i follow answers

best regards

I am an expert of that field.

But from my personal experience, I found that with the change of food alone, a drastic change in the LDL and total Cholesterol level found. I think along with the change of lifestyle towards physical exercise, less tension, timely eating and sleeping, regular eating of citrus food, leafy vegetables and high fibre carbs etc. , that effect will be more.

Nature of diet (red/ white meat, animal fat, trans fat etc.) may have some strong effect on size of LDL (As the fuel have effect on fire).

Experts on the field of Cholesterol bio-synthesis may answer it clearly.

Thanks.

There is a well document that LDL-C is involved in atherosclerosis. Well the question here is the size of particle related to atherosclerosis or CVD? Let us review our knowledge when we compare the sizes of the three classes of particles HDL-C , LDL-C and VLDL-C. which is the bigger and and which is smaller? the VLDL-C is the biggest size then LDL-C finally HDL-C the smallest. OK so this means that VLDL-C is accused more than LDL-C in atherosclerosis but the reality is not!! why because the composition of VLDL-C in terms of fatty acids is different than LDL. To get to the point the size play a role but the composition of each particle is more important. By the way VLDL contain more monounsaturated fatty acids than LDL. please look at my work in this area and my justification about the issue of VLDL.

All the best

Aly

Small, dense LDL is associated with the Metabolic syndrome and Diabetes

It is associated with a particular lipid profile: elevated triglycerides and reduced HDL

We should be testing more routinely for it, but it can be costly. How accessible is the test to you?

Regards

Following

Today I read my previous post. Sorry, I wanted to write 'not an expert', but posted otherwise.

I may not be blamed for it. The power of my spec and my age may be blamed!

Thanks.

Thank you for the discussion.

Perhaps we need to look at the patho-physiology of the small, dense LDL

How does it arise and how can we reverse it?

I have my 'pet theory' about this, but will wait for colleagues views, before sharing it...

Thanks Dr. Aley R for sharing important information with us.

I think this topic has really sensitized some and made aware of something new emerging up. While i guess everybody had shard something really nice on the subject.

I feel especially obliged Fazleh Mahomed Aly R Abdel-Moemin Shibabrata Pattanayak

Well the discussion i guess was great. Below i am sharing some of the pictorial stuff which may substantiate my point of view will encourage you all share their most valuable perspectives and knowledge on the subject.

A person with same level of LDL concentration but smaller sized particles are at risk for CVD

Smaller LDL particles can penetrate blood vessels easily

Smaller LDL particles in an individual predispose him to multiple risks as shared below:

I imagine that as we change our daily lifestyle by exercising and eating the right food regularly and also by exercising our work with less stress. All these things will be very useful on this subject.

So. My pet theory: total speculation, of course:

'With insulin resistance, the uptake of LDL from the circulation is reduced and thus the LDL spends a longer time in circulation. As such, the endovascularly active lipoprotein lipase has more time to remove the hydrophobic core of LDL, making it smaller and denser. so- a double whammy- small, dense LDL and longer time of exposure to the vasculature- explains the diffuse nature of atherosclerosis in Diabetes. And to solve it- tackle the insulin resistance with exercise and diet, as mentioned above'

Please feel free to debate this. I love debate.

Dear Fazleh Mahomed

That's really interesting and technical.

I will comment more on that

regards

Please call me Faz

My clinical experience shows that usually, the complete removal of a patient’s dietary sugar, refined carbohydrates and alcohol will lower the triglyceride/HDL ratio to below 0.8 and the ApoB/ApoA ratio to less that 0.6 which is desireable. This is accompanied by the complete disappearance of the atherogenic LDLs 3,4,5,6 and 7 (see red area of graph) leaving only the less atherogenic LDL 1 and 2 using the LDL subfractionation test.

This also involves moderate exercise, meditation, eating whole seasonal foods, high in vegetables, fruit, legumes, whole grains, fibre, cold water fish, chicken, eggs and using only cold pressed olive oil.

LDL SUBFRACTIONATION TEST

Dear Robert

That's a very comprehensive share. It proves the point that there are few LDL fractions like LDL3 to LDL7 to be more atherogenic especially the ones with less size. So broadly there is a definite existence of small dense LDL particles and yes they can be addressed with treatment and lifestyle

Questions:

1- Do you measure sdLDL in your lab ?

2-What about NMR spectroscopy for its measurements?

Regards

The labs I use to get lipoprotein subfractionation tests (including sdLDL) in Australia are:

San Pathology, Sydney Adventist Hospital

https://www.sah.org.au/diagnostic-services and

NutriPATH Integrative and Functional Pathology Services https://www.nutripath.com.au

Lipoprotein subfractionation Analysis can be carried out using Gel Electophoresis, Density-Gradient Ultracentrifugation, NMR Spectroscopy and Ion Mobility Analysis see:

https://www.aacc.org/publications/cln/articles/2017/january/lipoprotein-subfractionation-analysis.

NMR Spectroscopy is a good method.

Dear Robert

Thanks a lot. How do you see "ion mobility analysis" in comparison to "NMR Spectroscopy" especially in terms of cost & feasibility.

If you work in a specialized lipid clinic do yo run any short courses on the latter?

Or can suggest some who actually do?

Thanks a lot for a very elaborate discussion

Regards

I do not work in a specialized lipid clinic which is why I outsource all my blood samples for testing. You would really need to talk to someone who specializes in and performs these analyses when regarding the comparison between tests and also availability of courses.

Regards

Robert

Robert Buist

' My clinical experience shows that usually, the complete removal of a patient’s dietary sugar, refined carbohydrates and alcohol'

How do you recommend we move the world's diet away from this?

It seems so difficult to do

Thanks@Robert & Faz

We really need to appreciate new data emerging.Yes,diet as suggested may help but in practice i have found only very very very few people sticking to the diet mentioned by Faz.

Rest VLFA(Very Low Fatty Acid) diets helps especially in people with raised cholesterol along with reduction saturated fatty acids

I had seen patients getting completely frustrated sometime.

Anyway more comments needed from experts on this subjects

regards

Following

very interesting, following