So the New York Times dropped a stunner to the world this week with an article that called into question how useful HDL really is. Lots of TheFatNurse’s fellow peers were shocked by it. Is this really new tho? Or has the community just been looking at HDL cholesterol in the wrong manner? Indeed, just earlier in the month another study showed HDL being harmful depending on whether the HDL has a apoC-III protein on it. In a manner similar to the discovery of Dr. Krauss that not all LDLs are alike, not all HDLs are alike either.
Dr. Thomas Dayspring, a lipidologist, has been saying all along that the standard LipidProfile test that you get done at the doctor’s office is outdated and may not accurately predict atherogenic risk. I know I know this is probably your reaction:
However, with the exception of Non-HDL (Total cholesterol- HDL cholesterol) and triglyerides/HDL to get a “poor man’s insulin resistance” (ratio of 3 or above = likely insulin resistance)” the other values on the standard lipid profile may not be as useful. Yes even the LDL cholesterol (insert another GTFO pic!). Instead, getting a test to see the size and number of particles in LDL may be a better predictor of atherogenic risk.
What is this particle nonsense you say? It’s the view that risk is not dependent on total LDL cholesterol but the way LDL cholesterol is carried through the number and size of LDL particles (Some evidence is showing that the size is of lesser importance than previously believed and it’s the number of LDL particles themselves that are important). The more particles the higher the risk (driven by insulin resistance). Dayspring believes a number below 1000 nmol/L would be ideal and a number above 1600 nmol/L is the start of high risk. If you find this intriguing, the video below features Dr. Dayspring talking about all of this along with a case study to follow along with:
The Bottom Line: The New York Times article is a good starting point for people to reevaluate and redefine what cholesterol is. Much of the cholesterol knowledge that is taught in schools and to the public is outdated and there have been newer theories and tests developed that are much better than the traditional “HDL = good LDL = bad” advice. Are these newer theories right? Maybe, maybe not, but they should certainly be discussed more often than the same old archaic advice which is often treated as medical fact rather than theory.