Small Dense LDL, You Don't Want It

"Krauss discovered that LDL actually comes in distinct subspecies, all characterized by still finer gradations in density and size. “It was blazingly obvious. Unignorable,” says Krauss.*49   Eventually, Krauss identified seven discrete subclasses of LDL. He also noted that the smallest and densest of the low-density lipoproteins had two significant properties: it had a strong negative correlation with HDL, and it was the subspecies that was elevated in patients with heart disease."


"What would now become apparent was that LDL cholesterol is little more than an arbitrary concept that oversimplifies its own complex diversity. The fact that LDL and LDL cholesterol are not synonymous complicates the science."


"Total cholesterol gave way to HDL and LDL cholesterol and even triglycerides. All fat gave way to animal and vegetable fat, which gave way to saturated, monounsaturated, and polyunsaturated fat, and then polyunsaturated fats branched into omega-three and omega-six polyunsaturated fats. By the mid-1980s, these new levels of complexity had still not deterred the AHA and NIH from promoting carbohydrates as effectively the antidote to heart disease, and either all fats or just saturated fats as the dietary cause."


"Everything should be made as simple as possible,” Albert Einstein once supposedly said, “but no simpler.” Our understanding of the nutritional causes of heart disease started with Keys’s original oversimplification that heart disease is caused by the effect of all dietary fat on total serum cholesterol."
Gary Taubes from chapter nine of "Good Calories, Bad Calories"


This book is a tough, magnificent read.  I kept reading and re-reading this section to try to nail it down.  The takeaways - LDL cholesterol is an imprecise term.  Diabetics and heart disease patients are most likely to have this profile:  high triglycerides, high levels of small dense LDL and low HDL.  The easiest way to treat this profile is through carbohydrate restriction.  Even those with the genetic predisposition to this 'atherogenic profile' can see a reduction in the severity of their profile through sensible carbohydrate intake.  


Unlike statins, carbohydrate restriction has no known adverse side effects.