As many of you know, my own HDL runs in the 130s, at least last I checked some months ago. How? Lot's of fat -- particularly saturated animal and coconut fat -- in my diet.
Then, "John," whose issues with cholesterol I profiled here emailed a few days back to let me know that life's not fair and that his wife rings in with HDL of 169, the highest I've seen (so, Dr. BG, looks like the "King" -- me -- is dead, and has been replaced by the new Queen).
And then another reader emails to ask if I think his HDL of 129 is too high.
Well, I still don't know for sure, only that in the study I profiled in this post, even small increases in HDL were very protective, and to a huge extent.
Many of these patients presenting with CAD had HDL levels, which are associated with excess risk. High-density lipoprotein cholesterol is inversely related to the risk of CAD. Even modest increases are associated with lower risk for nonfatal MI or death from CHD. There were 54.6% of patients hospitalized with CAD with admission HDL <40 mg/dL. In addition, fewer than 10% of patients had HDL ≥60 mg/dL. Ideal levels (defined as LDL <70 mg/dL and HDL ≥60 mg/dL) were present in only 1.4% of patients hospitalized with CAD.
But, does that mean it's OK to take it through the roof?
Well, here's a clue that perhaps it's A-OK, maybe even the best of worlds.
A MASSIVE dose of HDL ''good'' cholesterol injected into patients after a heart attack can quickly break down fatty deposits in the arteries and might prevent subsequent attacks, Australian scientists have said after early tests of a new therapy derived from donated blood.
[...]
In one study, a single infusion of HDL therapy had reduced the amount of fat in leg arteries by 60 per cent after a week, Dr Wright told a briefing in Sydney yesterday. Larger medical trials to establish correct doses and make preliminary assessments of how well the treatment works could start next year.
''Cholesterol is carried to the heart by LDL and carried away by HDL,'' Dr Wright said. Company scientists were ''trying to use this natural process to carry cholesterol away from the artery wall and reduce the chance of a second heart attack'' - which was a common cause of death in the weeks following a first attack.
Of course, we all know how to get our HDLs up now, don't we? (Yes, I understand some have had difficulty accomplishing this with their high-fat diets.)
(HT: a commenter on Dr. Eades' blog)
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Wow, super cool news.
My HDL is 72. I was, frankly, surprised that it wasn’t higher after 1.5 years of eating this way. I’m now focusing on omega 3 and vitamin D… I believe those can raise it.
Wait, is that an IV treatment to eliminate arterial plaque? Really?
Um, isn’t that a truly extraordinarily useful tool for cardiologists? It’s a procedure, so it makes them money. It’s noninvasive, so carries much lower risks than stents and bypasses, etc. It attacks the primary causative problem for CVD, so it’s actually effective (unlike stents and bypasses, etc.)
Why isn’t injection of large quantities of HDL currently undergoing FDA stage III trials?
Sorry to reply to my own post, but this should also replace statins. If your periodic CT heart scan (low dose) shows any arterial plaque, take an HDL treatment every six months until it’s clear.
Bwwwhahahaha…!!! If I ever have a heart attack, I’m gonna track you down and SUCK YOUR BLOOD Richard!! No joke. Got HDL-envy. Mine’s only 105 mg/dl and I’m a GRRRRRLLL d*mn it.
OH Yeah. Thanks for pointing out John too. *HAAA aha* He’ll go first… But keep drinking that coconut oil and butyrate/butter/cream 4me…
(oops wasn’t reading… I meant John’s WIFE. This vamp grrl swing both ways)
When Cordain was researching HG cholesterol levels, most of them were in the 100 to 150 range.
Seems like a high HDL is great, but I’d keep an eye on the latest research!
Here’s the paper: http://www.thepaleodiet.com/articles/JACC%20LDL%20Final.pdf
Dean Ornish calls HDL cholesterol “garbage trucks” for the body to ostensibly remove the “garbage” (LDL cholesterol). What a freakin’ dope! GREAT NUMBERS, Richard. The highest I’ve ever personally had is 72 and women are predisposed to have higher HDL than men are.
Hey Jimmy, I just googled for the garbage truck line and read your 4 part interview with dr ornish on your website.
It was posted in 2006, and he was saying at that time that risk factors for heart disease and actual heart disease are not the same, and that his diet has proven the ability to reverse actual heart disease (determined by looking at the arteries) while there was no evidence yet for low carb being able to reverse heart disease just modify perceived risk factors on paper.
In the last 4 years since that interview are you aware of anyone showing that low carb can reverse heart disease in the same manner he claims the ornish diet can?
“There were 54.6% of patients hospitalized with CAD with admission HDL 60? Without knowing that, the above statement is not indicative of anything.
You must have misread. The 54.6% was those under 40. Only 10% had levels above or equal to 60.
Looks like my comment got garbled so let me try again:
“There were 54.6% of patients hospitalized with CAD with admission HDL 60? Without knowing that, the above statement is not indicative of anything.
I don’t know where you’re getting that.
“There were 54.6% of patients hospitalized with CAD with admission HDL <40 mg/dL. In addition, fewer than 10% of patients had HDL ≥60 mg/dL. Ideal levels (defined as LDL <70 mg/dL and HDL ≥60 mg/dL) were present in only 1.4% of patients hospitalized with CAD.”
And again: What percentage of the population has HDL more than 60? One needs to compare this to the 10% of patients.
Very high HDL isn’t necessarily better, because HDL can also be targeted for oxidation. HDL has several sub-fractions, with different atherogenic profiles. I’m sure Dr. B.G. can give us a good explanation about this. Some statistics: HDL above 100 mg/dl is very rare. In a brazilian database of more than 10.000 individuals, only 7 of them had 3-digits’ HDL. Only 4% had HDL > 70 mg/dl. Maximum value was 130 mg/dl. The average value was 48 mg/dl. Some links about “HDL gone bad”:
http://www.youtube.com/watch?v=H_rPFF5X-pc
http://content.onlinejacc.org/cgi/reprint/51/6/634.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC515190/pdf/bmj32900471.pdf
In my opinion, the experts worry too much about blood lipids. In the mean time, they loose focus of what’s really important, and the prevalence of hyperinsulinemic diseases, like diabetes and CVD, is increasing (but not necessarily mortality values, possibly because of better health care). We should focus much more on glucose and insulin metabolism control. Important parameters are GTT (glucose tolerance test), HbA1C, fasting insulin, etc. Diabetics have double or triple CVD risk. Guess why?
I’m jelous. After 2 years of Paleo my HDL was only 55. But my lipds were just 44, which I think si pretty good. And if insulin is an issue, my insulin level was just 2. At least of got a couple of good numbers to brag about! Anyhow, way to go!
Which leads us to another question.
Why
won’t
conventional
wisdom
listen?
Just wanna say thanks to Richard for a great blog and to O Primitivo for that youtube link. This has got me thinking that we perhaps shouldn’t drive our HDL up too high. Dr. B G has said that women usually have higher HDL than men (if I understand correctly), but I also know that women, at least where I’m from (Denmark), have a higher likelyhood of CAD.
Richard,
I am not sure about the validity of the second quote in this post.
The SMH newspaper article to which you refer is wrt an upcoming RCT for a drug CSL112, which is a development of another drug CSL111, which has essentially the same action, that is it sucks cholesterol back to the liver via a large increase in HDL The only problem was that the ERASE RCT that tested whether this in turn had any impact upon plaque volume, suggested that the impact was mild, at the dosages administered (see: http://jama.ama-assn.org/cgi/content/abstract/297/15/1675?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=2520&resourcetype=HWFIG available as a free PDF).
As this study itself notes, the (limited) favorable impact of high levels of HDL on plaque volume may be related to cholesterol efflux, but it could also be related to a number of other factors, such as anti-oxidant properties. The CSL112 trial essentially proposes an increase in the dosage and efficiency cf CSL111.
I have no expertise in this area, but note that the postulated beneficial “cholesterol sucking back to the liver” function of HDL appears not to be consistent with most of the low carb high fat theories on this issue, which are more related to the roles of LDL size, fructose, the liver, glucose, the pancreas and insulin, etc. in the formation of plaque, via inflammation etc.
Nevertheless, CS112, via increasing HDL levels, may of course promote the other beneficial effects of HDL on plaque volume, but the CSL111 ERASE RCT, did not suggest the impact was significant.
O Primitivo is correct — not all HDL are created equal. Of course I meant beastly Paleo HDL !! Low carb and high saturated lead to large particle sizes which invoke regression of plaque. Grain-free, legume-free (paleo) means less oxidation from gliadin, gluten, lectins and downstream damage from phytic acid. Hormesis, cold water immersion, fiber, thyroid/sex steroid optimization, and both aerobic conditioning (50-60% max HR; ‘play’),resistance training, and HIIT raise the # and proportion of the large HDL subfraction (HDL2) as well. Richard does ALL of this nicely.
I don’t want no s*cky HDLs created by 100% olive oil…
Gosh, I eat primarily (actually pretty much exclusively) animals fats and coconut oil. Never eat any PUFA-oils, just an occasional drib of olive oil, a pretty paleo diet. I’ve been eating this way exclusively for a year now, yet my recent HDL reading was only 52.
I’d just like to remind everyone of an insight vis-a-via Peter from Hyperlipid. We shouldn’t take any sort of HDL/LDL numbers all too seriously as we don’t actually have good/a lot of data on people eating like we should be eating…..
My wife has awesome genes. Her HDL was 94 on the SAD 5 years ago. I wouldn’t mind numbers like that on Paleo (mine was 62 before Paleo, and 62 after 3 months Paleo). Richard is still the King for HDL/Tri ratio, though. Her Tris were 68 … so her ratio is 2.49. His 133/4x is somewhere over 3, or at least close to 3.
Okay, I’m new here, but really would like to raise my HDL levels, lose weight and prolong healthy life.
“Of course, we all know how to get our HDLs up now, don’t we?” Well, no, not actually, but I am very open to new ideas on this topic. I’ve read in the comments above about omega-3s and Vitamin D, paleo (presumably diet not politics (: ), IV treatments and other things. I’m now looking at other blog posts referenced after this one.
Want to know more.
And I’m adding this ’cause I missed checking the follow-up box on the comment above.
Eat lots of meat & fat (natural fat, i.e., animal, butter, etc.). Coconut oil is 90% saturated fat. For most people this raises HDL pretty well.
Remember, to a great extent your cholesterol numbers (total and fractions) are unique to you, like your shoe size and fingerprint. Creating ideals is good for drug sales but little evidence would support the idea that manipulating those numbers will make you healthy or prevent disease. Eat paleo and let the numbers fall where they fall.
Don – I totally agree. Numbers can only tell you so much. The trends are most important I would think – where are you going? And if your numbers are a little off or less than you would like, what are you going to do – go back to Cheetos n chocolate shakes?
Dr. Doug McGuff made that point originally (without the crack about specifics) on Art DeVany’s site – paleo or Evolutionary Fitness is clearly the way to go, so just keep at it and enjoy good health.
I am a bit pumped today because I just saw my doctor to review my physical from 6 weeks back. After 20 months of paleo, apart from losing weight and inches, my triglycerides are less than 1/3 of what they were, HDL up by more than 50%, LDL up slightly, but way more large fluffy particles – the good ones. And very longstanding wonky elevated liver enzymes indicating non-alcoholic fatty liver disease? – done – gone – back to normal – down 75%.
Paleo works – period. But the best part is that you feel great – getting older and feeling better? How much better can life be?
Don,
I agree with you. I don’t think it is necessary to track so modern neolithic lab or radiology tests…
However, life insurance metrics and determination of premiums still are based on health and lab metrics: proteinuria, elevated creatinine, elevated BP, elevated glucoses, elevated triglyerides, low HDLs, high liver tests, etc. The improved numbers translates to reduced risks and therefore reduced charges and expenses all around. Win-win IMHO.
(NASH/fatty liver — CONGRATS John Campbell for reversing on Paleo low carb + sat fat!)
http://www.genre.com/sharedfile/pdf/RiskInsights200708-en.pdf
-G
Various things can help to increase good cholesterol (hdl cholesterol)
naturally.
1- Go for exercise.
2- Keep your triglycerides as low as possible.
3- Go for omega-3 fatty acids found in fish.
4- Eat foods high in niacin
For more about click increasing hdl naturally
http://www.cholesterol-hdl-ldl.com/increase-hdl.html
I recently had my cholesterol checked and my HDL was 115. My PCP told me to stop taking fish oil because I should lower my HDL. I have always had levels higher than my LDL (reverse ratio) and I thought perhaps more was better. My absolute ratio didn’t change much with the fish oil supplement.
This might be a strange question, but I’m a vegan, and I’m trying to find trainers (sneakers) that don’t contain any animal “element”. I gather that many trainers contain perhaps parts that are tested on animals, or are made with animal products. Are there trainer brands that are completely man-made?