The Full LDL Story – High Cholesterol and Heart Disease

[DISCLAIMER: I’m not a doctor, nor do I play one on the Internet. Speak with a medical professional before doing anything medical-related] [8]

The #1 Killer

Heart Disease is the number 1 Killer in North America, even beating out all types of cancer combined! [1] That is an insane statistic, making it well worth writing a post to break down some of the confusion surrounding the biggest risk indicator of this disease.

Medical diagnosis errors sometimes happen. I think everyone has a story of a friend or someone in their family having to ask for an additional test or second opinion to get to the bottom of their particular illness. Even though you would think a standardized diagnosing procedure would be in place for the number 1 disease that plagues us, it isn’t, and has these same types of problems. I am writing this post to shed some light on a concept on the forefront of diagnosing risk that might not have reached your doctor as of yet. I myself have encountered just this, as well as one other member of my family, from 2 different doctors in my area.

The LDL-C Risk Factor

LDL-C is widely known as the biggest predictor for Heart Disease in the medical community to date (Early 2016).  Chances are your doctor will rely mostly on this 1 of 5 markers of Metabolic Syndrome to determine your risk of Heart Disease. That being said, there is a shift in thinking on the forefront of this field that makes LDL-C on its own seem like a poor indicator of risk. It turns out that the number of LDL particles and possibly the size of those particles are the best indicator of added risk of Heart Disease. This means that someone with low LDL-C could have high Heart Disease risk and someone with high LDL-C could have low risk, depending on the number of LDL particles. [3]

“You can not treat this condition of so called high cholesterol without knowing what is the particle size is. To put patients on statins without knowing what their particle size is, is malpractice in my opinion.” – Professor Tim Noakes

“…and therefore much better predicted by the number of lipoprotein particles (LDL-P) than by the cholesterol they carry (LDL-C) “ – Dr Peter Attia [2]

Why is this?

For the detailed step by step on how Heart Disease forms in your arteries please see Dr Peter Attia’s article in the references. [2]  I will also give you a short explanation in this section for those without a technical or extensive background in cholesterol as it relates to heart disease.

Atherosclerosis (CVD) or Heart Disease is an artery narrowing disease that reaches it’s peak when their is a blockage. The narrowing of the arteries is caused by LDL-C particles getting caught in the lining of your artery walls, which in turn causes inflammation.

LDL particles stuck in lining of an artery.

It is known that LDL-C particle counts (LDL-P) play a major role in determining Heart Disease Risk factors through studies done. [4][5][6] The exact mechanism or way it is influencing risk is not known but their are two prevailing theories:

  1. Since LDL particles are what get stuck in the lining of our arteries, some believe a sheer increase in number will increase the amount that will get stuck in the lining to cause inflammation.
  2. LDL-C is a volume measurement, so if your LDL-C is high, but your particle count is low, this would mean the particles are large and less likely to get through the lining of the arteries.

They are not mutually exclusive theories and I believe it is likely a combination of both.

Why Should We Know This?

This is a very important thing to know for your own personal health because your doctor might not know this. Wait, what?… Yes, It really does depend how long ago your particular doctor went through their schooling for diagnosing Heart Disease and if they are staying up on the forefront of this field. Do I think this makes any particular doctor bad at what they do for not knowing this? Absolutely not, don’t be silly! Every doctor I know has an amount of information crammed in their brain that I can’t even imagine being able to retain. The vast amount of information out there is also the reason there are specialists in almost all fields.

As mentioned in the beginning of this post, myself and another member of my family have both been diagnosed with risk based on Total Cholesterol and LDL-C alone. That being said, the best thing is to know when to ask additional questions. Doctors are brave individuals taking on great risk and responsibility by claiming to be experts in something that is almost impossible to retain an expert perfect working knowledge of. They should have our respect for taking on such a difficult role in society and you should be polite and respectful when questioning their diagnoses. At the same time you should not feel like you can’t question their authority. After all, our doctors are human and to expect them to be perfect is unrealistic and also careless.

If I Lower LDL-P Then What?

Even if you lower your LDL-P you are just lowering your future risk and the rate of accumulation. There is little to no evidence that lowering the number of particles will help you with your existing risk. Without LDL-C there can’t be life, but it is not necessary and unhealthy to have high numbers of LDL particles. Risk is cumulative and intervention will often reduce future risk or slow progression but will not help with current accumulation in your arteries. I still think it’s worth the dietary intervention to make the most of this one life we have.


Tips & Takeaways:

  • Stay away from fructose as much as possible as it has to be processed in the liver and much more likely to create LDL-C and Triglycerides.  [6]
  • In line with the previous point, vegetables can give the benefits of your fruits minus the sugars. More about questioning fruit as a health food HERE.
  • Low carb, high fat, ketogenic or modified ketogenic diets have been known to move cholesterol markers in desired directions to lower risk. [7]
  • Don’t assume because you are not fat, you don’t have risk, as it might be the opposite. The Lean Gene and Metabolic Disease Risk[10].


Click for References:



Note: If you read something in this article that you whole heartily disagree with based on scientific empirical evidence, please share it with me here. I’m always interested in appending and updating my information to be as accurate as possible for my readers.

Also contact me if there is anything you would like me to expand on or write about as it applies to your personal situations.



  1. frz

    Based on her own history of misdiagnosis, one of her concerns is that people might know they have high cholesterol, but not realize they have FH. As a result, they may be given only a statin rather than the combination therapy that usually works better for people with FH. And without an official FH diagnosis, people might not know to encourage their immediate family members to be screened and treated for high cholesterol.

    1. Chris MacSweyn (Post author)

      For those unaware of what HF is….

      “Familial hypercholesterolemia is a genetic disorder. It is caused by a defect on chromosome 19. The defect makes the body unable to remove low density lipoprotein (LDL, or bad) cholesterol from the blood. This results in a high level of LDL in the blood.”

      Definitely a genetic abnormality to take into account as a possibility if having cholesterol issues.


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