When Size Matters (and when it doesn't) ...
Off the bat notice: This will not be one of my usual referenced posts. It's off the top of my head but based on research and the statements of others made in the past. So if I get something wrong please let me know, if you want links and references, please ask and as soon as time permits I will get to them. I am very busy with other matters besides this blog at the moment so please be patient. Thanks!
I think it is fair to say that Dr. Dayspring is "the particle number guy". For good reason. Of the various lipoprotein biomarker predictors these days, apoB and LDL-P seem to be the leaders of the pack. But what of LDL-C? For all the caution expressed by those clinging to TWICHOO about not throwing the proverbial baby out with the bathwater, these same people seem more than willing to throw out the bathtub, fixtures and attached plumbing!
We know from familial hypercholesterolemia, that high LDL-C promotes atherosclerosis. We know this. High LDL-C = atherogenic. Forget the errors of not eating eggs or the clogged pipe analogies etc. The fact remains: High LDL-C = atherogenic. What is high? There is some debate. Surely the current cut-off may well be too low. Truth is there can never be a single value cut-off, and these ranges are all just based on percentiles and often a few studies anyway. But Dayspring puts "high LDL-C" around 200+.
To paraphrase him, if your LDL (I'm dropping the "C") is above 200, nothing else matters. Not size, not HDL, not low trigs. In those with these LDL levels, traditional lipid panels were sufficient to identify risk!
The fact that some with LDL under 100 still develop atherosclerosis and suffer heart attacks does not mitigate one iota the reality that those with LDL over 200 predictably develop atherosclerosis.
So what's this particle number thing? How to explain those with low/normal LDL that develop atherosclerosis or suffer a "cardiac event" anyway? Here is where triglycerides and particle size come into play.
- Triglycerides: Since LDL is usually calculated, it is well documented that when trigs exceed 400, the calculated LDL will be artificially low. In other words, people with high trigs and low LDL actually have higher LDL than the lab report indicates.
- Particle Size and Concentration. If you were to gently add 10g of oil to a liter of water, the "concentration" of oil would be 10 g/L. If you were to then seal the container and shake vigorously, the oil would be broken up into many tiny bubbles, but you would still have 10 g in your liter. The "concentration" of oil in the pot is the same, it is just distributed differently. LDL particles are essentially spherical, and the volume is the amount of lipid they carry. The volume of a sphere is proportional to the cube of the diameter. According to Wiki, the low end of the small LDL range is 19 nm and the upper size of the large LDL is 22 nm -- by geometric relationship of volumes, a 22 nm particle can carry 1.55X the amount as a 19 nm particle.
Many use the vehicle vs. the cargo analogy for cholesterol, etc. It's a pretty good one. Consider your blood stream an enclosed track and the various lipoproteins as different sized and types of vehicles shuttling people around. If you have a lot of people to transport from A to B, you are going to need a lot of vehicles ... big, small, doesn't matter ... it will be a lot. With that many vehicles on the track, there are bound to be a lot of collisions with the guard rails leading to lots of people stranded on the side of the road. If you have fewer people to transport, then if you transport them in minivans your track is not very crowded and there will be few brushes with the guard rails, and few people stranded. If however you transport them all in Mini Coopers, the track gets crowded and you're back to lots of banging into the guard rails and stranded passengers.
Even Jimmy Moore and his cadre of cholesterol apologists* cannot get around the retention hypothesis, they just try to excuse it away. The cholesterol must penetrate the arterial wall and stick there to cause the damage. Clearly more factors are involved than just the numbers game, but these do not mitigate this physical/mechanical part of the process. More particles, more opportunities for the apoB wrapped particle (mostly LDL) to breach the endothelial wall of your blood vessels and get stuck there.
If you have a lot of cholesterol in LDL, size is irrelevant, because you are going to have a lot of particles. Period. If you don't have a lot of cholesterol, you may still be at risk. Now, size is relevant. If you are carrying your modest cholesterol load in small LDL then there will necessarily be more of these particles. It's not as much the small size that is the problem, but that so very many more of these particles will be required to transport the load. Often, it appears, this condition of high particle number but low cholesterol occurs concurrently with elevated triglycerides. In a future post I hope to address the issue of triglycerides as this is more closely related to the basic purpose of this blog. Carb restriction has the greatest impact on triglyceride levels and this is probably instilling a false sense of security in many.
- LDL > 200, you have high particle number and you are at elevated risk
- LDL in normal range: Particle size matters because smaller particles = more particles and elevated risk.
* I am not calling every expert in Cholesterol Clarity an apologist, just the ones that are. For many years now I've been hearing low carbers describe their LDL as "large and fluffy". This type of LDL has been described as everything from benign to protective, and in this regard the term apologist applies. At best, even Dr. Ronald Krauss describes these LDL as less harmful and this seems to be the most responsible designation. Again according to Wiki, the normal gaps in the endothelium are 26 nm in diameter. At 19-20.5 vs. 20.6-22 nm, we aren't exactly comparing throwing tennis balls vs. soccer balls through a basketball hoop here, we're talking regulation women's vs. men's basketballs. If someone with LDL of 100 and 22 nm particles has an LDL-P of 1000, that same person would have an LDL-P of 1552 if their LDL is 19 nm. I've read Dr. Dayspring put the particle size cut-off for penetration quite a bit larger than 26, more like 70 nm if memory serves. Which do you think is the more important characteristic, knowing that in familial hypercholesterolemia the LDL are large and fluffy, and atherosclerosis is almost a given?
I've been taking flack again for being "obsessed" with Jimmy Moore. For those not aware of some facts, I used to be a regular participant on his discussion forum. I also have a very good memory, especially where numbers are concerned etc. It's been two years since I was kicked out, and four years since many of the conversations I had on that board. I remember to this day a lot about people, their weight, their pets, their struggles, the teams they rooted for, their families, etc. etc. I don't want to needlessly highlight some individual that has nothing to do with this blog, or I could rattle off 10 names and 10 facts about each name off of the top of my head in about 10 minutes. Seriously, that's how my mind works.
The first time I heard of how bad Jimmy's lipid profile was was in December 2009. This was also when I began to hear about large, fluffy, protective LDL and all that. Unfortunately some posts seem to have been truncated by the switch of his forum to a new platform. (I am the unregistered Low Carb Cheater.)
Total Cholesterol 351
Triglycerides 79LDL Particle Number 2130Small LDL-P 535LDL Part. Size 22.0Large HDL-P 10.9Large VLDL-P 0.4THANK YOU for your comments, Paula. However, with all due respect, my numbers are fantastic according to Dr. Westman and my small LDL-P is still pretty amazing.
My truncated comment linked to a study where it was particle number, not size, that predicted risk. And then:
Jimmy: To Paula and anyone else who sees concern with my numbers, what would you suggest I do to "improve" them? This is a sincere question for the edification of all of us.
Me: I don't think anyone knows what exactly is the one or most significant factors. Just wanted to point out that the linked study is from the much referenced Framingham study and linked to (although I can't find direct from there) from LipoScience's site.
I am concerned as well by your HDL/LDL ratio and/or the Total/HDL ratios. I've all my life had borderline to low end of high cholesterol as my HDL is high (although LDL is not low it is only slightly high). Surprisingly my docs have avoided alarmed responses of late because my ratios and HDL levels are high (69 my last test) ... and any doc who has showed alarm has been challenged by me about my good ratios. So when I see your numbers quite the opposite I am concerned as to why.
What can you do? I believe that your numbers are what they are because you have a high fat diet AND you are in a state of overnutrition. You have mentioned gaining weight since your last test and will share weight loss with numbers but curiously don't share any gains with numbers. I follow your menu blog and you lost 15 or so lbs cutting portions and over 10 lbs on 6WC but I can only guess like everyone else that those pounds have returned and you are still struggling with a 30-40 lb regain.
IMO being in a gaining mode vs. a losing mode makes a huge difference ... LC/LF/HF/HC/whatever. If you consume more fat/carb than your energy needs, circulating lipids of various sorts increase. If your Purity pizza is any indication, you eat a LOT -- In your video it looks like you put 3-4Tbs of butter on that!!!! That's 300-400 calories before anything else is added. I don't know where this "add fat to anything because low fat is evil" notion came from, but it is crazy to add tablespoons of butter to the bread used for a pizza because the bread is low fat. I would bet a decent sum that cutting your added fats would have a beneficial impact on the scale and the lipids.
Leave the butter off those pizzas. Add some hamburger to the pepperoni. Or make a tuna melt. None is low fat ... just not overly (and unnecessarily) fatty.
Just a thought!
In his usual fashion, Jimmy asks for input and then ignores or brushes it off (when he doesn't lash out at the solicited advice he doesn't like):
Excellent info guys! THANKS! For the record, I am not at all worried about my numbers. They are stellar in my book and Dr. Westman was not fazed a bit when he saw them.
Yes, Dr. Westman. "Co-author" of his book. Silly me for thinking that this sort of information may be relevant to potential buyers of that book on Amazon, eh?
Check out about the 4:35 mark if you're wondering about the Purity pizza.