From The Desk Of Clarence Bass
About HDL “Good” Cholesterol
Lifestyle The Key Factor
When I’m asked about my latest Cooper Clinic exam, I respond that the highlight was my “best ever” HDL cholesterol reading—86. There is no reaction. They know that must be good, but they’re not sure how or why. Even when I add that the normal range is 40 to 70, they’re still not quite sure what to make of it.
IT'S TIME to explain what’s good about HDL “good” cholesterol.
People with high levels of HDL cholesterol in their blood generally have a low risk of developing heart disease. It appears that HDL particles absorb excess cholesterol that might otherwise be used to form plaques that clog your arteries. HDL is also believed to reduce inflammation and make blood vessels more pliable. The HDL cholesterol is then carried to the liver, where it is broken down and passed into your intestines and out of your body. HDL level is thought to be an indication of how well your blood vessels are being “scrubbed” free of excess cholesterol.
HDL levels below 40 are associated with an increased risk of coronary artery disease. People with normal HDL levels between 40 and 60 are not very much affected one way or the other. However, HDL levels greater than 60 are associated with a reduced risk of heart disease.
That said, it would be a mistake to think of HDL cholesterol as always being “good.” A recent paper in Therapeutic Advances in Endocrinology and Metabolism (2014:5(1):10-17) made this excruciatingly clear; the complexity makes your head spin.
Some methods of increasing HDL levels, it turns out, do not reduce cardiac risk. For example, recent clinical trials with drugs aimed at increasing HDL cholesterol have been a big disappointment. Cardiac risk was actually increased in some cases. Fortunately, these drugs were not approved by the FDA.
Statins are a different story. They have proven highly successful in reducing LDL “bad” cholesterol. However, they are not very effective at increasing HDL levels.
Lifestyle factors have proven to be the only reliable way to raise HDL cholesterol levels—and reduce cardiovascular disease risk. I’ll list changes that have proven effective—and then tell you what apparently moved my HDL level from neutral to increasing levels of protection.
Aerobic exercise may be the most effective way to increase HDL levels. Traditional thinking is that duration is more important than intensity in raising HDL cholesterol. If my case is any indication, however, intensity is being given short shrift. (More below)
Being overweight increases bad cholesterol, and reduces good cholesterol. Lose weight if you are overweight.
Stop smoking. Giving up tobacco will increase your HDL level.
The trans fat in the partially hydrogenated vegetable oils found in many processed foods not only increase LDL cholesterol, it also lowers HDL levels.
Low-fat diets, long the standard for fat loss and cholesterol control, appear to be another major culprit. They have been found to be dangerous in some cases, especially when deficient in the essential fats (omega 3 and omega 6). What is more, very-low fat diets have been found to significantly reduce HDL cholesterol in some individuals.
A new study from Japan looked at the association between fat intake and all-cause mortality, a concrete measure of total health. In men, no clear association was found for total fat or for types of fat. In women, however, the lowest mortality risk was found in those with the highest intake (top quintile) of saturated fat, monounsaturated fat, and polyunsaturated fat. The lowest mortality risk appeared at a total fat intake of 28 percent, which is within the acceptable range recommended by USDA guidelines (20-35%), but exceeded the upper limit recommended for Japanese women (25%). For many more details, read Wakai et al, Nutr Metab 2014;11(12).
A fat intake emphasizing fatty fish, eggs, canola oil, olive oil, nuts, and seeds (with chicken, bison, or range-feed beef from time to time) is considered healthy by many---and should help raise HDL cholesterol. Cutting fat intake below 25% is probably not a good idea.
Now, let's look at my case.
In 1998, my triglycerides were cut in half and my total cholesterol dropped below 200—when I began adding small amounts of olive or flaxseed oil to snacks and meals. (I’ve included peanut or almond butter in my diet for about 40 years.) But it wasn’t until 2009—when I started having salmon 2 or 3 times a week—that my HDL cholesterol moved into the mid-70s. It hit 83 after I started having sardines as a regular part of my breakfast. My 86 reading came after I switched from skimmed to organic whole milk. (For details on my switch to organic whole milk, see http://www.cbass.com/wholemilk.htm )
Eating mostly whole foods, and avoiding processed foods, as I have for many years, is also part of the formula for maintaining high levels of HDL cholesterol.
Finally, the jury is still out on high-intensity aerobic exercise as an effective way to increase HDL level. My aerobic workouts are short and hard + walking. Long duration aerobic exercise is not a part of my regimen.
In my experience, a combination of high-intensity aerobic exercise (intervals or sprints), resistance training, and walking works best for most things. Why not for increasing HDL level?
As always, check with your health care provider before making major changes in your lifestyle.
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