only modestly-this past reading increased from an LDL of 4. Is it possible that there is an explanation or cause that should be at least looked for and addressed before artificially lowering the number?
I understand your concern Tami. Fish oils and omega-3 supplements may be helpful as well. Then he could have his lipid numbers reevaluated in six months. Sometimes hypothyroidism low thyroid function causes elevation of LDL-cholesterol, but I assume this has been ruled out already. Anyway, wondering what diet I could do to lower LDL-p..?
I have Hoshimotos, could that make my LDL-p so high. Your triglycerides are high as well. However, to your benefit HDL-C is high as well. There is no particular diet that lowers LDL-P. A Mediterranean type diet may be helpful. Omega-3 may help as well. Reducing carbs may help.
The Hashimotos might possibly explain the elevated hcCRP. I am 60 years old. I consider myself to be in great shape. Most people think I am My numbers are:. Lots of other numbers — not sure what you would want. My doctor wants me to take a baby aspirin. My last doctor said to quit the baby aspirin. What do you think? What else can I do to avoid problems? Thank you so much. Just found this site and it is so informative. I hope you understand that it is very difficult and irresponsible of me give individual recommendations.
Therefore I can only answer you in very general terms. Your lifestyle appears to be healthy. Avoiding refined sugars and processed meat will probably help. Lots of fish, vegetable, fruit, fiber and seeds is not a bad idea.
Thank you so much for responding. I appreciate your suggestions and will work on them. God bless. Thank you for this information. I have recently been put on statin and niacin therapy and would like to ask your opinion. Total — ApoB After my test 3 months prior I was put on niacin and baby aspirin once per day.
Now my doctor has added pravastatin. I eat an anti inflammatory diet, mostly gluten and dairy free. I have a glass of red wine every evening while cooking dinner. After reading my post I want to make sure it makes sense. The first numbers after the type of protein, etc are the most recent results taken in February. The second number is from the test taken in December after the stroke. Sorry to hear about your stroke. I guess the main reason you are being treated with statins is the stroke, rather than the lipid numbers per se.
In my practice we more or less give statins to all persons who suffer ischemic stroke. However, niacin is much less used in Europe than in the US.
If your lifestyle is healthy as you suggest, including exercise and healthy food choices, I guess there is probably not much more you can do. As atherogenic particle levels increase in your bloodstream, more particles deposit in the artery wall and promote plaque formation.
Low-density lipoprotein cholesterol LDL-C is the cholesterol carried in your LDL particles, while non-high-density lipoprotein cholesterol non HDL-C is the cholesterol carried in all potentially atherogenic particles.
Similarly, your LDL particle score is the number of LDL particles in your bloodstream while your ApoB score is a measurement of the number of all potentially atherogenic particles. Although a cholesterol test can estimate a value, a nuclear magnetic resonance NMR lipoprotein particle number test directly quantifies your atherogenic particle value.
However, because the amount of cholesterol carried inside lipoprotein particles is highly variable, cholesterol tests and particle number tests frequently show conflicting values with regard to your cardiovascular risk. Cholesterol is generally neither good or bad; the particles carrying cholesterol and triglycerides are what are important for you to track.
When cholesterol and particle number tests disagree, your risk for a cardiovascular event is more accurately assessed using your particle number, rather than cholesterol. Achieving a low particle number LDL-P significantly improves your risk of not suffering future cardiovascular events and brings down your overall cost of healthcare. The higher the scores for a longer time, increases your risk. Here are actions you may consider taking under the care of a licensed physician in your area:.
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. You can think of LDL as a taxi service that delivers important nutrients to the cells and tissues of the body.
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. 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, young Finns with no established disease. The participants with the highest LDL particle number were 2. 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. 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.
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.
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