Sometimes, small LDL is easy to get rid of. Take niacin, for instance, and it can simply disappear from your body.
But other times, it can be aggravatingly persistent. Several times every day, in fact, I need to run through the checklist of strategies to reduce small LDL with patients.
How important is small LDL? In my experience, it is among the most potent causes behind coronary plaque known. It's a big part of the explanation why some people at an LDL of cholesterol of X mg/dl will have heart disease, while others with the same X mg/dl of LDL will not. When present, small LDL particles are much more likely to trigger atherosclerotic plaque formation. Small LDL particles magnify Lp(a)'s ill-effects tremendously. The data vary but small LDL probably increases heart attack risk at least three-fold.
Here's a checklist of strategies that I advise patients to consider to minimize the small LDL pattern:
--Lose weight to ideal weight--This is very important and effective.
--Fish oil--A relatively small effect unless triglycerides are high to begin with.
--Reduction of wheat products--This can provide a BIG effect. More precisely, a reduction in high-glycemic index foods is effective. But the biggest day-to-day high-glycemic food culprits are wheat products like breads, pasta, crackers, chips, pretzels, and breakfast cereals. "You mean whole wheat bread makes small LDL?!" Yup.
--Reduction of sweets--For the same reasons as reducing wheat products.
--Add raw almonds and walnuts--1/4 to 1/2 cup per day.
--Replace wheat products with OAT products, especially oat bran. This does NOT mean oat-containing breakfast cereals with added sugar and wheat, e.g., Honey Nut Cheerios, Cracklin' Oat Bran Cereal, etc. You might as well eat candy. Buy oat bran as plain oat bran--nothing added. Use it as a hot cereal or added to yogurt, "breading" for chicken, etc.
--Vitamin D--A variable effect, likely resulting from its beneficial effects on "insulin resistance".
--Niacin--Very effective but not always enough.
Among the choices, my favorites are weight loss, niacin, and reduction of wheat products. Those will give you the biggest bang for your buck.