Size Really Does Matter

By Dr Ernst
May 26, 2017

Hey now… we’re talking about cholesterol here.

If you’re in your 30s or 40s or above, you can probably relate to what seems like an endless debate over certain nutrients, health markers and foods. Coffee is good for you; no it’s bad. Wait.. it just depends. Butter is bad, eat margarine. Wait, margarine is a nightmare, eat butter… bot only if it’s grass fed! And cholesterol. It used to be universally considered bad for you. Then it was separated into either LDLs (bad) or HDLs (good).

But guess what? It’s not that simple! What we’re now discovering is that the degree to which cholesterol is either good for you or bad for you depends on the size of the individual molecules.

Take LDLs for example. There are four main types: “A” size, “B” size, the “A/B” size and Lp(a). The LDL molecules in an A size type are quite small, where the B size are larger and the A/B size is a combination of small and large LDL cholesterol molecules.

While none are preferable to have in high quantities, the A size molecules are problematic. Their small size allows them access to damaged a smaller blood vessels and makes it more likely for them to cause clogs–which as you know are what lead to heart attacks and stroke.

Think of it this way, if you have a 4-lane highway, and on that highway, 10,000 people are being transported in some way or another. In one scenario, every one of those 10,000 people is in their own, small car. That freeway is going to be much more congested than if those 10,000 people are all filling every seat of 500 busses.

But what’s even worse than that are the Lp(a) LDLs. They have a higher potential to clot than any other type of LDL. So to use our highway analogy again, imagine the 10,000 drivers all in their own little cars, but in this scenario, the cars are sticky. If there’s any kind of accident, they’re going to immediately form a barrier. That’s the potential problem of large vs. small LDLs.

HDLs, widely regarded as “good cholesterol” because of their ability to collect LDLs and carry them away from problem areas, have different types as well.

There are subtypes of HDL, such as HDL2 and HDL3. Both of these fractionate with greater ease than regular-old HDL (fractionate means they break up into smaller pieces). So again, the larger type of HDLs, the better.

The same principle applies to triglycerides. You want larger molecules rather than smaller ones.

There is a test you can take to determine what type of cholesterol molecules you have in your system. It’s called a NMR Lipoprofile. This test basically counts the number of LDL particles in your blood. The more particles, then the smaller they must be, thus your cholesterol profile is a bigger problem. This test also looks at your level of insulin resistance, a great indicator of your risk for Type II diabetes.

A note on the cholesterol myth

Cholesterol, being a naturally occurring phenomenon in the human body, has its uses as nothing is without a purpose in our biology. Cholesterol forms the molecular basis for everything from our cellular membranes to our hormones to the neurotransmitters in our brains.

Furthermore, the idea that cholesterol buildups in blood vessels is the cause of heart disease and stroke is false. The cause is inflammation. Imagine things like sugar or various toxins like sandpaper. As it travels through your bloodstream, it scrapes up against the inside of your blood vessels. Not only does this cause inflammation, it simply damages the blood vessel walls. Cholesterol travels to these damaged areas and forms a protective layer–a buildup if you will. So, in essence, cholesterol is a protective mechanism and not the problem itself. The problem is what you put in your body that causes damage and inflammation in the first place.

Therefore, the goal should not be to minimize LDL (and its sub-types) and/or maximize HDL (and its sub-types). The goal is to maintain a balance of the two. Most of us in the West are higher in LDLs, which come from unsaturated fats and omega-9 fatty acids (vegetable oils, mostly). So, to strike that balance, eat more Omega-3 fatty acids in fish, avocados, coconut oil, etc.

And don’t believe anyone who says size doesn’t matter.



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