Exercise. Exercise reduces small LDL. Drawback: The effect is short-lived, lasting only a few days. Exercise therefore needs to be regular to obtain a small LDL-reducing benefit.

Niacin. Niacin, or vitamin B3, at therapeutic doses is very effective for reducing small LDL, as well as increasing HDL. While standard "immediate-release" or "crystalline" niacin at the health food store works quite well, it creates an annoying "hot flush" effect, i.e., a hot prickly feeling over the neck and chest that usually lasts 30-60 minutes. Slow-release niacin sold in stores, on the other hand, has been associated with liver toxicity. So-called "no flush" or "flush-free" niacin doesn't work at all - it's a scam product. What's left? We use a brand called Sloniacin®, a form of niacin sold in pharmacies that releases into the bloodstream over approximately 4-6 hours, yielding less "hot flush" and low risk for liver toxicity. The effective dose is 750-1000 mg, occasionally higher; niacin is best taken under the supervision of your healthcare provider.

Having small LDL particles is not good. It represents an aggressive cause for heart disease and heart attack. But there's good news: You have substantial, often total, control over small LDL particles. You can reduce small LDL dramatically, often eliminate them entirely, by following strategies like those above.