You Have Good and Bad LDL

Dr. Eric Berg 08/07/2024

Many of us have heard that LDL is the "bad cholesterol," and something to be avoided at all costs. But it turns out that not all LDL is so bad after all. Did you know that there is actually a difference between good and bad LDL?

In this article, I'll break down the two different types of LDL so that we can begin to better understand what to look for to assess our health.

I will cover:

The myths about cholesterol in general.
LDL and HDL cholesterol, explained.
Why not all LDL is considered "bad cholesterol."
The two different types of LDL.
Testing for good and bad LDL.
Other factors to consider.
The bottom line.
References.

The widespread cholesterol myth

First off, let's clarify something. There is a widespread myth that cholesterol is all a bad thing.

But cholesterol is not the enemy in your body. It actually serves a purpose, and we need it in order to be healthy. Proper cholesterol levels are vital for things like building our hormones, making vitamin D, and producing bile. There are many benefits of cholesterol.

Without it, our health can really suffer. Learn more about the myths about cholesterol here.

So cholesterol as a whole is not the enemy. But there are many different types of cholesterol, and they each do different things in the body. Some types can be healthy, while others can be harmful.

Let's take a closer look at cholesterol and the different terms associated with it. I'll help you understand HDL and LDL cholesterol so that you can find out what's actually good and what's actually bad.

Anatomy drawing of artery with different types of cholesterol lipoproteins, HDL and LDL.

LDL and HDL cholesterol

LDL stands for low-density lipoprotein. And HDL stands for high-density lipoprotein.

While most of us think of HDL and LDL cholesterol as types of cholesterol, neither of these is actually cholesterol itself. In fact, they are proteins that carry cholesterol throughout the body. LDL carries it from the liver to your tissues, and HDL takes it from your tissues and back to the liver.

HDL is generally considered the "good" one because it takes cholesterol out of your tissues. High levels of HDL are linked with positive health outcomes.

And most of us have been taught that LDL is the "bad cholesterol." But this is not actually true. There is more than one type of LDL cholesterol, and no one differentiates between them.

Pad of graph paper with chart and writing, words cholesterol, HDL, LDL, good and bad cholesterol.

Not all LDL is "bad"

Typically, we have been told that LDL cholesterol is completely bad. But this is actually not the case.

There are actually two types of LDL, and they behave very differently in the body.

One type of LDL doesn't cause problems in the body and is completely benign. You actually need these kinds of LDL carriers to transport cholesterol to different places in the body. As I mentioned earlier, your tissues require cholesterol to carry out many different important functions.

On the flip side, there is another type of LDL that is quite harmful to the body. It gets deep into your tissues and can cause a lot of damage.

But not all LDL is bad. It depends on which type you are talking about.

The two main types of LDL

LDL written on checkered graph background, low-density lipoprotein cholesterol.

As we now know, not all LDL is created equal. There are two types, and it is very important to differentiate between them.

1. sdLDL-P ("bad")

The letters "sd" stand for small dense and the letter "p" stands for particle. This is referred to as type b.

This is the really bad kind of low-density lipoprotein. Here are some facts on it:

Because it is small and dense, it can easily invade your arteries, getting deep into your tissues and causing all sorts of problems.
It carries oxidized cholesterol, which can increase your risk of heart attack by 4x.
It comes from high carb diets and is often seen in high levels in diabetics.
It can be caused by high amounts of fructose.

This is the kind of LDL that you want to keep low.

2. lbLDL-P ("good")

The letters "lb" stand for large buoyant and the letter "p" stands for particle. It is referred to as type a.

This is a benign form of LDL that doesn't cause any problems in the body. Here's more to know:

It is a large and fluffy type that does not clog up arteries.
You'll often see higher lbLDL-P levels in people doing keto and intermittent fasting or who are eating higher-fat diets.
You need this kind of LDL to move cholesterol to parts of the body where it is needed.

Get your own testing for good and bad LDL

Most people think of high total cholesterol levels as the thing only thing to look at when it comes to getting blood tests. But standard cholesterol tests don't really tell you very much.

If you have high cholesterol, is that due to high HDL levels? High LDL levels? And under the category of LDL, do you have more of the good kind or the bad kind? You need to look at more specific cholesterol levels to really paint a true picture of your health.

Fortunately, there are specific tests you can get done to help answer those questions.

Blood test tube for cholesterol level testing, results written on paper in background.

I suggest that you ask your doctor to order the specialized test that will tell you how much lbLDL-P you have compared to how much sdLDL-P you have. This will help you to look at the different LDL types, rather than just your overall LDL cholesterol levels.

You'll likely find that if you are doing Healthy KetoTM and intermittent fasting, you'll have higher "good" lbLDL-P and lower "bad" sdLDL-P.

If you are eating lots of carbs and sugars, the opposite is likely to be true. And if that is the case, diet and lifestyle changes can help you get back on the right track.

Other factors to consider: triglycerides and HDL

As you've read above, high cholesterol scores don't really tell you much. It's when you differentiate between your different cholesterol levels that you can start to learn more about your state of health.

Here are a few other factors to consider when it comes to artery and heart health:

HDL cholesterol. You want high levels of high-density lipoprotein. If you are eating healthy on the keto diet and doing intermittent fasting, you'll usually find that your HDL is at a higher, healthy level.
Triglycerides. You want triglyceride levels to be low. And if you are doing Healthy KetoTM and intermittent fasting, they will generally end up low. That is because you are using them as an energy source when in ketosis.

Don't rely on total cholesterol levels alone. Get these more specialized tests done to really get a clearer picture of what is going on in your body.

The bottom line

Not all LDL is created equal. In fact, there are two types and they behave very differently.

sdLDL-P. This is the "bad," harmful kind you want to keep low.
lbLDL-P. This is the "good," harmless kind that won't cause damage in your body.

The difference between good and bad LDL is important to understand.

Because even if your cholesterol level testing shows high LDL cholesterol levels, that doesn't necessarily mean you are at high cardiovascular risk. You could have high lbLDL-P and normal or low sdLDL-P – which is totally fine.

Hand in blue medical glove holds test tube of blood with label cholesterol, cholesterol testing.

But you'll want to find out the details to get the true picture of your health, and that will take specialized blood tests. I recommend advanced lipoprotein testing, so speak with your doctor to see if they can order these tests for you. Based on your results, you can find out whether any lifestyle changes are needed for you to get healthy.

Have you been told you have high LDL cholesterol? Have you done further testing to differentiate between the good and bad types? What did you learn?

Share your thoughts in the comments below.