Ldl Not Actually Bad?

I am reading the book Grain Brain and if you've heard anything about it, David Perlmutter (the author) makes some pretty controversial claims. One being that LDL is not actually "bad" like it was actually thought to be. According to Perlmutter, LDL becomes an issue when it is oxidized. Oxidized LDL causes a loss of functionality (LDL is suppose to shuttle cholesterol to cells).


Thoughts on this? Studies would be great


Comments

  • StevoStevo Upgrade in Progress


  • I am reading the book Grain Brain and if you've heard anything about it, David Perlmutter (the author) makes some pretty controversial claims. One being that LDL is not actually "bad" like it was actually thought to be. According to Perlmutter, LDL becomes an issue when it is oxidized. Oxidized LDL causes a loss of functionality (LDL is suppose to shuttle cholesterol to cells).


    Thoughts on this? Studies would be great




     


    I'm more interested in something outside of Perlmutter. I know his opinion, I'm interested in someone elses

  • StevoStevo Upgrade in Progress

    Yep, the study is linked:


     


    Author(s) 

    Sabrina Schilling, MSc; Christophe Tzourio, MD, PhD;

    Carole Dufouil, PhD; Yicheng Zhu, MD, PhD; Claudine Berr, MD, PhD’ Annick Alpérovitch, MD, MSc; Fabrice Crivello, PhD Bernard Mazoyer, MD, PhD Stéphanie Debette, MD, PhD

     

    Abstract 

    Objectives:

    We examined the cross-sectional association between lipid fractions and 2 MRI markers of cerebral small vessel disease, white matter hyperintensity volume (WMHV) and lacunes, representing powerful predictors of stroke and dementia.

    Methods:

    The study sample comprised 2,608 participants from the 3C-Dijon Study (n 5 1,842) and the Epidemiology of Vascular Aging Study (EVA) (n 5 766), 2 large French population-based cohorts (72.8 6 4.1 and 68.9 6 3.0 years; 60.1% and 58.4% women, respectively). Analyses were performed separately in each study and combined using inverse variance meta-analysis. Lipid fractions (triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol) were studied as continuous variables. WMHV was studied both in a continuous and dichotomous manner, the latter reflecting the age-specific top quartile of WMHV (EXT-WMHV). Analyses were adjusted for age and sex.

    Results:

    Increasing triglycerides were associated with larger WMHV in the 3C-Dijon Study (b 6 SE 5 0.0882 6 0.0302, p 5 0.0035), in the EVA Study (b 6 SE 5 0.1062 6 0.0461, p 5 0.021), and in the combined analysis (b 6 SE 5 0.0936 6 0.0252, p 5 0.0002) and with higher frequency of lacunes in the 3C-Dijon Study (odds ratio [OR] 5 1.65 [95% confidence interval 1.10–2.48], p 5 0.015), in the EVA Study (OR 5 1.58 [95% confidence interval 0.93–2.70], p 5 0.09), and in the combined analysis (OR 5 1.63 [95% confidence interval 1.18–2.25], p 5 0.003). Associations were attenuated but maintained after adjusting for other vascular risk factors or for inflammatory markers. Associations were present and in the same direction both in participants taking and those not taking lipid-lowering drugs but tended to be stronger in the former for EXT-WMHV. 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.

    Conclusions: Increasing triglycerides but not other lipid fractions were associated with MRI markers of cerebral small vessel disease in older community persons.

     

     

    Date 

     

     

    November 11, 2014

  • ACH85ACH85 ✭✭ ✭✭

    Yep. LDL isn't bad, LDL-C (total LDL cholesterol, what's measured in a standard blood lipid panel) doesn't correlate well at all to incidents of heart disease. 


     


    Very high LDL-P (total particle count) and it's correlated measure ApoB, however, is still closely correlated (though perhaps not causative) of incidents of heart disease. 


     


    There are quite a few discussions about this kind of thing buried in the forums. You can probably find them with an advanced search of thread titles. 


  • edited November 2014


    Of course it's not bad, you just need to know what it is and what it does to understand this fact.




     


    Why was it considered bad in the first place? There must have been some basis for distinction


     


     




    I'm more interested in something outside of Perlmutter. I know his opinion, I'm interested in someone elses




     




     


    Yep, the study is linked:


     


     

     





    I have followed the study Perlmutter talked about in his book. I am not interested in anything tied to Perlmutter is what I am trying to say. 




  • Yep. LDL isn't bad, LDL-C (total LDL cholesterol, what's measured in a standard blood lipid panel) doesn't correlate well at all to incidents of heart disease. 


     


    Very high LDL-P (total particle count) and it's correlated measure ApoB, however, is still closely correlated (though perhaps not causative) of incidents of heart disease. 


     


    There are quite a few discussions about this kind of thing buried in the forums. You can probably find them with an advanced search of thread titles. 




     


    Isn't LDL-P associated with carbohydrate consumption?

  • ACH85ACH85 ✭✭ ✭✭


    Why was it considered bad in the first place? There must have been some basis for distinction



     


     


    Tests get better over time. In the analogy of lipoprotein particles as "boats" that carry cholesterol, early blood lipid tests totally destroyed the boat to measure the cholesterol. The only thing they could isolate from early tests was total cholesterol (LDL+HDL.) Since there is a causative link with oxidized LDL, LDL-P, and Lp(a), early studies did indeed show a connection between total cholesterol (all that they could measure at the time) and heart disease. 


     


    Later, they managed to isolate LDL and HDL from total cholesterol with a more advanced test. They then declared it was LDL that was the problem, since there was indeed a correlation. Except it was really oxidized LDL, LDL-P, and Lp(a), which they couldn't yet measure. That was in the '40s or '50s I think, and since then there's been plenty of time for the nation to learn that you want HDL but not LDL.


     


    Now, the tests to measure these things are available, and some solid science is coming out, but most docs received their training before it came out. And "only certain forms of LDL are bad, but it's a complicated situation and involves inflammation" isn't exactly news headline material. So only docs who focus on lipidology and health geeks on forums are up-to-date.


     




    I have followed the study Perlmutter talked about in his book. I am not interested in anything tied to Perlmutter is what I am trying to say. 



     


     


    You will find additional studies if you advanced search the forum, but I highly recommend Peter Attia's "straight dope on cholesterol" blog series.


     




    Isn't LDL-P associated with carbohydrate consumption?




     


    I think you're thinking of triglycerides, which are associated with carb consumption, especially morning carb consumption. One of the benefits of both BP intermittent fasting, as well as the general BP plan is that your breakfast is pretty much zero carb, only a bit at lunch, and then the bulk of carbs in the evening. 

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