Wake Up and Smell the LDL Coffee: Size Matters

As far back as ten years ago, please correct me if it has been longer, research has supported the notion that Total LDL cholesterol was an inferior measure of heart disease risk.
Excuse me for being a little annoyed and confused. I do not understand. Why today, in 2017,  are there so many people, especially health experts, still not seeing the whole cholesterol picture? There is no excuse. A healthcare provider should use and educate patients on the most up to date practical information for their patients. My advice, surround yourself with well rounded clinicians not just those who are reputable or have graduated from an ivy league school.
These are just 4 doctors who have been on the cholesterol forefront for many years:

1. Ronald M. Krauss, MD
2. Uffe Ravnskov, MD, PhD http://www.ravnskov.nu/
3. Thomas Dayspring MD,FACP http://www.thefatemperor.com/blog/2014/11/12/ldl-its-not-the-bad-cholesterol-thats-simplistic-foolery
4. David Perlmutter,MD, FACN, ABIHM and is a Board-Certified Neurologist and Fellow of the American College of Nutrition http://www.drperlmutter.com/ldl-friend/

WHY LDL CHOLESTEROL SIZE MATTERS
In general, cholesterol and LDL cholesterol both have a negative connotation and are associated with heart disease. More precisely, cholesterol is a natural substance your body produces as part of  cell membranes and sex hormones (testosterone, estrogen, progesterone), as a precursor to vitamin D and as an antioxidant for the brain. LDL, like HDL, is a  protein “package” that carries cholesterol throughout the body supporting these body systems. In fact low LDL has been linked to cancer, http://www.anh-usa.org/ldl-cholesterol-may-protect-us-against-cancer/, as well as an increase risk of brain illness such as stroke and dementia, http://www.ncbi.nlm.nih.gov/pubmed/25320101.
The general, total LDL number is not very informative, it is the specific size that matters. LDL packages come in four different sizes, http://www.nbcnews.com/id/35058896/ns/health-heart_health/t/bad-cholesterol-its-not-what-you-think/#.VpqkCBUrLIU:
Dr. Ron Krauss explains, “a big, fluffy form known as large LDL, and three increasingly dense forms medium, small, and very small LDL. A diet high in saturated fat mainly boosts the numbers of large-LDL particles, while a low-fat diet high in carbohydrates propagates the smaller forms” and increases triglycerides (fat in the blood associated with increased heart disease risk). The smaller the LDL size the greater the health  risk.
Krauss found two significant predictors as patterns to heart disease:

1. A combination of high levels of smaller and medium LDL (size matters; a dreaded diabetes-linked syndrome or pattern B) with low HDL
2. Low HDL levels

High total LDL (not taking size into account) levels were a risk for men but not as significant.
Genetics, lifestyle and environment influence the size of the LDL package. While it is true that what you eat can affect both cholesterol and LDL, if you eat more cholesterol the body compensates and produces less. It handles saturated fat differently than expected as well.
Dr. Krauss discovered that “a diet high in saturated fat from dairy (cheese, butter) products or beef can make total LDL rise but the increase is the low risk larger more buoyant size LDL (pattern A) not the unhealthy smaller LDL. Following nutritional guidelines and reducing saturated fat while increasing carbohydrates in a diet can shift a person’s LDL profile from safe to dangerous,” http://ajcn.nutrition.org/content/83/5/1025.full.
Be progressive. Test the pattern or size of your LDL cholesterol, http://www.bostonheartdiagnostics.com/patients_assessing_risk.php, www.longevitytesting.com.  When it comes to LDL and HDL cholesterol size matters  if you are specifically measuring risk for cancer, brain and heart health.