Dr. Steven Gundry explains why LDL particle size matters more than total cholesterol. Small, dense LDL particles are more likely to oxidize and damage artery walls, while high triglycerides predict whether you'll have these dangerous particles. Big fluffy particles are safer.
I really don't look at people's total cholesterol counts. I really don't look at their LDL counts. In fact, it may amuse your listeners to realize that there are major international lipid meetings that occur on a yearly basis. And many of these international lipid meetings we'll have a group meeting to decide. We vote once a year as to whether we should eliminate LDL from our nomenclature in talking about people's risk factors, because most lipidologists will absolutely tell you that LDL has really no meaning. Because there are seven particles of LDL that are at least known now, and they are generously described as either big and fluffy or hard and dense. And the big and fluffy guys, I actually use for my patients the idea that LDL carries fat around your body. And these are mainly moving bands that carry fat. And if you have big moving vans, big professional moving companies, these are actually good for you. They carry fat around safely, they deposit it safely, and so much the better. On the other hand, these little hard particles are what I call little pickup trucks. These are guys who put three rooms of furniture on the back with bungee cords, and the folks have mattresses flying off down the freeway. And in fact, I think the analogy is actually really good because these little guys are the ones that get activated, get oxidized. They're the ones that burrow the endothelium, that cause the foam cells, that bring the macrophages and start this whole process. So the big guys are doing their job. It's the little guys that we have to worry about. Well, the nice thing is, it turns out that in general, triglycerides are very, very good indication of what kind of particle size you're going to make. And I use, again, the example. I'm a very simple person. I use the example of. Triglycerides are the first form of fat that we manufacture from sugars and starches. And the only time, way long time ago in our evolution we ever saw sugars and starches is when fruit ripened on a tree. And that happened to be once a year in the summer, and we needed to store fat for the winter. So it turns out that if we're making lots of triglycerides, we actually kind of overwhelm this moving van system, and we tend to make quite a few of these little pickup trucks. On the other hand, if we're not making very many triglycerides, we don't overwhelm any of these systems, and we actually don't make very many of these little guys and that's simplistic, but it's amazing how accurate this is.
