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My small LDL is dropping but my LDL is staying the same. Should I be concerned?

Answered on September 12, 2014
Created October 05, 2012 at 6:23 PM

Just got some bloodwork back and would love to get some feedback. Really happy to see my small LDL dropping back to where it was when I went off a statin but my LDL total is still high but not sure I should be concerned. Any advice on next steps? I am supplmenting with 1g fish oil, calcium and magnesium.

2/14/12 5/21/12 10/1/12

Cholestreol 198 282 297

HDL 54 59 61

Triglycerides 58 44 72

LDL-C 132 214 222

Ratio (Total/HDL) 3.7 4.8 4.9

LDL-P 1550 2779 2202

HDL-P 33 31 34

Small LDL-P 550 1290 526

% Small LDL-P 35% 46% 24%

LDL Size 21.3 21.1 21.8

LP-IR (insuilin resistance) 25 36 15

Cbe1731034411e1ce373cdc62e7d4eef

(65)

on February 17, 2013
at 02:10 AM

Here is my latest results OCT 12/FEB 13 Total Cholesterol: 297/203 HDL 61/55 Tri 72/80 LDL 222/132 LDL-P 2202/1597 HDL-P 34/33.8 Small LDL-P 526/639 LP-IR 15/30 (not sure why this has increased. Could be the sweet potatoes after days of lifting. Any concern?) T4 1.25/1.09 TSH 3.55/1.09 Triiodothyronine - Free Serum 3.1/3.3 Like some of it but not my small LDL-p ratio increasing. Will probably stop taking red rice yeast.

A402a961303d312055dc0b253f29deac

(320)

on February 10, 2013
at 02:11 PM

I am totally amazed what you know. Thanks for the info, I haven't had time to find out what dietary changes are most helpful for ApoE4 allele carriers.

5dd50f78f47b8848d93724d6eb38d4c1

(907)

on February 10, 2013
at 09:48 AM

Basically no one subscribes the "big fluffy Lld is harmless" hypothesis anymore.

Cbe1731034411e1ce373cdc62e7d4eef

(65)

on November 27, 2012
at 08:07 PM

It was lipitor. 20 mg. I am APO E3/E3. My doc has put me on red rice, C0Q10, kyloic garlic and a thyroid supplement. I continue to take fish oil and just added a probiotic. Will keep you posted.

F694fc245d03b64d6936ddb29f4c9306

(2613)

on November 04, 2012
at 01:27 AM

I got the info from this podcast by Dr. Dayspring: http://www.askthelowcarbexperts.com/2012/10/29-dr-thomas-dayspring-cholesterol-testing-what-matters-most/

Da3d4a6835c0f5256b2ef829b3ba3393

on November 03, 2012
at 10:07 PM

Large LDL particles are nothing to worry about and actually may be protective? Not calling you wrong, but are there cites for this? I've been reading Chris Masterjohn and have taken what he writes as authoritative, and he doesn't write that. Again, not saying you're wrong. Just questioning it.

Cbe1731034411e1ce373cdc62e7d4eef

(65)

on October 06, 2012
at 12:01 PM

Hi AgingHippie, Great question. I was on a statin fron Nov 11 to Feb 12. I went off of it and kept eating as I always had but cut down a bit on eating a big breakfast. I think my body was bouncing back from being off the statin. The amazing thing that I am really happy about is my small-LDL is now lower than when I was on a statin even though my base LDL has gone from 132 to 222. Any thoughts? Should I be concerned if my LDL is 78% big and fluffy.

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3 Answers

1
F694fc245d03b64d6936ddb29f4c9306

(2613)

on November 03, 2012
at 02:21 PM

The best test predictor of atherosclerosis risk is your small LDL particle count. That's because atherosclerosis is really caused by the collision of Apolipoprotein B (Apo B) molecules with blood vessel walls and the cascade of inflammatory responses thereafter. Small LDL particles are much more likely to collide with the walls and get stuck, while big LDL particles may actually be protective against atherosclerosis. In short, you shouldn't be worried about big, fluffy LDL.

Overall cholesterol levels mean very little. LDL concentration doesn't tell you much about LDL particle count. High triglycerides can also mask high Apo B counts, but your trigs weren't high enough for that to be true.

I'm concerned about two things: your Total/HDL ratio is increasing and your trigs are increasing. The change is small, but if the trend continues, you may want to take some steps to change it.

You still need to tell us more about your dietary habits along this timeline.

F694fc245d03b64d6936ddb29f4c9306

(2613)

on November 04, 2012
at 01:27 AM

I got the info from this podcast by Dr. Dayspring: http://www.askthelowcarbexperts.com/2012/10/29-dr-thomas-dayspring-cholesterol-testing-what-matters-most/

Da3d4a6835c0f5256b2ef829b3ba3393

on November 03, 2012
at 10:07 PM

Large LDL particles are nothing to worry about and actually may be protective? Not calling you wrong, but are there cites for this? I've been reading Chris Masterjohn and have taken what he writes as authoritative, and he doesn't write that. Again, not saying you're wrong. Just questioning it.

5dd50f78f47b8848d93724d6eb38d4c1

(907)

on February 10, 2013
at 09:48 AM

Basically no one subscribes the "big fluffy Lld is harmless" hypothesis anymore.

0
D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on November 17, 2012
at 05:51 PM

First what statin were you on? Was it a strong one like Crestor or Lipitor? Dosage? Or a less toxic one like Pravastatin? If you go off a strong statin, everything else being equal, your LDL will increase. Ergo, your TC will increase. More often, your TG would increase, too.

Assuming you made no dietary change before and after, the reasonable explanation is that you're probably ApoE4. About 25% of the population is either hetero/homozygously E4. You're genetically predisposed to higher LDL and TC when eating saturated fat like dairy, eggs, beef. Assuming: You're not undergoing any weight loss. You have no thyroid issues nor pronounced micronutrient deficiency.

That increase in LDL-P from 1500 to 22-2800 is an issue. That's pretty significant and TC of around 300 is getting up there. Perhaps not FH but probably E4-induced. I'd lay off saturated fat from dairy, eggs, try eating lean beef an fish, poultry. Then retest. To confirm, you can sign up with 23andme and get your rs7412 & rs429358 genes figured out.

Why is this happening? Polymorphism. That is, SNP: Single Nucleotide Polymorphism. People react differently to diets. There is no one size fits all diet. High fat Paleo may not be ideal for you. If you wanna lay off statin, might try high carb, safe starch Paleo. But I'd focus on getting your LDL=P down below 1200.

Cbe1731034411e1ce373cdc62e7d4eef

(65)

on November 27, 2012
at 08:07 PM

It was lipitor. 20 mg. I am APO E3/E3. My doc has put me on red rice, C0Q10, kyloic garlic and a thyroid supplement. I continue to take fish oil and just added a probiotic. Will keep you posted.

A402a961303d312055dc0b253f29deac

(320)

on February 10, 2013
at 02:11 PM

I am totally amazed what you know. Thanks for the info, I haven't had time to find out what dietary changes are most helpful for ApoE4 allele carriers.

0
336c383a3c4d28652d7ab888c79108a3

on October 06, 2012
at 12:46 AM

Why did the small LDL-P increase between 2/14/12 and 5/21/12?? Did you change anything in your diet?

What is your diet like now?

Cbe1731034411e1ce373cdc62e7d4eef

(65)

on October 06, 2012
at 12:01 PM

Hi AgingHippie, Great question. I was on a statin fron Nov 11 to Feb 12. I went off of it and kept eating as I always had but cut down a bit on eating a big breakfast. I think my body was bouncing back from being off the statin. The amazing thing that I am really happy about is my small-LDL is now lower than when I was on a statin even though my base LDL has gone from 132 to 222. Any thoughts? Should I be concerned if my LDL is 78% big and fluffy.

Cbe1731034411e1ce373cdc62e7d4eef

(65)

on February 17, 2013
at 02:10 AM

Here is my latest results OCT 12/FEB 13 Total Cholesterol: 297/203 HDL 61/55 Tri 72/80 LDL 222/132 LDL-P 2202/1597 HDL-P 34/33.8 Small LDL-P 526/639 LP-IR 15/30 (not sure why this has increased. Could be the sweet potatoes after days of lifting. Any concern?) T4 1.25/1.09 TSH 3.55/1.09 Triiodothyronine - Free Serum 3.1/3.3 Like some of it but not my small LDL-p ratio increasing. Will probably stop taking red rice yeast.

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