cholesterol-particlesHow did we arrive at the conclusion that LDL cholesterol is the villain in heart disease?

Well…once again we see the mistakes made by researchers that lead us to think of LDL as the culprit.

A little history…

It had to do with a machine used in the laboratory, called an analytical centrifuge that created evidence that ultimately mislead researchers and clouded the issue of cholesterol sub-particles.

Invented in 1949 and used until 2004, this device was used to spin blood plasma samples at 40,000 rpm to separate out the cholesterol fractions such as HDL and LDL.

However this spinning process cannot separate the particles with the precision required to identify all of the sub-fractions of cholesterol that are present in the blood. It may have been state of the art when it was first used, but still fell far short in the accuracy required to actually identify all the sub-fractions of cholesterol.

This started the characterization of cholesterol particles as either good or bad cholesterol, depending on the particle density. This was a gross oversimplification that stuck in the minds of the public.

For many years this simplified version of a person’s risk of heart disease based on their ratio of good and bad cholesterol stood as the cutting edge of cholesterol testing and heart disease prevention.

This was accompanied by the now debunked view that saturated fats caused heart disease because of their association with cholesterol. People avoided saturated fats out of a fear that was not founded in good science.

They also consumed statins, the most prescribed class of drugs on Earth due to the same fear of cholesterol and it’s supposed relationship to heart attacks.

Americans have consumed some 14 billion dollars in cholesterol lowering drugs, which some health experts have advocated be given to people of all ages including children allegedly to prevent heart disease.

John Abramson argues in his book Overdosed America that lowering LDL cholesterol has inadvertently become the main focus of preventative medical care in the United States.

Cutting edge thinking about LDL cholesterol

Yet a more recent breakthrough utilizing a new technology called ion mobility analysis has shaken the traditional concept of cholesterol’s role in heart disease to the core, and called the entire LDL cholesterol theory into question.

Ronald M. Krauss, of the Children’s Hospital Oakland Research Institute, is using ion mobility analysis to count cholesterol particles such as LDL and HDL down to the smallest sub particle types using principles of physics.

Even though it’s extremely expensive and not widely available, this technology has helped to rewrite the rules on how we think about cholesterol and heart disease.

Rather than continuing to believe that LDL cholesterol is the bad cholesterol here, we now know that there are four types of LDL particles that factor into the risk of heart disease.

Some LDL particles are benign and others more dangerous. Thus it makes no sense to continue to base diet and drug recommendations on an outdated theory when the science regarding cholesterol particle types is far more precise now.

We could be using drugs that target the wrong particles, and making dietary recommendations that are doing more harm than good at this point, all while dramatically escalating health care costs and actually making treatment less effective!

Low Density Lipoproteins

LDL comes in four sizes:

  • Large (big fluffy particles)
  • Medium
  • Small
  • Very Small

As the LDL particle size decreases the particles become more dense, (and more dangerous). This is because the large fluffy particles can’t lodge in your artery walls as plaque, while smaller dense LDLs CAN!

High fat diets tend to increase the large fluffy LDL particles, while low-fat high carbohydrate diets increase the smaller more dense particles.

From this you can see why the standard medical advice about how we should eat to avoid heart disease is seriously flawed! It was all based on an oversimplified and outmoded concept of the nature of cholesterol particles.

Typical cholesterol tests can’t differentiate between large and small LDL particles. There are also genetic, environmental, and lifestyle factors that affect LDL particle size.

Enter “Ion Mobility Analysis”

Using ion mobility analysis, Dr. Krauss and his colleagues determined that there are some 11 different particles. This was done using a sample of 4,600 healthy men and women volunteers.

Eight percent of the test subjects went on to develop heart disease, and using statistical algorithms the researchers developed a series of three very accurate predictors for who would go on to develop heart disease.

Here are the correlations that Dr. Kraus’s team found:

    1. High levels of small and medium LDL particles with low HDL (called atherogenic lipoprotein phenotype) Also known as pattern B
    2. Low HDL levels
    3. High total LDL cholesterol

So as it turns out LDL cholesterol and the risk of heart disease is a complex relationship that standard cholesterol tests are almost useless to predict.

The PLAC Test

There is one test however that can give you a better idea of what your risk is. You can read about it in my article called “The PLAC Test.” This is the latest test that really utilizes our new knowledge of LDL to make more accurate predictions about what your real risk for heart disease is.

Using this test you can make better choices about lifestyle and diet, because they are based upon a more complete understanding of the science of cholesterol particles.

What are optimal cholesterol numbers? Doesn’t this contradict the latest theory that cholesterol does NOT cause heart disease. The truth is that it is a “factor” but not the “cause”!

cholesterol numbersHow do we establish what the optimal levels for LDL and HDL are? These are important questions because the idea that cholesterol specifically causes heart disease is so deeply ingrained in the average person (and most doctors as well).

This is a difficult question to answer definitively because the issue is just so complex. I can tell you what some of the guidelines are, and of course they vary from one source to another. There is a generally accepted “optimal range” for cholesterol numbers.

Here are the guidelines issued by the American Heart Association.


Desirable Borderline Risk High Risk
Total Cholesterol 200 or less 200-239 240 and over
HDL 60 or higher 40-59 40 or less (men)
HDL 60 or higher 50-59 50 or less (women)
LDL less than 100 130-159 160-189
Triglycerides less than 150 150-199 200-499






Keep in mind that these guidelines somewhat reflect the influence of the drug industry and their attempts to increase their market for cholesterol lowering drugs called “statins.”

The recommended cholesterol numbers keep being adjusted downward, in my opinion in order to get doctors to prescribe more statin drugs which of course boots revenues of the drug industry.

In addition, there are other tests which are called “inflammatory markers,” that have a direct bearing on your risk for developing heart disease, and these tests should also be used to more accurately determine what your overall risk of cardiovascular disease is.

Once you know your level of risk based on the latest tests and analysis of particle types, then you can target your lifestyle strategies (exercise, diet, and stress reduction) to protect your heart health. This should always be the end point of ANY testing…a program to address whatever risks the tests have identified.

What really DOES Causes Heart Disease?

Here’s a simplified explanation. Heart disease is caused by inflammation. That is what actually damages the lining of your arteries. As Dr. Stephen Sinatra likes to say “Cholesterol is found at the scene of the crime, but it’s not the perpetrator!”

When arteries are damaged, your body uses LDL to try and repair the damage, kind of like patching holes in a wall. Obviously the LDL did not cause the damage, but gets attached to the artery walls and accumulates eventually clogging the artery. This is called an “occlusion.”

When the LDL particles that stick to your arteries become oxidized and thus inflammatory, the process of arteriosclerosis begins. This is where the small highly inflammatory LDL particles called HP(a) come in.

So again, the cholesterol did not initiate the process of heart disease, but it IS an important factor in the progression of heart disease. With that out of the way, lets move on…

Focus on Particle Size and Type, Not Just Cholesterol Numbers

The real focus should be on the type and particle size NOT just the levels. According to Dr. Stephen Sinatra, an integrative cardiologist who is board certified by the American College of Cardiology, if your LDL particles are large and fluffy then you really don’t need to worry so much about your LDL levels.

However if the LDL’s are small dense highly inflammatory particles, then your risk is greatly elevated. There is a test that measures for these small inflammatory particles (HP(a)), called the Lipoprotein Particle Profile (LPP) test.

The LPP test measures the level of HP(a) which is a small dense LDL particle which is very toxic and inflammatory to the blood, potentially causing your blood to become “hyper-coagulated” which is another word for sticky and more likely to clot.

The takeaway message is that if you have this dangerous inflammatory LDL particle, then obviously the higher your total cholesterol numbers, the more of this dangerous particle you have, and the greater your risk. Simply stated, high levels matter when you have dangerous LDL particles in your blood.

So in closing, optimal cholesterol numbers are totally dependent on particle size and type. If your cholesterol particles are the small dense inflammatory type, then you need to make a greater effort to lower your levels.

If your LDL type is large and non-inflammatory, then your total levels are not something to be overly concerned about. You should take the time to consult with an integrative cardiologist to determine how best to manage your heart health.