What should you do if you suspect that you have small LDL particles (the number one cause for heart disease in the U.S.)?
Perhaps you have one or more of the telltale features (see Who's got small LDL) that commonly signal small LDL. Maybe your doctor actually thought to check for it with a blood test.
Whichever way you come to the issue, what can you do to reduce small LDL?
Unlike large LDL particles, small LDL particles are wonderfully responsive to your nutritional efforts. Modest changes in food choices and nutritional supplements can have large effects in reducing small LDL particles and either eliminate them or convert them to the less harmful large particles, thereby reducing heart disease risk.
Among the strategies helpful to reduce small LDL are:
Reduction of carbohydrates. Reduced reliance on carbohydrates, the macronutrient that (wrongly) dominates the diet of most Americans, can yield substantial reductions in small LDL.
While large LDL particles drop by reducing by fat intake (something I do NOT advocate), small particles drop by reducing carbohydrate intake. In my program for heart disease prevention and reversal, we eliminate-yes, eliminate--wheat products. This provides a BIG effect. Wheat elimination packs a big punch because the biggest day-to-day high-glycemic food culprits are wheat products like breads, muffins, bagels, pasta, crackers, chips, pretzels, and breakfast cereals. Many people ask, "Whole wheat bread makes small LDL?!" Yes, extravagantly. "You mean the 'official' advice to increase consumption of 'healthy, whole grains' increases small LDL?" Yes, absolutely.
In fact, I regard the conventional advice to increase consumption of whole grains as the most destructive nutritional advice of the last 40 years, along with the misguided advice to reduce fat intake. Both have led to this peculiar epidemic of obesity and diabetes.
Lose weight to ideal weight. This is very important and effective, especially if accomplished via reduction of carbohydrates. Small LDL will plummet.
Fish oil. The omega-3 fatty acids from fish oil provide a small effect for most people. However, if triglycerides are high, fish oil can yield substantial small LDL-reducing effects, making LDL particles larger and less harmful.
Avoid fructose. Fructose can be found in abundance as high-fructose corn syrup, sucrose (table sugar), honey, maple syrup, and dried fruit (especially if soaked in sugar or high-fructose corn syrup). Fructose is a uniquely metabolism-distorting sugar that has exploded in the American diet and increases small LDL substantially. Avoid any food that lists any of the above ingredients.
Add raw nuts. Raw almonds, pecans, pistachios, walnuts, hazelnuts, Brazil nuts. Don't worry about the fat: It's good for you. Not only can raw nuts reduce expression of small LDL particles, they can add up to two years to your life!
Vitamin D. You should be taking vitamin D or obtaining a normal blood level of 25-hydroxy vitamin D anyway, even if you don't have small LDL. Among vitamin D's many, many beneficial effects is improved insulin responsiveness in tissues, which leads to fewer small LDL particles.
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.