LDL-P (LDL Particle Count) Levels
Hopefully, you have read my page on
LDL-P - The Most Important Number for Plaque Reversal. If you haven't, I suggest at least a quick
scan, because the beauty of the LDL-P number is that it is a fantasic dietary policeman. It seems to capture just about everything that one can do wrong in a diet and encapsulate it into one number. (That's not quite true, however, and there are definitely other markers you should follow.) For example, if you eat too much saturated
fat, your LDL-P will often go way up. Likewise, if you eat too many refined carbs, your LDL-P will also likely shoot up. It have Metabolic Syndrome (prediabetes), your Particle Count will also likely be artificially elevated. In other words, it also does a good job of essentially flagging insulin resistance. Basically, LDL-P
keeps everybody honest, whether you are Paleo, Low Carb, Vegetarian/Vegan or Low Fat and makes sure your diet is doing what you think it is doing.
I also want to mention that LDL-P is merciless and the reason is that it is a gradient-driven chemical process. This is why it is so important to pay attention to this number. If you had high school chemistry, you may remember what I am talking about here. A gradient refers to the situation where the concentration of a molecule, in this case an LDL particle, is higher than on the other side of the membrane. If the membrane is porous, there will be a "force" or "pressure" to try to equalize both sides of the membrane. What this means is that LDL, when the Particle Count is too high, is driven into your arterial walls by simple chemical processes, where they can do little except cause inflammation and plaque.
So how do we keep those LDL particles floating along in our blood instead of imbedding themselves in our endothelium? Basically you have to somehow lower your LDL-P enough to keep that from happening. Unfortunately, as far as I know, no one has studied an exact level of LDL-P to target for plaque reversal. Does this make LDL-P useless? For example, I have a page on my site where I discuss
HDL, LDL and Triglyceride Levels for plaque reversal according to the men that I call The Plaque Reversers. However, there are no such guidelines (with one exception) for LDL-P.
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In spite of that, I think we can make a reasonable estimate for a Target LDL-P based on several lines of evidence and a bit of common sense:
1. Dr. Davis' Target (700 nmol/l). I recommend every man read this book on plaque about ten times. You can read my praise and appraisal of it here:
A Review of Track Your Plaque. It has the best coverage of cardiovascular markers for the layman that I have read and is just great info. And one of the sections in the book covers Dr. Davis' recommended LDL-P for plaque reversal which is
700. Now my one comment is that Dr. Davis tends to have very aggressive thresholds compared to either Dr. Gould or Dr. Esselstyn. I think the reason for that is that Dr. Davis wants to make sure that virtually every man and woman that tries for plaque reversal actually achieves it and thus sets aggressive targets.
The bottom line is that, if you want to play it very safe, then you should probably shoot for his target. However, as an example, Dr. Davis recommends LDL-C levels below 60 mg/dl and
I have seen other reliable sources recommend between 70 and 80 for plaque reversal. Basically, Dr. Davis wants to save as many lives as possible and that is certainly admirable!
2. Aim For the 2nd or the 5th Percentile. In a person who is diabetic or prediabetic, using LDL-C (the traditional LDL value) is risky. The reason for this is that those individuals often have a high LDL-P even though the LDL-C is much more reasonable. Studies show that having high LDL-P even with low LDL-C places you at high risk for heart disease. And odds are that a high percentage of men who make it to my site are probably prediabetic or diabetic, since those go hand-in-hand with erectile dysfunction and low testosterone so often.
Nevertheless, pretend just for a minute that LDL-C is always valid. The Plaque Reversers do this in their patients by insisting that they have low triglycerides and reasonably high HDL, something that is uncommon in those with insulin resistance. Thus, if you properly control these other two lipid markers (HDL and triglycerides), LDL-C is usually going to be a decent target value for you and the Plaque Reversers want your LDL-C between 60 mg/dl and 85 mg/dl.
Getting your LDL-C in this range is no small task for the typical American. For example, the Framington Offspring Study showed that only 5% of participants had LDL-C less than 78 mg/dl. And this is my point: the Plaque Reversers are trying to get your LDL-C into the top 5%. In other words, you need to be the best of the best to avoid plaque.
Now what is the corresponding LDL-P number? The same Framington Offspring Data showed the 5th percentile of LDL-P to be 850 nmol/l.  Therefore, I suspect that 850 is a very good starting number to shoot for for many men, but, again, there is no data to prove or disprove this.
Therefore, to play it safe you may want to target the 2nd percentile. The 2nd percentile of LDL-C was 70 mg/dl. 70 is an excellent LDL number and when accompanied with low triglycerides (less than about 90) and would give you a high probability of plaque reversal. What LDL-P does this correspond to? It turns out that the 2nd percentile of LDL-P is 720 nmol/l, which is almost exactly Dr. Davis' target value. Obviously, being in the top 2% of Americans or any modern culture is a much, much safer place to be, considering the rampant heart disease (and complications such as erectile dysfunction) that dominate the general population.
CONCLUSION: 700-850 nmol/l is probably a good range to target for LDL-P, depending on your existing plaque levels and cardiovascular risk. Using a knowedeable cardiologist to assess risk is the way to go, but there are few that are knowledgeable in plaque reversal according to what I have seen.
Get an IMT or Heart Scan - generally speaking you will not need a doctor's order and can get this done yourself - and see how much plaque you have. (A Heart Scan does involve some radiation, so you have to research that.) If you have a significant amount of plaque, then you want to probably get as close to that 700 number as possible, since the only recommendation that I know of for arterial plaque reversal is Dr. Davis' 700 number.
Again, it is always better to find a cardiologist or physician that knows about plaque reversal and can help you out. (Most doctors are uninterested in this subject yet and will just hand you a statin and some Cialis and send you on your way.)
I also recommend that you read pages on
How to Clear Your Arteries and The Importance of LDL-P For Plaque
Reversal.. LDL-P is the best number to use. In the case of the latter, I make the case that LDL-P is a much better number to use than LDL-C,
because so many men in modern cultures are prediabetic. If you do not have access to testing for LDL-P, which is common in other countries and
in certain (Gestapo-like) states in the U.S., then you can use the a combination of LDL-C, triglycerides and HDL like the Plaque Regressers
to approximate LDL-P. See my page on HDL, LDL and Triglyceride Levels.
1) J Clin Lipidol,m 2011 Mar-Apr, 5(2):105-13, "Clinical implications of discordance between low-density lipoprotein cholesterol and particle number"
2) American Assoc of Clinical Chemistry, 2009, 55:3, "Apolipoprotein B and Cardiovascular Disease Risk: Position Statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices"