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Special Thanks to my team and Nicholas Norwitz – Oxford Ketone PhD Researcher and Harvard Med Student – for working diligently on research as well!

Your Doctor Thinks You Have High Cholesterol: Here’s What to Do – Thomas DeLauer

HDL, LDL, and the LDL misconception

So, what about LDL “bad” cholesterol versus HDL “good” cholesterol. Actually, LDL and HDL are not different types of cholesterol, rather they are different types of cholesterol “boats.” You see, cholesterol doesn’t like water, which means it can’t swim freely in the bloodstream. Therefore, your body needs to package cholesterol into boat-like carriers called lipoprotein particles. LDL (which, here, also includes VLDL) stands for Low-Density Lipoprotein and HDL stands for High-Density Lipoprotein. Both LDL and HDL carry the same cholesterol. The only difference is that LDL carries cholesterol from your liver to your other organs, whereas HDL carries cholesterol out of your blood vessel walls back to your liver, and is therefore generally considered “good.”

It’s also important to recognize that the main function of LDL is not actually to transport cholesterol, but to transport triacylglycerides (TAGs), fats that your cells burn for energy! Dave Feldmen, whose lectures you can watch on YouTube, extends the boat analogy, introduced above. The boat is the Lipoprotein particle, the passengers are the TAGs, and the cholesterol is the life preservers. The life preservers are important, but the main objective of the boat is to transport the passengers (the TAGs) around in the bloodstream.

But perhaps the most important question, “is LDL actually “bad” cholesterol?” The short answer is, it depends on whether or not LDL has been turned to the dark side by sugar! LDL by itself is fine, good in fact. It’s goes about its business transporting TAGs and cholesterol to organs around the body for energy, cell membranes, and hormone synthesis. But when LDL mixes with too much sugar in the blood, the sugar becomes attached to the LDL in a process called “glycation.” This makes the LDL particle more vulnerable to a damaging process called “oxidation,” and it is this oxidized LDL that is dangerous to our health. Oxidized LDL is also called small dense LDL because glycation and oxidation make LDL smaller (aside: combining processed vegetable oils and n-6 PUFA-rich foods with sugar is the worst because it accelerates the glycation-oxidation process that turns Anakin/Good LDL into Darth Vader/BAD sdLDL).

Anyways, the reason small dense LDL is bad is that this damaged form of LDL can’t be recognized by LDL receptors and taken back up by our livers. So where is the small dense (oxidized) LDL to go? Well, first it begins to accumulate in the blood (this leads to what’s known as a “high LDL particle count”), but eventually it invades the walls of our blood vessels, leading to the formation of a plaque. Not only is small dense LDL particularly good at getting into our blood vessel walls, but, once there, it is the only kind of LDL that is recognized by the scavenger receptors on blood cells. These white blood cells try to gobble up the small dense LDL and, in the process, turn into sickly “foam cells” that bunch up and clog our blood vessels!

So, to review, LDL transports fats and cholesterol to cells around the body. When LDL is exposed to too much sugar, it gets damaged (turned to the dark side) and becomes small dense LDL. Small dense LDL can’t be recognized by classical LDL receptors and taken back up by the liver, so it builds up the in the blood and slips into our blood vessel walls. Here is it eaten by white blood cells that poof up into foam cells that clog our arteries.

It’s common that people on ketogenic diets will have high LDLs and that this will create a conflict with their doctors, most of whom will advise going off the LCHF diet and onto a statin. If this happens to you, ask your doctor for (1) a lipid panel with fractionation to determine if you have high levels of sdLDL and/or (2) for a coronary calcium CT scan (known as a CAC test) or a carotid intima-media thickness CT scan (CIMT test) as functional test to look at whether you have plaques forming.

Nicholas Norwitz – Oxford Ketone PhD Researcher and Harvard Med Student: