LDL Particle Size: A Key to Cardiovascular Health in Functional Medicine

Dr. Erin Hendriks • February 6, 2024

February is Heart Month!

In functional medicine, a holistic approach to health emphasizes the importance of personalized care and digging deeper into the root causes of various health issues. When it comes to cardiovascular health, the focus has shifted beyond simply measuring cholesterol levels to a more nuanced understanding of lipoprotein particles, particularly LDL (Low-Density Lipoprotein). February is heart month, so let's explore the significance of LDL particle size and how to optimize it for improved cardiovascular well-being.

Understanding LDL Particle Size

Traditional cholesterol testing typically involves measuring the total amount of LDL cholesterol in the blood. However, this approach overlooks the crucial factor of LDL particle size. LDL particles come in different sizes, and size matters when it comes to cardiovascular risk.

Small, dense LDL can penetrate the arterial walls, contributing to atherosclerosis—or plaque buildup in the arteries. On the other hand, larger LDL particles are less likely to infiltrate the arterial lining and are therefore less harmful.

Importance of LDL Particle Size in Cardiovascular Health

Risk Stratification: Understanding LDL particle size allows for a more accurate assessment of cardiovascular risk. Individuals with mostly small, dense LDL particles may be at a higher risk for heart disease, even if their total LDL cholesterol levels appear normal.
Inflammation and Oxidation: Small LDL particles are more susceptible to inflammation and oxidation, which play a significant role in the development of atherosclerosis. By addressing the underlying causes of inflammation and oxidative stress, functional medicine practitioners can work towards improving LDL particle size.
Insulin Resistance: Insulin resistance is associated with elevated small, dense LDL particles. Functional medicine approaches that address insulin sensitivity can positively impact LDL particle size.

Strategies to Improve LDL Particle Size

Dietary Modifications:

Emphasize a whole-food, anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids.
Reduce intake of refined carbohydrates and sugars, which contribute to insulin resistance and small LDL particle formation.

Regular Exercise:

Regular physical activity can improve LDL particle size and reduce cardiovascular risk.

Balancing Hormones:

Address hormonal imbalances, especially those related to insulin and thyroid function, as these can impact LDL particle size.

Supplementation:

Consider targeted supplements, such as omega-3 fatty acids and antioxidants, to support cardiovascular health and reduce inflammation.

Determining LDL particle size provides a more comprehensive understanding of cardiovascular risk. By addressing factors such as inflammation, insulin resistance, and hormonal imbalances, functional medicine doctors can work towards optimizing LDL particle size and ultimately promote heart health through personalized, holistic approaches. As we unravel cardiovascular health's intricacies, embracing functional medicine principles opens new avenues for prevention and improvement in overall well-being.

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Meet the Drs.

Dr. Hendriks and Dr. Castillo MacKenzie are board-certified physicians, female, specialized, with over 10 years of experience.

Elle MD started after practicing in a traditional primary care setting together for over a decade. We grew frustrated with the current healthcare model, which places no emphasis on addressing the root cause of chronic disease. A lot of times, conventional care doesn’t even promote overall wellness!

We founded Elle MD in Royal Oak, MI, with a vision of providing this care in a compassionate and personalized way.

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Your Skin & Aging: FAQs, Hormones, and a Smarter Skincare Approach

August 1, 2025

As we age, changes in our skin can feel sudden and confusing—thinner texture, more dryness, loss of elasticity, and that “tired” look that shows up even after a good night’s sleep. These are natural changes, but they don’t have to be inevitable. In this post, we’re addressing some of the most common questions we get about aging skin, the role of estrogen, and how we integrate evidence-based solutions—like topical hormones and therapeutic skincare—to help restore skin vitality from the inside out. Why does skin change so much with age? Collagen loss starts in our 30s and accelerates during menopause, driven largely by hormonal shifts—especially the decline in estrogen. Estrogen supports hydration, elasticity, and collagen production, so when it drops, the skin becomes drier, thinner, and more fragile. You may also notice increased sensitivity, slower healing, and a duller appearance. What role does estrogen play in skin health? Estrogen isn’t just a reproductive hormone—it plays a critical role in skin physiology. It improves: Collagen production Skin thickness Moisture retention Wound healing Sebum (natural oil) production For some women, topical estrogen can be a safe, localized way to target skin aging—especially in areas like the face, neck, and even vaginal tissue, where estrogen receptors are abundant. We often use compounded low-dose topical estriol or estradiol as part of a customized plan. It’s not about reversing the clock—it’s about optimizing how your skin functions now. Are topical hormones safe? When prescribed appropriately and monitored, topical estrogen for skin use is generally well-tolerated and low-risk. Unlike systemic hormone therapy, these formulations are localized and often used at low doses. We assess your history and current hormone levels before initiating any protocol and monitor your response over time. What else helps aging skin? This is where skincare gets smarter. We look at: Barrier repair: A compromised skin barrier leads to sensitivity, dryness, and inflammation. Inflammation control: Chronic low-level inflammation accelerates aging. Antioxidant support: To neutralize daily oxidative damage. This is why we’re now offering Epionce® in our practice. It’s a dermatologist-developed line that aligns well with a functional approach—focused on skin barrier health, calming inflammation, and restoring a more resilient skin environment. We love it because it’s evidence-based, botanical-forward, and works beautifully alongside hormonal support or other medical treatments. Where do I start if I’m noticing aging changes? Start with a comprehensive evaluation: hormones, nutrition, stress, and skin history all matter. For some, that means testing estrogen levels and considering topical support. For others, it means addressing gut health, reducing inflammatory load, or rethinking skincare ingredients. We’re here to help you understand what’s changing—and offer personalized tools to help your skin reflect how good you’re starting to feel inside. Aging skin is not just a cosmetic issue—it’s a reflection of internal changes, especially hormone shifts. With thoughtful, integrative care—including hormone support when appropriate and smart topical therapies like Epionce—we can help restore balance and vitality at the cellular level.