NMR Lipoprotein Interpretation Made Simple

Many people, including most doctors, are overwhelmed when they first receive the results of a NMR lipoprotein analysis. 

Here is a simple way to understand and then apply everything you need to know by addressing a SINGLE VALUE on the panel. 

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Why Heart Disease Still Progresses

William Davis, MD 0:00

Hello everybody, I'm Dr. William Davis. If you don't know who I am, I practiced cardiology for about 30 years, including the last several years, focused more on prevention of coronary disease, the disease that I managed in the CATH lab for many years, putting in stents and opening arteries and those kinds of things. But it became clear that it's actually quite easy to put a stop to the progression of coronary artery disease. If you track it, for instance, by doing uh CT heart scans that generates a coronary calcium score. You often hear people say things like, you can't reduce the score. Yes, you can. In fact, most of the people I deal with have reduced their score. We have published some of those data. I should do a better job of publishing more data. But when you're in private practice, when I did a lot of this, it's kind of hard to publish when you're not part of a university and you don't have the funding of the drug industry, the people with money. Nonetheless, so I can tell you uh how I did this. But one of the things that if you've been following my videos, you'll see that I've rejected, I rejected many years ago, the idea that cholesterol values, like LDL cholesterol, is the thing that drives heart attacks, sudden cardiac death, the development of symptoms that leads to heart capitalization, stent implantation, bypass surgery. My disappointment with those

Coronary Calcium Scores And Reality

William Davis, MD 1:16

kinds of numbers began many years ago when we helped publish these data. So just for background. If you have a carneur calcium score as an index of total atherosclerotic plaque volume, not of hard plaque. If that confuses you, see my other videos where I talk about why a calcium score is not an index of hard plaque, as is often said. Carnec calcium score, yes, itself calcium is hard, but it's a it's a gauge of total atherosclerotic plaque in all of its forms. Fibrous tissue, inflamed tissue, soft tissue, inflammatory tissue, calcium, etc. So the calcium score is an index of total atherosclerotic plaque. If you had a score that was say high-ish, like 400, which is pretty high, what happens if you did nothing a year later? It would be 25% higher. That's well established. So 400 now, a year later 500, another year later 625, more or less, right? And every leap ahead, you're closer to dying, heart attack, and those other things. What if you took a high-dose statin cholesterol drug that reduced your LDL cholesterol rock bottom, say maybe 50 or 60 or 70 milligrams per deciliter, and you took a baby aspirin, and maybe a beta blocker, and you cut the saturated fat in your diet, and you had an exercise program, right? All the things that my colleagues advocate. How fast, how quickly would your carneur calcium score increase? 25% per year. It's almost, it seems like a cruel joke, doesn't it?

Why Statins Don’t Stop Plaque Growth

William Davis, MD 2:54

So that was very unsatisfactory to me. That was unacceptable. Even though many of my colleagues simply said, well, just don't repeat the calcium score, let the score go up, and then deal with the heart attack when it happens, which I think is a lousy answer, because you likely now have gathered that half of heart attacks end in death at home or en route to the hospital. So that's a lousy answer. So, what could we do? Well, one of the things I did many years ago was reject cholesterol as a measure of risk and reducing cholesterol as a way to gain control because it clearly does not work.

Switching From Cholesterol To Lipoproteins

William Davis, MD 3:30

And so one of the improvements I engaged in was to measure lipoproteins, that is the particles in the bloodstream that are solubilized, that is, they're soluble in an aqueous environment, your serum or your plasma, by the combination of fats that are aqueous insoluble, coupled with proteins and phospholipids and some other things that solubilize those particles, made them soluble in the bloodstream. So those are called lipoproteins. So one of the things you can do is to actually measure lipoproteins. Now, 30, 40 years ago, there were a variety of ways to do that. These competitive methods such as ultra-centrifugation, gel electrophoresis, and nuclear magnetic resonance, NMR. Well, over the last 30 years, NMR has pretty much proven to be the method of choice. There's nothing wrong with those other methods, but NMR was inexpensive, it's easy to do, you can repeat it. The problem is the report yields about a dozen different measures. And most of my colleagues throw their hands up in frustration because they don't know how to interpret it, they don't know what to make of it. They get various measures such as various fractions of HDL particles, various fractions of VLDL particles, and of course the various fractions of LDL particles, not LDL cholesterol, low density lipoprotein particles. And you get some other things, they'll do a calculated insulin resistance index. But here let me show you how to make this very, very easy.

The One NMR Number That Matters

William Davis, MD 4:58

You only need one value, and that's the small LDL particle number. Okay? So of the dozen or so values provided to you in an NMR panel result, all you want is the small LDL particle number. So at the start, if you have risk or you have caronary disease, the typical number would be 1800 nanomoles per liter, particle count per liter, particle count per volume. Okay? It may be part of a total LDL particle number, say of 2400, meaning 2400 minus 1800 600 nanomoles per liter of large LDL. But you that's okay, but don't worry about that. The only value you need is the small LDL particle number. Well, and you can ignore the other numbers. Here's why. The small LDL particle number is the first domino. Remember when you lined up dominoes when you were a kid? And maybe you lined up 60 dominoes? You push the first one down, what happens to the rest of them? They all go fall down, right? You don't have to know what's on the second or the fifth or the twentieth or the sixtieth domino because they will all fall just by you pushing that first domino down. Same thing here. If you know its small LDL particle number is, everything else will follow. What happens if you do something about that small LDL particle number? If you want to know what to do, see my other videos. It's very easy to get rid or minimize small LDL particles. But let's say you took the steps that got rid, got rid of small LDL particles, such that maybe you're down to zero or you want to get to 200 nanomoles per liter or less. And by the way, to convert those numbers to make to make them understandable in terms you might understand better, take the LDL particle number, whether it's total or small, drop the last digit. So let's say we try to get your small LDL particle number down to 200 nanomoles per liter, the LDL cholesterol rough equivalent would be 20 milligrams of death. It gives you some perspective on what that means. So you take steps to minimize or eradicate small LDL particles. What else follows when you engage in the list of steps you take to do

The Domino Effects Of Lowering Small LDL

William Davis, MD 7:19

that? Well, HDL will go up. HDL particles will get larger and thereby more protective. VLDL will go way down. Triglycerides go way down, typically below 60 milligrams per deciliter. Insulin resistance goes down. Inflammation goes down. Your blood pressure goes down. Measures of inflammation like C reactive protein, interleukin 6, interleukin 1 beta, TNF alpha, even your white blood cell count, all go down. Your liver markers like AST, ALT, that signal fatty liver and deposition of fat, triglycerides in your liver, they go down. Your abdominal visceral fat, that's a source of inflammation, goes down. Your waist circumference shrinks, and you're losing abdominal visceral fat, the inflammatory fat that drives risk for cardiovascular disease and drives small LDL. So, in other words, you just take the steps to eradicate small LDL particles and everything else follows, just like those dominoes. Now, ironically, this was the reason many of my colleagues dismissed the value of measuring small dense LDL particles because they said, well, if it doesn't occur in isolation, what good is it? Well, the opposite is true. Because it occurs in this entire universe, this whole collection of abnormal phenomena that in total takes you down the path of coronary disease, progressive carnial calcium scores, and all those nasty events. So all you need from that NMR panel is your small LVL particle number. And you want to get it down to less than 200, 200 nanomoliter or less, or ideally even zero. Can you get it to zero? Most people, the great majority of people can. It's rare to not respond to the basic efforts. And please see my other videos to how

How To Reduce Small LDL Particles

William Davis, MD 9:09

to do that. But in a nutshell, it's errat eliminate the foods that trigger formation of small dense LDL particles. Wheat, grains, and sugars, not saturated fat. That's ridiculous. It's the amylopectin A of wheat and grains and any sugar, sucrose, glucose, fructose. We address common nutrient deficiencies that are common in modern life, that when combined, minimize insulin resistance and inflammation, vitamin D, omega-3 fatty acids, magnesium, and iodine. They seem random, but they're not random. They address common nutrient deficiencies and they synergistically act to minimize insulin resistance and inflammation. And lastly, we address the disrupted microbiome because a disrupted microbiome, especially if it involves a small intestine, small intestinal bacterial overgrowth, which is wildly out of control. I would say it's epidemic in this country. At least half the country has this now, driving risk for multiple diseases, including type 2 diabetes, dementia, as well as coronary disease. We address SIBO and endotoxemia, and we do it with microbes as what I call SIBO yogurt. So that's a whole nother conversation. Please see all my conversations about that, including the recipes I post in my blog, WilliamDavismd.com, as well as my books, like Super Gut. Bottom line, all you need when you get that NMR panel, don't be intimidated, don't be confused by the whole bunch of numbers I give you. All you want is the small LDL particle number. Ignore the rest. Because if you tackle the small LDL particle number and get it down, everything else will follow, just like that bunch of dominoes.

SIBO, The Microbiome, And Endotoxemia

William Davis, MD 10:54

Now, if you'd like some guidance, if you want some help, you want some camaraderie discussion about these kinds of things, I invite you to join my conversation. Including nearly every week, we have about a two-hour conversation to talk about these kinds of things. Me and usually about a hundred some people show up and we talk about it for about a couple of hours, as well as we have a busy forum where we discuss these kinds of things. We have our own internal artificial intelligence because we reject a lot of the information that comes from outside of our own resources. Because I don't know if you know this, there's nothing wrong with AI per se. It's the input to AI for health questions. It comes from such things as the Mail Clinic or Cleveland Clinic or WebMD, because most science, most scientific journals, have blocked the access of AI bots. And so you don't get science when you do an AI search. So we did we develop our own artificial intelligence in our own drawing from our own resources. So if you want an answer that's appropriate and relevant to the program, you've got AI, internal AI. We've got lots of other resources, including our extensive video library. Uh, if you have if you want to dive deeply into these kinds of issues. But that's in the inner circle.dr Davis Infinite Health dot com.