How to Make a sdLDL (Small Dense LDL)

February 13, 2017

How to Make an sdLDL (Small Dense LDL) 

 References: Lecture by Ron Rosendale, Researchgate, PLOS, JCI

This is the most common question I get asked: what do I do when my doctor wants to put me on a statin? It gets asked by healthy folks who have all data they need to prove that they don't need a statin. They are eating optimally and their lipids are, in fact, beautiful. But their doctor thinks they should be on a statin because the rules for cholesterol treatment have been dumbed down to the barest essentials: is your cholesterol over 200? Statin! 

 Repeatedly, I go through the exercise of explaining that it's not the total cholesterol that matters, it's the number and size of particles that matter. If you have big, fluffy LDLs, you are in great shape. If you have small, dense LDLs, you are in big doo-doo. The proper analogy has come down to asking which has more volume, a pick up truck bed or a 5 gallon bucket. (Hint, it's the truck.) And how many basketballs can you put in a pickup truck? I usually hear "About 50." And how many golf balls can you put in a five gallon bucket? I hear 400-500. 

This is as close to your cholesterol as I can get. You don't need a statin to treat basketballs, they are harmless. They are the equivalent to big, fluffy LDLs. And you don't need a statin to treat sdLDLs either unless you can't change your lifestyle. But your doctor is unlikely to know how you make sdLDLs (golf balls) so they can't advise you how to do it differently by lifestyle. Besides, a pill is easier and faster and you get to bare the side effects and consequences, but not much benefit from taking a statin. 

 Ok. The nugget comes down to, "How can I change my small, dense LDLs to big fluffies?" That's the nugget. And the answer is ..... get rid of insulin. This will save your life. Get rid of insulin. How do I know that? And vice versa: How do I make small dense LDLs? Turn on insulin. SdLDLs are made in response to insulin. Insulin is made in response to carbohydrates overwhelming your ability to burn glucose. You are signaling your body that you are in the season of carbohydrate excess. That's fall when plants ripen.

You are gorging on carbs. Winter is coming. You need to get fat. You want insulin to make a lot of different actions. You need to increase the production of fat in your liver. Those are called triglycerides. You need to make more transport modules to move the fat from your liver to your fat cells. Those transport modules are called LDLs. But because you have to make oodles of them very quickly, you make small ones just to get them off the production line. And as your fat cells get bigger, they become insulin resistant as the insulin receptors get further apart on the expanding fat cell. Your insulin level rises. You have insulin around all the time, and presto, you have small dense LDLs. 

 Want to make your LDLs bigger, safer, kinder and gentler? Sure. Then get rid of insulin. Stop eating carbs, and stop eating too much protein. That leaves fat and very low glycemic carbs. (Above ground vegetables) Your LDLs deliver their product, turn into HDLs and you can watch your LDLs drop like a rock and your HDLs climb steadily - about 5-8 points a month. Get your carbs below 20 grams a day and your HDLs will reach 100 in about a year. 

 WWW. What will work for me. It's that simple. You can prove it in weeks if you have a lab that will order your HDLs, your sdLDLs and your insulin. Get your insulin below 7, and you will be good. My HDLs were 28 all my life until I lowered my carb intake. I'm now in the 60s, and not quite disciplined enough to get higher. I've seen this question so many times, I wanted to put it all in a handout I can show my clients. Here it is. Cut the carbs, eat more butter, make your LDLs get big and harmless. Eat cookies, brownies and ice cream and presto, all the sdLDLs you want. And that's how to make a sdLDL. 

 Pop Quiz 

 ‪1. Total cholesterol should be below 200. T or F?                   Answer:  True if you are the American Heart Association. It doesn't matter if you are a scientist and want to know truth. The HUNT study from Norway says women live longer if their cholesterol is over 200. ‪

2. If total cholesterol isn't the measure of trouble, what is?                       Answer:  Probably your Triglyceride/HDL ratio or your Apo-B/Apo A2 ratio - both connected to sdLDLs 

 ‪3. I can raise my HDL be eating bacon and eggs?                         Answer:  You're kidding? Yup and Nope ‪

4. There is consensus in literature review that eating saturated fat is harmless for you. T or F                  Answer:    True. Read the review in the American Journal of Clinical Nutrition. 

 ‪5. sdLDLs are the ones that cause heart disease? T or F?                     Answer:  True.