So I just watched/listened to a slew of videos on YouTube. The old saying "Opinions are like *******s, everyone has one" is definitely true. :D

Ultimately, I think my favorite video was this one below by Dr. Jonny Bowden..."The Great Cholesterol Myth."

It's over an hour, but here are some important moments

Dr. Jonny Bowden "The Great Cholesterol Myth" - YouTube

37:45 Talks about the particle test
39:00 Talks about the Ldl cholesterol particle size issue
45:00 Talks about inflammation being the real culprit in heart disease
1:04:00 7 steps to heart health (summary slide at 1:06:53)
1:07 :00 Favorite supplements for heart health (Omega 3s, magnesium, CoQ10, Citrus Bergamot, D-Ribose, Curcumin, Vitamin D, Vitamin C, Reservatrol
1:10:28 Overall summary slide

Not saying I believed absolutely everything he said, but I enjoyed it. It's a different slant on the cholesterol issue.

Thanks much, kiwi.

The diet you described is the diet I changed to in 2014. I eat tons of fresh vegetables, next to no processed food or grains, lean protein, salmon once a week, no added sugar, etc, etc... And still, you can see my Ldl. The only thing I feel I can improve on is exercise. I used to get a ton when I didn't work...now, not so much except on weekends. I need to work on this.

Also despite this diet and despite my blood sugar being under 90 the vast majority of the day, my A1c is creeping up.

My test results seem to give me more questions than answers.

I'm all about a whole foods paleo lifestyle, eat more healthy fat etc (and that is basically what I practice). However, I keep hearing this community say that cholesterol doesn't matter and that if you have light fluffy particles, then you are okay. This is not really accurate.

There is a study (maybe more than one for all I know) that shows that LDL size loses significance when you adjust for LDL particle number. Therefore, the particle number will be the most important risk factor in your profile, more important than your particle type. Particle type matters also, but it's secondary to the number of particles. It's the whole cars analogy- the more cars (particles) that you have on the road (arteries) the higher the incidence of accidents (atherosclerosis).

Let us know what your doctor tells you.

There are also others things besides diet and exercise that drive that LDL particle count - thyroid, stress, infections etc. Plus you haven't yet figured out a root cause for yours SFN and for all you know, that could be driving those numbers.

You have a tightrope to walk with your insulin issues. And high insulin can drive that your particle count up as well. I was thinking maybe you had some genetics at play, but you are not an ApoE4. I'm stumped....

Here is one more to ponder or not. All I can say in my folks life, none of these tests were done, they lived into 90's. Cholesterol wasn't a word.

Why Your Cholesterol Test Can Lie | Dr. Stephen Sinatra

Thanks. I found this article by Chris Kesser which discusses possible causes of increased LDL. You pretty much nailed it.

What Causes Elevated LDL Particle Number?


A tightrope is definitely what I'm walking with my insulin issues. When I get home from work, my blood sugar is often in the low 70s and sometimes high 60s (which I can usually feel). I'm going to have to start snacking more.

I've seen my new primary care once for a new patient visit, but didn't come away with a great feeling. I'm thinking about asking for a referral to an endocrinologist to see if they might spot something.

I'm also 35 minutes from Johns Hopkins if I could just figure out what kind of doctor to try to see!

While a lot of the ongoing research into lipid particle sizes is very interesting--
 

--from a clinical perspective, I still don't think the researchers really have a handle on exactly what drives cardiovascular risk when it comes to particle size and number.

Certainly, the correlational studies don't provide a lot of strong absolute evidence for any particular size or number of particles resulting in greater infarction risk without other factors being taken into account, such as blood sugar, blood pressure, triglycerides (yours are impressively low), and measures of inflammation such as C-Reactive protein levels. There are plenty of people who go around with pretty high levels of "harmful" particles who because of healthy measures on some or all of these other levels are at relatively low risk for cardiac incidents--and a goodly number who have been found to have "good" cholesterol profiles as currently defined who are at high risk for events due to high blood sugar readings, high blood pressure, high inflammatory levels, and the like.

More reserach is certainly needed, but these situations are complex and multifactorial, and a lot of it is driven by heredity as well as lifestyle--although at least lifestyle is alterable. What makes me wary is how the "acceptable" lab levels have been driven down over time--Total cholesterol normal has gone from less than 240 to less than 200 over the last twenty years, and now many want to set it at 170--without REALLY good solid evidence that these have significant salutary effects. (We do need a certain amount of cholesterol available for our brains and other tissues--hypocholeterolemia is not good for body functioning, either.) I often wonder how often these decisions are driven by the lobbying of big pharma wanting to sell new product rather than by good research into actual health outcomes.

Thanks much for the input, glenntaj. You're concisely stating the feeling I've been getting reading all the conflicting opinions. I just don't think they really have a grasp on things yet.

Your comments on the acceptable levels being set lower and lower is also enlightening. I didn't know that, but am not surprised.

It'll be interesting the stance my new doctor takes on this. She's part of a medical conglomerate here, and I'm sure there are Standards of Care she's supposed to adhere to.

Well, it was interesting today. My new doctor was completely unconcerned about my LDL. She pretty much said, "Yeah, it's a little high, but try getting more exercise." She went on to say that if I had a family history of people keeling over when they were young she might consider a statin, but when I said I wouldn't take one anyway, she just smiled.

So this doctor is part of the big MedStar conglomerate down that is slowly taking over medical practices and hospitals here in the Baltimore/Washington area. I know they have Standards of Care that their docs are supposed to follow, and she actually showed me briefly what MedStar software pooped out about my cholesterol. What I saw was "borderline."

"Your blood work looks good, unless you need me sooner, I'll see you in a year. "

Janieg, your new doctor sounds sensible to me.

As far as exercise is concerned, I walk briskly for about 30 minutes every day - good for my aerobic fitness.

It also gives me a chance to notice, without judging, the sights, sounds and smells of what I experience on my walk (mindfulness).

Maybe something along those lines might work for you as well?