Ladd McNamara, M.D discusses the future of medicine both as it relates to health, supplementation, and how health professionals are finding new ways to increase income in an ever evolving world!

Oxidized LDL Cholesterol Testing

Most people have their Lipid Panel blood work done on a semi-routine basis and feel that if their LDL cholesterol is low that they are not at risk for heart disease, stroke, or atherosclerosis.  This is a false assumption.  Here’s what you need to know!

(Please read medical disclaimer below, and consult with your personal health care provider prior to acting upon the information presented on this website.)

The most predictive blood work available at this time to evaluate your risk for heart attack and stroke is testing your OXIDIZED LDL Cholesterol level and comparing it to your HDL Cholesterol.  (1, 2)     In fact, oxidized LDL cholesterol is the best predictor predictor of unstable coronary artery disease. (3)   Knowing your  Triglycerides, Total Cholesterol, HDL, LDL, VLDL, and Oxidized LDL cholesterol is extremely important to understand your true risk and what you can do other than the knee-jerk reaction of taking a cholesterol-lowering statin drug.  (4)   (Here’s a hint:  If oxidation is the problem, antioxidants must be the solution!)

There are other “top tier” labs that I like to see: C Reactive Protein, Homocysteine, and Vitamin D.  (5, 6)  In this blog post I want to focus on Oxidized LDL, and the ratio of Oxidized LDL-to-HDL Cholesterol.  (Please see other blog posts about C Reactive Protein, Homosysteine, Vitamin D, etc.).

Although I am no longer practicing medicine, I do encourage people to have their oxidized LDL blood work done.  Here’s what I think people should pay very close attention in regard to their lab work.

OXIDIZED LDL CHOLESTEROL and OXIDIZED LDL-to-HDL CHOLESTEROL RATIO

LDL cholesterol in and of itself is not bad at all.  In fact, you would die in a day without LDL cholesterol.  It’s important for the integrity of cellular membranes, cellular repair, and hormone production.   Native (non-oxidized) LDL cholesterol does NOT cause atherosclerosis, heart disease, or stroke.   LDL is only “bad” or only causes disease when it is damaged, or oxidized.    ONLY when LDL cholesterol is oxidized does it lead to inflammation in the arterial lining and leads to arterial plaque …no matter what the level.

Studies have shown a very poor correlation between LDL cholesterol levels and cardiovascular disease and death.  In fact, approximately half of people who die of cardiovascular disease do not even have elevated LDL cholesterol, essentially taking the level of LDL out of the equation, and making it all about the oxidized LDL cholesterol.  (7, 8, 9)

Just the opposite is true.  Even if you have low or normal LDL cholesterol you can still die of cardiovascular disease!   That is, if your LDL cholesterol is damaged, no matter what the level, it will lead to plaque, atherosclerosis, heart attack, stroke, and death!

If your LDL cholesterol is not oxidized, even if it is elevated, it will not lead to inflammation, nor plaque, nor disease!  So, what is your OXIDIZED LDL CHOLESTEROL LEVEL?   Have you had it checked?  Does your doctor understand the importance of testing this?  Certainly, the pharmaceutical companies do not want you testing your oxidized LDL cholesterol because the best “treatment” for oxidized LDL cholesterol is NOT STATIN DRUGS, but ANTIOXIDANTS!

Since HDL Cholesterol is very good, in that it “cleans up” excess cholesterol, as well as it directly repairs the damaged arterial lining (endothelium), allowing for the natural and normal release of nitric oxide (NO) from the cells that line the arteries, it is very good to have high HDL cholesterol.   It is good to have an HDL cholesterol level above 60, …and even better an HDL cholesterol above 90!  The higher the better.

With LDL cholesterol, the higher the level the more likely it is to be oxidized, particularly if you are not taking a full spectrum of antioxidants, eating right, not smoking, and not eating fried foods, particularly trans fats.

This is the most important thing I can get across to everyone considering a cholesterol-lowering statin drug:  FOCUS on lowering your OXIDIZED LDL cholesterol and increasing your HDL cholesterol, not on just lowering your LDL cholesterol with statin drugs.   You may need to read that again, and please see my site (with references at www.cholesterolconspiracy.com).

UPDATE: My book, “The Cholesterol Conspiracy,” is now available as an audio book, digital download on iTunes and Amazon’s Audible.

There are only a few labs that test OXIDIZED LDL Cholesterol, a.k.a. oxLDL.   Most labs do not test for oxLDL, and most doctors know nothing of this, …or pass it off as “not necessary.”  A simple search of the literature shows that oxLDL is a key factor in the development of cardiovascular disease.  This has been known for at least 20 years!  So, why not test for it, especially since you can decrease your oxLDL levels?

Here’s the breakdown when you have your OXIDIZED LDL CHOLESTEROL tested:

Oxidized LDL: 

< 45           Low Risk
45 – 60      Mildly Elevated Risk
60 – 68      Borderline Elevated Risk, Refer to oxLDL-to-HDL ratio for interpretation
69 – 79      Elevated Risk
80 – 90      High Risk
> 90           Very High Risk

However, this is direct test of the oxidized LDL, and certainly, the lower the oxidation the better, but to truly understand the results, one must take into account their HDL Cholesterol levels, so the following test ranges are MUCH MORE PREDICTIVE of your atherosclerosis risk than the above:

Oxidized LDL-to-HDL Ratio:

<35           Low Risk
35 – 51      Borderline Elevated Risk
52 – 74      Elevated Risk
75 – 80      High Risk
> 80          Very High Risk

These results are what you should consider the most, and particularly in light of your C Reactive Protein.  (If your C Reactive Protein is less than 1.0, and you have a “Borderline Elevated Risk” of Oxidized LDL-to-HDL Ratio, then you are at LOW RISK of heart disease.)   However, if your C Reactive Protein is greater than 3.0, and you have a “Elevated Risk” of Oxidized LDL-to-HDL ratio than it’s time to make changes!

An elevated C Reactive Protein (CRP) alone is a risk factor for atherosclerosis, particularly among diabetics. (10)   High blood sugar levels are very inflammatory, leading to damaged arteries.

However, if your Oxidized LDL-to-HDL Ratio is Elevated, and particularly if you are at High Risk or VERY High Risk (no matter what your C Reactive Protein) then it is time to take action, because this test is more predictive than your C Reactive Protein alone.  (It’s best to look at all parameters, not just one test.  BUT, if you were to look at one test, the oxidized LDL-to-HDL cholesterol would be it.)

Okay, so what do you do if your Oxidized LDL-to-HDL Cholesterol Ratio is ELEVATED?

Well, if oxidation is the problem, anti-oxidants are the answer (NOT STATIN DRUGS)!!!

If your Oxidized LDL Cholesterol-to-HDL Cholesterol is Elevated, do the following and repeat your test in 8 to 12 weeks (please see medical disclaimer below):

1.  Consider a full-spectrum of multi-antioxidants, including Vitamin E, Vitamin C, Green Tea Extract, Alpha Lipoic Acid, N-Acetyl-Cysteine, and Turmeric Extract (Curcurmin) (11) Vitamin E (tocopherol succinate) includes d-alpha tocopherol, gamma tocopherol, delta tocopherol,  & tocotrienols, etc. at the level of at least 300 IU per day.  The natural form of vitamin E (d-alpha tocopherol with gamma and delta tocopherol) can safely be increased to 800 IU/day.   (Do NOT take vitamin E in the form of tocopherol acetate, which has only DL alpha tocopherol, without gamma tocopherol.)  All the various antioxidants mentioned above (and more) work together in various ways to both protect LDL cholesterol from being oxidized, as well as protecting the arterial lining from being oxidized and inflammed, which is the initiating factor in the development of plaque.

2.  Consider Grape Seed Extract (GSE) and Resveratrol.  (12 – 14) Take at least 400 mg of GSE per day with 30 mg of Resveratrol.  A Spanish study in 2012 showed the synergistic benefits of lowering oxidized LDL cholesterol with at least 350 mg of Grape Seed Extract along with 8 mg of Resveratrol.  (14)   The combination of both GSE and Resveratrol obviously do more to decrease oxLDL greater than either separately.  These two extracts from the red grape have been shown to act synergistically to protect LDL from oxidaition.   Again, consider adding 200 mg of Grape Seed Extract twice daily, along with at least 15 mg of Resveratrol (often found in an antioxidant booster with grape seed extract) twice daily.    In my opinion, this is a MUST for a cardio-protective supplement program.

3.  Fish Oil Capsules: at least 2000 mg per day.  Fish oil contains the omega-3 fatty acids, both the EPA and DHA.  Not only will fish oil help LOWER YOUR TRIGLYCERIDES (blood fats), it will also help protect your LDL cholesterol from oxidation, and help raise your HDL cholesterol.  (Plus, fish oil is great for the brain, nerves, joints, and skin.   Just make sure your fish oil is pharmaceutical grade, as most fish oil products may contain PCB’s and other toxins that build up in your fatty tissues.  Don’t trade one disorder for another.)

4.  Olive Fruit Extract (at least 30 mg, if not 75 mg) per day.  Olive fruit extract contains polyphenolic antioxidants as found in olive oil, in which the higher consumption is associated with a decreased lower risk of heart disease, and also cancer!  Olive leaf and fruit extracts are shown to decrease oxLDL.

5.  Lower your Homocysteine Level, as homocysteine directly creates more oxidized LDL cholesterol and damages the arterial lining, creating nicks in which the oxLDL gets underneath and initiates plaque formation. (15)  You can lower your homocysteine with the B vitamins, particularly,  folic acid, vitamin B6, and vitamin B12, as well as with a broad-spectrum of vitamins: vitamin E, beta carotene, vitamin C, alpha lipoic acid, N-acetyl-L-cysteine, etc.  Also, betaine (a.k.a., TMG, or Tri-Methyl-Glycine) lowers homocysteine.   Choline (a precursor to the neurotransmitter acetylcholine) converts in your body to betaine.  Therefore, a person can directly take betaine or choline to help lower homocysteine.   The lower the homocysteine the less oxidized LDL cholesterol will be created.  Ideally, deep your homocysteine levels below 7.0.   (See blog post about homocysteine.)

If your homocysteine and oxLDL-to-HDL ratio are both elevated, it is critical that you lower both through the means mentioned here.   However, if your oxLDL-to-HDL ratio is low, and your homocysteine is found to be in the “mid-range” (7.0 – 7.5), then it is not so critical to chase your homocsyteine level, trying to lower it further IF you are already taking a full-spectrum, quaility nutritional supplement program.

6.  Eat Low-Glycemic Foods.  (16)  It is critical to maintain healthy blood glucose levels.  High blood glucose, even blood glucose in the higher end of “normal” will almost immediately oxidized LDL and cause arterial inflammation.  This is the primary reason that diabetics have a significant increased risk of atherosclerosis and coronary artery disease.  This is also why exercise reduces oxidized LDL, because it burns up and reduces blood sugar levels.   Please refer to my Dr. Ladd VIP Program to learn more about the low-glycemic index, food examples, weight loss and management strategies, and nutritional supplement protocols.

7.  Avoid Trans Fats.  Trans fats, like high blood sugar, will instantly oxidize LDL cholesterol, and people who eat high glycemic foods and trans fats will invariably have higher oxLDL levels.   Trans fats are found in fried foods, fast foods, and many processed foods.   It is much better to use monounsaturated fats, such as olive oil.

8.  Don’t Smoke!   Why do you think smokers die of heart disease and cancer?  It is because smoking increases the oxidation of LDL cholesterol, as well as DNA.  Toxins from cigarette smoke oxidizes and inflames arterial walls, allowing oxLDL to get under the arterial lining and accelerates plaque formation.

9.  Exercise at Least 30 Minutes per Day.  This does not need to be a tiresome workout.  It only needs to be a moderate activity program such as a brisk walk.  Do this daily, your heart will thank you.  (It will also elevate your mood and help you sleep better.)   Exercising will help you stabilize blood sugar, which in turn reduces a major causative factor in the creation of excess oxidized LDL.

10.  Get Restorative Sleep.  Sleep at least 7, if not 8 hours per night.  Take melatonin (1 to 2 mg per night) to help improve the QUALITY of your sleep.  Melatonin  is not a sleeping pill.  It is beneficial in everyone, particularly after the age of 35, whether you’re sleeping well or not.   If you’re 22 years old and not sleeping well you can safely take 2 mg of melatonin!

11.  Don’t Treat a Lab Result, “Treat the Patient,” (you).   Take care of you.  Eat your vegetables, fruits, reduce stress, get plenty of sleep, get regular moderate exercise, avoid toxic exposures, and take your vitamins.   Most people will never need a drug, particularly not a statin drug (please refer to my book, “The Cholesterol Conspiracy”) if they make proper lifestyle changes.

 

To get a specialized Oxidized LDL Triple Marker cardiac panel (including oxidized LDL-to-HDL ratio), no matter where you live in the United States, you can contact Shiel Medical Lab in New York. It is my understanding that they make arrangements for you to get the blood drawn local to you, and have it sent to them.  Contact them about details, as I don’t have any affiliation with Shiel Labs.  (There may be other places that do the testing, but I think the “Triple Marker” test is the best option I’ve found to date.  

 

REFERENCES:

1.  Am J Cardiol. 2006 Mar 1;97(5):640-5.

2.  Dis Markers. 2008;24(6):341-9.

3.  Int J Cardiol. 2006 Nov 10;113(2):167-73.

4.  Arterioscler Thromb Vasc Biol. 2001;21:844-848.

5.  Gene. 2012 Apr 1;496(2):128-35. doi: 10.1016/j.gene.2011.12.039

6.  Cardiology. 2011;119(4):187-90. doi: 10.1159/000331429.

7.   N Engl J Med 2002;347:1557-1565.

8.  J Clin Invest.  1994;94:155-164

9.   J Lipid Res. 1994 May;35(5):803-19.

10.  J Diabetes Complications.  2011 Nov-Dec;25(6):368-70

11.  Am J Cardio. 2012 Apr 3.

12.  Free Radic Res. 2003 May;37(5):573-84

13.  Chem Biol Interact.  2010 Jan 5;183(1):105-12.

14.  Mol Nutr Food Res.  2012 May;56(5):810-21.

15.  Semin Thromb Hemost. 2000;26(3):243-54.

16.  Diabetes.  2011 Jul;60(7):1973-80.

 

Medical Disclaimer- Everything on this website, and in this article, is not to be interpreted as, or substituted for, medical advice.  It is for informational purposes only, to be used to faciliate a conversation with your health care provider.  Please consult with your own personal health care provider before embarking on a supplement program.   The information on this website is not meant to take place of the information and recommendations you receive from your personal physician or other licensed health care provider, as the information and considerations offered on this website may not apply to your health condition and needs.   Do not use any information on this website for the use of diagnosing, treating, or managing your care without a thorough discussion with your health care provider.   Do not stop, start, or change any medication without consulting with your physician.   If you have, or suspect that you have, a medical problem, contact your health care provider promptly. Do not disregard professional medical advice or delay in seeking professional advice because of something you have read on this website.  Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.

Comments

Posted On
Mar 15, 2012
Posted By
Nadine Lederfine

Can you supply the names of the labs that test oxidized LDL. I have all of the other tests run, but need to do the oxidized LDL. Thanks for all of your great information…you are the best!!!

Posted On
Mar 15, 2012
Posted By
Ladd McNamara, M.D.

Nadine, give you the names of all TWO of the labs in the U.S. that run oxidized LDL? One is in NY State, and that single test costs MORE than the Specialty Cardiac Panel performed by the lab in Orange and LA Counties in Southern California. You cannot just walk in to the lab and get the discounted rate I was able to obtain for those who use the “USANA” discount. Contact Molly Fini, at mollyfini@att.net. For less than $300 you can get a “Specialty Cardiac Panel” that includes: Total Cholesterol, LDL, HDL, VLDL, Triglycerides, ApoA1, ApoB, OXIDIZED LDL, Oxidized LDL-to-HDL Ratio, C Reactive Protein, Homocysteine, and a Vitamin D level! At other labs that will cost you well over $600, and at least $129 or more for just the oxidized LDL. So, I think the best way to go for all in Southern California, or any other place is to contact Molly, and arrange to get the tests done (and/or sent in if you’re out of state). It makes no sense to walk in and pay 3 times as much money when you can contact Molly to get a “Cardiac Panel,” and mention the “USANA discount.”

Posted On
May 04, 2013
Posted By
Molly Fini

I just wanted to correct the information on my email. It is mollyrfini@gmail.com. IT IS NOT mollyfini@att.net

For those of you that are interested in the having your oxidized LDL levels checked, please email me at mollyrfini@gmail.com

Thank you!

Posted On
May 03, 2013
Posted By
Anne E McGarrett

The Oxidized LDL Triple Marker Test, including Oxidized LDL, HDL and hsCRP with a Risk Stratification is available at Shiel Medical Laboratory in Brooklyn, NY. Please contact me at annem@shiel.com for more information.

Posted On
Mar 26, 2012
Posted By
Craig

You mentioned “pharmaceutical grade” fish oil. How do we know what grade we are getting? Are there other ingredients to look for on labels?

Also, lot of supplements here… any recommended sources for “full-spectrum, multi-antioxidants”, B vitamins (are there mixtures that are better than others?), GSE/resveratrol, OFE, melatonin, etc.?

Posted On
Apr 09, 2012
Posted By
Ladd McNamara, M.D.

Craig, good question! Yes there are supplements that are manufactured to “pharmaceutical” quality, meaning to the same practices of Good Manufacturing Practices (GMP) assigned to the pharmaceutical industry, as opposed to the GMP applied to the food industry. Most supplement manufactures follow the lesser standards. As I’ve mentioned in one of my blogs, that many, if not most, fish oil products have PCB’s and organic residues (like dioxins) that can accumulate in fatty tissues possibly leading to disease. A good reference book for quality supplements is “The Comparative Guide to Nutritional Supplements” by Lyle MacWilliam. That resource book will both reveal quality manufacturers of “combined mixtures” of vitamins, minerals, antioxidants, which was the second part of your question.
Personally, I use the MegaAntioxidants, Chelated Minerals, BiOmega (fish oil), Proflavanol (grape seed extract), Hepasil DTX (the combo of many of the nutrients I mentioned in the blog), and CoQuinone (Co-Q10) manufactured by USANA Health Science, Inc. which has products that are the highest rated in the supplement guide, and has the highest customer satisfaction from another independent source, Consumer Labs. The NSF has certified USANA to follow the pharmaceutical GMP, and lastly, this is the brand trusted by many Olympic and Professional athletes, in which the quality must be pure, potent, and effective.
Hope that helps. (See http://www.customer.usana.com for more detail on the products I use.)

Great article! Shiel Medical Laboratory has been performing the Oxidized LDL test and the Oxidized LDL Triple Marker test (OxLDL, HDL and hsCRP with a patient risk stratification) for seven years now. The test was brought to our attention by Harold Bates, PhD., who assisted in collating data for Nina Johnston’s study published in AJC, March 2006. We have exhibited at AHA and ACC Scientific Sessions for the past six years. Many physicians and researchers we meet at Scientific Sessions have known about the existence of Oxidized LDL and its’ role in the atherosclerotic disease process for years but were unaware their was a clinical laboratory running the test on an automated platform. We are detecting 50% more patients with Cardiovascular Disease than the traditional lipid panel and helping to improve patient outcomes. Thank you for giving this test the recognition it deserves.

Posted On
May 04, 2013
Posted By
Molly Fini

We provide the “rea oxidized LDL test” in a complete cardiac panel here in Southern California. The oxidized LDL test is the same reagent from the company in Sweden, the TRUE oxidized LDL test in which Nina Johnson study used as mentioned in Dr. McNamara’s blog post. We offer a “full cardiac panel,” beyond just oxidized LDL, HDL, and hsCRP. We also include Total Cholesterol, HDL, LDL, vLDL, ApoA1, ApoB, Triglycerides, Oxidized LDL, Oxidized LDL-to-HDL Ratio, Homocysteine, and Vitamin D; all for one low price. The value is having a full cardiac panel, providing more information than just a few markers. If you are interested in ordering this test, please call Molly Fini at 949-463-3607, or email me at MollyRFini@gmail.com.

Posted On
May 04, 2013
Posted By
Molly Fini

Please contact me if you have any questions regarding the oxidized LDL Test. I have been working with Mercodia in Sweden that created the oxidized LDL test for years. In addition to the “true oxidized LDL” test, our cardiac panel offers oxidized LDL, oxidized LDL-to-HDL ratio, hsCRP (C Reactive Protein), Total Cholesterol, HDL, LDL, vLDL, ApoA1, ApoB, Triglycerides, homocysteine, and vitamin D; all for one low price.
Molly Fini
949-463-3607

Posted On
May 04, 2013
Posted By
Molly Fini

For those of you that have questions about the Advanced Cardiac Panel with the oxidized LDL and oxLDL to HDL ratio, please contact me at mollyrfini@gmail.com

Thank you!!

Posted On
Dec 08, 2013
Posted By
Maggie Lancy

Excellent information! I have been following you Ladd and the knowledge and education you provide is invaluable.
People need to read up on this and not believe just what their doctors say!

Posted On
Jan 10, 2014
Posted By
Dexter

My PCP always runs a NMR Lipid Panel for small and large LDL particle sizes. I am always 8-10% small dense as compared to total LDL particle number with triglycerides of 40, HDL 70 Total around 280. You have introduced me to a new category of LDL that I have not been aware of and must investigate. 1/10/2014

Posted On
May 21, 2014
Posted By
MYRON ADAMS

I am trying to contact Molly at the contact information provided on this blog, but so far I have not had any success. I would like to get more information. Is there any other way to get in touch?

Posted On
May 21, 2014
Posted By
Ladd McNamara, M.D.

Molly does not work with the lab in Southern California any longer, and hasn’t for some time. And, I was not pleased (and neither was Molly) about that lab, so I no longer refer people there. I am now referring people to get their oxidized LDL (actually, the “Oxidized LDL Triple Marker Test”) from Shiel Lab. Please contact them at http://www.shiel.com, and they will assist you in testing your oxidized LDL and true cardiovascular risk.

Posted On
Jul 24, 2015
Posted By
Kam

Dr,

Is there another lab besides Shiel that does this test?? I’m having trouble calling Shiel. Nobody seems to be able to help me when I call, and also how would this work if I live in California??

Any other labs that offer oxidized LDL? And preferably in Southern Cal? And how much does this cost??

Much appreciated

Kam

Posted On
May 22, 2014
Posted By
MYRON ADAMS

Dr. Ladd,
Thanks for the update! I have just sent a contact email to Shiel and am now waiting on their response.

Posted On
Jul 17, 2015
Posted By
Steven

I currently live in NC. Can this test be done remotely or do you have to show up in one of their locations?

Posted On
Jun 20, 2015
Posted By
Terminology Man

Your numbers for Oxidized LDL to HDL ratio don’t really look like ratios:

80 Very High Risk

If I have Oxidized LDL of 90 (very high risk) and HDL of, say, 90, the ratio is 1 – low risk.

If I have If I have Oxidized LDL of 90 (very high risk) and HDL of, say, 45, the ratio is 2 – low risk.

Perhaps this isn’t really a ratio.

Posted On
Jun 24, 2015
Posted By
Laurence Smith, ND

The ratio information is somewhat confusing. Could you please clarify? For example, is the ideal ratio no greater than 2:1? etc. I don’t understand the whole number.Thank you so much.

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Medical Disclaimer

Information on this web site is provided for informational purposes only. The information is a result of years of practice experience and study by the author. This information is not intended as a substitute for the advice provided by your physician or other healthcare professional or any information contained on or in any product label or packaging. Do not use the information on this website for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or using any treatment for a health problem. If you have or suspect that you have a medical problem, contact your health care provider promptly. Do not disregard professional medical advice or delay in seeking professional advice because of something you have read on this web site. Information provided on this web site and the use of any products or services purchased from this website (or as a result of information provided this website) by you DOES NOT create a doctor-patient relationship between you and any of the physicians or authors affiliated with this website. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.