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    LDL pattern A / LDL pattern B
    Anon_154228 posted:
    Has anyone requested from their MD to have their LDL gradient pattern type measeured?

    As I understand it pattern B is bad but the standard test does not search for this since it is expensive to determine.
    bobby75703 responded:
    I had at test done 10 years ago which determined I was the high risk pattern B with the small dense LDL particles.

    I stumbled upon an article in a respected journal of clinical nutrition. Studies showed a favorable change in LDL pattern simply by avoiding wheat.

    Despite my unfavorable LDL pattern, ultrasound shows no development of heart disease yet. I am 54 years old with clear arteries where visible by ultrasound.
    jp747 replied to bobby75703's response:
    Did you request the test or did your MD?

    Can you share the link to the article? I will talk to my MD next time I see him about the gradient test and hope for patter A.

    ldl-225, tri-190, total 300, hdh-51
    currently on 2g of niacin and get most of my fibre from wheat.
    billh99 replied to jp747's response:
    Google - ldl particle size diet - will get lots of info.

    Here is one.

    After the CHO (high carb) diet, a significant increase in LDL particle size (P < 0.035) was noted with respect to the MUFA diet in apoE 4/3 subjects, whereas a significant decrease was observed in the apoE 3/3 individuals (P < 0.043). In conclusion, a Mediterranean diet, high in MUFA-fat increases LDL particle size compared with a CHO diet, and this effect is dependent of apoE genotypes.

    A very quick glance at some of the other results gave similar results. First the size of the particles are determined by genetics, but 2nd a high triglyceride levels will lead to small size LDL.

    bobby75703 replied to jp747's response:
    Hi jp747,

    No, I didn't request the test. The Doctor ordered it. When the results came back He said I have "very bad cholesterol".

    I will have to search for the article as this was several years ago and I didn't book mark it. But I remember it clearly because I had asked my doctor if dietary changes could influence particle size and he said "no". When I stumbled upon the article about avoiding wheat changing particle size I was enraged at my doctors lack of knowledge on nutritional impact on LDL partical size.

    If I find the article I will post the link for you.

    billh99 responded:
    My cardiologist did not think that I needed such a test because of the my lipid profile.

    The Bottom Line: A number of cardiologists use these new tests on many of their patients. However, it's usually not necessary for a doctor to know the size of a patient's LDL particles to choose the right treatment. That's because knowing blood levels of LDL cholesterol, HDL cholesterol, and triglycerides from the standard blood lipid test -- along with other traditional risk factors such as your smoking habits, blood pressure, and blood glucose levels, to name a few -- are enough to make the correct treatment decision in the vast majority of people.

    In fact, your doctor can usually predict whether you have small, dense LDL particles based simply on your levels of triglycerides and HDL: Triglyceride levels higher than 120 mg/dL and an HDL level below normal (less than 40 mg/dL in men and less than 50 mg/dL in women) are usually associated with small, dense LDL particles. What's more, treating traditional risk factors with a low saturated fat diet, weight loss, exercise, and statin drugs also lowers levels of small, dense LDL particles.

    But that it would not hurt to get a test of Lp(a) because of a family history of early heart attack.

    While there is a separate Lp(a) test available the VAP test measure it along with the all of the sub-fractions of cholesterol.

    So at my next cholesterol test I ask my PCP for the VAP test. He had never heard of it and it was not in his computer system. But he finally found the code to order it.

    VAP and NMR are available through the national laboratories (Quest and LabCorp).

    They are roughly $75-125 list.

    As it turns all of the sub-fractions where very good, as the cardiologist suggested. But the Lp(a) was mildly elevated.

    But my LDL was optimum (less than 70) on statin. He would add niacin, if I wanted, to lower the Lp(a). But currently there is no trails that show just lowerng Lp(a) helps. Most guidelines indicate to treat LDL if you have high Lp(a).

    So we agreed to just the statin.
    bobby75703 replied to bobby75703's response:

    Here is one article. Like I said its been years so I can't remember if this is THE article I read, but this is one relating wheat to smaller dense LDL particle size.

    The take home message I get from this: If a guy chooses oats over wheat, his LDL particle size will change to a larger particle.

    jp747 replied to bobby75703's response:
    correction to my levels...

    hdl 51
    ldl 185
    ttl 258

    based on this patter A is likely
    bobby75703 replied to jp747's response:
    The only way to know for sure is to do the test. But I honestly don't know how good of a predictor of heart disease it is.

    Some people follow the particle size theory, others don't. I have been sitting on the fence undecided on this, watching to see what happens.
    bobby75703 replied to jp747's response:

    Here is an interesting article discussing the matter of particle size.

    I noted the statement "Studies indicate your condition is likely to worsen if you get below 25% of your calories from fat."
    billh99 replied to bobby75703's response:
    From what I have seen, looking at more doctor directed sites, is that a very large number of doctors don't think that current lipid profiles is really a good measure.

    And that the next report from the national panel (due in the next 6 months) will have some changes.

    But what is still up in the air.

    Some thing that particle count is more important. Others particle size or distribution.

    And some look at ApoB100 which is related to particle count.

    And some look at non-HDL cholesterol. That is total ch - HDL. And it is suppose to track ApoB100.

    AFAIK there is no common test (ie, low cost) test for size or particle count. But there might be (just don't remember) one for ApoB100.
    billh99 replied to bobby75703's response:
    I think that a lot of medical problems (heart, obesity, diabetes) relates to the 80's mantra of low fat. And many of the commercial low fat products where high in carbohydrates, specially simple ones.
    bobby75703 replied to billh99's response:
    I agree with you Bill. I remember the low fat craze. America got fatter and fatter, with more diabetes.
    OHB3dotcom responded:
    The test you need is called the VAP test. It's available to doctors every where and the price is now comparative to regular lipid profile test.
    OHB3dotcom replied to bobby75703's response:
    Low fat foods use sugar to make them palatable. That's why America got fatter. Sugar will do that.

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