Category: Science

LDL is Your Friend

LDL or low density lipoprotein has been given a bad rap. Ever since someone decided to call it “bad cholesterol” it has been demonized as being responsible for just about everything bad in the world. Medical doctors and cardiologists in specific have joined the crusade against LDL with a pervasive mentality that somehow the lower the blood value of LDL, the better. Fortunately, the justification for this altruism is unjustified.

So let’s take a step back for a moment and review just exactly what LDL is and does, and then I’ll move on and explain why the notion of it being something to fear is ill founded.

LDL is what we call a carrier protein, and one of its important jobs is to carry a fundamentally important chemical to every cell in the body. This chemical is a critical component of cell membranes, serves as a brain antioxidant, and is the raw material from which your body manufactures vitamin D, cortisol, estrogen, progesterone, and testosterone. And this important, life-sustaining chemical is cholesterol.

So the notion that LDL is “bad cholesterol” is flawed on two counts. First, it is, in and of itself, not cholesterol, it is a protein. Second, now that you’ve embraced all of its functions in human physiology, it’s clear that LDL is anything but bad. How could we castigate a part of our biochemistry so fundamental for life?

LDL plays a particularly important role in brain health and function as you would expect based on the information above. In fact, you might expect that low levels of LDL might well be associated with compromise of brain tissue, and you would be right.

Earlier this month, researchers publishing in the prestigious journal, Neurology, designed a study to explore possible correlations between various markers of blood fats and risk for specific changes on MRI scans of the brain in 2,608 adults. The MRI changes in the brain they explored were changes associated with damage to small blood vessels, and, changes in the brain’s white matter associated with small strokes as these changes represent “powerful predictors of stroke and dementia.”

The researchers concluded that there was a strong correlation between these threatening brain changes and the blood measurement of triglycerides. While the reverse was true as it related to LDL. Meaning that higher levels of LDL were associated with less risk of the brain changes that are so worrisome.

The authors concluded:

Increasing low-density lipoprotein cholesterol tended to be associated with a decreased frequency and severity of all MRI markers of cerebral small vessel disease in both studies. Increasing triglycerides but not other lipid fractions were associated with MRI markers of cerebral small vessel disease in older community persons.

This is really important information first because triglycerides, which you will generally see as one of the results on your typical blood work, is strongly associated with detrimental changes in the brain. What’s more, triglycerides reflect blood sugar and as such, reflect the amount of sugar and carbohydrates in the diet, not the amount of fat a person consumes. Second, this study is one of many that should clearly reframe our view of LDL as higher levels appear to be strongly brain protective.

So here’s what I would like you to do. If you are being told by your doctor that your LDL is too high and that the lower it is, the better, please print this study and ask why you would want a lower level of a blood marker that may well be protecting you from stroke and dementia.

LDL is our friend and is here to help us.

  • KCJerry

    So is any number of LDL good or bad or just indifferent?

    • kanor74

      It is the quantity and size of the particles that is important.

    • David Perlmutter

      What seems most important is the measurement of oxidized LDL, in relation to cardiovascular risk and this is something many cardiologists are now measuring.

      • KCJerry

        Since dropping wheat my HDL has gone from 58 to 90. Below are my NMR readings since going grain free 4 years ago.

      • KCJerry

        Wheat Free and Statin Free LDL-P is now 691 LDL-C 84 per latest NMR. LDL Size is 21. Stopped eating wheat 4 years ago. Kicked my Statin 15 months ago!

    • KCJerry

      On Statin and On Wheat HDL 54 LDL 66 Triglyceride 64. 4 years of wheat free; Now NO Statin and NO Wheat HDL 90 LDL 73 Triglyceride 58.

  • CommonSense

    Very interesting, thank you! I knew that those on a ketogenic diet could see their LDL increase, but the particle density would be large and fluffy compared to small and dense, large and fluffy being good. I am considering getting the particle test to prove it.

    Since adopting a keto lifestyle about 14 months ago, I’ve been an experiment of one, largely to prove to my Dr Ornish-following parents that I’m not going to keel over from a heart attack or stroke from all the fat. I have lost 60 lbs so far with another 15 – 20 to go.

    My first blood test was about 2 months after my diet change and I’ve been doing them at 6 month intervals since, so I’ve had 3. I wish I had done a baseline before I started, but it was a spontaneous thing so I didn’t plan for it and had no idea I would have such spectacular results.

    The first one showed a significant drop in total cholesterol, triglycerides, and LDL with a corresponding increase in HDL. The second one showed a further drop in the first 3 and higher again HDL. The 3rd test, about 3 weeks ago, show a big jump in total cholesterol and LDL but a further drop in triglycerides and a big jump in HDL. My chol/HDL ratio continues to improve as well.

    The numbers:
    Total Cholesterol: 202 –> 193 –> 263
    LDL: 121 –> 108 –> 145
    HDL: 64 –> 71 –> 105
    Triglycerides: 84 –> 69 –> 63
    Chol/HDL Ratio: 3.2 –> 2.7 –> 2.5

    All of my other numbers are also excellent. I do take a large variety of supplements based on reading Dr. McCleary’s The Brain Trust Program book which I found while researching perimenopause sleep issues (my sleep issues were actually from eating to close to bedtime)

    I am in the best health of my life with this lifestyle. At 52, I’m more active than ever, feel good, and have lost the perimenopause brain fog I was suffering from. My husband also reports increased energy and clearer thinking. Neither of us are on any medications or have any health issues, unlike so many our age. I’m convinced that this lifestyle will keep us healthy, active and sharp for decades more as we hopefully avoid, obesity, diabetes, cancer, Alzheimer’s, and autoimmune disease.

    • kanor74

      Your latest Trigs/HDL ratio is 0.6 which is phenomenal…and indicates those LDL particles are huge and fluffy! Congrats!!

      • Amba

        My ratio is 0.44.
        Can you explain how this implies the huge and fluffy LDL particles? Thanks so much

      • CommonSense

        Thanks! After some reading, I did start tracking the other ratios as well. I find it interesting that it took about a year of keto to affect LDL.

    • David Perlmutter

      You’re an incredible success story. Thanks for sharing the story of your good health with others!

      • CommonSense

        Thanks! And thank you for continuing to share such interesting info, I find the biochemistry of it all fascinating.

        • @ Lee and Common Sense, you guys are awesome ! Keep sharing your success with anyone who will listen !!!

    • Lee Penrod

      Good for you Common Sense!!! I’ve had the same results/success. 84 lbs down eating whenever I’m hungry with 15 or so lbs left to go. I started my change on 3/2/14. I’m 60 years young and now realize how sick I really was. I have the energy of an energizer bunny and it’s hard for me to sit still. And I love it!
      I went to my primary November 2013 and he wanted to start me on diabetic medications. I said, “Give me one year.” and with reluctance he did. He about did flips when he saw me a few weeks ago and asked how I did it. I told him I removed processed foods, gluten and sugar from my diet. He was stunned. So many of us are noncompliant after all.
      My A1C was 6.1 last year. This year 5.8. My cholesterol ration is 2.5 and that from eating all the fats I want. People don’t recognize me and walk right by me. I KNEW that saving my brain would also save many more aspects of my health. I’m remembering things I was unable to do a year ago. My job calls for a lot of that and it’s amazing how I used to have to repeat numerous times in order to store it in my brain and now several times and it’s there.
      I’m just north of you Dr. Perlmutter in the Fort Myers area and want to come your way to give you a HUGE HUG! Thank you! Thank you! Thank you for going against mainstream medicine and saving the quality of my life.

      • Irina Godunko

        Of cause he was stunned. Out of 4 (!) years of med school he studied nutrition 1 (!) hour!!!! And my guess he wouldn’t apply your way to his other patients….

    • Joe Texan

      I have a similar story, but I’m 64 and have never felt this healthy in 40 years. I just had a blood test and the only thing that was not perfect was my LDL, which was “above normal limits” according to 20th century medical science. It’s all because I read Dr. Perlmutter’s book. I have read a lot of other books now and I just finished a must read “Excitotoxins – The Taste That Kills” by the neurosurgeon Russell Blaylock, M.D. I’m a neuropsychologist and I now tell my patients to not eat anything sold in a box, bottle, can, or parkage by a food processing company. They are poisoning to death the American people for profit and they know it. Dr. Blaylock said it has been established scientific fact for 30 years that excitotoxins that enhance food taste are poison, but the FDA has made it easier for food processing companies to disguise these poisons. These are terms now used for glutamate.
      Monosodium Glutamate
      Hydrolyzed Vegetable Protein
      Hydrolyzed Protein
      Hydrolyzed Plant Protein
      Plant Protein Extract
      Sodium Caseinate
      Calcium Casinate
      Yeast Extract
      Textured Protein
      Autolyzed Yeast
      Hydrolyzed Oat Flour
      These are addictives that frequently contain MSG
      Malt Extract
      Malt Flavoring
      Natual Flavoring
      Natural Beef or Chicken Flavoring
      Processed food is designed by Ph.D. chemical engineers to be cheap, delicious, and have a long shelf life, with no regard for the health of the consumer.

      • Joe Texan… TWO THUMBS UP !!!

  • Colby Kulyn

    This reminds me of a quote in your book which was something around the lines of “why would a diet that is specifically helpful/healthful for one organ (heart) be so detrimental to another (brain)”. Obviously a big part of this LDL craze was due to an observation: LDL particles are present in atherosclerotic plaque, so we should try to reduce blood levels of such to prevent this process. As we all know, correlation does not equal causation. Inflammation is the true enemy here!

    I like the part “How could we castigate a part of our biochemistry so fundamental for life?” Well said. Thank you Dr. Perlmutter to posting this!

    • David Perlmutter

      Glad you find this valuable! Yes, that’s a quote I particularly enjoy as well.

  • allessio77

    I have high LDL-C (176) and LDL-P is 2700, too much of that is small particle (>20.5%). I eat grain free and low carb. Should I worry or not worry? Tri-HDC is 1.2. This is so confusing.

  • Neesee

    After 14 months of low carb lifestyle my cholesterol is below 300. My ldl is now 178

  • Chris Wark

    I think you mean bad rap… A bad wrap is an unappetizing sandwich made of fillings wrapped in a tortilla. A bad rap—otherwise known as a bum rap—is dishonor resulting from false accusations.

    Plant-based diet. My total cholesterol is 116. LDL 45. HDL 60.
    Triglycerides 57. C-Reactive Protein 0.12
    8-10 servings of fruit per day. Organic beans and grains every day!

    • David Perlmutter

      Chris, you got that one right. However, if there was ever a slip-up to make, that’s an appropriate one for me I think.

      • Tanene Kurtenbach

        I appreciate your sense of humor! ( ^ : ^). I participate in several LinkedIn groups; find that I am so focused on responding in concise manner to focus question that I hit the ‘send’ button and then discover an error. Let’s label it human.
        My cholesterol is 184 and Kaiser wants to give me meds. I’m saying NO….just how to defend my intuitive sense?

    • CommonSense
      • Bio-Hacker

        Though her article may be giving correct references, I personally, would not trust an article with medical information that does not actually link to the specific studies she references; especially from someone with an English degree. Not that there’s anything wrong with having an English degree. 🙂

        • CommonSense

          That’s just the first reference I found, there are many more. As Dr Perlmutter has stated, as have many other references, cholesterol and it’s accompanies substances are crucial for a healthy brain and body. An extremely low total cholesterol and tons of fructose from fruit, are not healthy.

    • You’re not paying attention ,Chris…

    • Tiffany Shalom

      Hi Chris, I just found you on the web and think it is great that you are encouraging people to go the healthy route to get cancer free 🙂 God is good, I was looking into all this stuff just because I was told I need my gallbladder out and started googling things and fear is trying to tell me I have cancer…but I need to calm down and just relax and continue to eat correctly……I would like to avoid gallbladder removal surgery though , what do you know about Gallbladders?

  • Becky Carney

    Wow–my head is spinning. . . I’m a 44 yr-old, fit (5’7″, 130lbs, 21%BF) woman who has been hyper-vigilant about my LDL and particle number b/c the women in my family die before age 60. I was put on a statin after it was discovered that my particle # was over 1600. The statin got it down to 600-800 for several years. Now it’s inching up and I’m at 1200 on a statin. My doc suggested increasing the statin or trying a ketogenic diet. I was already quite low carb/paleo, but gave it at try.

    2-months on strict keto (I did blood ketone monitoring and was religious about my intake and tracking–I know I was doing it “right”)–left my cholesterol #s through the roof. LDL went from 55 to 127, Total chol from 137 to 214, particle # from 1200 to 1840. My HDL and triglycerides stayed the same (43 and 89, respectively).

    But then I read your post here and don’t know what to think?

    Do I have to pick between heart and brain health? You mention getting a measure of oxidized LDL. How do I do that??

  • Rocio Sparrow

    What about people with familial hypercholesterolemia? Any suggestions?

  • larry

    my understanding is that LDL-p ( the # of LDL particles) is thought to be of cardiovascular concern not traditional LDL-c (cholesterol).See Dr. Attia’s website for a good explanation http://www.eatingacademy.com

  • Sonie

    I went to the Doctor today. She showed me by results for a NMR LipoProfile test. LDL-P 1355 LDL calculated 136 HDL 114 Triglycerides 84 Cholestrol 267. What would make my number so good, yet so bad, in her eyes

  • Undecider

    This whole thing about cholesterol is a myth. A myth fabricated by the profiteers of the phony health care system. This scam was designed to get the individual to voluntarily lower one of the most essential substances in the body. Cholesterol is needed and used from head to toe, front to back, inside and out.

    If a deficiency can be manufactured with by willingly lowering it through diet and then pharmaceuticals, the scam artists will have succeeded in creating a cascade of systemic failures.

    Yes, people. You can consume as much fatty dairy (raw/organic) and eggs as you want. You are robbing yourself of essential cholesterol if you fall for the egg white scam. The best part of the egg is the yolk. That’s the very part of the egg people have been conned into discarding.

    Are we really that stupid? Many of us seem to fall for just about anything the “experts” tell us.

  • Ty Shlackman

    It’s only the VLDL or very low density lipoprotein which is the oxidized cholesterol which is bad. High triglycerides cause high VLDL cholesterol. Triglycerides divided by the number 5=VLDL cholesterol

  • Joe C

    Dr. Perlmutter, please help me stay the course here! So after a year living gluten-free and ketogenic, I went to my doctor to get blood levels checked. When I first started this diet last November, my CHO levels went from 220 to 300. A month later they jumped to 408. My most recent lipid profile is TRG 152, HDL 92, LDL 393, Total CHO 510. This has me a little shaken and I was hard-pressed to defend these numbers to my PCP, and my wife! So my TRG/HDL ratio is still within the healthy range which indicated large particle size. My C-reactive protein number is .6 which is also good. I run between 40-65 miles a week, low BMI, low BP. Should I be concerned with these high CHO numbers? Help please!

    • I would love to see an answer to this. I am familiar with a very similar situation. Have you eaten a lot of cheese by any chance?

  • Rollergranny

    I just knew instinctively that modern medicine has the cholesterol thing wrong. I have done some online research with regard to cholesterol and have concluded that (1) cholesterol must be important to the body since it is so precious the body recycles it and (2) if you have high cholesterol numbers it is because the body is sending the cholesterol to help heal damage done by inflammation caused by a diet of excess sugar and refined foods, environmental toxins etc. Thank you Dr. Perlmutter for posting the truth about this subject.

  • Thank you Dr Perlmutter for sharing this study! I have so many patients who come to me on statin drugs and I do my best to educate them about these very issues. You make my work of helping them easier. Thank you, thank you, thank you!

    • David Perlmutter

      So glad all this information is helpful Kara.

  • Mary

    It might b useful to check out the book by Jonny Bowden, PhD (nutritionist) and Stephen Sinatra, MD, in their book, The Great Cholesterol Myth.

    It may provide more ammunition for your PCP to stay off the side-effect laden statin drugs. Common ones are muscle death, amnesia, and now it appears to increase the chances of developing diabetes and/or ALS.

    • I think you mean “muscle wasting”… which can include rhabdomyolysis, as well as the fact that statins can block important enzymes such as CoQ10…

  • So timely to read. After cutting out the carbs and grains from my life over 4 years ago, my LDL finally tested high and has freaked out my doctor. I was supposed to go in to see her on Wednesday but feel and broke my ankle is 3 places on Sunday, so didn’t get to see her and have her scare me with her concerns. Thank you one again for providing information that helps explain how my LDL is fine where it is!

  • JR

    Grammar: ” LDL is what we call a carrier protein. And one of it’s important jobs is to carry a fundamentally important chemical to every cell in the body.” “It’s” means “it is.” Your scientific material will be taken more seriously if the grammar is correct.

    • tessmck

      Whereas you’re correct about the grammar, your input does not add value We know what Dr. Perlmutter meant to say.

    • Al

      Really? That’s just nitpicking whining….

    • Joe Texan

      There is now a nutritional supplement to treat OCD – N-acetyl-cysteine.

      • Candy Perkins Lind


      • Angela Dark

        clearly you don’t know anyone with clinical OCD. It’s not a joke. Asshole

    • Soteria Charis

      I agree with JR. Poor and sloppy grammar is unacceptable in a professional article. We used to do something called proofreading! 😀

      • Jay

        Quiet please!

    • David Claude Warlick

      JR: You must have freaked out when you saw “caseinate” and “casinate” in the same paragraph by Joe Texan. I dislike such grammar mistakes, but i find when I right i often make miner mistakes two.

  • gaither

    Is it possible to have numbers that are too low? My HDL is 83, LDL is 91 and Triglycerides are 30.6. I’m 67, cycle and hike 6 days a week and really watch what I eat (e.g., lots of greens, salmon, lean grass-fed beef, quinoa / amaranth, ice cream).

  • Cathy

    I have been having trouble with doctor’s that want me to take drugs to lower my cholesterol. LDL is at 4.12 and HDL 2.05 they keep telling me it is to high. I eat mainly fish, chicken and lots of vegetables. No butter or dairy occasionally something fried but unsalted to keep my sanity. I am on fish oil, flaxseed oil and am using Sytrinol cholesterol support. I use to use Red Rice Yeast but they told me it was not working for me because the cholesterol was to high. My doctor does not believe in going to a health food store. This is the 3rd doctor that I have gone too (they all have the same feeling). These doctors today need more education dealing with cholesterol and using something other that prescription drugs. I have tried them but did not like the side affects so I went off of them. I am also from Canada.

    • Cathy, do not use red yeast rice… it is the equivalent of a statin… tell your “doctors” to “stick it where the sun does not shine” (lol)…. unless you are suffering from medical “condition”, ignore the doctors, and find a good nutritionist….

      • Tanene Kurtenbach

        And how to find a ‘good nutritionist?’ One who does not buy into the American pyramid diet? Who does not believe that we need milk for calcium? Etc. thanks!

        • Tanene, there are hundreds of us on LinkedIn… and I work with people all over the world, by letter, email, and Skype…

  • Elliot

    “LDL cholesterol tended to be associated with decreasing frequency and severity of all MRI markers of SVD in both studies, reaching significance for WMHV and EXT-WMHV in the meta-analysis, but this weak association was no longer significant after additional adjustment for vascular risk factors, APOE [epsilon] genotype, or inflammatory markers.”
    Correct me if I’m wrong but it seems that you removed context to further validate your conclusion whereas in the article they state that the results weren’t significant.

  • Susan Sico

    What should my LDL level be?

    • David Perlmutter

      See my previous comment Susan: What seems most important is the measurement of oxidized LDL, in relation to cardiovascular risk and this is something many cardiologists are now measuring.

      • LLCorsetti

        Dr. Perlmutter, What can one do about oxidized LDL?

  • So what are ideal numbers to aspire to for all the categories of lipid measurements listed in the discussion? My total Chol is 140; Trigl: 46; HDL: 47; LDL: 84; VLDL: 9. Haven’t gotten the other tests mentioned.I am dairy and gluten free and eat Paleo for the past 2 years. 6′ 1″ 165 pounds Have been taking Red Yeast Rice for 3 months now. My cardiologist wants my LDL down below 70 and nearer to 50. I believe he is misguided at best. He wants me to take Lipitor–I won’t!! Any input would be appreciated.

    • tessmck

      “chasing numbers” is a mistake — we only do this because we CAN in our technological world.

      • Regardless a reference range would still be helpful.

        Dr. P mentions in 2 comments that the measurement of oxidized LDL is significant in assessing cardiovascular risk. How is that measured? By which tests?

        • David Perlmutter

          Some information on that Yanni: http://www.liposcience.com/nmr-lipoprofile-test

          • Thank you, Dr. Perlmutter. Helpful site and the study that is referenced on the site in the journal “Atherosclerosis” is quite helpful. The study states that “aggressive therapies” were used to lower the LDL-P levels in the patients. What therapies besides exercise and diet were they referring to? : natural therapies, e.g, Red Yeast Rice, guggul, etc or allopathic statins such as Lipitor?

          • Ralph Boas

            link does not work

    • Don’t use red yeast rice… this is a statin…

  • Factotum

    Thanks for another excellent article! Nearing my 73rd birthday, I’ve been in nutritional ketosis for three years now, verified with blood ketones of 0.5 – 2.0 mmol/L. I eat ‘good fats’ like mct saturated fats, grass-fed beef & butter, fish-oil, and minimal omega-6 fats. Lots of fibrous veggies, no pasta, bread or starches. Yet, contrary to all normal predictions, my triglycerides remain very high (400-500) and HDL low (~35). My body fat is very low and I am a runner, swimmer and bicycler, doing at least one triathlon a year for the past 30 years. Trigs used to run around 100 so I don’t buy into familial hypercholesterolemia and none of my doctors have been able to explain what is going on here. How can this happen?? At one point a cardiac nutritional expert told me not to pay so much attention to it because a calcium scan showed very low plaque for my age and my diet was perfect to reduce trigs (but didn’t)! Although somewhat comforting from a cardio point of view, I suspect you would recommend reducing trigs for neurological health. But how???

  • Perlmutter Follower

    Cardiac effects of LDL?

    I read, with great interest, the article in Neurology. A statement in that article is essentially what my PCP recently said to me when I told him that I wasn’t as concerned about LDL cholesterol as he was: “In contrast with the strong undisputed association between high low-density lipoprotein (LDL) cholesterol and myocardial infarction ….” I’ve been a strong fan of your recommendations since Grain Brain was released. but I’m wondering if I’m ‘saving my brain’ at the expense of my heart? Or is there conflicting data on the potential link between LDL cholesterol and heart attacks?

  • paul youn

    David, Thank you for your excellent article which makes me think different regarding Cardio blood panel.
    Take care!

    • David Perlmutter

      I am glad this post could bring new information to you Paul.

  • Sue

    Great info on the function/importance of LDL, but what about info on the difference and danger, in LDL particle size as seen in a VAP cholesterol panel? My husband is dealing, not surprisingly, with high ratio of small density LDL plus elevated triglycerides. What is your opinion of the VAP panel asa bigger picture of heart health and risk? Thank you.

  • Candis

    Thank you so much for this. I run lipid profiles all day and see so many sky-high triglycerides. Did you see this in the literature about Stiff-man syndrome:


    It is so sad they didn’t just change their diet.

  • Charles Taylor

    roots of “the cholesterol myth” date back to Framingham. In the 1940s the Framingham study was
    conducted. A very weak link between
    cholesterol (well before the LDL/HDL distinction) was suggested by the
    evidence. The one concrete finding in
    the study was that consuming saturated fat/cholesterol rich foods had no
    correlation to cholesterol levels in the body, but this finding was not
    publicized because it contradicted the very cholesterol theory that the study
    tried to prove. Subsequently
    cholesterol and then LDL cholesterol was demonised, but as Dr Perlmutter
    rightly says it is an essential and natural part of our health. Despite a mass of research showing that
    those with lower cholesterol have a much higher mortality rate than those with
    higher cholesterol (e.g. Hacobs et al “Circulation” 1992; 86:1046-1060) the
    cholesterol myth is still a fixed part of ‘mainstream’ thought. This reversal of the truth is a source of
    profit for purveyors of statins and ‘low cholesterol’ foods (foods which often
    have sugar in place of fat). Professor
    John P. Cooke says, “Cholesterol itself is not bad. In fact, it is essential for life. Cholesterol is a building block for all
    cell membranes. It is also the
    precursor for sex hormones and other steroids that our bodies manufacture. It is only when cholesterol becomes
    oxidized that trouble begins.” (“The Cardiovascular Cure”, page 38). Lee Penrod is spot on in rejecting processed foods, because oxidization of cholesterol in the
    veins is caused by sugars, most sweeteners, trans fats and other elements in
    processed food, as well as, of course, smoking, air pollution, prolonged
    stress, extended exercise, heated oils (except coconut) etc.. Rather than damaging our health by reducing
    LDL, we should take anti oxidants, including vitamin C, co-enzyme Q10 and,
    above all, L-arginine.

  • Susie

    I would feel better if you were discussing the atherogenic sub type of LDL–the small dense LDL. That is the particle size that doesn’t function as the LDL-receptor protein as it is designed. The “buoyant” LDL-are the “normal” and functioning form of LDL carrier of cholesterol, whereas the small, dense LDL are the ones that keep circulating until they get engulfed by macrophages in the intimal lining of arteries (and the one that gives the bad name to cholesterol). I wish every doc had his patients tested for lipid profiling on density.
    Dr. Rockway

  • tarantilla

    all wonderful

  • tarantilla

    as I was trying to say, all wonderful comments. So where are the negative ones? fake “science”. A good racket. Always good to lose weight, but be careful, or you will be a skinny person in your coffin.

  • Plants and Pesco

    It is important for Americans understand what cholesterol is and how your body makes cholesterol as the raw material for many hormones for proper endocrine function etc… So I think it is important that you bring this up. Women around the world find robust fertility, lack of vascular disease and overall good health with low (in American standards, say 100-140 total cholesterol) and, they keep these cholesterol levels consistent throughout their lives.

    If an American woman has LDL levels of say 60-80 in their teens, twenties and thirties with perfectly functioning bodies including fertility and normal menstruation, should they really have LDL levels twice that in their 50’s, 60’s and 70’s. This is not the norm in cultures w/ little vascular disease, including both ischemic stroke and heart disease and Alzheimers.

    The same goes for blood pressure. If one’s blood pressure is consitenly +- 5 of say 100/60 in teens, 20’s, 30″s why should it jump twenty to 40 points with age? An example: the Okinawans on their traditional diet have very little if any changes in blood pressure levels as they age.

  • JackL

    Some people need to catch up 🙂 ref to JAMA Neurology – http://bit.ly/1vUQqy9

  • Raul01

    Hello Dr Perlmutter, I am reading your book, and find it very interesting and good. Congratulations. Just one question, what would be ‘good’ levels of LDL and of HDL?, that is something I havent found in your book. I understand that ‘good’ levels will depend on various factors, but maybe some guidelines?.. I would appreciate it. Thank you.

  • Dave

    I’m 61, male, 6’2″, 180, run 6 days/week, average 5 miles per day run. I also bike and get plenty of walking in daily. My father had a heart attack at age 70, lived to be almost 87. My blood pressure is decent averaging about 120/78 over a multi year period (I give blood & platelets so am checked each time). My doctor wants to start me on 20 mg of Crestor as my total cholesterol was near 250 this year, LDL of 155 and HDL of 82. I attribute the higher HDL to 35 years of running and other exercise. So I have a good ratio of about 3.0. After reading the benefits of higher LDL is starting Crestor in my best interests? I hear one side effect is muscle aches, especially for those who exercise. And apparently another is potential kidney and liver issues. Don’t want to second my doctor but would like to have a meaningful discussion with him. I also had a 220 score on a calcium scoring test recently.

    • David Claude Warlick

      Hi Dave. I’m an accountant. The problem with calcium is that it is a raw material for kidney stones. You can’t imagine the pain. Personally, one stone was sufficient for me. Now I eat no calcium after about 5 pm. I do not recommend calcium intake without plenty of fluid. Again, I’m an accountant, so my experience might not be repeatable by science.

  • Sando

    How do I increase my LDL? It is 44. HDL is 105, Cholesterol total is 154

    • Angela Dark

      sadly it seems no one anywhere will answer this question, ever… 🙁

  • Frieda Nugen

    Okay, please tell me about these results:

    Cholesterol, Total 295
    HDL Cholesterol 81
    Triglycerides 114 <150 mg/dl
    LDL – Cholesterol 191

    CHOL/HDLC ratio 3.6
    Non HDL Cholesterol 214

    Glucose 94

    A1c – 5.8

    Homocysteine 9.8 <10.4

    Creatine Kinase – 187H 29-143 range (not on statins)

    LP PLA2 402 81-259 range

    C-reactive protein – .10 <0.80

    LPa cholesterol 24 100
    Real LDL size pattern A

  • Spiderplant

    So Dr Perlmutter….could the fashion for statins to lower LDL have contributed to the increase in neurological diseases such as alzheimers and parkinsons?

  • Great article. This will be an excellent discussion on my upcoming P/exam and lab work. I’ve been on Keto Adapted and doing awesome on my bike ride/weights workout this winter. Besides trimming off some fats and strenghtened upper body core, my energy is sustainable. Thanks Dr.Perlmutter!

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  • drericdo

    What happens when LDL-P, LDL-C, CRP all go up after 6 months on a ketogenic diet? Especially if the numbers are in the extremely high ranges (LDL-P >2000, LDL-C >200)?

    • ChickInkPen

      Then paleo-ketogenic pushers will either ignore you or tell you you’re doing it wrong. Apparently the high fat low carb diet works fine for about 75% of the population. The other 25% will see skyrocketing LDL. Research the APOE gene and have your genetics tested by 23andme. One diet does not fit all. I love cream and cheese, so all these “hey, look, my cholesterol improves when I gorge on fats” make. me. sick. Enjoy your sweet genetics, people, but realize that it does NOT work for everyone. See this man’s personal experimentation with dietary effects for people with APOE4: http://www.fivediets.com/the-paleo-diet/

  • Debbie McDermott

    What if your LDL is too low? My teenaged son had an LDL of 63 2 years ago, and now it is 84. He doesn’t seem to have any huge symptoms, but he does have some anxiety and GI issues, which we are not sure are related to each other and/or to the very low cholesterol.

    • Angela Dark

      GI issues and anxiety can both be caused by NAFLD, as can low LDL. Most doctors are ignorant of the existence of NAFLD and are obsessed with the myth that only alcohol can cause liver disease. in truth, most liver disease is inherited and has nothing to do with the patients lifestyle. Not saying this is the answer, but it might be. i was a teen when i started having the more severe symptoms but it was decades later before a doctor acknowledged I had a problem with my liver. It didn’t help that when i was a kid asking for help they didn’t believe NAFLD existed at all, it only has been something doctors look for in the last 10 years, so most doctors are still unaware of it, even though it is the #1 type of liver disease in the western hemisphere

  • Garry Smith

    check the LDL ratio – it is extremely important too http://cholesterol-calculator.com/

  • Joy

    I have been told by Dr to take Lipitor because my LDL is high also my triglycerides
    I had recently stopped by medication
    I’m type 2 diabetic as well
    I’m limiting and trying to delete my carbs and sugars
    Where do I get the good supplements that you recommend
    Thanx joy

  • Arlene Gleeson

    I recently saw a functional medicine physician who ran a very comprehensive lipid panel that broke down the LDL particle sizes and quantities. I completely agree with the recommendation that LDL is our friend but do I need to be concerned if the specific LDL-C and small LDL-P numbers are quite elevated. Small LDL-P for example was 1140 and LDL-P total was 2273, LDL-C is 178. I know you don’t recommend anything to lower cholesterol artificially, the recommendation by the physician was to start Red Yeast Rice. Thank you so much for all your great advice and sharing your knowledge and research with the world!

  • Jay

    What is a good number for the LDL- particle size? I think the test is called Berkeley Test. I really don’t think I understand much of the numbers.

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  • Kelly

    I am enjoying your book ‘Grain Brain’ and this blog very much as I have been eating a diet free from refined sugar and high carbs since recovering from cancer. I note in the book you stated:
    “Once free radicals damage the LDL molecule, it’s rendered
    much less capable of delivering cholesterol to the brain. In addition to
    oxidation destroying the LDL’s function, sugar can also render it dysfunctional by binding to it and accelerating oxidation”

    I seem unable to move past this as it worries me that years of sugar could have damaged me beyond repair. I am very unlikely to return to my old eating habits as I really do see it as poison now. I have experienced many benefits of removing cakes, pastries, bread, pasta, potatoes, sweets etc from my diet but my mental acuities do feel duller than they used to.
    is it possible to repair the damage over many years?
    Thanks again for an excellent book

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  • Mike

    I’m 34, been in ketosis for the better part of a year. My numbers came back yesterday”
    HDL- 50
    LDL- 33
    Chol- 97
    trigl- 72

    I’m on ballpark 3k/cal a day, 70% fat. Should the LDL concern me?

  • T. Hart

    If a higher LDL is good for you, then why does tha post about drinking red wine says:
    And even the alcohol content of red wine has some beneficial effects as well, by raising HDL, reducing LDL, and helping to modulate blood pressure, when consumed in moderation. – See more at: http://www.drperlmutter.com/support-drinking-red-wine/#sthash.kanqWYk9.dpuf

  • Paul Queen

    Such a good write-up and so true. However please fix the last sentence in the third paragraph. It is not a life-sustaining chemical called cholesterol.

  • Signe Gad

    I really appreciate this article, thanks! Last year I had some general tests, as I took part in a cancer-in-generations-study. All my numbers were perfect: weight, blood pressure, stomach fat, longtime bloodsugar lovest possible, so very fine for everything. Except – according to what the papers told me – my cholesterol. It was 5,8 and Baaaad. I myself was very pleased with this high number, as I have read “Put Your Heart in Your Mouth”, “The Cholesterol Myth” and many other books like that. I just find it peculiar, that a person can have really fine numbers in everything tested – and ups, just one thing sticks out and is considered baaaad. How does that relate, taking into consideration, that the body (and mind!) is one whole interconnected organism. Logic sais that it doesn´t. I bet the reason my cholesterol number was high was that I had a knee injury some months before, and my back up friend cholesterol was trying to help me out of it, thank you cholesterol!

  • cat

    what about LDL-P and LDL-C and small and large LDL P?

    i’ve read that it is only oxidized LDL that is harmful. is this true. thanks for thinking outside the box Dr Perlmutter!

  • Karan Kataria

    I am a huge supporter of the Ketogenic diet and will always be. I am just confused about one thing on cholesterol. I read an article (i was researching the both sides of cholesterol) that LDL when it delivers the cholesterol to the tissues, and if the tissue “rejects it” the excess cholesterol just attaches to the arterial wall. That doesn’t make sense to me because I thought there had to be some sort of damage to the arterial wall, and then only would they attach and plaque up. Like why would they sit there if there was no damage on the wall. h
    Here’s the source I saw this on: https://www.askdrsears.com/topics/feeding-eating/family-nutrition/cholesterol/cholesterol-facts-you-should-know

    I am confused, I know this is ridiculous, just wondering why the author of the article said this.
    THANKS 🙂

  • Tish

    My total cholesterol is 507 with LDL- 400 and triglycerides- 75. I am a 60 year old female, 147 lbs. I play tennis 3-4 times a week. I have been trying natural remedies/supplements to lower it but it continues to rise. My Dr. says I MUST go on statins or I definitely will have a heart attack. I plan to start the ketogenic diet, and put off the statins. Your thoughts?

  • Angela Dark

    I’ve known this for some time, as my cholesterol is bottomed-out and I have a lot of symptoms as a result. My low cholesterol is cause by NAFLD and google seems determined to believe LDL is evil, therefore it won’t point me to any results that tell me how to increase it. I’ve been experiencing worsening symptoms since my NAFLD diagnosis 2 years ago, including mental impairment which has been worsening, but no one cares. I live in Nova Scotia, Canada, so there are no doctors taking patients, and my last doctor was transphobic and refused proper treatment altogether so i have to stop going to him (got tired of him lying that he was making referrals his secretary told me he never made, and hated how he kept obsessing over my genitals when they were irrelevant to my disorder)

    I’ve had this illness all my life and have had symptoms since I was 13 of loosening skin, healing from cuts and such getting slower and slower over the years, and so forth. No one would even examine me until my 20s, and then they refused to look at anything other than standard blood work because I was still too young to possibly be sick in any way (so sayeth the doctors). Once I was finally diagnosed (in part due to me constantly asking what could make my cholesterol low) they couldn’t come up with a cause, so it’s assumed generic, but with my parents both long gone I have no way to confirm this – no one will test me either.

    I have had no advice given to me on how to treat or manager this condition and it is getting worse, but without a family doctor I am basically blocked from getting any medical care at all. It is a living hell. My depression is worsening as s my fatigue. I have no money with which to take the time off work that would be needed for me to go to another province to seek help.

    This article is one of the few that acknowledges the need for LDL in the body, but I don’t see any advise on how to increase it. Keep i mine with liver dysfunction my liver is not working as well as it should, so all this “your liver should detox itself” and “your liver should make your cholesterol” are useless things people keep telling me.

    I know what SHOULD be happening, if I were healthy, but I am not healthy. It has nothing to do with my lifestyle so I wish people would lay off that harp as well. I exercise more than most people I know and while my diet isn’t perfect, I did do better in the past. Since the dietary changes I have tried in the past all made me SICKER, I’ve given up on that, unless someone can come up with something no one else has advised….

    I can’t use olive oil, it makes me sick and causes me to produce enormous amounts of foul smelling gas. They tell me my BMI is high, but I’m not sure how they can be sure given how much fluid has built up in my gut since I was 13 or so. BMI doesn’t take muscle or fluid retention into account so it’s really, really meaningless.

    Most sites are freaking out at me not to drink alcohol, yet the few sites I can find that don’t assume LDL is evil, are sites that tell me that NAFLD can be helped by moderate alcohol consumption. Since I almost never drink and it is called NON-alcoholic fatty liver for a reason, I wondered if this might help me, but it’s impossible to corroborate this theory.

    Recently a study came out saying that NAFLD can cause cognitive impairment which for me has been getting much worse, and since LDL is needed to make cells, I figure this is possibly the reason: LDL is a symptom of liver disease (one most doctors are willfully ignorant of)

    If I don’t get some kind of help soon I am going to kill myself. i simply cannot live like this

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