Nutritional approaches: Large vs. small LDL

It is now a rare person who does not have at least some proportion of their LDL cholesterol as small particles. I estimate that, of the people who come to the office or report their data on the Track Your Plaque website, 90% have at least 40-50% small LDL particles. Some people have 100% small LDL particles. The sample NMR lipoprotein report shows the result for someone with a severe small LDL pattern (the tallest red bar labeled 1354 nmol/L, compared to the 74 nmol/L of the tiny red bar of large LDL.)

The nutritional approach for small vs. large LDL differs. Small LDL particles are most sensitive to carbohydrate intake; large LDL particles are more sensitive to saturated fats.

The conventional "heart healthy" diet that restricts saturated fat reduces large LDL but exerts no effect on small LDL. Thus, a diet that is restricted in saturated fat and weighed more heavily with "healthy whole grains" triggers small LDL particles. Followers of the conversations here recognize that small LDL particles are flagrant triggers for coronary plaque; they have, in fact, become the number one most common cause for heart disease in the U.S.

When you have lipoproteins tested, you can therefore gauge the likely result obtained when specific dietary changes are made. Follow the low saturated fat advice, large LDL will drop modestly, but small LDL skyrockets.

(Image courtesy Liposcience, Inc.)

Eliminate sugars, wheat, and cornstarch and you will see small LDL plummet (along with total LDL).

As an aside, my personal observation is that the "need" for statin cholesterol drugs can be reduced dramatically by paying attention to this important LDL size distinction.

Comments (13) -

  • craig&jan

    11/10/2008 8:50:00 PM |

    I was wondering what your thoughts are on the information recently released on the c-reactive protein study and statins.  Do you feel that inflammation in itself is a condition that should be treated with statins? Which comes first the plaque or the rise in crp?


    Jan Jones

  • Anonymous

    11/11/2008 4:08:00 AM |

    will this approach work in the majority, or all people?  I have heard that diet deemphasizing carbs will only affect LDL particle size in a small number of the population.
    how much sat fat is ok, and does fruit count as sugar in the diet?

  • Peter Silverman

    11/11/2008 12:45:00 PM |

    How does rice affect large and small LDL?

  • Anonymous

    11/11/2008 1:43:00 PM |

    Ive read some time agoon Dr. Eades blog, that one can reduce inflammation with L-Argenine. (no statins needed).

    Jeanne Shepard

  • Anonymous

    11/11/2008 2:03:00 PM |

    I would love to see a post about the nutritional implications for the varying ApoE genotypes... I have been told that my 3/4 alleles indicate that I need a low-fat (20%) diet, which I know you normally don't recommend.

  • Anonymous

    11/11/2008 6:28:00 PM |

    Jan Jones, Thanks for mentioning this. I too have been interested in the CPR and statin studies.
    18 months ago my C-Reactive Protein was 4.6. Since then I have followed the excellent dietary advice of Dr. Davis as well as walking 3-5 miles a day. I believe this helps considerably with controlling blood sugar/insulin.
    I also learned that my Vitamin D was very low (tested through Life Extension) and with more sunlight and supplementation it has now increased.  Interestingly, my blood pressure is much lower in summer months.

    My C-reactive protein tested last week is now reduced to 0.89 with NO statins.  

    One of the foremost statin researchers is Dr. Beatrice Golomb, MD at the University of California. My understanding is that she takes no pharmaceutical funding for her extensive research.  Many of her findings can be read online or search  â€œBeatrice Golomb” on You Tube.

    Thanks again, Dr. Davis!

  • Dr. S

    11/12/2008 4:48:00 PM |

    Ahh, interesting.... but mixes and conflates data.  Corn starch, sugar are not on any barely reasonable diet.  Wheat I think is a no go for most though they don't know it.  

    It would be really interesting to see the difference between in LDL types broken out with tightly controlled intake of different starches/carbs.  

    Also, carbs plus fat is very problematic, but carbs and true low fat MAY not be.  

    By far most of the studies claiming to look at low fat diet use 25 or 30% as the low fat and that is much too high to count as anything but high fat.  

    I would not be surprised if fat induced insulin resistance is somehow connected to the explosion of the small LDL particles.  It might even be that many more are ok w/ whole, unprocessed wheat berries it the fat intake is low enough so no IR.  

    Should be organic too, though a different issue-- wheat is one of the more pesticide and fumigant treated food crops and research labs that use fruit flies must feed them only organic or the residues kill the little buggers right quick.

    Any answers/responses here?


  • Amadeus

    11/13/2008 6:15:00 AM |

    Maybe yes, maybe no.

    HDL has been thought of as the good cholesterol but as in everything there is more to the story. it is much more than just a number.

    There are subfractions of HDL and some are good, some not so good.

    In recently published research on men in a three-week low fat program, blood tests showed that on entry the men (typical high-fat American-style eaters) had normal amounts of HDL, but the HDL tended to be pro-inflammatory. Pro-inflammatory HDL promotes plaque build-up in the arteries.

    But after three weeks on a healthy low fat diet, exit blood tests showed the HDL had been converted from having pro-inflammatory qualities to having anti-inflammatory qualities despite the fact that total levels of HDL had on average gone down a little. Anti-inflammatory HDL is beneficial because it does a good job of removing LDL from the arterial system.

    The lead author Dr. Christian K Roberts and colleagues at UCLA concluded, "Pay attention to the quality of HDL, not the quantity, The function of HDL may be more important than the steady-state plasma [blood] levels.”

    Journal of Applied Physiology, 2006; 101: 1727.

    In addition other new research found that even one meal rich in saturated fat could interfere with the ability of “good” HDL cholesterol to protect against damage to arteries.

    In the study, scientists at the Heart Research Institute in Sydney, Australia fed subjects 2 different meals. One meal was high in saturated fat. Three and six hours after each meal, the scientists measured blood flow and assessed how well HDL was protecting arteries from inflammation. The saturated fat meal essentially turned “good” HDL cholesterol into “bad” HDL cholesterol particles. Instead of being anti-inflammatory, they become pro-inflammatory.

    Journal of the American College of Cardiology, 2006; 48: 715.

    Another study measured reverse cholesterol transport (RCT) which is the ability of HDL to remove cholesterol. When the subject were put in a healthy low fat diet, the level of HDL went down but the RCT stayed the same. This showed than while the absolute number may have dropped somewhat, the efficiency of the HDL went up.

    In other words, having a high HDL from a higher fat diet, may not be a good thing and may in fact, be a bad thing. Yet, having a lower HDL from a healthy lower fat diet, may not be a bad thing and in fact may be a good thing.

  • Anna

    11/15/2008 7:11:00 PM |

    Hmmm, those studies on "high fat" meals have never been very convincing to me, using milk shakes for high fat meals, etc., plus the number of participants and length of study are so limited.  It's so artificial.  I'm just not sure how meaningful many of these studies are in the context of a lifetime of eating.

    Viewed historically (not just a few 100 or 1000s of years, but looking back 50,000, 100,000, or a million of years ago), while quite varied depending on geographic location, the human diet until quite recently often wasn't restricted in saturated fat, in fact, the parts of hunted animals with the most saturated fats were often most prized and consumed first, or saved for later use, such as organs/offal and the fat that surrounds the kidneys, respectively.

  • Deb J

    12/23/2008 3:13:00 PM |

    Dr. Davis. Thank you for your blog. I have been on low carb <30 g/d since Jan 1, 2008 and vlc <15 g/d since May 2008, and zc (meat,fat and water) <5 g/d since 10/28/08. Most recent lipid profile was Nov 14,2008.

    Jan 4, 2007 and I wasn't real good about my diet during the Holidays.

    Why would you suspect my TC and LDL to have gone so high and my TRG's to not have improved more? The only thing that did what I expected was HDL.

  • sal

    12/23/2009 6:47:36 AM |

    Just watched this youtube video, and was referred to your blog.

    Lots of info here

  • buy jeans

    11/3/2010 6:35:14 PM |

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  • glutaminl

    2/8/2011 11:34:21 AM |

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