How to Read Cholesterol Particle/Fractionation Tests

Patients often come to me with questions
about their lipoprotein fractionation or their cholesterol fractionation studies.
I tend to steer them away from that and it’s not so much because the
fractionation studies are not true. It’s not so much because they’re not relevant.
It’s really more of an issue of priorities. As we’ve mentioned before
multiple times and most viewers of this channel know this. Over half of people
that have heart attack and stroke have normal cholesterol or LDL values. So
getting way deep into LDL is usually not the top priority. For most folks again
the top priorities lifestyle. It’s getting to a proper relative fat mass, a
proper exercise pattern, a proper macronutrient or diet focus; but again
because there’s so much discussion out in the rest of the medical community and
with patients, I thought I’d do a quick video to cover just what is lipoprotein
fractionation or cholesterol fractionation, and what does it mean? What
do you do with it? Well as you see from this picture. This is a cholesterol
fractionation. This is looking at the different types of particle populations.
You’ve got HDL which is known as the good cholesterol. It’s the smallest and
densest of them all. Then you’ve got LDL which is known as the bad cholesterol.
It’s a little bit larger and here you’ve got LP(a) which has that Kringle
repeat section on it. We’ve got several videos on LP(a) and I’m not going
to go there on this video. We’ve got VLDLs or very low density lipoproteins
and chylomicrons. We’re not going to cover the VLDLs or chylomicrons other
than just to make a quick mention, a few minutes from now. Actually I’ll go ahead
and make some of that mention now or some of that point now. What’s the
difference between these families? For the most part, it’s
size and amount of fat in it. The H and the L and the VL stand for
high-density or HD, VL, LD. High density, low density, intermediate density, and
very low density proteins. In other words remember this. Protein – it’s put – these
particles are made of protein and – and fat. It’s protein on the outside with the
hydrophilic layer, the part that touches the water in the blood on the outside.
And a lipophilic or oil-loving or fat loving component of the protein on the
inside. So that’s how the packet is made. We’ll cover that a little bit later.
That’s a little bit of a digression right now. Let’s go back to the – the focus
on the fractionation pattern itself. So what the fractionation is doing. It’s
looking to see okay, how much of the LDL is in this very unhealthy section, the
small dense LDL, because we know that those are the ones that – of the LDL
related risk, the SD, small dense LDLs are the ones that – that have the most risk.
Now we used to say they slipped into between the cells of the intima, the
damaged intima. Recent research has shown that no that’s – that may be the case but
actually small dense LDL is actually transported from the bloodstream through
the intima lining cells. So again you know, there’s always something new coming
up, something there to learn. So based on that assumption that it’s important to
look at – look at what, how much of your population is these small dense LDLs,
then we get into a thing, the labs will get into a thing called fractionation
and I’ll cover that fractionation again in this video. First of all, for the
lipoprotein fractionation, what the lab report
summary looks like. This is a typical patient. Actually this patient’s doing
fairly well for the most part but he’s still got a little bit of smaller LDL
particles and more of those smaller particles then we want. That’s what this
shows us but it doesn’t show us a whole lot like any summary. Let’s get into more
of a visual look at it. Now, visually again what the the fractionation process
is doing is measuring the number and density of these populations. So you
remember the HDL were clearly the smallest and the densest so they’re over
on the left hand side. LDL was the next up so they’re on the right hand side. In
both populations, as you can see from this green and red on the population
indicators below, it’s healthier to have the larger less dense HDL. It’s also
healthier to have the larger and less dense LDL. On this patient, it could be a
little bit better if they were if these peaked over at in the large category but
they don’t, but you also see the vast majority of this patient LDL particles
are really on this larger end. We don’t have a peak over here which is, again, if
you’re looking at LDL related risk that would be – well that would be the peak
that would be more of an LDL risk. Underneath that you have some numbers
which again help you for the people that rather look at numbers than images
themselves. This person has what’s called a B
pattern. In that, it doesn’t peak here at the highest. It does peak a little bit
lower but again so that’s – I get so many patients that come to me saying, well you
know I’ve got a B pattern, that’s a real problem. I’ve been working
a lot and I’m struggling with it; and my advice for reasons I’ve already
discussed is let’s worry – let’s put the B pattern LDL stuff, the whole
fractionation thing aside, and let’s focus on our priorities. I can explain it
to you like it I have in this video but again let’s focus on our priorities. Now,
again I got into – in this video, we got into a lot of details. Apolipoprotein,
which is the protein part of the – the packets. We got into fractionation and
looking at the details of the differences between the different
populations. Let’s go way back up to about 30,000 feet and talk about for
just a reminder, why do we have those proteins and why do we put the by – the
fats and oils in our bloodstream and tiny microscopic packets anyway? Well, a
basic component, oil and water don’t mix. If you – we all know that and we all know
if you got what a glass of water and you pour oil in it, it would form a big blob
at the top. If that happened in our bloodstream, that blob would cut off the –
it would lodge somewhere and cut off the flow of the blood which is 90 – over 95%
water to the – that tissue. That’s the same thing as a a clot embolus and – and
embolous, that’s embolus is the medical term that we use for something that
flows through the blood stream, is not the same consistency as the rest of the
blood so it can lodge somewhere and cut off the blood supply. So you can have fat –
and a fat embolus just like you can have a clot embolus. We talked many times in
many videos about forming clot embule- embolus or emboli which is the plural
using hot – when hot plaque touches the blood – liquid blood. Now where’s – where are the
cases when this actually happens in human life?
With large wrecks. So orthopedist that see patients that have been in a 60
mile-per-hour wreck and have multiple broken bones. When you get those kind of –
that kind of trauma you get especially to multiple large bones, the bone marrow
has a lot of fat in it and quite often these fat globules will just get into
the bloodstream and form an embolus. These people can have heart attacks,
strokes, kidney major chunks of tissue taken out by these fat emboli. Surgery is
in its basic form, of a form of trauma as well; and this was a headline from a
woman that died from a fat embolus attributed to surgery. So again that gets
us back up to maybe 30,50 thousand-feet after we spent a little bit of time in
the weeds. If you made it that far with me, thanks again for your interest and
attention; and again let’s not get too focused on LDL. It’s important but most
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