Dr. Peter Attia Ultimate Guide on Cholesterol

Cholesterol is hydrophobic, so it needs to be carried around our bloodstream using a protein transporting molecule.

The protein wrapped “vehicle” that transports the lipids are called lipoproteins. The ratio of lipid-to-protein in the lipoprotein structure determines its density:

1. HDL: high-density lipoprotein. Sometimes called "good" because it carries cholesterol from other parts of your body back to your liver, to be removed
2. LDL : low-density lipoprotein. Sometimes called "bad" as it leads to the buildup of plaque in your arteries
3. VLDL: very low-density lipoprotein, mainly carries triglycerides

LDL carries other molecules than cholesterol (LDL-C). These extra particles are called LDL-P. For example, triglycerides (TG) are also carried within LDL-particles.

Studies have indicated that if there is discordance between LDL-C and LDL-P (one low, the other high), cardiovascular disease risk tracks more closely with LDL-P than LDL-C.

So risk is high if there is a discordance and LDL-P are high. Because the particles are more to blame than the actual cholesterol.

Doctors focus on lowering LDL-C. Most will recommend eating less meat & dairy products or statins. However these interventions do little to lower LDL-P.

Interventions that lower LDL-P more than LDL-C include omega-3 fatty acids, exercise and Mediterranean and low carbohydrate diets. Although statins lower LDL-P, it's not significant.

Sugar seems to be the most harmful food category for LDL-P. Especially when sugar combines with fat.