Test to determine LDL particle size

(Marianne) #1

Hello, got a doctor’s appointment on Tuesday, 7/7/26 and I know I’m going to get the cholesterol lecture again. My HDL/trig. is 1.4. Trig. have gone down 226 points since March. My LDL and total cholesterol went up. What is the blood test I can request to determine the particle size of my LDL? Also, should I have a CAC test done? I think that’s the one that is usually self pay but that’s okay. Just want to arm myself with the positive markers to come back at her with.Thank you.

(Bob M) #2

CAC is always good.

For the particle size, for LabCorp, it’s called the NMR LipoProfile. It may be referred to as something else by another company.

This one also gives you an “LP-IR score”, which is supposedly related to insulin resistance.

#3

NMR with LabCorp, Cardio IQ with Quest.

CAC’s are good to see, but not all predicting either. Wish I remembered the test but many are switching to scanning for soft plaques vs the calcified ones since they’re the ones that move around and get you.

(Bob M) #4

If you can get your doctor to test for both hard and soft plaque, that’s better. But CAC has an excellent – though not perfect – record. It’s also $100, which you have to pay yourself where I live. The other test is way more expensive.

The other test:

coronary CT angiography (CCTA)

This says the cost is typically over $1,000:

https://www.mdsave.com/procedures/cardiac-ct-coronary-angiography/d786ffc8

If you can get your doctor to get this done, that’s best. If you have to pay for it yourself, that’s tougher.

By the way, if LDL is not causal (which I believe it is not), then LDL particle size is meaningless as a CAUSE of heart disease. That is, all LDL, regardless of size, is meaningless.

I believe that what it’s telling you is how your metabolism is working. The cause is poor metabolic health, not LDL. That poor metabolic health translates into poor mitochondrial (and possibly immune system) function, and that leads to more damage than repair.

#5

THATS the one! Definitely didn’t know it was that pricey.

Wonder if a mainstream doc that’s still misinformed on keto could order one? "Hey doc, I used to be obese and now been eating nothing but fat for years. Ever put a stick of butter in your coffee and drink lard? Ahahahaha, hey, if it works right?

(Marianne) #6

What is LabCorp and Quest? Is that where most doctor’s offices send bloodwork?

(Marianne) #7

Oh, didn’t know. I thought the larger LDL particles were more favorable in the presence of very high overall LDL. I know my PA is going to get on me - again - to take a statin.

(Marianne) #8

I was under the impression, however, that in the presence of high overall LDL, the large particle LDL was not a contributor to arterial plaque unlike the small “sticky” LDL?

#9

The two largest labs in the country, and yes almost all docs send all their stuff to those two. Many “in house” labs in hospitals are usually actually one of those two as well.

(Marcia T) #10

If you want to arm yourself with great information, check out Dave Feldman’s movie, The Cholesterol Code (2026). Directed by Jennifer Isenhart, the documentary follows citizen scientist and engineer Dave Feldman as he discovers sky-high LDL cholesterol after reversing his pre-diabetes on a low-carb diet. You can get it on Amazon prime - and probably other places. Tell your doc to watch it too - she might (might) reverse her thinking about the whole issue.

(Sean Stafford) #11

I recently got the advanced CardioIQ test with the lipids at Qwest. I ordered it because I was tired of “total cholesterol” being the focus of attention. I love my cardiologist but he was trained on pushing super low LDL for people with prior signs of atherosclerosis. 10 years ago I had a valve repair (with a blockage). 3 years ago I had endocarditis and nearly died, but endo is a bacterial infection not impacted by any LDL one way or the other. I took my results and put them in Grok and probed and probed and probed and I recommend you all doing the same to understand the complexities of lipids so you can understand the real risks. This Keto/Carnivore journey really started a year ago and I’m pretty darn happy with it.

The Cardio IQ is a great test of how healthy your LDL/LDL is. It will determine if you are pattern A (large fluffy particles that dont cause blockages) or pattern B which are more prone because of their size and density. I have TRIGs under 60 which is outstanding and a sign of metabolic health, but I also had glucose at 106 which was puzzling since I eat low/no carb, no sugars but have a few drinks a week. Some people on keto will experience glucose sparing which is an odd adaptation where your body makes glucose and sends it where it is needed and usually in the morning, that number is a bit higher because its anticipating being needed. It then drops after workout, excercise…YOu really need to dive into this detail with your medical provider. Keto adaptations might score in the red, but be perfectly healthy. Get into the weeds on all these measurements and ask AI about each one and tell it how much you adhere to a low carb plan. I was surprised it told me it was normal to have a slightly elevated (pre diabetic) glucose and AIC on the low carb diet because of adaptation. It told me my HDL of 50 and TRIGs of 58 is an outstanding market of metabolic health. But it didnt like that despite I was pattern A - LDL, I had a too many small particles (strange).
I also encourage you to get an LDL oxidation test also offered by Qwest. I just had mine today and am awaiting results. Oxidized LDL means higher risk and as much as I have been refusing a statin, I might take a smaller dose if my LDL comes back unhealthy.

Dont keep doing the standard lipid tests. If anything comes back above or below range, demand the advanced tests and deep dive into all this, talk about it with your Doc.

(Jane) #12

I experienced that when fasting a few years back. My blood glucose had been below 100 and even dropped into the 70;s then on day 3 (last day of my fast), I measured a blood glucose of over 100 and was surprised since I had had nothing but water and black coffee for 3 days.

That is when I discovered the glucose sparing phenomenon and was relieved. My body just taking care of itself!