The small LDL epidemic

Ten years ago, small LDL was fairly common, affecting approximately 50% of the patients I'd see. For instance, an LDL particle number of 1800 nmol/l would be 40-50% small LDL in about half the people.

But in the last few years, I've witnessed an explosion in the proportion of people with small LDL, which now exceeds 80-90% of people. The people who show small LDL also show more severe patterns. 80-90% small LDL is not uncommon.

Why the surge in the small LDL pattern? Two reasons: 1) The extraordinary surge in excess weight and obesity, both of which favor formation of small LDL particles, and 2) over-reliance on processed carbohydrates, especially wheat-based convenience foods.

The constant media din that parrots such nonsense as the report on CNN Health website, Healthful Breakfast Tips to Keep You Fueled All Day, helps perpetuate this misguided advice. The dietitian they quote states:

"If you don't like what you're eating, you won't stick with it. If your choices aren't the most nutritious, small tweaks can make them more healthful. For example, if you have a sweet tooth in the morning, try a piece of nutty whole-grain bread spread with a tablespoon each of almond butter (it's slightly sweeter than peanut butter) and fruit preserves instead of eating foods that offer sweetness but little nutritional benefit, like doughnuts or muffins. If you enjoy egg dishes but don't have time to prepare your favorite before work, try microwaving an egg while toasting two slices whole wheat or rye (whole-grain) bread. Add a slice of low-fat cheese for a healthful breakfast sandwich that's ready in minutes. And don't overlook leftovers. If you feel like cold pizza (which contains antioxidant-filled tomato sauce, calcium-rich cheese, and lots of veggies), have it. It's a good breakfast that's better than no breakfast at all."

It sure sounds healthy, but it's same worn advice that has resulted in a nation drowning in obesity. The food choices advocated by this dietitian keep us fat. It also perpetuates this epidemic of small LDL particles.

If you have small LDL and its good friend, low HDL, it's time for elimination of wheat products, not some politically-correct silliness about increasing fiber by eating whole grains. Whole grains create small LDL! Or, I should say, what passes as whole grains on the supermarket shelves.

For some helpful commentary on this issue, see Fanatic Cook's latest post, Playing with Grains.

Comments (24) -

  • Nancy M.

    10/16/2007 8:13:00 PM |

    Gary Taubes, in "Good Calories, Bad Calories", would argue that what is causing the small LDL is in fact the same thing causing the obesity.  Over consumption of starchy carbohydrates and sugars basically.  

    I think you'd find that book amazing. It is a comprehensive history in the mis-information cascade about diet and heart disease (and cancer).

  • Anonymous

    10/16/2007 8:23:00 PM |

    Previous month oats (oatmeal/oatbran) were advised for correcting LDL numbers.
    No grains is the advise this month.
    Oats are also grains, are they not?
    So is it okay to eat oats or not?

  • Dr. Davis

    10/16/2007 10:37:00 PM |

    Hi, Nancy--

    Yes, I agree. I am presently reading Taubes' book and am impressed with his grasp of the issues, a refreshing re-examination of issues most of us accepted as "fact."

  • Dr. Davis

    10/16/2007 10:39:00 PM |

    I'm using the word "grains" too loosely. I really mean processed wheat. I've had positive experiences with oats and flaxseed. I think some of the coarse grains like quinoa and barley are good to neutral.

  • Melanie

    10/16/2007 10:41:00 PM |

    Dr Dave - why do you think the American Heart Association, and other similar influential organizations, are failing to advise the public about wheat products, if they are contributing to the raise in small LDL particles, as you state?

  • Dr. Davis

    10/16/2007 10:46:00 PM |

    I can't speak for them, but I suspect that, as always, it has to become common knowledge among physicians before the policy makers in the AHA decide to make a change. They usually wait until data become overwhelming before allowing it to become their position. Also, there is a lot of money in the low-fat concept. See my posts about the AHA Heart CheckMark program, a very profitable program.

  • Melanie

    10/16/2007 10:54:00 PM |

    Yes the unfortunately it's the 'Big Business' monopoly again. Quite sickening actually!

    I am very interested but also concerned about this, and as a dietitian I do recommend wheat based products - can you suggest any journals/books on this matter?

  • Dr. Davis

    10/16/2007 10:58:00 PM |

    Yes, several sources:

    1) See my Blog post Oat vs. Wheat at in which I discuss Dr. Brenda Davy's study.

    2) Dr. Ronald Krauss has published rather extensively on this. Enter "Krauss" and "small LDL" into your PubMed search.

    3) Look at Dr. Loren Cordain's website,, that contains reprints of his many reviews of the effects of grains on health.

    The most recent addition to the lay literature on this topic is Gary Taubes excellent book, "Good Calorie, Baad Calorie".

  • Melanie

    10/16/2007 11:04:00 PM |

    Dr Davis - many thanks for that, I will look into it.

  • Anonymous

    10/17/2007 5:19:00 AM |

    Excellent clip: leftover pizza = healthy breakfast. I love it. I can hear my friends now, "I order pizza because the leftovers make such a good breakfast."

    Next we'll hear that chocolate muffins made with vegetable oil are good for b'fast because "they're better than nothing, have no cholesterol and chocolate enhances serotonin function."

    Healthy breakfast choice = bad food + one slightly positive attribute grossly exaggerated.

  • Dr. Davis

    10/17/2007 12:34:00 PM |

    Well said!

  • Anonymous

    10/17/2007 4:16:00 PM |

    I would love to hear your thoughts (review) on Taubes' book, "Good Calories, Bad Calories", after you have finished reading it.

  • Dr. Davis

    10/17/2007 4:50:00 PM |

    Thank you. I will.

    We are also going to add a Book Review section on the website near future.

  • jpatti

    10/17/2007 7:11:00 PM |

    I'm only a few hundred pages into Taubes book, but one of the things I'm liking a great deal thus far is his explanation of many of the factors measured in the TYP program.

    I was already familiar with the carb/insulin stuff (which is greatly simplified, leaving out the effects of glucagon, amylin, cortisol, the thyroid and sex hormones - all of which also effect blood glucose).  

    I'm much newer learning about heart disease.  A lot of what was empirical in the TYP book is explained much more thoroughly by Taubes.

    I like the Fanaticcook blog entry also - it's refreshing to see someone discuss whole grains who actually knows what a whole grain *is*.

  • wccaguy

    10/18/2007 2:59:00 PM |

    I watched the online video debate between Taubes, Ornish, and Dr. Barbara Howard of the AHA.  Taubes appeared to be unaware of the TYP program and the kind of incredible results being frequently reported at the TYP forum by forum members.

    Here's the YouTube link:
    For what it's worth, IMO, you and Mr. Taubes need to have a chat so he's better armed with evidence of what a low-carb diet can do with heart disease.  (As if you needed more to do, huh?)

    Jimmy Moore must have his contact information given that he did an interview with Mr. Taubes.

    You da' man doc!

  • Anonymous

    10/19/2007 6:09:00 PM |

    I watched the online video debate between Taubes, Ornish, and Dr. Barbara Howard of the AHA.


    FYI: I am pretty sure that this show is from 2001, after Taubes published his "What if it's all been a big fat lie" article on saturated fats and the lipid hypothesis.

  • John

    10/19/2007 7:19:00 PM |

    You comment "whole grains create small LDL!". Would beer (which is grain-based) be a culprit in your opinion, even in moderation? tia


  • Dr. Davis

    10/19/2007 9:38:00 PM |

    Hi, John--

    Great question. However, I am uncertain. There is very little data on this specific issue, nor have I seen enough lipoprotein patterns pre- and post- beer inclusion.

    My gut sense: one or two beers a day is okay, provided weight is not impacted

  • John

    10/20/2007 3:19:00 PM |

    Not meaning to belabor the subject, you single out wheat versus "grains" in general as particularly detrimental, while oats for example are not, and can be even beneficial. Where does corn sit in this whole "grains" scheme? In a typical TYP program, are corn-based tortillas for example preferred to wheat-based ones, or are both to be avoided?

  • Dr. Davis

    10/21/2007 1:04:00 AM |

    Hi, John--

    From a glycemic index/small LDL/weight standpoint, corn products are every bit as detrimental as wheat.

    I single out wheat, however, since Americans are over-dependent on wheat products by such a huge margin. It isn't at all unusual, for instance, for someone to eat wheat products 5 times a day. That would be very unusual with corn products, however.

  • buy viagra

    7/21/2010 8:05:37 PM |

    Interesting article, never thought that grains may do such things. I was also wondering the same that John about beer.

  • Buy Jeans

    11/2/2010 7:56:21 PM |

    It sure sounds healthy, but it's same worn advice that has resulted in a nation drowning in obesity. The food choices advocated by this dietitian keep us fat. It also perpetuates this epidemic of small LDL particles.

  • Anonymous

    3/7/2011 6:23:28 AM |

    In response to Johns comment about beer:

    I'm no expert on the subject but from my experience with home brewing, it is my understanding that all, or at least most, of the carbohydrates are converted to simple sugars which are then fermented by yeast into alcohol and CO2.

    And so, rather than the sugar ending up in the persons blood stream, it is transformed into alcohol which enters the blood stream.

    So the real question is:

    "How does alcohol affect the ammount of small-LDL in the blood stream?"

    What I do know is that alcohol tends to lower the blood glucose levels, which I would think would be beneficial since it's blood glucose that the body uses to produce small-LDL.

  • Anonymous

    3/7/2011 6:38:04 AM |

    After further research i've descovered this:

    Results: Alcohol intake was associated with total low-density lipoprotein (LDL) particles in a U-shaped manner. Consumers of one or more drinks per week had the highest number of large LDL particles, whereas consumers of 7–13 drinks per week had the lowest number of small LDL particles. Alcohol intake was strongly positively associated with large- and medium-sized high-density lipoprotein (HDL) particles but had an inverse relationship with concentrations of small HDL particles and small- and medium-sized very-low-density lipoprotein particles. Average particle sizes of all three lipoproteins were positively associated with alcohol intake. Associations were generally stronger among women than men but in similar directions. Beverage type did not consistently modify these findings.

    Long story short:


    Transform all those nasty carb ridden grains into beer!

    Grain industy's happy, people are happy and we'll all be alot healthier.