This has been the most informative podcast that I have seen to finally put the LDL into perspective in a meaningful way to a non medical person. Thank you..

As a practising doctor of 40 years and intensely interested in the cholesterol problems and knowing that most doctors know very little about the significance of the sub fractions of the lipids, this could be the most important video on the subject.In answer to the reason why vegan diets are not the best, is because the very high carbs firstly stimulate appetite(especially sugar)and secondly the over supply is turned into triglycerides in any case.

@garybranch4383

5 жыл бұрын

As someone with high Lp(a), I'm intrigued by the suggestion that the atherogenicity of Lp(a) could also be related to particle size. This means that if one has pattern A, with very low serum triglycerides and high HDL and low inflation (as reflected by hsCRP etc) then one is a much lower risk of CAD. Prof Ron Krauss says as much when he explains that Lp(a) x2 or x3 one's risk ... meaning if all other risk factors are low, then the Lp(a) risk is lowered - conversely, unattended risk factors such a high sdLDL particle count , inflammation (mostly secondary to obesity and lack of exercise) hypertension and hyperinsulinemia ... to name a few, in the presence of high Lp(a) are a much greater risk .... unnecessarily. Until I watched this again, I didn't understand why my CT coronary angiogram reported very little plaque. Perhaps these reports of better health span and longevity in individuals is variant of the healthy individual bias in that these individuals probably have pattern A hypercholesterolemia ? There are reports of populations with longevity associated with high Lp(a) ... do these individuals also have "pattern A" LP(a) ?

@spoudaois4535

4 жыл бұрын

Sugar is bad but whole food starches are what we are supposed to eat. If one is on a low fat diet he can handle the carbs and diabetes 2 can be cured.

@howardhill3395

4 жыл бұрын

@@spoudaois4535 "what we are supposed to eat"? Not if it poisons our system.

@tenminutetokyo2643

3 жыл бұрын

Insulin drives fat storage and damages tissues.

@guillermorivera6332

2 жыл бұрын

Vegans don’t choose that diet cause is the best for their body, they simple havw the moral of don’t want to kill animals !

A topic about which there is much misinformation.Beautifully explained

This is the best explanation of sdLDL I have seen. Ken Sakaris integrates so much seemingly contradictory bits of information into a sensible set of principles. Very helpful.

Finally! Dr. Sikaris is back! The most amazingly scientific communicator of the LCHF mantra. I've missing your thoughts Sir, thanks for dropping back to educate us with somes pearls of utter wisdom. Hope the next video won't take 3 years to come to fruition.

Thanks a million ( on the behalf of all my future patients)

Why wasn't that guy suggested earlier by the youtube algorithm. Watched feelingly around 100th of Low Carb Down Under videos. So great!!!

Great lecture, thanks for the upload.

Had to watch repeatedly!

Just to clarify. The accumulation of triglycerides is the underlying lipid problem in insulin resistance and this correlates with sdLDL. However Trigs are too variable from day to day (measure to measure). Nevertheless, because HDLC reduces when Trigs increase, a low HDLC, which is not too variable, becomes a better indicator than Trig. That's why all the ratio predictors; TC/HDLC, Trig/HDLC or even LDLC/HDLC all have been found to be better predictors than Trig.I still mock anyone that doesn't realise the importance of triglycerides in metabolism, but acknowledge the ratio (esp TC/HDLC) is the best measure.

@rangerpretzel

6 жыл бұрын

Thanks so much for this recent video upload. It's a great talk. Keep up the good work!

@zambrocca

6 жыл бұрын

thank you Dr. Sikaris...waiting for you in Italy!

@zambrocca

6 жыл бұрын

somebody saying you're contractiding yourself comparing this video to another one of 2014. could you please clarify which are the best predictors and correct levels of them? thank you

@erastvandoren

5 жыл бұрын

Accumulation of triglycerides WHERE?? If you speak about muscles/liver/pancreas - then most FA are delivered via albumin anyway.

@petardotlic2670

4 жыл бұрын

@@zambrocca I feel free to speak on professor's behalf :-) ... the is no contradiction, he just shifted away from TG alone because of their variability, towards TC/HDL because HDL is a better and more stable indicator. As he says, HDL is a better indicator of TG that the TG itself. So it is still TG, via HDL, kinda, lol.

great presentation awesome perfect. thank you deeplyfromGreece

Thank you, you answered my questions, one being how to lower LDL. Blessings

i think what he is trying to say [25:4] is Small D Ldl is some function of the Integral of TriG over time. (integration smooths out the data variability)

Brilliant!!

Another great presentation! Thank you. Does this mean that apoB (or LDL-P) could be misleading for individuals with discordance between apoB and sdLDL? Have such analyzes been done?

Thank you sir

Thanks for the grate content, Is there any way to get our hands on the slides?

Does anyone have any information on the length of time damaged LDL remains in the blood ? Thank you.

Very useful info. Thanks Prof.

Hi Prof great talk, can you say if I now have my Trig at 0.43 HDL at 1.3 and LDL at 4.55 will the body undo arterial damage? TIA

Just Said, nobody has a constant colestrol it varies, this is quite logic, how much the body needs colestrol does vary.

How can TC/HDLC be a fraction? (@ 24:20) That would mean HDL was double that of total cholesterol. The goal is to keep it neer or below 3.5

24 Small Dense Low Density Lipoproteins watched this video and hated it.

Thumbs up and subscribed!

One downvote so far. I just wonder what qualification he/she has to demur with Dr. Sakiris. Sadly we will never know, as almost certainly the presentation clashes with a deeply entrenched world view. And it wouldn't go beyond the bounds of probability it would be a vegan stance.

@warriorsrule9350

4 жыл бұрын

Those were Small Density LD LipoProteins voting. Mainly the LDL5s.

Thank you. So whart is the best total cholesterol to HDL-C ratio in men and women?

I'm confused by the logic of some of this. I have total chol 9.5, total/HDL ratio of 4.4, so showing high risk. I have triglycerides of 0.8, showing low risk. But if low triglycerides indicates low sdLDL, then most of the total chol in the numerator of the ratio is LDL which must include the benign non-sdLDL. Which makes my ratio worse. So are my risk factors high or low?

@GenkiDamaSSJ

6 жыл бұрын

Derek Philpott I hope you get an answer

@erastvandoren

5 жыл бұрын

Your non-HDL cholesterol is 283, which is high risk. Nowadays non-HDL-C is viewed as the most important biomarker, because all ApoB-lipoproteins are dangerous.

@netxyz00

4 жыл бұрын

high TC and LDC is not a problem for low TG and high HDL. It is the TG/HDL ratio that is important.

Great video. One question- how does the LDL become small and dense as it hangs around in the blood? Does is lose something...? Thanks

@erastvandoren

5 жыл бұрын

It loses triglycerides.

My HBA1C decreased from 10.2 to 7.5 in one month in Keto diet and intermittent fasting. However my triglycerides increased from 92 to 240

@netxyz00

4 жыл бұрын

What is your HDL? TG changes. Do another blood test. Depending on what you eat a few days before the test, your TG may vary a lot. See videos by Dave Feldman on hacking TG & TC.

@hoon_sol

2 жыл бұрын

*_«Surprisingly, given the enthusiasm for LCHF diets in the media and from some professional commentators, we found that lower carbohydrate intake was associated with significantly greater odds of T2DM and higher HbA1c concentration. Higher adherence to conventional dietary recommendations (basing meals on starchy carbohydrates, lower fat and saturated fat contents, eating more fruits and vegetables) was associated with lower HbA1c concentration.»_*

@eugeniebreida1583

2 жыл бұрын

@@hoon_sol Could you please tell me from what study you grabbed this? Thanks much.

How many studies have shown that statins actually reduce sdLDL. And does the proportion of small dense LDL to large buoyant LDL matter? If true, and if statins lower both wouldn’t that be bad?

When you speak about triglycerides of 1, 2, 3 etc could please define what a point is with respect to the US measurement system. for example y tri's generally rn under 100, bt have been as high as 163; most recently they were at 42, following an intense workout and fast the dat before.

@xp1296

2 жыл бұрын

88.5 mg/dL = 1.0 mmol/L

"A few months ago he had a cholesterol of 4!" but the date shows a 7 year period, not a few months. 14:00

I am on daily total carbs intake of 50g. I use butter at 20 to 30g per meal as fat intake knob. No butter onto meal if there is roast pork!! . If I were to go for a blood test the next day, what is the hours for minimum & maximum fasting interval, from last meal for today?. 12 hours for minimum fasting interval and 16 hours for maximum fasting interval?. This would be revelant to meaningful result for TRIG in blood. I am on a 8 hours daily eating interval and tyically finish the meal for the day by 4pm. Regard. God bless you all out there!

Got a couple of things I didn’t know

What should the ideal TC/HDL-C ratio be? And what ratio will signify risk? He was not clear about the specific numbers on this.

@xp1296

2 жыл бұрын

4.5 or lower (based on Melbourne Pathology reference ranges in 2020)

@joeohalloran9309

2 жыл бұрын

Isn't it 1.5?

@nickbardan3867

2 жыл бұрын

@@joeohalloran9309 1.5 is the triglycerides.

Does Ken Sakiris consult with patients

Hi. Can someone please tell me what the recommended LDLC/HDLC ratio is to predict you have a sufficiently low amount of sdLDL? If so, could you please provide a link? Thanks!

@erastvandoren

5 жыл бұрын

Optimal HDL - 40 to 60mg/dl. Optimal LDL - as low as it goes (some get to 60-70mg/dl on a vegan diet, side effects are unlikely until below 40mg/dl). Very high HDL is also atherogenic.

@netxyz00

4 жыл бұрын

LDL is not important. It is higher HDL and lower TG.

small dense ldl, or ldl particle number, or are these basically the same thing?

@erastvandoren

5 жыл бұрын

All lipoproteins (which are small enough to fit into a caveola - roughly 70nm) can go through an endothelial cell. All lipoproteins featuring ApoB can be trapped inside the arterial wall. Small LDLs hang around longer, but larger LDLs deliver more cholesterol at once. It isn't completely clear if sdLDL and LPL-P are important - all ApoB lipoproteins are atherogenic.

Hyper responder here with a total cholesterol of 12.19, HDL 1.97, Triglycerides 1.11, LDL 9.7. A CAC CT scan score of 12.

@jobrown8146

Жыл бұрын

I'm a hyper responder too. 65 yo F had been low carb for 12 months when this blood test was done: TC 8.7, HDL 1.7, Trig 1.0, LDL 6.5, CAC 0. And the cardiologist recommended, not suggested, low dose statin (I said no). I feel confident from information that I have found online explaining the increase in LDL (Paul Mason video) that I have the large fluffy LDL but my low carb doctor would like me to get the LDL particle test to confirm it. However he also feels sure that the results will just confirm what we both think.

@dr.proteomix1257

Жыл бұрын

How old are you? And have you had a previous CAC CT scan or one after?

Ken, thought my old neighbours moved back and where pounding their music again. Turns out the clip on microphone on your chest was picking up your heart beat.

Some doctors on KZread say that statins increase the number of receptors on liver, and these attract and remove large ldl. They can’t remove small ldl since receptors do not recognize them. This video contradicts it. What is then the truth?

@JD-rc6lq

Жыл бұрын

He showed the study at 13:33 which demonstrated the decrease in sdldl by statin-usage. Note that if the higher liver receptor capacity successfully removes LDL before it becomes small dense that would also be seen in the result and would decrease burden on waste disposal...

Interesting, that Sikaris now contradicts what he said in 2014. Back then he was mocking everyone who was using anything else than TRG for risk prediction. Calling even particle size as 10 years outdated. Just to return in 2017 to an old school risk predictor, TC/HDL. Not only that. He uses the predictor cardiologists usually use, but promotes a hazard ratio as low as 2.5. Cardiologist establishment uses 4.0. With this bold move he basically is putting most of the Keto world above the hazard ratio. Ivor Cummins for example promoted TRG/HDL as risk predictor and his TC/HDL ratio was 3.5 in one of his videos. Which is a pretty normal lowcarb number. I am wondering myself how my lipid profile turned from excellent (TRG 81 mg/dl) and HDL at 69, which makes a TRG/HDL ratio of 1.17 to hazardous TC/HDL 3.3 when using the now promoted TC/HDL. Using one and the same lipid profile my sdLDL risk went from excellent to hazardous just by watching two different Sikaris videos. Should I now take statins... as recommend in this video to reducie sdLDL... LOL.

@billytheweasel

6 жыл бұрын

Interesting. Do you recall the title of the 2014 vid, or have a link please? Can't find it...

@derekphilpott4282

6 жыл бұрын

This is the same issue I have--see below, a couple of posts ago. The logic doesn't add up. I have TRG 70 mg/l, HDL 85, so on the TRG measure I am fine, but on TOTAL/HDL ratio I am 4.4, very bad. So what am I to make of this?

@totaletransformation9440

6 жыл бұрын

Here is the link, he was even calling the direct measurement of sdLDL 10 years outdated. I think, I won't trust not one word coming out of his mouth. In the comment section of this 2014 video, you can also find comments of Keto people with low TRG, who went for sdLDL testing and found themselves in the red zone with high sdLDL counts. At 16:20 you see his ranking of risk prediction methods: kzread.info/dash/bejne/a3Z6tMtmnquXpps.html

@zambrocca

6 жыл бұрын

in your opinion, which are the best predictors and levels?

@zedman4068able

5 жыл бұрын

You might be a lean mass hyper-responder? (Cf Dave Feldman)

I must be weird or something because my triglycerides was 0.9 yet i have sdLDL. My HDL was 1.3 My sdldl 2 was 1.03 sdLDL 3 was 0.67 sdLDL WAS 0.31 Yet I've been on lchf diet for years

@renus6015

7 ай бұрын

same... my trigylcerides are low - 41mg/dl (follow low carb plant based diet) still my small dense ldl - 49mg/dl( cut off is 21mg/dl) small dense ldl 3 - i don't know what that is my ldl - 96mg/dl (after eliminating cheese, meat, oils).

💚💚💚

Great talk and information but I need direction, how to use that information to improve my heart disease risk factors. LCHF cleared my pre-diabetes right up (insulin 30.8 at 4 months 11.0 at 7 months, HbA1c 5.3 at 4 months and 5.1 at 7 months [eating no sugar thought it would go lower], fasting glucose hovering in the 100's like 109 down to 75-80) Soooo with very high lp(a) 79.9 and trigs around 199 HDL around 35 small dense LDL (Total LDL Particles 1396) been LCHF for one a year but had this test at the 7 month mark (have another scheduled soon also had one at 4 month mark). What should I do to help with my lp(a), HDL, trigs and particle count/size? I am already LCHF (close to what dr. Westman) recommends but with higher quality food and no unnatural oils (so only , olive, meat fats, avocado, dairy [hvy cream and cheese] and small amount of coconut oil). Do I need to take a statin (despite all the bad possible side-effects)? Not to mention a very high CRP around 14-16. I think LCHF is the best way to go and pre-diabetes and trig drop (started at 450) are great but other things not coming in line yet, any advice? Anyone?

@dobe762

6 жыл бұрын

You've made good headway, there's some interesting research regarding Niacin, also Nicotinamide Ribose and its effects on raising HDL plus lowering lp(a).

@Janarae18

6 жыл бұрын

Try adding in lots of magnesium such as jigsaw slow release alpha lipoic acid k2 etc.

@GeorgeHenderson

6 жыл бұрын

Your TGs might be still be high if you're still losing weight, due to mobilised fat being recycled by the liver. The insulin and HbA1c reductions predict that CRP will be down in your next screen (and it's likely that HDL will improve too but this can happen very slowly). Mean sdLDL level in ARIC was 43.5 mg/dL so your level would probably put you in the middle of the second quantile, a lower risk category. Have you tried adding intermittent fasting to your diet regime?

@eugeniebreida1583

2 жыл бұрын

High crp = inflammation. Perhaps dairy and/or other is not your friend?

I have FH and I chose to go against my dr advice and not take statins. This guy had me interested when he talked about the stains being important for FH. However he says that statins remove SDLDL which is wrong. They remove the ability for your body to produce cholesterol in the beginning of the process not take it out!

@director2345

Жыл бұрын

Amen...Statins only inhibit the creation of all good cholesterol such as VLDL, way before the process downstream turns to good LDL and then oxidized LDL in the arteries....so statins really stop cholesterol at its source but it's not oxidized yet...so how does statins go to the end of the process to stop small dense LDL if it is only involved at the birth of good cholesterol in the liver...does a statin also inhibit HDL creation in the liver? so a statin is like a cop who blocks all the people trying to deposit money in the bank for fear that one of them might rob the bank....so, the bank now gets no money deposited...

@Connie7881

Жыл бұрын

You are absolutely correct! He got it wrong. Please listen to Paul Mason’s video at lowcarb down under.

@jobrown8146

Жыл бұрын

@@Connie7881 I thought that a statin allows the liver to take in the LDL dense particles whereas without the statin the liver is not able to accept them so they stay in the blood.

@JD-rc6lq

Жыл бұрын

He showed the study that statins reduce sdldl at 13:33. If you increase liver removal of ldl you would by necessity lower the number of sdldl (either they are removed as sdldl or b4 they can become sdldl.)

2mins 39secs; you call Fredricksen "father of lipidology": I think John Gofman deserves that title; by 1947, using an ultracentrifuge first described by Theodore Svedberg in 1927; Gofman identified the various fractions; Fredricksen started late 60s?? Dr Ron Krauss; who described small, dense LDL; and identified it as the atherogenic particle; started in the mid 1970s; and he used the Gofman centrifuge from the 1940s for all his work; he could measure LDL; Fredricksen developed the "fudge" that attempts to "calculate" the LDL level; many countries are still stuck in that 1970s technology; and advise statins solely on a putative LDL level.

8:17 mark. Makes no sense to me at all. Why on earth would a person 20 yrs old have a stroke? Seems totally impossible. How on earth can this ldl be the cause? Yes I understand these particles clogged up something but the person is 20. How on earth did his body get in such bad shape that these naturally occurring particles called ldl, caused this to happen.

OTHER THAN STATINS WHAT CAN ONE DO TO LOWER THIS AND BE HEATHLY ? i KNOW ABOUT DIET AND EXCERCISE BUT i NEED MORE ADVICE

@davidt5770

4 жыл бұрын

Lori Moose I’m not an expert - So diet includes keto and intermittent fasting and the right supplements or minerals in diet (sodium, potassium, magnesium, perhaps selenium, and not excessive iron) also the issues around Calcium (don’t take, or take with appropriate A and D3) and K2, I mention it incase you don’t know. Other things I’ve heard are good sleep, low stress, and morning/evening sunlight to get nitrous oxide to reduce blood pressure). I don’t know about a little (~tablespoon tid) of apple cider vinegar to reduce blood glucose.

I been in Ketogenic died for the last 4 months,I have had my blood test last week. My Gp was mad at me because of the high cholesterol total 13 , HDL 2.4 , LDL 9.9 , trig 1.3 Glucose normal.BP normal Any advice please I’m really frustrated

@geoffarden917

3 жыл бұрын

Hi mona hanna; your GP doesn't understand these things; if you are on keto, you will have large fluffy LDL particles; and they are GOOD; your TG/HDL ratio says you are doing very well; I hope you have stuck to your keto way of eating: we are so much healthier on it. LDL isn't an issue: it is low HDL; and high TG that are markers of illness:

@Connie7881

Жыл бұрын

Same here. I won’t worry about it.

But, but, but... statins pay for the yacht and the jet fuel bill. My Dr says I need statins or I will die. I figured this out, why can't my Dr.

statins does not prevent CVD It blocks coQ10 enzymes which are good for heart. See many other videos. If you take statins take also coQ10 also. or do LCHF diet.

@erastvandoren

5 жыл бұрын

LCHF raises LDL

@batoketo1210

4 жыл бұрын

Erast Van Doren high LDL means you are a Fat Burning Machine 👍🙂👏👏👏

Surprised he likes Statins so much. If they lower small LDL why shouldn't everyone take them?

@hurcorh

3 жыл бұрын

I don't think he's a big Statin fan compared to a 'regular' Doctor. He was clear that in healthy individuals there is no benefit to taking statins and only a marginal benefit if you have diabetes but for people with familial hypercholesterolemia has a 80% benefit. He also said they work because they make small dense LDL disappear and if you're a normal healthy individual you don't have small dense LDL whereas if you have familial hypercholesterolemia you have small dense LDL.

To reduce insulin resistance, lose weight. What prevents you losing weight? Insulin resistance. 🤷‍♀️

@scrimmo

3 жыл бұрын

That is not how not losing weight works. To lose weight you follow the laws of physics - calories in < calories out. Those laws can’t be broken

@YiannisDoritis

2 жыл бұрын

Insulin Resistance can be reversed by Intermittent Fasting. I know from experience. From a fasted blood sugar of 115 I went back to normal of 80 - after just a few Weeks of Low Carb, High Fat - 2 meals a day - which is now a one meal a day! My LDL is now a bit high - but low TG & Good enough HDL 🙏🏽

@JD-rc6lq

Жыл бұрын

​@@scrimmo If you want to build muscle do you follow the laws of physics or apply biological principles? Let me know if there is a way to violate the laws of physics while doing hypertrophy training so I don't "cheat". Lol.

This guy’s opinion on statins contradicts with Paul Mason and many others’ understanding! Do your own research.

6:50 is BS. Of course sdLDL can/should/does go back to the liver. The problem is only, that the smaller LDL particle becomes, the worse is its ApoB affinity to the LDL receptor.

@erastvandoren

5 жыл бұрын

Also the sequence of events at 6:50-7:15 is also BS. LDL can and does go through the endothelial cells all the time. Back and forth. There is a system inside the endothelial cells consisting of caveolae and microtubules, which transports LDL/HDL through the cell. After that, ApoB can be trapped by the proteoglucans, after that LDL can become oxidized, after that oxLDL is eaten by a macrophage.

@erastvandoren

5 жыл бұрын

There you go - at 9:06 graphic by D. Krauss pictures the events exactly as I described them.

@erastvandoren

5 жыл бұрын

13:20 - statins do inhibit HMG-CoA reductase, which upregulates LDL receptors, which upregulates LDL clearance from blood. sdLDL among them. Which directly contradicts what you said at 6:50.

@erastvandoren

5 жыл бұрын

14:10 - few months ago?? It was 7 years ago!

@erastvandoren

5 жыл бұрын

14:23 - what happens here are the deleterious effects of the high-fat diet. Period.

The way this guy is publicly shameless contradicting himself is breathtaking... :) Watch his lectures from 2014. He was telling Triglycerides are the only reasonable measurement and now he tells you that Triglycerides are not what to look for... and the Keto crowd still applauds this contradicting nonsense... Great stuff. Only possible in a diet world, in which science gets influenced by religious belief...

@egadzitsme

6 жыл бұрын

In science new observations lead to new ideas and theories to test. The understanding of the mechanisms and predictors behind heart disease is currently expanding and changing at a rapid rate, which is fantastic for all of us. Contradiction is not a sign of falsity.

@netxyz00

4 жыл бұрын

It is lower TG and high HDL, so it is the TG/HDL raito. He is not contradicting himself.

Low carb keto diets increase mortality. Just google all cause mortality wth Keto diet.. Then google all cause mortality on plant based diet.