The Difference in the LDL's

Pretend you just came to me with your blood work. Your doctor took it and expressed concern about your LDL cholesterol, but you're not really sure why! Here are a few things we would talk about:

(The values below do not reflect the numbers that we're talk about right now, but it is an example of how you might see your blood work if you get a quick blood draw.)

Why do we bother getting all these numbers for your cholesterol? LDL-P represents the actual number of low density lipoprotein (LDL) particles in your blood. We look at this number more than LDL-C in relation to heart disease, because more of the smaller LDL particles versus fewer of the big, fluffy LDL particles puts you at higher risk of atherosclerosis, even though the big, fluffy ones may give you a higher LDL-C reading. For example, from your blood work, we can see that you have an LDL-C of 150 mg/dl. Although this is a generally considered a high reading, it doesn’t mean a whole lot yet, because we don’t know what those particles look like. After taking your LDL-P, we see that you show a reading of 1500 nmol/L. 

Now we know that you have a whole lot of tiny, dense LDL particles in your blood. These like to make their homes on the artery walls, forming blockages. If we see this, we might worry about heart disease, fatty liver or liver congestion, excess oxidative stress, problems with your cholesterol levels, or especially atherosclerosis. Inflammation plays a huge role in this by hardening the LDL cholesterol, contributing to the buildup. Our goal is to decrease the LDL-P to below 1000 nmol/L, because then we’d know you have the light, fluffy LDL in your blood that is great at carrying fatty acids where they need to go!

How do we do that? Of course, we’re checking out your diet first, looking for too many refined carbohydrates and not enough fiber. That means making sure you’re eating your vegetables! We make sure you’re getting plenty of good, healthy fats such as nuts, seeds, and fatty fish. These foods decrease inflammation and lower your risk of heart disease related to your LDL-P levels. Trans fats, or hydrogenated oils, should also be eliminated, as they increase both inflammation and LDL levels. The Mediterranean diet has long been considered a fantastic model for avoiding heart disease, as it encompasses all of these good foods and eliminates the detrimental ones. Once diet is under control, we look at increasing exercise and decreasing stress. Both of these changes can reduce inflammation, further protecting you from heart disease!

Beavers, K. (2011). Effects of lifestyle interventions on inflammatory markers in the metabolic syndrome. Frontiers In Bioscience, S3(1), 168-177. http://dx.doi.org/10.2741/s142

Giugliano, D., Ceriello, A., & Esposito, K. (2006). The Effects of Diet on Inflammation. Journal Of The American College Of Cardiology, 48(4), 677-685. http://dx.doi.org/10.1016/j.jacc.2006.03.052

Saita, E., Kondo, K., & Momiyama, Y. (2015). Anti-Inflammatory Diet for Atherosclerosis and Coronary Artery Disease: Antioxidant Foods. CMC, 8(3), 61. http://dx.doi.org/10.4137/cmc.s17071