The HDL cholesterol value is one of the four values on any conventional lipid/cholesterol panel, along with total cholesterol, triglycerides, and calculated LDL cholesterol (what I call “fictitious” LDL because of its incredible inaccuracy when compared to superior measures).
The HDL cholesterol value has some unique characteristics not shared by the others, however, and can serve as an index of overall health. Very high HDL values, for instance, are associated with extreme longevity. Centenarians typically have values of 90 mg/dl or higher. Higher HDLs are also associated with less risk for diabetes, hypertension, cancer, and dementia. Conversely, low values for HDL cholesterol can suggest that some bad things are going on in health.
When I was in my 30s, I made the mistake of eating an ultra low-fat vegetarian diet. I only ate vegetables, fruit, low-fat dairy products, and whole grains, while avoiding all meats, fats and oils. After several months of my vegetarian lifestyle, my cholesterol panel showed an HDL of 27 mg/dl and triglycerides of 350 mg/dl, while my blood sugars were in the diabetic range (161 mg/dl fasting–very high). As I came to understand diet and converted to a high-fat diet minus all grains and added sugars, my HDL increased to 94 mg/dl, triglycerides dropped to 47 mg/dl. (NMR lipoprotein analysis also showed zero small LDL particles, something I did not assess 25 years ago when I had the awful HDL/triglycerides, but small LDL back then was likely sky-high). I take no medication to improve these values, but use only the strategies I’ll discuss.
While HDL values are under genetic influence (e.g., CETP variants, Apo C3, others), there is plenty you can do to raise it. While it is not entirely clear whether it is HDL particles themselves that are responsible for longevity and protection from disease or whether they are simply associated with some other factor(s) that are responsible for the benefits, you can still view HDL as a gauge of the quality of your lifestyle. The same strategies also increase HDL size and number of HDL particles, yielding HDL particles that are more protective and provide, for example, better anti-oxidative protection.
A dramatic rise in HDL values is common following the Wheat Belly wheat/grain-free lifestyle. However, note that recent weight loss causes an initial drop in HDL, sometimes dramatic, that “rebounds” over time. HDL can also respond slowly. A typical response, for example, for a 240 pound man who starts with an HDL value of 35 mg/dl would be a drop to 27 mg/dl while losing 40 pounds, rebounding to 40 mg/dl 3 months after weight loss has ceased, then 63 mg/dl 1-2 years later. So time and patience is key.
During my busy cardiology practice days, I consulted in an area called “complex hyperlipidemias,” i.e., complicated lipoprotein and cholesterol abnormalities. Among the conditions I managed was something called hypoalphalipoproteinemia, a group of conditions associated with really low HDL values, e.g., 25 mg/dl. People who are overweight or have diabetes or pre-diabetes (metabolic syndrome) also commonly have low HDL values typically ranging 25-40 mg/dl. Following the strategies used below, I witnessed such powerful rises in HDL in these and other people that I abandoned the use of conventional treatments, such as niacin and fibrates (gemfibrozil, fenofibrate) used to raise it. HDL values of 60 mg/dl or higher were achieved with ease–no drugs required. Because the effect of the strategies below is so powerful, I no longer recommend any nutritional supplements to raise HDL, either, beyond those in this list.
Among the strategies that help raise HDL and thereby potentially protect you from multiple chronic health conditions, or at least provide a gauge of improved overall health, are:
- Wheat and grain elimination–HDL is reduced by wheat and grain consumption, especially if gliadin, gliadin-derived peptides, wheat germ agglutinin, and other proteins trigger inflammation–exceptionally common. In addition, the amylopectin A of wheat and grains fuels high triglyceride levels in the bloodstream (via the process of liver de novo lipogenesis, the same process that causes fatty liver) that results in more rapid clearance of HDL particles, reducing the HDL value. Remove wheat and grains and watch HDL go up over time.
- Limit carbohydrates–Just like grain amylopectins, sugars reduce HDL by the same triglyceride mechanism. Adding no sugars, avoiding sugar drinks and foods, while limiting carbohydrates, as we do in the Wheat Belly lifestyle, allows HDL to rise. Banishing the excessive consumption of fructose, as in high-fructose corn syrup, also helps raise HDL. We limit carbs in this lifestyle to 15 grams net carbs (total carbs – fiber) per meal or your individual carb prescription obtained by checking fingerstick blood sugars aiming for no change pre-meal compared to 30-60 minute post-meal peak.
- Fish oil supplementation–As a source of omega-3 fatty acids, EPA and DHA. The omega-3 fatty acids reduce triglycerides (fasting and after-meal), thereby making them less likely to contribute to accelerated HDL clearance. This effect is maximized with an EPA + DHA intake of 3000-3600 mg per day (divided into two doses).
- Don’t restrict saturated fat–Eating fatty cuts of meat, not trimming off the fat, eating more eggs with the yolks, using more butter, and adding coconut oil and other healthy oils all raise HDL.
- Vitamin D–Vitamin D can contribute to substantial rise in HDL, though it is a slow process. I use the blood test for 25-hydroxy vitamin D to gauge dosage needs, but most adults need 4000 to 8000 units per day in gelcap form (never tablets) to achieve a 25-hydroxy vitamin D level of 60-70 ng/ml.
There are some other strategies that make smaller contributions to HDL rises, such as modest alcohol consumption (e.g., dry red wine) and exercise.
Be aware that substantial emotional or physical stress can work against you by reducing HDL values, as can many common drugs (e.g., Lipitor, beta blockers like metoprolol and atenolol, diuretics such as hydrochlorothiazide). But, given the above strategies, combined with the tincture of time, you can watch this wonderful index of overall health called HDL climb higher and higher.