Patients often come to me with questions about their lipoprotein fractionation or
their cholesterol fractionation studies. I tend to steer them away from that and
it's not so much because the fractionation studies are not true. It's
not so much because they're not relevant. It's really more of an issue of
priorities. As we've mentioned before multiple times and most viewers of this
channel know this. Over half of people that have heart attack and stroke have
normal cholesterol or LDL values. So getting way deep into LDL is usually not
the top priority. For most folks again the top priorities lifestyle. It's
getting to a proper relative fat mass, a proper exercise pattern, a proper
macronutrient or diet focus; but again because there's so much discussion out
in the rest of the medical community and with patients, I thought I'd do a quick
video to cover just what is lipoprotein fractionation or cholesterol
fractionation, and what does it mean? What do you do with it? Well as you see from
this picture. This is a cholesterol fractionation. This is looking at the
different types of particle populations. You've got HDL which is known as the
good cholesterol. It's the smallest and densest of them all. Then you've got LDL
which is known as the bad cholesterol. It's a little bit larger and here you've
got LP(a) which has that Kringle repeat section on it. We've got several
videos on LP(a) and I'm not going to go there on this video. We've got
VLDLs or very low density lipoproteins and chylomicrons. We're not going to
cover the VLDLs or chylomicrons other than just to make a quick mention, a few
minutes from now. Actually I'll go ahead and make some of that mention now or
some of that point now. What's the difference between these families? For
the most part, it's size and amount of fat in it.
The H and the L and the VL stand for high-density or HD, VL, LD. High density,
low density, intermediate density, and very low density proteins. In other words
remember this. Protein - it's put - these particles are made of protein and - and fat.
It's protein on the outside with the hydrophilic layer, the part that touches
the water in the blood on the outside. And a lipophilic or oil-loving or fat
loving component of the protein on the inside. So that's how the packet is made.
We'll cover that a little bit later. That's a little bit of a digression
right now. Let's go back to the - the focus on the fractionation pattern itself. So
what the fractionation is doing. It's looking to see okay, how much of the LDL
is in this very unhealthy section, the small dense LDL, because we know that
those are the ones that - of the LDL related risk, the SD, small dense LDLs are
the ones that - that have the most risk. Now we used to say they slipped into
between the cells of the intima, the damaged intima. Recent research has shown
that no that's - that may be the case but actually small dense LDL is actually
transported from the bloodstream through the intima lining cells. So again you
know, there's always something new coming up, something there to learn. So based on
that assumption that it's important to look at - look at what, how much of your
population is these small dense LDLs, then we get into a thing, the labs will
get into a thing called fractionation and I'll cover that fractionation again
in this video. First of all, for the lipoprotein fractionation, what the lab
report summary looks like. This is a typical
patient. Actually this patient's doing fairly well for the most part but he's
still got a little bit of smaller LDL particles and more of those smaller
particles then we want. That's what this shows us but it doesn't show us a whole
lot like any summary. Let's get into more of a visual look at it. Now, visually
again what the the fractionation process is doing is measuring the number and
density of these populations. So you remember the HDL were clearly the
smallest and the densest so they're over on the left hand side. LDL was the next
up so they're on the right hand side. In both populations, as you can see from
this green and red on the population indicators below, it's healthier to have
the larger less dense HDL. It's also healthier to have the larger and less
dense LDL. On this patient, it could be a little bit better if they were if these
peaked over at in the large category but they don't, but you also see the vast
majority of this patient LDL particles are really on this larger end. We don't
have a peak over here which is, again, if you're looking at LDL related risk that
would be - well that would be the peak that would be more of an LDL risk.
Underneath that you have some numbers which again help you for the people that
rather look at numbers than images themselves.
This person has what's called a B pattern. In that, it doesn't peak here at
the highest. It does peak a little bit lower but again so that's - I get so many
patients that come to me saying, well you know I've got a B pattern, that's a real
problem. I've been working a lot and I'm struggling with it; and my
advice for reasons I've already discussed is let's worry - let's put the B
pattern LDL stuff, the whole fractionation thing aside, and let's
focus on our priorities. I can explain it to you like it I have in this video but
again let's focus on our priorities. Now, again I got into - in this video, we got
into a lot of details. Apolipoprotein, which is the protein part of the - the
packets. We got into fractionation and looking at the details of the
differences between the different populations. Let's go way back up to
about 30,000 feet and talk about for just a reminder, why do we have those
proteins and why do we put the by - the fats and oils in our bloodstream and
tiny microscopic packets anyway? Well, a basic component, oil and water don't mix.
If you - we all know that and we all know if you got what a glass of water and you
pour oil in it, it would form a big blob at the top. If that happened in our
bloodstream, that blob would cut off the - it would lodge somewhere and cut off the
flow of the blood which is 90 - over 95% water to the - that tissue. That's the same
thing as a a clot embolus and - and embolous, that's embolus is the medical
term that we use for something that flows through the blood stream, is not
the same consistency as the rest of the blood so it can lodge somewhere and cut
off the blood supply. So you can have fat - and a fat embolus just like you can have
a clot embolus. We talked many times in many videos about forming clot embule-
embolus or emboli which is the plural using hot - when hot plaque touches the
blood - liquid blood. Now where's - where are the cases when this actually happens in
human life? With large wrecks. So orthopedist that
see patients that have been in a 60 mile-per-hour wreck and have multiple
broken bones. When you get those kind of - that kind of trauma you get especially
to multiple large bones, the bone marrow has a lot of fat in it and quite often
these fat globules will just get into the bloodstream and form an embolus.
These people can have heart attacks, strokes, kidney major chunks of tissue
taken out by these fat emboli. Surgery is in its basic form, of a form of trauma as
well; and this was a headline from a woman that died from a fat embolus
attributed to surgery. So again that gets us back up to maybe 30,50 thousand-feet
after we spent a little bit of time in the weeds. If you made it that far with
me, thanks again for your interest and attention; and again let's not get too
focused on LDL. It's important but most of us have far bigger priorities. If you
hit the like button and for sure if you subscribe or share, the algorithm reads
that is the strong message that humans think this is interesting and important
information and the algorithm can share it more than any of us humans. Speaking
of sharing, the one of the best ways of sharing is on social media. We've got
active Facebook, Instagram, and LinkedIn activities going on right now. We've
recently started up things in Pinterest and Twitter so we'd love to see you
there! Check us out! Finally with over 500 videos, a lot of people are
saying, I can't find this video or that video. Our new social media manager Caim
Hermoso is starting to work on ways to help with that, so join the community. You
can click on the links below and you can get a little bit better access.
Thank you again for your interest!