For years, getting your cholesterol checked meant finding out whether your cholesterol numbers-total cholesterol...LDL "bad" cholesterol...and HDL "good" cholesterol - were in the "healthy range." But researchers have found that there is more to cholesterol than just numbers. Based on the latest research, it is the size of the cholesterol particles, not simply how much cholesterol we have, that is key to cardiovascular health. Here's what you need to know about cholesterol particle size…

New LDL Findings

LDL "bad" cholesterol is a low-density lipoprotein that has long been regarded as the more dangerous form of cholesterol (even though it is needed by the body for functions such as forming cell membranes). High levels of LDL are associated with greater risk for heart disease.

The reality is that LDL particle size is a greater concern than either total cholesterol or LDL levels. Some particles are small and dense-and dangerous because they easily can infiltrate artery walls, where they can create plaque buildup in the arteries, increasing the risk for stroke and heart attack. Having a predominance of small LDL particles puts you in the category of people with a B 'cholesterol pattern." (Think of the "B" as standing for bad.)

The other type of LDL particle-pattern Ais large and buoyant. The particles are so big that they can't work their way into blood vessel walls. Having pattern A think of the "A" as the star of the class) seems to protect against heart disease and stroke.

What this means: Two people with the same overall LDL level can have totally different risks for heart disease, depending on whether small or large LDL particles predominate. For example, in the recent past, having an LDL level of 130 milligrams per deciliter (mg/dl) to 160 mg/dl would point to a moderate risk for heart disease. However, if 75% of your LDL particles are small and dense, your risk for a heart attack is far greater than if 75% of your LDL particles are large and buoyant. The proportion of small to large LDL is what categorizes you as either pattern A or pattern B. You may inherit a propensity for small, dense LDL...or you may wind up with small particles if you are sedentary and/or overweight. But regardless of how you got them, you can change your particle size through diet and exercise-and with the help of supplements.

The new philosophy: Holistic doctors like me do not think in terms of "lowering" bad LDL cholesterol. Instead, the goal is to enlarge the particle size of our LDL cholesterol.

And what about "good" HDL levels? Having small, dense LDL often is linked with having low "good" HDL. There is some evidence that small HDL particles are dangerous, too, but there has not been as much research in this area as there has been in the area of LDL particle size.

Testing LDL

In my practice, I routinely order an LDL particle size test to get a clearer picture of a patient's risk for cardiovascular disease. This test is available through standard medical laboratories. It has different names but often is called a vertical auto profile (VAP). VAP is covered by most insurance and by Medicare. I have patients repeat testing three to four months after starting treatment in order to confirm that the treatment is working. I urge all of my readers to have this test done-it could save your life.

Lifestyle Choices

The good news is that just like taking steps to lower your total cholesterol, you can takes steps to enlarge your cholesterol particle size. The way to enlarge LDL particles is not that different from the way to reduce your total cholesterol. The key is to have your particle size tested and, if you have large LDL particles, to incorporate these natural therapies until you have a healthful proportion of large-to-small LDL particles.

Everyone, regardless of risk, can benefit from making the following lifestyle changes…

  • Get active. A study by researchers at Texas Women's University found that walking on a treadmill for one hour a day at a moderate rate resulted in increased LDL particle size. If you don't already participate in regular aerobic activity (biking, jogging, swimming, rowing several times a week, start by walking for 20 minutes a few times a week. Increase your distance and speed little by little.
  • Lose weight. Shedding a few pounds if you are overweight will boost your LDL cholesterol particle size. According to a study published in Public Health Nutrition, both the Dr. Atkins New Diet Revolution (low carbohydrate) and Weight Watchers Pure Points diet (healthy food choices) plans increased LDL particle size, but diets focused on just low-fat intake did not provide the same result. For most people, it is better to try a high-protein, low-carbohydrate diet. (If you already are at a healthful weight but have a type-B cholesterol pattern, then address other lifestyle issues, such as exercise.)
  • Load up on vegetables. Vegetables are loaded with antioxidants, plant sterols and soluble fiber-all of which can help enhance the ratio of small-to-large LDL particles.
  • Eat less sugar. Studies show that high consumption of fructose from sweetened drinks and desserts (but not from whole fruit) is associated with smaller (more risky) LDL particle size in adults and children. In addition, all sugars and refined starches (such as white bread, cereal, pasta and bagels) boost levels of insulin, a hormone that increases the activity of an enzyme (known as HMG-CoA) involved in the production of LDL cholesterol. Reduce consumption of sugars and "white" starches. Research shows that lowering your glucose and insulin levels is effective in improving the size of your LDL particles.


The following supplements should be taken by those who have LDL cholesterol pattern B and who need to do everything they can to enlarge their particle size…

  • Niacin. Also known as vitamin B-3, niacin has been proven effective in increasing LDL particle size. You can try 1,000 mg to 2,000 mg daily. Niacin may elevate liver enzymes-ask your doctor to monitor yours.
  • Fish oils. Omega-3 fish oils can reduce levels of triglycerides (a type of fat found in blood) and increase the size of LDL particles. I recommend that patients take 1,000 mg to 2,000 mg daily of combined EPA and DHA. Fish oil has a mild blood-thinning effect, so be sure to speak to a physician if you are on blood-thinning medication, such as warfarin.
  • Plant sterols and fiber. Plant sterols are available in small quantities in some foods, such as nuts, seeds, vegetables and vegetable oils. In one study, published in the British Journal of Nutrition, a combination of plant sterols, soluble fiber, soy protein and almonds worked especially well at reducing blood concentrations of small, dense LDL particles. Consider taking a plant sterol supplement (many are available at health-food stores) and a fiber supplement (such as psyllium, glucomannan or beta-glucan). Follow label directions.

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