Which labs should I use for testing sdLDL ?

[apod]

In the past, I've been using RequestATest.com (labcorp) for NMR Lipoprofile testing / A1C measurements. I was planning on using them again for a VAP test to try to measure sdLDL, but it appears as though they no longer offer a VAP test -- and this might not be the ideal test for measuring sdLDL. I'd like to check in on the latest iteration of my diet sometime in the next month or two and see how things are looking under the hood.

So far, my transition has been:

Western Diet:

• Trigs: 155
  Total Cholesterol: 186
  HDL: 52
  Non-HDL: 134
  Blood Pressure 120/80+
  Body fat: 15%+
  Resting heart rate: 70+

Paleo diet (animal fat / butter / cheese / coconut) + IF:

• Trigs: 59
  Total Cholesterol: 199
  HDL: 71
  LDL-C: 116
  Non-HDL: 128
  LDL-P 1322
  Small LDL-P: 126
  Blood Pressure 120/80
  Body fat: 12%
  Resting heart rate: 50-60

SFA < 15g/d with carb cycling (low-fat+high-carb at a caloric surplus / low-carb+moderate fat at a deficit)

• Trigs: 56
  Total Cholesterol 132
  HDL: 58
  LDL-C: 63
  Non-HDL: 74
  LDL-P: 908
  Small LDL-P: <90
  Blood Pressure <115/75
  A1C: 5.3%
  Body fat: 8-9%
  Resting heart rate: <50

I've since moved toward a consistent high-fat, moderately low-carb (but high fiber) diet, where I could happily stay for the foreseeable future. Lately, blood pressure is down in the 95/55 - 105/65 spot. I'm limiting animal fats and concentrated sources of SFA, but there are still days that might supply upwards of 30g of SFA at ~10% calories up around 2600kcal. I've also narrowed in my IF window closer to 18/6 (as low as ~2-3hr on some days.) I'm curious to see how this moves the numbers one way or the other -- I suspect A1C has budged down a bit, HDL up a bit, and perhaps LDL-P and trigs are still down.

Would this be an ideal test for looking at sdLDL, or am I better off with another NMR Lipoprofile to compare directly against the last 2 NMR Lipoprofile LDL-P measurements ?
http://www.spectracell.com/patients/pat ... s-testing/

[hill dweller]

A very lengthy series on cholesterol, Part III addresses testing: http://eatingacademy.com/nutrition/the- ... l-part-iii

VAP is not equivalent to NMR. From the linked article:

VAP tests do not report the number of LDL or HDL particles, but they do attempt to estimate atherogenic particle number (apoB) using a proprietary formula . . . .

Thus, VAP is a proxy/estimate of particle number and not an actual count.

"only one company, LipoScience, has the FDA approved technology to do so using nuclear magnetic resonance spectroscopy, or NMR for short. The other available methodologies are ion mobility transfer and ultracentrifugation (by Quest) and separation of LDL particles with particle staining (by Spectracell). Virtually all guidelines (e.g., ADA, ACC, AACC and NLA) only advise LDL-P via NMR at this time."

This blog was posted May 2012, so it may be dated. But the point remains that VAP is distinct from NMR. Here is Spectracell's description of their product:

SpectraCell’s LPP™ test is a proprietary technology originally developed at Texas A&M University that separates the lipoproteins in blood serum by density using analytical ultracentrifugation, the CDC gold standard for lipoprotein testing, then measures the particles photometrically.

http://www.spectracell.com/clinicians/products/lpp/

A 2014 paper compares methodologies to measure particle size and number: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990359/[

[apod]

A very lengthy series on cholesterol, Part III addresses testing: http://eatingacademy.com/nutrition/the- ... l-part-iii

VAP is not equivalent to NMR. From the linked article:

VAP tests do not report the number of LDL or HDL particles, but they do attempt to estimate atherogenic particle number (apoB) using a proprietary formula . . . .

Thus, VAP is a proxy/estimate of particle number and not an actual count.

"only one company, LipoScience, has the FDA approved technology to do so using nuclear magnetic resonance spectroscopy, or NMR for short. The other available methodologies are ion mobility transfer and ultracentrifugation (by Quest) and separation of LDL particles with particle staining (by Spectracell). Virtually all guidelines (e.g., ADA, ACC, AACC and NLA) only advise LDL-P via NMR at this time."

This blog was posted May 2012, so it may be dated. But the point remains that VAP is distinct from NMR.

I suppose what I'm asking, is if I'm going to spend $100 to $200 bucks on a test (while avoiding spending $200+ on multiple tests) would I be better looking at a VAP test which will measure LDL3 and LDL4, then I can add these together to sort of measure sdLDL (while not measuring it exactly) then look at apoB as a sort of LDL-P measurement (which is also not going to give me a 1:1 comparison against my old tests which directly measured LDL-P). I would get useful "bonus" information like homocysteine / Lp(a) via the spectracell lab. Or, should I go with a 3rd NMR Lipoprofile test so I have direct apples-to-apples comparisons for these slight variations in diet -- this does provide me with a "Small LDL-P" measurement (which I'm more interested in lately), but it's not as sensitive as the VAP's LDL3+LDL4 measurements.

Ordering my own test, am I better off with a SpectraCell lab, RequestATest, or some other 3rd party (LEF?)

[hill dweller]

Sorry, I was editing my reply. There's a link to a paper there that compares methodologies. It seems to conclude that any of the methodologies in the study are more predictive than the traditional cholesterol panel. But it stops short of preferring one over the other.

[apod]

I just noticed that SpectraCell's lab does include "Total LDL Particles", which seems to be an LDL-P measurement. Yet, they're also providing LDL3 + LDL4, which seems to be a VAP measurement. The test is only $50 bucks more than an NMR from RequestATest, which ends up being a large discount if I tack on an A1C and homocysteine measurement.

It seems like the "CardioMetabolic Risk" test is the way to go?

[TheBrain]

apod, I don't have an answer to your question (I'm finally getting my first advanced lipid testing done next week).

But I'm curious about your latest test results, which show a total cholesterol of 132. I've never seen one that low—not that I've been paying close attention thus far to lipid testing. Is it optimal to have such a low total cholesterol? I do see that some of your other markers improved with the diet that yielded that number.

[apod]

apod, I don't have an answer to your question (I'm finally getting my first advanced lipid testing done next week).

But I'm curious about your latest test results, which show a total cholesterol of 132. I've never seen one that low—not that I've been paying close attention thus far to lipid testing. Is it optimal to have such a low total cholesterol? I do see that some of your other markers improved with the diet that yielded that number.

I'm not too sure. This book comes to mind:


Then again, I've also seen this video:
http://nutritionfacts.org/video/optimal ... rol-level/

During this time, I was eating ~2500-2800kcal on workout days with multiple cups of white rice, several potatoes at once, full bunches of bananas, and handfuls of dates at 400g+ carbohydrates with fats kept quite low (low SFA / low PUFA / low dietary cholesterol), often going straight from exercise into a bowl of white rice on an empty stomach without fiber/fat/protein. Then on rest days I was eating around 1600-1800 kcal and keeping carbs down around 50-100g with fat coming up close to 90-100g, while still keeping my weekly SFA average down in that <15g range (to the extent of limiting cacao / nuts.) It was an interesting diet that allowed me to eat all the fatty foods I like to eat, and all the sugary / starchy foods I like to eat, and eat them both toward their extremes, while putting on more muscle than usual and losing more body fat than usual. Interestingly, fasting TGs didn't seem to become too elevated and small LDL-P didn't come up too high either. Post-prandial glucose did seem to be getting up there. I found if I switched to a more mixed meal approach, I could attenuate the glucose spike, then I've worked down from there to a modest Gundry-inspired diet. This has maybe traded a post-prandial glucose spike for a post-prandial triglyceride / lipoprotein spike.

[TheBrain]

apod, you are a master at n=1 with dietary changes and evaluating those changes. It will be interesting to see what your upcoming test results show.

That book and that video could not be more opposite in their views about how low or high cholesterol should be for optimal health! I don't know what to believe.

[Julie G]

I completely understand what you’re trying to do, but would suggest chasing sdLDL probably isn’t necessary in your case. Given that you had a rock bottom measurement of small LDL-P from your last NMR, I can easily hypothesize with higher fat that has decreased that even further which would subsequently translate to a very low sdLDL.

Remember this from George?

From what I recall on an NMR small LDL-P lower limit of detection is 90. When I had this, my sdLDL was ~27. In any case sdLDL <90 is an excellent number! As I recall, Dr. Gundry said, "you aren't expressing any sdLDL".

FWIW, my preference is always the NMR. You get a lot of information; the best bang for your buck. I also like that you’d be comparing apples to apples. The deal on Spectracell, however, may be too good to pass up. I just saw results from one and it included sdLDL, adiponectin, and other cool biomarkers. (They may have cost extra.) Be sure to request a sample copy of results first so you know exactly what to expect. Also, keep in mind that SpectraCell uses their own reference range with regards to LDL-P- a completely different scale. You'll lose the apples to apples capability that the NMR will provide.

Like Alysson, I’m also surprised at how low your LDL-C is on your last test. Out of curiosity, were your LDL particles classified as Type A or B one that one. I bet it was close. I love how your HDL consistently stays highish (new word) for a guy- even when you drop fat. You have some helpful genes there. I'm always impressed with your experimentation, apod. Kudos to you for tracking, quantifying, tweaking, and constantly improving. IMO, you are a role model for young E4s.

[apod]

I completely understand what you’re trying to do, but would suggest chasing sdLDL probably isn’t necessary in your case. Given that you had a rock bottom measurement of small LDL-P from your last NMR, I can easily hypothesize with higher fat that has decreased that even further which would subsequently translate to a very low sdLDL.

Remember this from George?

From what I recall on an NMR small LDL-P lower limit of detection is 90. When I had this, my sdLDL was ~27. In any case sdLDL <90 is an excellent number! As I recall, Dr. Gundry said, "you aren't expressing any sdLDL".

FWIW, my preference is always the NMR. You get a lot of information; the best bang for your buck. I also like that you’d be comparing apples to apples. The deal on Spectracell, however, may be too good to pass up. I just saw results from one and it included sdLDL, adiponectin, and other cool biomarkers. (They may have cost extra.) Be sure to request a sample copy of results first so you know exactly what to expect. Also, keep in mind that SpectraCell uses their own reference range with regards to LDL-P- a completely different scale. You'll lose the apples to apples capability that the NMR will provide.

Like Alysson, I’m also surprised at how low your LDL-C is on your last test. Out of curiosity, were your LDL particles classified as Type A or B one that one. I bet it was close. I love how your HDL consistently stays highish (new word) for a guy- even when you drop fat. You have some helpful genes there. I'm always impressed with your experimentation, apod. Kudos to you for tracking, quantifying, tweaking, and constantly improving. IMO, you are a role model for young E4s.

Ah, tricky -- that's annoying that their LDL Particle number will be different than a NMR LDL Particle Number, but it makes sense. Hmm! For the price, I'm still thinking the SpectraCell gives me some interesting data for the $, and perhaps if I test again sometime much further down the road then I'll have these apples to compare against.

On the Paleo diet, with a high intake of saturated fat my LDL Size was 21.6. On the low-SFA / higher carb split, my particle size measured 21.2 -- both of these sit toward the middle of the Pattern A range of 23.0-20.6.

Interestingly, on the Paleo diet my HDL-P measured 29.3 -- marked "Low." Eating less fat, my HDL-P then became 24.5 (Very low?) While I was on the high carb / low carb split, my fat wasn't too low -- I was still eating 900-1,000 calories of just fat alone several days throughout the week on rest days from olive oil, avocado, and nuts. Perhaps this helped to bump up HDL-C a bit (I was also supplementing a little bit of fish oil.) When I was eating the high amount of carbs, this was after heavy glycolytic compound resistance exercise that was performed fasted after 16hrs+ of not eating, where I was then a bit of a sponge for carbohydrate without out too much lipogenesis / triglyceride-raising / hdl-lowering potential. I was eating a bunch of fructose at this time (200 grams+ of sugar while eating at caloric surplus) -- I suspect if I went more starch heavy rather than fruit, the numbers might have been even better.

I'm slowly figuring some things out! I feel like as long as I'm eating primarily good, fresh food in the form of mostly plants in an omnivorous diet, I should be pretty safe -- there's not a whole lot of tweaking you can do past that point. Although, you can really dig into these macros and micros and food exclusions (eg. lectins...) Lately, I've bumped up protein, but that's a whole other can of worms.