Cholesterol Code Workbook 2: The Mysterious Lipoprotein(a)

On this episode of the Cholesterol Code Workbook, we discuss five papers about the most mysterious lipoprotein: Lipoprotein(a). We discuss its involvement in wound healing, its role as a carrier for oxidized phospholipids, and potential influences on risk for cardiovascular disease.

Take a seat, grab a snack, and join us as we venture into the puzzling curiosities of lipoprotein(a)!

Studies and Figures mentioned in this episode:

Note: All images used are for the purpose of discussion and entertainment, all credit is given to the original authors. Figures come from the studies they are represented under.

A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies

doi: 10.1016/j.jacc.2016.11.042

New Insights Into the Role of Lipoprotein(a)-Associated Lipoprotein-Associated Phospholipase A2 in therosclerosis and Cardiovascular Disease

doi: 10.1161/01.ATV.0000280571.28102.d4

Oxidized Phospholipids, Lipoprotein(a), Lipoprotein-Associated Phospholipase A2 Activity, and 10-Year Cardiovascular Outcomes

doi: 10.1161/ATVBAHA.107.145805

Immunolocalization of Lipoprotein(a) in Wounded Tissues

doi: 10.1177/002215549704500408

Relationship between lipoprotein(a) concentrations and intima-media thickness a healthy population study

doi: 10.1177/1741826711423216

Other material mentioned:

Peter of Hyperlipid’s post on Bantu Lp(a) Levels


5 1 vote
Article Rating
Notify of

Newest Most Voted
Inline Feedbacks
View all comments

6 years ago


I really appreciate all your work on this subject. I just discovered you as I recently embarked on a Keto diet. I’ve seen a number of your YouTube presentations and read many of your blog entries (I have listened to your appearance on the Keto For Normies podcast at least three times now) and I think at this point I understand the basics of cholesterol and its effects on people who follow LC/HF diets – even though I wasn’t born with the brain of an engineer. That’s to your credit, the way you present this incredibly complex information in an understandable way is impressive.
That said, and I know you hear this a lot, I think I may be one of those people who has seriously high LDL levels because of the, as you’ve put it ‘bad reasons’ (not dietary fat, heredity or something else).
If I’ve calculated it right, my Remnant Cholesterol number is pretty terrible. My HDL isn’t bad and my Triglycerides aren’t terrible – in fact my HDL/Tri ratio is ideal – but these LDL numbers are making me feel like you did when you first saw your own numbers and determined to learn more about how cholesterol works.
Here they are:
–==== v0.9.2 ====– 
…4 months on Keto (less than 20g carbs) ::: 22 hours water fasted… 
Total Cholesterol: 
493 mg/dL 
12.75 mmol/L 
LDL Cholesterol: 
294 mg/dL 
7.6 mmol/L 
HDL Cholesterol: 
96 mg/dL 
2.48 mmol/L 
107 mg/dL 
1.21 mmol/L 

Remnant Cholesterol: 
103 mg/dL
2.66 mmol/L >>> High Risk Quintile
Remnant Chol to HDL:

1.07 >>> High Risk Quintile
Go to for more on Cholesterol Remnants

AIP: -0.312 >>> Lowest Risk Third 
Go to for more on Atherogenic Index of Plasma

Friedewald LDL-C: 376 | Iranian LDL-C: 345 
Total/HDL Ratio: 5.14 
TG/HDL Ratio in mg/dL: 1.11 | in mmol/L: 0.49

What I’m hoping to get from you is not medical advice – I understand the disclaimer – but some guidance on what to do next.

A quick bit of background – although I’ve been eating low-carb for more than five years or so now, I’ve really just recently started following a real Keto diet – I didn’t know much about tracking macros, moderating protein, being mindful about calories, making sure I got enough fat etc. until a few months ago.
I’m a 5’8”, 53-year-old male – reasonably lean when I started Keto – when I began the diet in earnest in February of this year I was at 20 % body fat – 159 lbs. I haven’t taken any new measurements since then, but I’ve noticed significant changes in my body composition, I’ve never felt better and going by the way my clothes fit, I’ve lost visceral fat all over, particularly that persistent pooch on my belly.
That’s where I was headed when I had an annual physical last week and I saw the numbers that are freaking me out. I should say, since I’ve been following an unstructured low-carb diet for years, I’ve had this argument with my physician about taking statins for at least two previous blood tests, and he’s indulged me so far and urged me to alter my diet (he doesn’t get it), but these latest LDL numbers have convinced him this is genetic. And, he may be right, I’m afraid. Since I was adopted, I have no family history to go on, so I’m trying to be as cautious as I can. That’s the reason I chose not to do the Feldman protocol for this blood test, as I’d like to get a real sense of the numbers. I’ve considered taking it again with the protocol, but I’m not sure what that will accomplish.
I’m thinking I should have a calcium scan and an NMR particle test, but I don’t see any way around this except for altering my Keto diet or just taking the statin.

Just so you have enough data, here are my cholesterol numbers from two previous tests:

January, 2016
Total 325
HDL 72
LDL 217
Tri 110

April, 2013
Total 350
HDL 84
LDL 200
Tri 162

If you’re still reading this (I am sorry this is so long), what do you think? I really appreciate you taking the time.


Doug in Salt Lake City

6 years ago

Thank you so much!
It’s reassuring to have you looking into these numbers. I’ll just mention that I, indeed did consume coffee the morning of the test and the days leading up to it – also coconut oil and MCT oil (MCT at least one of the days) – I think I did the fast right, but maybe not, I did put 2 TBS of heavy cream in my coffee that morning. I should also point out that in those days before the test, I was intermittent fasting (16/8) – that’s a regular part of my Keto regimen.
I very much appreciate this.

6 years ago

I think you’re right – I can manage going without coffee etc. for a few weeks (that coffee part won’t be easy, I confess). I’ll schedule a new test. This time I’ll get the fasting part right (not sure what I was thinking). I’m grateful for your time.

6 years ago

Siobhan, Forgive a few nit picky questions – I have a chance at a new blood test in ten days – is that enough time to be coffee-free? Also, should I follow the Feldman protocol for this test? And, should I lay off the calorie restriction until I take it? I had been cutting back on calories a bit (and losing weight, by the way) when I took the test the last time – it must have had an impact on the numbers. I did the calcium scan yesterday. Easy peasy… you should do it. Thanks, again, Doug

5 years ago

Siobhan, It’s Doug again – happy to report I received the results of the CAC test and I scored a 0 (zero). I realize that doesn’t tell the whole story, but I took it as good news and maybe some indication of inflammation in my body. I have a new cholesterol (NMR and hs-CRP scheduled for Friday) – I should have the coffee and coconut oil out of my system by then. One quick worry, though – I received a nasty bruise on the back of my thigh a few days ago – it’s healing, but I’m concerned it may kick up my triglyceride number. Should I re-schedule the test or just go forward? Thanks, as always, Doug

5 years ago

Siobhan, Got my NMR profile back – and I’m not sure what to make of it. The actual cholesterol numbers didn’t change much – like I expected my total cholesterol went up from the 493 (in my first post to you) to 510 – my trigliceryides went down from 107 to 101 – my HDL went up from 96 to 99. Most of the other markers are optimal (C-reactive protein >1.00 – Homocyst(e)ine, Plasma 12.7 – LP-IR <25) BUT my LDL-P number is astronomical at 3500! And yet my small LDL-P is at <90. I’m utterly confused. What do you make of that? Should I be worried? I’ll also add I recently did a bodpod test and my body fat percentage continues to drop (currently at 18%) and so does my weight (down three more pounds – while increasing muscle mass).

5 years ago

Hi again, Yes, these are the results after not drinking coffee (or consuming MCT/coconut oil). LDL-C is 391. I can’t say I understand the difference between the LDL-P number and the Small LDL-P number – does the <90 indicate I don't have a concerning number of small-dense particles, or am I missing something? If I understand this right (which I barely do), it's the number of particles and the size of particles that are the indicators of risk. Anyway, thanks as always for taking a look at these. I always feel better after I hear from you.

6 years ago

Haha I tried to keep up with this presentation, super interesting. Had a couple of questions I could be way off. If you had low HDL and higher triglycerides, do you think your body would produce more lp(a) to get ride of the oxidation caused my that and act as an hdl to remove the waste with a different pathway than the liver. (I’m probably way off in left field on this just a question )
Also if I just started lifting heavy weights and and my muscles are tearing and repairing bigger would that call for a bigger amount of lp(a) to help with the wound healing . Thanks guys love this stuff !

Jo Anne
Jo Anne
6 years ago

Is there any known relationship between an elevated CRP level and an elevated Lp (a)?

Jo Anne
Jo Anne
6 years ago

Thanks, Siobhan! I have elevated Lp(a), also. As I was listening to you and Dave review the studies and speak about the processes it suddenly made me think of the CRP. I will have to go back and review, but I’m pretty sure the one time I was tested for Lp(a) , my CRP was quite elevated (around 18…no idea why). My CRP has been checked twice since then and was <1, but Lp(a) has never been retested. Seems I recall the MD indicating that it was a test that only needed to be done once in a lifetime (but I would like to know how much it can change…and can it also be manipulated). Dave did mention that his changes, if I understood him correctly. I am an nurse, so this is all very interesting to me. It is also very frustrating at the same time because so little is known. Thanks to you and Dave for all the effort you put in to these videos. I think it is so interesting that A non-medical person is asking questions that the medical community should have asked. I think the two of you may end being the change agents for this issue! Thanks, again!

Jo Anne
Jo Anne
6 years ago

I will definitely let you know the results and will request a retest if my Lp(a)…it may take a bit of time to make that happen, but I will get it done. Thanks for your responses…I’ve learned a lot from you!

Roger Johnson
Roger Johnson
5 years ago

D9id you repeat your Lp(a) after the week of pasture fed and finished beef? I read as you that supplementation with L Carnitine can contribute to lowering Lp(a(. Beef has way more carnitine than pork. Do you suppose that is a reason that your Lp(a) dropped when you switched from pork to beef?

4 years ago

In the video at 42:35 you are comparing two different lab assays. The study used an assay where normal values are <800 IU/L(μmol/min/L) (

Quest Diagnostics uses an assay where normal values are <123 nmol/min/mL

4 years ago

Late to the discussion here but scared just the same. 48, post menopausal with hashimoto’s. Oh, yeah did I mention my most recent LP(a) was 471 nmol/L. It was 329 4 months prior. I don’t know what I’m doing, or not doing. Didn’t have this tested prior to being a fat burner so I don’t know what my “normal” is. Well, I think I am a fat burner. Coconut, avocados, mct’s are my friends, along with dark chocolate and I avoid sweets, grains and casein. No, I have no reason to eat except chocolate. LOL . I do have an IUD, so I’m not sure if the estrogen in that is helping/hurting either.

Other tests from 4 months ago:
Homocysteine 11.3 umol/L
Total Cholesterol 246
HDL 105 mg/dl
Triglycerides 29 mg/dL
LDL 132
Chol/hdlc ratio: 2.3
Non HDL Cholesterol – 141 mg/dL (I didn’t even know this existed)
Glucose 88 mg/dL
Bilirubin total – has always been slightly high 2.0 mg/dL
FSH 133.9 which is even out of the range of post menopausal 23.0 – 116.3 mlU/mL
Testosterone (thought I’d balance this out) fine at 21 ng/dL
HS CRP – 0.4 mg/L

I don’t drink coffee, but some green tea on occasion, and a homemade hot chocolate every day with almond milk, cacao and stevia. Delicious. I don’t know what to do/don’t do and feel like a ticking time bomb waiting for a heart attack or stroke. Especially since my father past away from CHF in his mid 40’s, they stated at the time due to him having the flu for a couple months and it weakened his heart. Rest of family appears fine. Grandparents lived till 90’s and the rest of the 8 siblings are still kicking in their 70’s. If you have any suggestions or what I should look for I’m all ears. I understand the disclaimers and am offering my tests up as well. I’ll go in for another LP(a) test in mid April and will stop coconut oil and MCT 2 weeks before then. How often can we test that little bugger anway? What is a good time frame to try different foods and such to see if it made a difference the LP(a)? Having it jump almost 150 points tells me there is a trigger. Could be thyroid, menopause, coconut, mct, environment and it better not be dark chocolate.

I also went to a seminar recently with Dr. Brownstein here in Michigan and he referred to a study with (I think guinea pigs) and where they reduced the LP(a) in half. His was in the 400’s too and he stated he lowered it to the 100’s now by using Lysine, Vit C and I think Taurine, but I could have heard it wrong over the speaker system. I’ll find out more at my appointment late April.

4 years ago
Reply to  Carol

Hello, Carol here again. Just wanted to give you an update. Doc put me on Cell Growth by Dr. Rath and it made my LP(a) go down some. He also stated its not a cure all and I’ll never have “normal” levels, but this should take me from freak out stage to a concern stage. Just to recap, my levels were at 471 on 1/17/20. Just being on the product for 3 weeks dropped the levels of LP(a) to 415 as of 4/17/20. Only other thing I did was reduce the amount of nuts I ate and lowered the coconut oil I cooked with. No, I’m not a spokesperson for Cell Growth, I’m simply a person looking for a panic reset button and wanted to share or give you something to look at and ask why? It will be a few months before I send in more results and I hope they are more impressive!

Manuel Sottomayor
Manuel Sottomayor
3 years ago


Is it correct to assume that if you are in Autophagy your Lp(a) will spike as you are recycling damaged cells?

I did my blood test after 48H fast and reached a 89.1 mg/dL.


Manuel Sottomayor
Manuel Sottomayor
3 years ago

Thanks for your reply, interesting data.

Would love your thoughts, please comment.x