The many faces of LDL

Pam has an LDL cholesterol of 144 mg/dl.

To most people, this means that she has a mildly elevated LDL value. Many people would respond by cutting the saturated fat in their diet. Most physicians would concur and talk about prescribing a statin drug.

Let me tell you what an LDL cholesterol of 144 mg/dl means to me:

1) It could mean an LDL of all large particles (which is good) or an LDL of all small particles (which is very bad). Or, perhaps it’s some combination of big and small. I can’t tell which just by knowing that LDL is 144.

Small LDL responds to a diet reduced in processed carbohydrates and wheat flour; large LDL does not. Small LDL responds in an exagerrated way to niacin; large LDL does not. It makes a difference.

2) It could mean that, hidden within LDL, is lipoprotein(a), or Lp(a). Recall that Lp(a) is a high-risk genetic pattern that can provide the false appearance of high LDL cholesterol. If Pam were prescribed a statin drug, it would have little effect and little benefit. (See Red flags for Lipoprotein(a).)

Knowing that Pam has Lp(a) can point us in an entirely different direction than just LDL cholesterol. It might mean high-dose fish oil, a more serious approach to niacin, hormonal treatments like DHEA or testosterone. It might mean more attention to warning your children about the possibility that they, too, might share this genetic trait.

3) It could mean both small LDL and Lp(a) are present simultaneously, an especially dangerous combined pattern that is among the highest risks for heart disease known.

4) Because Pam’s LDL of 144 mg/dl was not measured, but calculated, it means that it is subject to tremendous inaccuracy.

In my office, calculated LDL cholesterols can be inaccurate by 50 or 100 mg/dl–commonly. So Pam’s LDL of 144 mg/dl could really be 70 mg/dl, or it could be 244 mg/dl. Once again, it’s a big difference.


Just like The Three Faces of Eve, the 1957 film in which Joanne Woodward played the three wildly different sides of Eve’s personality–the daytime Eve White, the fun-loving and daring Eve Black, and Jane–so can LDL assume several different faces, all with different personalities, different implications.

Accepting LDL cholesterol as LDL cholesterol is a fool’s game. It is only a starting point, nothing more. Accepting a statin drug based on LDL is, likewise, a trap fraught with uncertainty, the potential for limited or ineffective results, the price being your heart and health.



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13 Responses to The many faces of LDL

  1. kdhartt says:

    Interesting that we just need to refine the notion of “good and bad cholesterol,” and it seems to be about particle size, not density. Are lp(a) small? Is there a treatment that converts small LDL to benign LDL but doesn’t raise HDL?

    Keith.

  2. Dr. Davis says:

    Lp(a) particle size tracks LDL particle size. Small, dense LDL therefore occurs with small, dense Lp(a) (referring to the LDL part of Lp(a), not the apo(a) portion).

    Small LDL responds to the same treatments that raise HDL. I do not know of any treatments that diverge on this point with the exception of alcohol, which principally raises HDL.

  3. moblogs says:

    That’s an eye opener. In England all we get is LDL, HDL and trigylceride reports, and even then the decision to put someone on statins varies between doctors and deviates from guidelines. It’s all messed up.

    Just to deliver some more from Trevor Marshall (against vit D), what’s your opinion of this article? It’s a lengthy one. http://bacteriality.com/2008/01/26/cad/
    I’m guessing the reason this has shown effect is not really the reduction of vitamin D but antibiotics that mimic it’s effects. Do note that the author of that author is biased because she follows Marshall.

  4. Dr. Davis says:

    Every so often, a kooky idea comes along that seizes the attentions of the fringes. Linus Pauling and high-dose vitamin C to cure heart disease, cancer, and most human illnesses was this way. Nanobacteria did this. Chelation is another.

    From what I’ve read of the so-called Marshall Protocol, I would lump this with the above.

    The focus of this blog and the http://www.trackyourplaque.com website is reduction of coronary calcium scores and regression of coronary plaque. I do not think that we need to invoke these sorts of ideas and reinvent the wheel to accommodate the rants of people like this.

    By the way, the article states that the causes of heart disease are not often revealed by conventional cholesterol values. I heartily agree with this. The answers will be found in lipoprotein analysis and associated laboratory and lifestyle examination. It is not in antibiotics.

  5. onewaypockets says:

    I did find a web site that outlined the risks for someone that follows the Marshall Protocol. I should point too that Dr. Marshall is not a MD.

    http://lassesen.com/cfids/MarshallProtocolRisks.htm

    * Major risk of Addison Syndrome (5%-25% of CFS that complete the protocol)
    * Increased risk (100 300%) of Heart Attack
    * Increased risk (100+%) of Cancer (Breast, Colon and Prostate are well documented)
    * Increased risk (67+%) of Multiple Sclerosis
    * Increased risk (400+%) of Diabetes
    * Increased risk of Depression
    * Increased risk (500+%) of Osteoarthritis and Osteoporosis
    * Increased risk of nephrotic syndrome, schizophrenia and severe bipolar disorder.
    * Increased risk of Hyperparathyroidism
    * Increased risk of Crohn Disease and Sjogren’s syndrome
    * Increased risk of Rheumatoid Arthritis
    * Increased risk of Systemic Lupus Erythematosus
    * May cause fetal and neonatal morbidity and death
    * Risk of Angioedema

  6. Anonymous says:

    Another from the UK! I’ve often wondered how cholesterol is measured in a standard lab (as described my moblogs) If cholesterol is contained within or is a part of a lipoprotein, how on earth do they separate out the different contents of the lipoproeins and then measure them with any precision?

  7. Dr. Davis says:

    Of course, LDL is NOT measured.

    The other cholesterol fractions are measured enzymatically and separated by density.

  8. Anonymous says:

    I looked at the article linked by mobloogs. At first I was surprised it didn’t list his background like it did the others it mentioned, until I looked around the site and realized the whole site is just a PR piece for Marshall. The site states Trevor Marshall, Ph.D., is a biomedical researcher.
    His site http://trevormarshall.com/ says “Prof. Marshall is currently a Director of the Autoimmunity Research Foundation, an Adjunct Professor of the School of Biological Sciences and Biotechnology, Murdoch University (Western Australia)”
    Wikipedia lists him as “Trevor Marshall received his PhD in Electrical Engineering from the University of Western Australia in 1984 [3]. He also possesses an undergraduate and a masters (1978) degree in Electrical Engineering.[4]“
    Murdoch dosn’t show him on their research page
    http://www.bsb.murdoch.edu.au/research/interests/

  9. Anonymous says:

    Thanks Dr Davis (anon from the UK)

  10. Anonymous says:

    Dr. Davis – I have been a faithful reader of your blog for about a year and try to follow your protocol for plaque reduction even though I have not been able to afford a CT Heart Scan. I did have a lipoprotein breakdown and believed that Vitamin D, Fish Oil, and Vitamin K are very important. My Vit D level was 36 while taking 2,000IU of Carlson’s capsules. I doubled it to 4,000IU and my blood level went to 48. I then decided to try to get it closer to 60, so I started taking 6,000IU back in Sept. I have a lot of cancer in my family history, have already been diagnosed with borderline osteopenia (-2.0) and fear heart disease, so Vitamin D seemed the logical thing to supplement up to a blood level of 60-70. Then…

    In December I came down with a c-diff infection out the blue, my immune system now seems to be in really bad shape which is a complete shock to me, a self-proclaimed health nut who strives to eat right, exercise and take multiple supplements. I am really devastated to think I might have done this to myself.

    A few weeks ago I ran across this new study indicating that high Vitamin D doses could harm the immune system.

    http://www.sciencedaily.com/releases/2008/01/080125223302.htm

    Please comment on this study to ease my mind….I dropped back to 2,000IU a day of the D supplement as I’m scared to death!
    Thanks,
    Noreen

  11. Dr. Davis says:

    I’ve commented on this bit of nonsense several times, both here and in the Track Your Plaque forum. It is patent nonsense based on the rants of a single man. Yes, there is a sliver of science in his comments, but nothing more. Vit D has nothing to do with catching an infectious bacterial disease in the gastrointestinal tract.

  12. Anonymous says:

    Thank you Dr. Davis — I felt like you would have an unbiased opinion on this. Its just scarey to read about immunosuppression, especially when you seem to be suffering from it! I’ve also had a flu-like episode and a cold since the first of Dec!

    I feel like I am literally starving myself on (ugh) white bread, white potatoes and white rice, but thats all I can eat at this time. Things I haven’t eaten in over 5 years!

    Thanks for clarifying the Vitamin D issue. I’ll go back to my 6,000IU dose.

    Noreen (who is healing slowly)

  13. buy jeans says:

    Knowing that Pam has Lp(a) can point us in an entirely different direction than just LDL cholesterol. It might mean high-dose fish oil, a more serious approach to niacin, hormonal treatments like DHEA or testosterone. It might mean more attention to warning your children about the possibility that they, too, might share this genetic trait.

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