Test to differentiate LDL-C big fluffy, medium, and small dense particles?

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Bongleur

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What are the names of the blood tests to differentiate LDL-C big fluffy, medium, and small dense particles?

I just requested a comprehensive blood test for that purpose, but of course the MD screwed it up and I guess I'll have to tell him specifically what tests I wanted.

Glucose 90, I don't know if that's an expected number on Keto.
My LDL is high as I expected on Keto (231) but my triglycerides are perfect (74, normal is up to 150). Cholesterol 74.

Did not do a VLDL test.
 
Is this included as part of a "lipids panel?"
 
Bongleur said:
What are the names of the blood tests to differentiate LDL-C big fluffy, medium, and small dense particles?

I just requested a comprehensive blood test for that purpose, but of course the MD screwed it up and I guess I'll have to tell him specifically what tests I wanted.

Glucose 90, I don't know if that's an expected number on Keto.
My LDL is high as I expected on Keto (231) but my triglycerides are perfect (74, normal is up to 150). Cholesterol 74.

Did not do a VLDL test.
Click to expand...


btw, when I went on Keto for about 3 months, my LDL dropped from 106 to 54, my Glucose varied between 72 and 100






https://labtestsonline.org/tests/ldl-particle-testing-ldl-p
Also Known As
NMR Particle Test
LDL Particle Number


Formal Name
Low-Density Lipoprotein Particles





https://www.lipid.org/sites/default/files/advanced-lipid-testing-tear-sheet_0.pdf
Advanced Lipid testing


https://www.everydayhealth.com/high...u-get-the-particle-test-for-high-cholesterol/

Particle Test
 
-- Yes part of a lipid panel but I don't have a copy of it yet, only some data over the phone. I THOUGHT this guy knew his lipid chemistry but apparently not. All he says is to try adding fruits & fiber before using a statin drug.

-- I need to know if a "high" value of LDL-C matters at all, if the ratio of LDL-C to LDL-P is "good."

-- what is the correct scientific name for small and dense and for large and fluffy particles? Or are the defined by a size range?

He used Quest, and they did not do LDL-P as part of the panel he ordered:

https://www.questdiagnostics.com/ho...dition/cardiovascular/advanced-lipid-testing/

What I wanted was what LapCorp does:
Understanding the NMR LipoProfile® Test Report
https://www.labcorp.com/tests/related-documents/L15035

So I need to see if LEF.org still has that "on sale."

What I THINK I need are the quantitative details of how to interpret the ratio of LDL-C vs LDL-P (Discordance) - what are the numeric ratios ? :

https://www.docsopinion.com/difference-between-ldl-c-ldl-p/

Also, the C and P stand for what words? Cholesterol and Particles, I think.

Also, I would bet that the LDL-C was calculated (probably using the Friedwald Equation; there is another one whose name I don't recall).

I need to know if that gives inaccurate results with a Keto diet - if so you should measure directly.

I'm having a hard time finding information that specifically tells me the differences in interpreting lipid chemistry for a keto diet.

*****

https://www.docsopinion.com/difference-between-ldl-c-ldl-p/
>
Some studies have suggested that the size of LDL-particles may be of importance. People whose LDL particles are predominantly small and dense, have a threefold greater risk of coronary heart disease.

Furthermore, the large and fluffy type of LDL may actually be protective.

However, it is possible that the association between small LDL and heart disease reflects an increased number of LDL particles in patients with small LDL. Therefore, the LDL particle count could be more important in terms of risk than particle size in itself.

ApoB and LDL-P both reflect the number of atherogenic lipoprotein particles. Measurements of ApoB and LDL-P are better predictors of cardiovascular disease risk than LDL-C.
...

In clinical terms, LDL-P does not add much to ApoB.

LDL-P measures the number of LDL-particles while ApoB measures the number of all atherogenic particles (chylomicrons, VLDL,IDL,LDL and Lp(a)).

Usually 85-90% of ApoB represent LDL-particles. <=BUT IS THIS TRUE FOR A KETO DIET :confused:

Therefore, in most cases you don´t need ApoB if you have LDL-P available and vice versa.
>
 
A standard lipids panel doesn't show you which type of ldl you have. There are advanced tests like the vertical auto profile test (VAP) that give you a lot more information. But you have to find someone who can read, interpret, and explain it. Many doctors can't.
 
Here you go.

https://requestatest.com/nmr-lipoprofile-testing

Thanks to Braumeister for this link, which I use regularly to order my own blood tests. You can choose a LabCorp near you for the test. I have a regular lipid profile done and typically the results are available on-line in 24 hours. No BS, no surprise fees. You can then send a copy to your doctor.

I see Time2 provided a link to a similar business.
 
And maybe it’s time to seek out a different doctor. One that can help you on your keto journey.
 
Bongleur said:
What are the names of the blood tests to differentiate LDL-C big fluffy, medium, and small dense particles?

I just requested a comprehensive blood test for that purpose, but of course the MD screwed it up and I guess I'll have to tell him specifically what tests I wanted.

Glucose 90, I don't know if that's an expected number on Keto.
My LDL is high as I expected on Keto (231) but my triglycerides are perfect (74, normal is up to 150). Cholesterol 74.

Did not do a VLDL test.
Click to expand...

My wife is a Medical Technologist, and has been laboratory manager at huge hospitals.

She never heard of big fluffy, medium & small dense particles.

HDL is probably the test you're looking for. She said with the numbers on your LDL, triglycerides and cholesterol the chances of having a problem with the HDL are slim.

You should be in good shape to enjoy your life.
 
Bamaman said:
My wife is a Medical Technologist, and has been laboratory manager at huge hospitals.

She never heard of big fluffy, medium & small dense particles.

HDL is probably the test you're looking for. She said with the numbers on your LDL, triglycerides and cholesterol the chances of having a problem with the HDL are slim.

You should be in good shape to enjoy your life.
Click to expand...

No, there are different types of LDL particles, and there are specific (non traditional) tests for them. HDL is a different animal completely. There's a lot of new science regarding cholesterol and it's likely impact on heart disease, and most medical professionals just don't know about it.

I don't mean any insult to your wife, she's just part of the large majority of medical that isn't aware of the newer science. Most med professionals pretty much follow a script for dealing with cholesterol, blood sugar, etc. But if a person is interested there are lots of sources for learning about cholesterol, the real (not historic) impact on health, and whether you should be concerned about it or not.

In my case, I asked for the VAP test to find out more about my heart health and cholesterol. I paid for it out of pocket (not too expensive, maybe $200), but when I got the results I couldn't interpret them very well. So I asked my doctor, and she couldn't either. She said a few things, but I could tell she was guessing. If you want to get a better understanding of your heart/artery health, you need to find a doctor that is up on the subject and is willing to work with you. I haven't been to a doctor in a couple of years now, but when I go back I think I'll be looking for someone new that understand cholesterol, LCHF, keto, etc. I'll be more comfortable with someone like that. If I can find them.
 
Bamaman said:
My wife is a Medical Technologist, and has been laboratory manager at huge hospitals.

She never heard of big fluffy, medium & small dense particles.

HDL is probably the test you're looking for. She said with the numbers on your LDL, triglycerides and cholesterol the chances of having a problem with the HDL are slim.

You should be in good shape to enjoy your life.
Click to expand...

It is indeed the large LDL versus small LDL particles. The large LDL particles are harmless. The small LDL particles are the ones that can get buried in blood vessel walls/contribute to atherosclerosis.

There are a couple of tests: Apo B gives a measure of large versus small as particle count- higher particle counts mean more small LDL, and the NMR lipid test gives an A “large fluffy” pattern versus B “small dense” pattern indication.

My doctor doesn’t think either is particularly reliable these days - the labs haven’t figured out how to do them properly.
https://www.marksdailyapple.com/how-to-interpret-advanced-cholesterol-test-results/
https://www.sciencemag.org/news/2017/12/it-time-retire-cholesterol-tests

And then interpretation of those test results can be challenging.

The ratio of triglycerides over HDL gives an indication of large versus small LDL particle ratio as well as overall cardiovascular risk. The lower the number the more large LDL particles you probably have. Under 2 is acceptable, under 1.5 great. Above 2 not so healthy.
https://www.thebloodcode.com/know-your-tghdl-ratio-triglyceride-hdl-cholesterol/
https://www.cooperinstitute.org/201...-coronary-heart-disease-mortality-risk-in-men
 
Last edited:
audreyh1 said:
The ratio of triglycerides over LDL gives an indication of large versus small LDL particle ratio as well as overall cardiovascular risk. The lower the number the more large LDL particles you probably have. Under 2 is acceptable, under 1.5 great. Above 2 not so healthy.
Click to expand...

Did you mean to say "ratio of triglycerides over HDL"?
 
harley said:
No, there are different types of LDL particles, and there are specific (non traditional) tests for them.
In my case, I asked for the VAP test to find out more about my heart health and cholesterol. I paid for it out of pocket (not too expensive, maybe $200), but when I got the results I couldn't interpret them very well.
Click to expand...


I wonder if the testing company could lead you to someone that could interpret results.
 
Time2 said:
I wonder if the testing company could lead you to someone that could interpret results.
Click to expand...

No, this was Quest labs. They can barely get the needle in the right appendage. They just draw the blood and send it out for non-normal tests. I should have done more research up front. But I thought since I could read a normal lipid test result I'd be able to figure this one out. Wrong!

Once I get a new doctor I'll probably get retested and see what I can find out.
 
Time2 said:
I wonder if the testing company could lead you to someone that could interpret results.
Click to expand...

I’ve noticed that LabCorp publishes extensive pamphlets on how to interpret some of these tests.

Nevertheless is seems doctors and researchers are encountering “wildly disparate results” with these more advanced cholesterol tests according to this article, which is why my doc doesn’t use them at the moment. https://www.marksdailyapple.com/how-to-interpret-advanced-cholesterol-test-results/
 
Got the hardcopy of the test.
The MD is my hormone replacement therapy endocrinologist. But he admits he's not a lipid specialist.

In my state, Big Brother will not allow me to control my own health care. I need a scrip for a blood test. Unless I get it done out of state.

What bugs me is that my standard lipid panels for many years are all OK.
It only happened since this Keto diet. So the particle size & density need to be the determining factors, right?

NON HDL CHOLESTEROL 249, ref <130 mg/dL (calc)
Surely if I had familial hypercholesterolemia it would have been noted decades ago.

CHOL / LDL-C >6.0 , reference < 5.0

So this is a normal level for an insulin & sugar metabolism, but I'd guess it to be lower when on Keto.
GLUCOSE 99, ref 65-99 mg/dL

Is A1C more of a go/no go line, or is lower demonstrably better?
HEMOGLOBIN A1c 4.8 ref <5.7 % of total Hgb Z99
For the purpose of screening for the presence of
diabetes: <5.7% Consistent with the absence of diabetes

My kidneys are fine:
UREA NITROGEN (BUN) 13 ref 7-25 mg/dL
CREATININE 0.96 ref 0.70-1.25 mg/dL

No inflammation:
C-REACTIVE PROTEIN 0.7 ref <8.0 mg/L Z99
CORTISOL, TOTAL 10.3 mcg/dL Z99
Reference Range: For 8 a.m.(7-9 a.m.) Specimen: 4.0-22.0
Reference Range: For 4 p.m.(3-5 p.m.) Specimen: 3.0-17.0
The time of day reference is STUPID - they didn't ask if I was a shift worker who just woke up in the afternoon, etc.
 
State by state limitations on direct access testing - another example of how egregiously broken and low quality the U.S. health system has become.
 
Last edited:
harley said:
No, this was Quest labs. They can barely get the needle in the right appendage. They just draw the blood and send it out for non-normal tests. I should have done more research up front. But I thought since I could read a normal lipid test result I'd be able to figure this one out. Wrong!

Once I get a new doctor I'll probably get retested and see what I can find out.
Click to expand...


Yes, as I said the testing company, they are doing the tests, they may know someone that could interpret the results or their tests.
The Phlebotomist would do no interpretation. Unless they want to tell you you have rollie veins. Of course how much your veins roll, if at all, depends on the Phlebotomist :)
 
I have had good experiences with Quest. The phlebotomist got the job done quickly and properly. I received follow up phone calls asking if I wanted to discuss my results with a physician. I have no objections to Quest's services.
 
I think what you're looking for is Apo A1 and Apo B. I had this done years ago as part of a research study. The description that came with my study results said:

Apo A1 is a major apoprotein attached to HDL and triglyceride-rich lipoproteins, Lower levels of apo A1 have been reported in subjects with cardiovascular disease.

Apo B is the major apoprotein associated with LDL. Higher levels of plasma apo B may signify increased coronary disease risk even when LDL-cholesterol is not in the high-risk range.

Here's a Mayo Clinic link to the expected ranges:

https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/607593

"...Elevated apolipoprotein B (ApoB) confers increased risk of atherosclerotic cardiovascular disease, even in a context of acceptable LDL cholesterol concentrations..."

"...Reduced apolipoprotein A1 (ApoA1) confers an increased risk of coronary artery disease..."

"...Elevated ApoB:ApoA1 ratio confers increased risk of atherosclerotic cardiovascular disease, independently of LDL and HDL cholesterol concentrations..."
 
Last edited:
I used to get the VAP advanced lipid panel, but I think they went out of business.

Here's somebody's report (not mine) to give you an idea:

Atherotec_2009_VAP_sample1.png

Atherotec_2009_VAP_sample2.png

Atherotec_2009_VAP_sample3.png
 
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