Beyond Total Cholesterol: The Truth About LDL Particles, Inflammation, and Heart Disease Risk

Cholesterol and heart disease are widely misunderstood topics in healthcare. Blanket statements like “HDL is good, LDL is bad” or “high cholesterol causes heart attacks” are too simplistic and often lead to unnecessary medication. This article will examine common misconceptions about cholesterol, explain how LDL particles work, analyze sample blood tests, review potential harms of statin drugs, and provide guidance on getting accurate heart disease risk assessments.

How LDL and HDL Work

LDL (low density lipoprotein) and HDL (high density lipoprotein) are carriers that transport cholesterol in the bloodstream. LDL contains more cholesterol than HDL. LDL delivers cholesterol to cells that need it. HDL collects excess cholesterol and returns it to the liver for recycling or excretion.

Having appropriate levels of large, buoyant LDL and HDL is healthy. The problem arises when LDL particles get damaged from inflammation and oxidative stress, causing them to become small and dense. Damaged LDL contributes to plaque buildup in arteries.

The goal should not be to simply lower total LDL, but rather to reduce the percentage of small, dense LDL through lifestyle and diet changes.

Analyzing Blood Tests

Looking at a blood test, many doctors only focus on total and LDL cholesterol levels. They may prescribe a statin drug if LDL is over 100. This overlooks the bigger picture.

Here is a breakdown of key markers on a sample blood test:

  • Glucose, triglycerides and VLDL improved, indicating reduced insulin resistance.
  • Liver enzymes AST and ALT also improved.
  • Total cholesterol and LDL changed little. However, LDL particle number dropped while HDL increased.
  • Most importantly, the ratio of small to large LDL dramatically improved, from 52% to just 9% small particles.

Though total LDL remained high, the reduction in inflammatory small LDL particles means this patient’s heart disease risk markedly declined. Relying just on total or LDL cholesterol would have missed these gains.

Dangers of Statin Drugs

Statins like Lipitor are routinely prescribed to lower cholesterol. However, they come with many potential side effects. Statins reduce production of coenzyme Q10, critical for energy production in the muscles, brain and heart. Statin risks include:

  • Muscle damage – pain, inflammation, weakness, even outright muscle breakdown (rhabdomyolysis)
  • Increased risk of diabetes
  • Cognitive impairment and dementia
  • Neurological dysfunction
  • Liver and kidney damage
  • Hemorrhagic stroke

Statins may lower total cholesterol, but do not reduce small, dense LDL particles that drive heart disease. Yet they impair the body’s energy production, which can lead to muscle wasting, neurological problems and more.

Saturated Fat and LDL

Conventional nutrition advice often states that saturated fat raises LDL cholesterol levels and increases heart disease risk. However, recent research indicates that saturated fat mainly increases large, fluffy LDL particles, which are benign or even beneficial.

On the other hand, excessive sugar and refined carbohydrate intake generates inflammation in the body. This inflammation damages LDL particles, making them small and dense. Small, dense LDL can more easily sneak into the artery walls and drive plaque buildup.

Therefore, while saturated fats may raise total LDL, they are not associated with increased cardiovascular mortality. The real risk lies with inflammatory diets high in sugar and refined carbs that generate higher levels of small, dangerous LDL particles.

Impact of saturated fats from sources like meat, butter and coconut oil

In the sample blood test earlier in this article, the patient reduced their sugar and carbohydrate intake significantly while increasing saturated fats from sources like meat, butter and coconut oil. Despite the higher saturated fat, their amount of small LDL particles plummeted from 1400 to just 200. At the same time, their total LDL number remained relatively stable.

This illustrates that lowering carbohydrate intake, even while increasing saturated fat, can lead to major improvements in the specific LDL particles that matter most for heart disease risk. Diets lower in sugars and refined carbs but higher in saturated fat from quality animal foods and plants can greatly improve LDL characteristics tied to cardiovascular health.

The key is making sure carbohydrate restriction is significant enough to lower insulin production substantially. This allows the switch from burning glucose to tapping into stored fat for fuel. Then saturated fats can be utilized efficiently for energy by metabolically flexible cells. Without lowering carbs enough to reduce insulin spikes, the body remains stuck burning glucose. In that case saturated fats are more likely to get stored rather than used for energy.

Evaluating True Heart Disease Risk

H Simply having high total cholesterol or LDL on a standard blood test does not necessarily equate to having high cardiovascular disease risk. Total cholesterol can be elevated due to genetic factors, saturated fat intake, low inflammation and oxidative stress, or even excessive health and vitality.

Likewise, LDL particles only become dangerous when damaged by inflammation. Without excess oxidative stress, even high LDL may be largely benign.

For this reason, relying only on total cholesterol or LDL numbers to determine heart disease risk can be misleading. A better approach is to get advanced lipoprotein testing, and also have a coronary artery calcium scan performed.

A coronary artery calcium scan takes a CT image of the heart to visually assess the actual amount of calcified plaque buildup within the coronary arteries. This provides concrete evidence if high cholesterol is translating into real cardiovascular blockages or not.

Calcium scan scores range from 0 to over 400. A score of 0 means no plaque detected, indicating very low risk despite other high cholesterol markers. Scores from 1-10 show minimal plaque, still reflecting low risk.

Mild calcification starts between 11-100, while moderate plaque buildup ranges from 101-400. Only over 400 represents extensive blockages and high risk of a heart attack within 5 years.

The cost of a coronary calcium scan is very minor – around $100 in many cases. This contrasts with the massive expense of cholesterol-lowering medications taken over a lifetime. Yet insurance rarely covers calcium scoring, only the far more expensive and profitable statin drugs.

A heart calcium scan provides concrete imaging of real blood vessel plaque buildup. This gives valuable additional data beyond cholesterol levels alone. When combined with advanced lipoprotein testing and a lifestyle/diet focus on reducing inflammation and insulin resistance, the true root causes of cardiovascular disease can be addressed – not just lab markers.

The key points:

  • Cholesterol markers like LDL and HDL are more complex than “good” and “bad.” Focus on reducing inflammatory small LDL.
  • Analyze all heart disease risk markers, not just total cholesterol. Diets that lower inflammation can improve many measures even if LDL stays high.
  • Statins have serious potential side effects but do not lower the most dangerous small, dense LDL particles.
  • Saturated fats mainly increase large, benign LDL. Sugar and refined carbs create small, inflammatory LDL.
  • A heart calcium scan provides concrete evidence of plaque buildup rather than relying just on cholesterol levels.
  • Addressing root causes of inflammation through diet and lifestyle changes leads to long-lasting heart health – not just taking a pill to lower one number. Evaluate overall cardiovascular risk rather than fixating on cholesterol alone.

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