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What's the test to identify the large, fluffy LDL component?

Discussion in 'Diabetes Discussions' started by AndBreathe, Nov 14, 2014.

  1. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
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    I'm having a bit of a brain freeze here. I'm doing my prep for my meeting with my GP next week, to discuss my lipids. The subtext is she will be recommending statins, which is a strategy I don't agree on.

    As my components are all good, and indeed some optimal, can anyone help me out with the name of the test that examines the particle size in LDL? As my trigs are low, it seems likely I have largely, large fluffy LDL, but that can't be proven without further testing. Does anyone know the name for this test, or how I might best describe it to her?

    Many thanks.
     
  2. noblehead

    noblehead Type 1 · Guru
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  3. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
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  4. phoenix

    phoenix Type 1 · Expert

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    I think that Dayspring (video in above link ) suggests that too many particles of are the problem (I think the large fluffy= good hypothesis seems to be on the wane even in low carb circles see:http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-v )) It may be very hard to get the type of tests Dayspring advocates.
    Here's a bit more from him. The summary includes a bit on how to read a 'normal pane'l in the absence of such tests.
    https://www.lipidcenter.com/pdf/Understanding_the_Entire_Lipid_Profile.pdf
    (the levels are in mg/dl so you need to convert_
    http://www.onlineconversion.com/cholesterol.htm
     
  5. forty six

    forty six Type 2 · Well-Known Member

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    I know this sounds strange but I have recently found out that they do not actually test for LDL or trigs as it is just far too expensive.

    This information came from Zoe Harcombe's website:

    'Cholesterol – what does the blood cholesterol test actually measure?'

    Therefore of the 4 figures they give you only 2 are evidence based, when I asked my DN if this was true she said yes and she called it a 'scientific estimate'. I asked how the words scientific and estimate went together as science is based on evidence and known facts, she had no answer.

    My cholesterol recently changed quite dramatically - went from 5 to 5.4 - but I was told that my LDL and trigs are dangerously high and that I should start statins right now to make sure I live another 10 years! That is what the locum said to me and I am only 47.

    Now I know that they don't actually test for those - how can he know what they are?
     
  6. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
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    Thanks @phoenix . I'll be having a read.
     
  7. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
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    I'm on my iPad at the moment, so don't have access to it, but I have a video that explains what calculations are done, and how important each is,....... Or isn't. I'll look it out tomorrow and post it here.
     
  8. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
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    I had to pop into the study for something, so here goes:

    These two presentations (by the same guy) are excellent:
    Cholesterol v Fat v Glucose:

    and

    Blood Tests to assess your Cardiovascular Risk:

    I was interested to Professor Siakris by @jack412 . Professor Sikaris is well worth the watch, in my view. He has a relaxed and easy to follow way of presenting. I hope you find something of value in there.
     
  9. phoenix

    phoenix Type 1 · Expert

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    As far as I know, if you have a full lipid panel rather than just a total cholesterol (in which case they wouldn't give the various fractions) they directly measure trigs and HDL C and then calculate LDL C normally using the Friedwald formula
    LDL cholesterol = Total cholesterol – HDL cholesterol – Total triglyceride/ 2.19 in mmol/l
    Very high TGs can interfere with the measurement of the other fractions.
    if your trigs are high then the equation used is likely, if anything, to underestimate the LDL C ( though this is more likely at lower levels of LDL).
    http://content.onlinejacc.org/article.aspx?articleid=1671271#bib6
    (NB if you read the paper the formula they give is slightly different : Tg/5 as it is in mg/dl.)

    edit just seem Pavlosn's post below, I'd been looking up methods and the methods reported on his lab results seem to those used in UK labs (well everywhere really)
     
    #9 phoenix, Nov 14, 2014 at 8:26 PM
    Last edited by a moderator: Nov 14, 2014
  10. pavlosn

    pavlosn Type 2 · Well-Known Member

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    Went back to look at my latest lipid counts after reading the above
    ImageUploadedByDCUK Forum1415996572.366040.jpg

    I note that the lab states the method used to arrive at the result:
    - for total cholesterol and triglycerides: enzymatic colorimetry
    - for HDL: specific measurement of HDL after elimination chylomicron and release of HDL
    - for LDL: no method is listed.

    I suspect the do not measure LDL but just calculate from the other three

    I will ask about this next time I go to the lab

    Pavlos
     
  11. jack412

    jack412 Type 2 · Expert

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    I didn't read it that way, I think fluffy = good may not on the wane.
    I understood it that they are saying that with lchf your reduce your sdLDL and have big fluffy, and the normal blood test may show high ldl because the large fluffy have say 100 particles, where the small dense may have say 200 particles for the same LDL mass reading. this is why they recommend that the total number of particles are counted and are a better measure.
     
  12. forty six

    forty six Type 2 · Well-Known Member

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    I found this very interesting and he does explain things clearly, but it still doesn't answer the main question for me which is should we be focussing as much on the breakdown of these lipoproteins anyway. This all depends if you agree with the current thinking by the medical sector (who are largely financed by the pharmaceutical companies). The descriptions of how our arteries become damaged and therefore eventually lead to heart disease are not always explained correctly. The picture of a tube filling up with fat is not how plaques form in arteries and is misleading at the very least.

    Dr's seem to forget that science marches on and what may appear to be correct one day is not the next, after all mercury was frequently used to cure all manner of illnesses as were leaches. The professor himself says that LDL has become demonised - it does after all serve a purpose and is only a particle in the blood not your total cholesterol.

    I feel that I want more evidence before agreeing with our medical profession. After all I would not buy a car after reading one review and especially if that one was paid for by the manufacturer.

    Having read the whole of the article by Zoe Harcombe I now know that giving me a scientific estimate based on suspect percentages has done nothing for me except make me question everything I am told. I trusted this test and now I don't.

    All my other tests came back perfectly normal including blood pressure so I will wait for my next blood test in a couple of months and go from there.

    I do however thank you for the links and the comments.
     
  13. forty six

    forty six Type 2 · Well-Known Member

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    Very interested in your printout - my last results were scribbled on a scrap of paper by the nurse! Must ask why this is not possible for our clinic.
     
  14. phoenix

    phoenix Type 1 · Expert

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    In the past @jack412, there was a tendency to assure people that high LDL doesn't matter if you are low carb ,especially if you have low trigs because they will all be large and fluffy.( you could find several examples on this forum, here's one from some time ago but it's typical of what was often written 'With low trigs and high HDL the LDL molecules are larger, fluffy and non-dangerous, it's the small VLDL which is a danger signal. Trigs/HDL ratio should be below 3 in US numbers, I think that translates to below 1.2 or 1.3 in UK numbers. http://www.diabetes.co.uk/forum/threads/carbs-the-lowdown.4542/#post-31363 I agree with him about monounsaturated fats ! )


    You don't necessarily lower your VLDL in any case on a low carb diet. Krause is the researcher who found this with dairy but then was surprised when he found it not to be the case on his combined beef and dairy trial where ApoB rose http://ctsi.ucsf.edu/news/about-ctsi/link-between-meat-

    Dayspring (and Attia) say that the number not the type of particle matters basically if there are a lot of them they are likely to cause damage. This is what was found when researchers controlled for number rather than just looking at the association between size and artherosclerosis. (and that is also in accord with people who have familial hyperlipidemia who have large fluffy particles People with insulin resistance though are likely to have large numbers of VLDL particles See the comments here
    http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-iv
    (and I have just found the statement about particle size that Dayspring mentions in his comment It summarises the available evidence
    p 358 https://www.lipid.org/sites/default/files/articles/expert_panel_paper.pdf )

    Dayspring also writes of a patient on a paleo/low carb diet whose trigs fell from 78mg/dl to 49mg/dl ( under 150mg/dl is considered norma) l but whose LDL rose from 105mg/dl (2.7mmol/l) to 230mg/d (5.9mmol/l). The trig/HDL ratio is still seemingly ideal
    However, when tested her particle number belied this, it was sky high (99th percentile). This according to him was a risky profile.
    http://www.lecturepad.org/dayspring/lipidaholics/pdf/LipidaholicsCase291.pdf
     
  15. jack412

    jack412 Type 2 · Expert

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    I take a low dose statin, even with a cholesterol of 2.7, trigs are my problem, ...my LDL is under 1, so I haven't gone into LDL a lot and it's just what I've picked up about LDL.

    I agree and posted before and previously on another thread, that it seems the LDL-p is important and it seems the normal cholesterol BT estimates a mass LDL but not the particle number...so a reading of 2.5mmol/l ldl or 5mmol/l LDL could in fact have the same number of particles and it's the size that is different.
    I don't think this diminishes the importance of flufy ldl vs small dense LDL. Only that the number of particles is a better way to count than estimated mmol/l mass


    with LCHF it seems half go down and half go up
    www.youtube.com/watch?v=y2zoDsVimyw
    upload_2014-11-15_10-24-12.png
     
  16. pavlosn

    pavlosn Type 2 · Well-Known Member

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    Unfortunately we do not have a national health service in Cyprus.

    I have no option but to go privately and pay for all my doctor visits, chemist prescriptions and in this case medical laboratory tests.

    Believe me staying healthy is an expensive business, but probably preferable to the alternative.

    As I am the lab's client and they are reporting to me directly and not to a doctor, they have to give me a full report, and as I am guessing that different lab's may be using slightly different tests, they have to state the method used.

    Having said all that, I was under the impression that you are entitled to receive the full results of all your tests in the UK. Even if printing/admin costs are the issue surely they could get round that by a small probably nominal charge?

    Regards

    Pavlos
     
  17. phoenix

    phoenix Type 1 · Expert

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    @jack412 It was late last night, I think we were coming at the issue from different perspectives and I wasn't taking proper note of what you were saying. I hope this clarifies things (and I'm not putting words into your mouth!)
    . From my perspective I was arguing that ,according to lipidologists and recent data, it is doesn't matter what size the particle. Large ones have an equal potential to cause an atheroma . However, the idea that large fluffy ones particles were benign was much touted in the past (and still is by certain internet gurus)
    You were coming at it from the perspective in that for any given LDL, it would be better for it to be made up of large particles since there would be fewer of them , This may be an important consideration if you have low LDL but also have (or had) the metabolic syndrome. I agree with that.

    @forty six
    I also get copies of my lab results sent to me. Unlike Pavlosn, I do live in a country with a health service. However, it is run on different lines to the NHS In effect, I buy the services of a private lab for tests then the health service reimburses me for some of the cost ( almost all in the case of some chronic diseases otherwise only about 60% with the rest paid for by private insurance ). It means I get all my test results , doctors reports, xrays etc but the cost both to the individual and to the country is much higher than in the NHS.
     
  18. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
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    If you ask for a printout, I'm pretty sure you would be given one. My practise always seem surprised I want it, but I do.
     
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  19. pavlosn

    pavlosn Type 2 · Well-Known Member

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    There is one thing I do not understand.

    It would seem to me not self evident that there would be a smaller number of LDL particles for the same LDL-c measurement if the particles are large as opposed to small.

    The LDL-c measurement is a measure of mass and I do not know if a large fluffy LDL particle differs in unit mass to a small dense LDL particle.
     
  20. forty six

    forty six Type 2 · Well-Known Member

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    I was only diagnosed a year ago and have had 2 full blood tests since then, my surgery are jumping up and down because of the second set and I see nothing to be concerned about - this just makes them even more forthright and pushy.

    Nov 2013: BP 135/78, Tot Chol 5.0, Trig 0.6, HDL 1.0, LDL 3.4, Ratio 5.0, Hb1ac 53/7%
    Sept 2014: BP 132/80, Tot Chol 5.4, Trig 1.5, HDL 0.66, LDL 4.1, Ratio 8.18, Hb1ac 51/6.8%

    At both blood tests all other items like kidney and liver function were clear as they have been at all blood tests in the past. Also my cholesterol levels at previous tests, before being diagnosed, were about the same as the Nov 2013.

    During the second test I was extremely stressed, a close relative was in a car crash and I was also covering 2 other positions at work. I believe that as all my other tests were normal that the stress I was under affected the test. When I raised this with the Dr he said it was perfectly possible, then when I spoke to my DN she said that cholesterol is not affected by stress, I have since been told that this is not true and that as it is linked via hormones to the flight or fight mechanism in the body then stress will play a factor in how high your reading is, as stress can to all other systems in the body. Clearly a bigger killer than cholesterol

    I ask you all, if you had these readings would you be worried or would like I have, said no to statins and worked hard to change my eating even further - again cutting carbs and increasing protein and green leaf vegetables?

    I really would welcome your input,

    Oh I am taking 1x500 Metformin SR.
     
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