Lipid Subfractions test results

[Cocosilk]

Just wondering if any other low carbers with high cholesterol have ever had a Lipid Subfractions tests, and even better, can show a before and after Lipid Subfractions result of how low carb (or keto or carnivore) lowered Small Dense LDL?

After having a high cholesterol result: Total Cholesterol 8.4 mmol; I decided to get the subfractions test done to see how much LDL is small and dense. My HDL was 2.8 mmol (good); my Triglycerides 0.7 mmol (good) and I've read that means you are unlikely to have any small dense LDL. However my results were:

Total Small Dense LDL 0.36
LDL 3 - 0.31 (0.00 - 0.15) more than it should be
LDL 4 - 0.05 (less than 0.01) also more than it should be

They call this an intermediate profile and say that I "probably have only a small increased risk of adverse cardiac events". Being over the recommended ranges is not where I want to stay if I can do something about it though of course.

Now I'm assuming low carb is the best thing to reduce small dense LDL based on some of the articles I have read.

Here is one such article https://www.bmj.com/content/347/bmj.f6340/rr/669222

The only thing that I haven't found a clear answer for is whether this amount of Small Dense LDL warrants trying a statin (probably not I imagine) and whether or not statins will actually lower Small Dense LDL.

A quick search brings up two conflicting results;

This study says statins DO NOT lower small dense LDL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2929871/

But Ken Sikaris says statins DO reduce small dense LDL and truly help those with familial hypercholesterolemia

Who do you believe?

And if you have slightly elevated levels of small dense LDL in your profile, would you think just dietary intervention would be enough? Have you tried it and done before and after tests to prove it to yourself?

I'd love to hear your experiences!

 

[HSSS]

Ldl4 at 0.05 is less than the range you quote. So it’s just your ldl 3 above reference.

I’m curious how many of us UK based people can even access this testing, I suspect it would be private (£££) only.

 

[Guzzler]

Statins do not lower sdLDL. They increase the number of LDL receptors in the liver, these LDL receptors do not recognise sdLDL. This is my understanding, anyway.

 

[Cocosilk]

Ldl4 at 0.05 is less than the range you quote. So it’s just your ldl 3 above reference.

I’m curious how many of us UK based people can even access this testing, I suspect it would be private (£££) only.

Sorry, I corrected that. The LDL 4 ranges are less than 0.01 mmol (not 0.1).

And the two GPs at the local practise where I collected my results had no idea what to make of this test because it's not routinely done. I only heard about it from Ken Sikaris, who is a pathologist in my nearest capital city.
Who knows if they are just trying to sell the test..? (It cost me $127 out of pocket - nothing covered by Medicare.) I decided to have it done after a GP warned me I might die in the next 5 years because of my cholesterol levels... Didn't seem real.

Some of the arguments I've heard about LDL cholesterol not being all bad would make sense if only small dense LDL is the one that is causing all the trouble.

 

[Cocosilk]

Statins do not lower sdLDL. They increase the number of LDL receptors in the liver, these LDL receptors do not recognise sdLDL. This is my understanding, anyway.

I've heard that, and then I've heard the opposite. I don't know who to trust. But I'm sure anyone paid to sell statins is going to tell you they help. I would want to see some before and after blood tests to prove it. I've heard so many negative things about statins that I wouldn't want to try them at all unless they were a last resort.

 

[Cocosilk]

Another study about whether statins can reduce small dense LDL. Here results vary https://www.karger.com/Article/Pdf/337829

 

[Cocosilk]

And here's one about plant sterols reducing small dense LDL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018958/

Oh, but wait, that means "In Australia,foods approved for enrichment with plant sterols are: margarine spreads, breakfast cereal, low-fat yoghurt and low-fat milk. "

Bah, none of these are on my menu...

Nuts maybe.


How about this one? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2837149/

Just losing weight should lower sdLDL - by reducing carbohydrates.

 

[Cocosilk]

Pregnancy affects cholesterol, and so probably does breastfeeding.

https://academic.oup.com/jcem/article/85/12/4543/2852752

 

[Guzzler]

I've heard that, and then I've heard the opposite. I don't know who to trust. But I'm sure anyone paid to sell statins is going to tell you they help. I would want to see some before and after blood tests to prove it. I've heard so many negative things about statins that I wouldn't want to try them at all unless they were a last resort.

In terms of NNT (numbers needed to treat) the benefit of statin treatment is ~1% in primary prevention. In secondary prevention the number is below 5%. That, of course, means nothing in terms of risk when it comes to adverse side effects of said treatment.

Lowering LDL imo serves no purrpose other than to line the pockets of manufacturers. A harsh thing to say but when you see those adverse reactions to statins such as heightened risk of permanent muscle damage (and remember that the heart is in effect a muscle), risk of Dementia, pain, weakness, ALS (MND) etc etc etc then those NNTs should make up your mind.

 

[ianf0ster]

I have no personal experience of delving into sdLDL, but it seems to me that LCHF is a safer method to try to reduce sdLDL than Statins. Because if Statins don't work, then they are making the problem worse by removing only the good LDL and ignoring the 'bad' sdLDL.
Though I can see how statins could reduce sdLDL ( by removing the good 'Fluffy' LDL before it hangs around long enough to get Oxydated or Glycated).

 

[Cocosilk]

In terms of NNT (numbers needed to treat) the benefit of statin treatment is ~1% in primary prevention. In secondary prevention the number is below 5%. That, of course, means nothing in terms of risk when it comes to adverse side effects of said treatment.

Lowering LDL imo serves no purrpose other than to line the pockets of manufacturers. A harsh thing to say but when you see those adverse reactions to statins such as heightened risk of permanent muscle damage (and remember that the heart is in effect a muscle), risk of Dementia, pain, weakness, ALS (MND) etc etc etc then those NNTs should make up your mind.

Not to mention a higher risk of developing T2 Diabetes..

 

[Cocosilk]

Well, Dave Feldman is answering my question about sdLDL. While many others I've heard are saying sdLDL is hard to clear from the body and that statins are the only way, it seems sdLDL changes as readily as LDL when you eat more or less fat.
The more fat Dave Feldman ate in his experiments, the lower the LDL, and sdLDL also seemed to follow a similar pattern.
https://cholesterolcode.com/cholesterol-code-part-ii-the-ldl-p-gap/

Statins, I've read in contradictory studies either:
DO reduce sdLDL
DO NOT reduce sdLDL but DO reduce overall LDL, which theoretically help reduce sdLDL by leaving fewer LDL particles that could become oxidised. I'm not sure that theory holds water though when there are cases of people with high cholesterol but no sdLDL on their panels, and others with "normal" cholesterol, but large numbers of sdLDL.
DO reduce HDL (which you don't want).

Again, the length of time fasting before a cholesterol test also seems to affect the result. A longer fast of 12 hours (I think they said) will cause insulin levels to drop and the expression of LDL receptors in the liver to go down, which causes LDL cholesterol to rise.

So it seems that cholesterol is definitely not the static number we are all lead to believe when we go for our once a year cholesterol tests..

Still waiting to see what the significance of sdLDL is when it apparently changes so easily too.

I have two other questions too: I think it was a Paul Mason presentation on Low Carb Down Under (or possibly some other study, maybe also a Dave Feldman one) where I heard that by increasing fat intake, insulin production is stimulated, which in turn increases the expression of LDL receptors on the liver and in then lowers cholesterol. But if this is the mechanism, wouldn't increasing insulin eventually lead to insulin resistance? And I wonder how this effect is on a more or less metabolically deranged body. Dave Feldman doesn't have diabetes I don't think. How would someone with a lot of insulin resistance handle this?

Although here is study saying the contrary... maybe I misheard https://www.ncbi.nlm.nih.gov/pubmed/9101427

 

[jjraak]

Interesting point @Cocosilk

" ...again the length of time fasting before a cholesterol test also seems to affect the result. A longer fast of 12 hours (I think they said) will cause insulin levels to drop and the expression of LDL receptors in the liver togo down, which causes LDL cholesterol to rise....."

Don't suppose you'd have a link, maybe?

I always like to fast for any blood, be interested in a longer fast having a down side.

Interesting posts over all, to boot.


Cheers.

 

[bulkbiker]

A longer fast of 12 hours (I think they said)

I think the "golden period" of pre blood draw fasting seems to be 12-14 hours for Dave and Siobhan.. whether this is true for everyone is of course another matter...as (like blood sugar) your cholesterol levels are pretty dynamic, one test really doesn't tell you much except what your levels are at that particular point in time.

We all seem to assume that our cholesterol test gives us something meaningful rather than a simple snapshot..

even found the link... need to download the pdf to read the study

https://www.ahajournals.org/doi/abs/10.1161/01.CIR.22.2.247

 

[KK123]

I think the "golden period" of pre blood draw fasting seems to be 12-14 hours for Dave and Siobhan.. whether this is true for everyone is of course another matter...as (like blood sugar) your cholesterol levels are pretty dynamic, one test really doesn't tell you much except what your levels are at that particular point in time.

We all seem to assume that our cholesterol test gives us something meaningful rather than a simple snapshot..

Yep, in that respect it is exactly like blood pressure and I don't hear about any Dr prescribing tablets for that based on one 6 monthly/yearly test.

 

[bulkbiker]

Yep, in that respect it is exactly like blood pressure and I don't hear about any Dr prescribing tablets for that based on one 6 monthly/yearly test.

We can but hope.... although some.....

 

[Cocosilk]

I think the "golden period" of pre blood draw fasting seems to be 12-14 hours for Dave and Siobhan.. whether this is true for everyone is of course another matter...as (like blood sugar) your cholesterol levels are pretty dynamic, one test really doesn't tell you much except what your levels are at that particular point in time.

We all seem to assume that our cholesterol test gives us something meaningful rather than a simple snapshot..

even found the link... need to download the pdf to read the study

https://www.ahajournals.org/doi/abs/10.1161/01.CIR.22.2.247

Have you read this one of his? https://cholesterolcode.com/cholesterol-code-part-iii-the-divergence/

How's his theory about high protein possible causing inflammation and affecting cholesterol in what appears to be a favourable way but may not be if it's responding to inflammation?

 

[Cocosilk]

Interesting point @Cocosilk

" ...again the length of time fasting before a cholesterol test also seems to affect the result. A longer fast of 12 hours (I think they said) will cause insulin levels to drop and the expression of LDL receptors in the liver togo down, which causes LDL cholesterol to rise....."

Don't suppose you'd have a link, maybe?

I always like to fast for any blood, be interested in a longer fast having a down side.

Interesting posts over all, to boot.


Cheers.

I'll have to retrace my steps to see if I can find where I heard that. I'll post a link if I find it.

 

[bulkbiker]

Have you read this one of his? https://cholesterolcode.com/cholesterol-code-part-iii-the-divergence/

How's his theory about high protein possible causing inflammation and affecting cholesterol in what appears to be a favourable way but may not be if it's responding to inflammation?

Possibly although I would make a few observations
3-day dietary changes are a very short term intervention
Dave designs his meals very specifically maybe the "rabbit starvation" syndrome was effecting his bloodwork so the body was maybe releasing fats into the blood to compensate?
Just a thought.

 

[Guzzler]

Sorry, I corrected that. The LDL 4 ranges are less than 0.01 mmol (not 0.1).

And the two GPs at the local practise where I collected my results had no idea what to make of this test because it's not routinely done. I only heard about it from Ken Sikaris, who is a pathologist in my nearest capital city.
Who knows if they are just trying to sell the test..? (It cost me $127 out of pocket - nothing covered by Medicare.) I decided to have it done after a GP warned me I might die in the next 5 years because of my cholesterol levels... Didn't seem real.

Some of the arguments I've heard about LDL cholesterol not being all bad would make sense if only small dense LDL is the one that is causing all the trouble.

Ken also says that these sub fraction tests are no better/no worse than the HDL/Trig ratio.