I'm angry at my boyfriend's doctor,but i don't know if I'm justified. Boyfriend has CAD but has been LC for several years. All his cholesterol markers are great, HDL in the 80's, LDL in the 90's. The only thing is that he has high lp(a) - it's 26 or so. His doctor has now added ezetimibe, which although not a statin, blocks cholesterol absorption in the gut. This after my boyfriend agreed not to accept any more statins over the Crestor he's taking. I know the doctor is thinking " OMG guidelines say get LDL below 70 now!"

I've read just a part of the way through Dr. Attia's cholesterol series and understand the importance of a LDL particle count. I was thinking of asking his doctors to order this test for him. My question is whether a low LDL-P, if he has the test and it is low in his case, can help blunt or ameliorate the atherogenic impact of the Lp(a).

I know this is very technical but if anyone can point me to some info that'd be great. Did a GA search on Attia's site but I don't think he's addressed it directly.

I think the book "Wheat Belly" might answer a lot of your questions.

Thanx Nancy - I think this will be a losing battle, but I'll pick up the book. I have to get the prescription today. In fact I'd sent WB to my mom, but hadn't gotten around to getting it for ourselves. He's been on Zetia/eze before so he sees less reason to refuse it. His VAP is good too.

I might see about getting the test myself - he has a tendency to do what I do. All this is double hard because I have to interpret and explain all this stuff to him because he's blind.

It wooorked...nmr is scheduled for both of us. All I had to do was say "hey, looky, Labcorp is offering it and it's on sale! I'm doing this!" And he wants one too.

We had a reasonable conversation this morning and it turns out the doc wants to get his number down to the 80's. So the idea is to spend $40-50 a month for a ten-point drop. Uh-huh.

For a number that is basically meaningless too.

I had the NMR done directly through LipoScience, and they have this useful guide on-line to Understand the Report. http://www.theparticletest.com/uplo...ng_theTests.pdf
My DH had his done by LabCorp, which sends the blood sample to LipoScience, but then report the results in their own LabCorp format with less detail. No nifty green, yellow and red scale, but having this .pdf will help you fit their results onto the LipoScience scale. All the most useful information will still be reported, including an Insulin Sensitivity score, however, the format will look different.

Thanks Jey, that's 10 kinds of awesome and will be a big help!

Maybe I'll post my numbers, although I'm more interested in his. There's been a lot of carb creep in his diet, especially on vacation.

If doc gives a good counterargument, I'll go along with my fiance's decision on the matter. Now it's apparent how frustrating this is for people.

Well, the results are in. His are awesome in all markers. My LDL-P is BAD, and I mean bad. I don't know what to do about this. The only thing I can think of is that I've been eating more fruit in the last few days, and cheese. I eat lots of fat and probably too much protein. However, IR score, particle size and trigs were ok but not as low as I'd like.

Aak. Maybe I should steal his Crestor and Zetia and take it myself.

There's no evidence it does anything for women. I never understood the point of taking meds just to influence a number that is irrelevant anyway.

Are your carbs creeping up? The important thing is really particle size. If you're not pattern B, you should be fine.

Oh, no worries. It would take an act of god to go the statin route.

Couldn't rule out carb creep. I have had single bites of bread when we go out to eat, I have been eating apples that fall off of our trees outside- but no binges, no large carby meals. I'm totally willing to admit, though, that those little things added up.

The only other thing I can think of is that I was terribly, terribly sore from a workout I did way too much of a couple of days before - at the time I could only gingerly get in and out of the car. Inflammation? But that's probably grasping at straws.

Carb creep? ummm... Dr. Davis wrote small LDL is "unforgiving"
http://blog.trackyourplaque.com/201...-particles.html

Yeah, I saw that post of Dr. Davis' at some point. So I knew someone would mention it

The plan is to be extremely strict until around mid-Dec, then test again. In poking around on the net I've seen claims that a high # is only dangerous if ldl-c is low, which mine is not, also that it doesn't mean much in low-carbers, blah blah blah. Nobody really seems to know. Seriously, though, this has me anxious to the point I'm having faux chest pains. Well, hope they're faux.

Lots of particle number, or ApoB, and a low LDL-C means you've got lots of small particles. Having a high LDL-C means there's lots of cholesterol, but depending on how it is packaged, it isn't an issue.

Yes, Dr. Davis talks about how bad wheat is for generating small particles of cholesterol.

I'd suggest reading his book (again).

My ldl-c would certainly make a doctor blanch, so I hope you're right, Nancy! Yeah, I'll read the whole book, instead of just excerpts.

If you never hear from me again, in lieu of flowers, please send bacon bouquets.

From the numbers I've see published, almost everyone (including me) on a low carb diet sees important numbers improve, especially TG/HLD-C. I think high triglycerides is mostly a marker for the unhealthy SAD (Standard American Diet) as endorsed by a licensed nutritionist or not.

Many low-carbers (including me) see "worsening" particle size, LDL-P, and LDL-C. For example, you can dig such "inconsistent" numbers out of the comments on Peter Attica's The straight dope on cholesterol – Part V.

Peter Attica asks (in comments), "It is possible that all of the risk stratification we have for heart disease is predicated on someone consuming a normal Western diet?" [I wish he had put the disclaimer prominently in the body of the article.]

Similarly, the comments on Stephan Guyenet's The Diet-Heart Hypothesis: Subdividing Lipoproteins, have a similar theme.

In those comments, Kurt G. Harris MD said, "I suggest following HBA1c, Triglycerides, HDL and (25) OH D levels to make sure one is on the right track. I think these four will prove to be the best predictors of mortality. I think LDL and total C can be safely ignored." I think that is best summary advice there is.

Basically, my conclusions (through study) are:

• TG/HDL-C ratio is important (as well A1c and OH D)
• TC, LDL-C, LDL-P, and particle size are irrelevant to low-carbers.

Basically, particle size is very noisy if you have a small amount of carbs (which is probably irrelevant to long-term health), and LDL is pure noise (except to those profiting from driving it to unhealthy, low values).