How To Raise Your Good Cholesterol

Photo: VinothChandar

Most people know it’s important to get their bad cholesterol (LDL) down to reduce their risk of heart attacks and strokes. Fewer people know that it’s also important to raise their good cholesterol (HDL) for the same reasons. Almost no one knows, however, that a low HDL likely puts them at a higher risk for heart attacks and strokes than does a high LDL. In other words, it’s more important to get your good cholesterol up than to get your bad cholesterol down.

In fact, though I can’t find the reference from which it was taken, I remember when I was a resident seeing a graph put up at a talk that showed the greatest risk for having a heart attack comes not from a high LDL, not from hypertension, diabetes, or even smoking, but rather from a low HDL. A recent study supports the notion that a low HDL contributes more to atherosclerosis (hardening of the arteries) than does a high LDL.

Why, then, do physicians focus most of their discussion and interventions on lowering their patients’ LDL and not raising their patients’ HDL? The reason is simple: we don’t have any drugs that have a significant effect on HDL. Exercise is known to raise HDL, but generally it must be of an intensity that in my own experience few patients are willing or able to maintain on a regular basis.

But recently, with the increasing popularity of low carbohydrate diets, a new, arguably less painful way to raise HDL—sometimes dramatically—has surfaced. It’s long been known that another component of total cholesterol—triglycerides—have an inverse relationship to HDL. That is, as triglycerides go up, in general, HDL goes down, and vice versa. And while dietary interventions have little direct effect on HDL, they can have a large direct effect on triglycerides. And when triglycerides go down, HDL often goes up.

How do you reduce your triglycerides? There seem to be two main ways: 1) weight reduction and 2) a reduction in dietary intake of carbohydrates. Especially in people who are overweight or obese, reducing the amount of carbohydrate in the diet (especially sweets—sorry) reduces triglycerides—and in so doing often raises HDL.

Though I only have anecdotal evidence of this effect currently, I have a lot of it—including evidence in myself. After learning that my triglycerides were 165 and my HDL 37 (40 is considered the point below which a low HDL puts you at higher-than-average risk for a heart attack), I went on a low carbohydrate diet, lost twenty pounds, and lowered my triglycerides to 41 and raised my HDL to 71. Given that we consider an HDL over 60 to actually be protective against heart attacks, this is an astounding result. And one in medicine we’ve traditionally viewed as impossible. As weight loss has been shown to have more of an effect on LDL, I strongly suspect the rise in my HDL was due mostly to the reduction in my triglycerides, which in turn was due mostly to my reducing the amount of carbohydrate in my diet (I’ve held the frequency and intensity at which I exercise constant since the first measurement of my cholesterol was taken).

The good news in all of this is that we can exert far more influence over our cardiac destiny that we previously thought. The bad news, of course, is that altering our diets isn’t easy. But for some, it’s easier than regular exercise. And if my experience—as well as the experience of a number of my patients—is to be believed, the power of lowering triglycerides to raise HDL may equal, if not outstrip, the power of intense exercise to do the same.

Next Week: Why I Don’t Drink

18 comments to How To Raise Your Good Cholesterol

  • Seana Smith

    How interesting. I didn’t have any idea. Thanks for this. Passing it on.

  • Aaron

    Hey Alex,

    I really appreciate you branching out, in terms of subject matter. I recently read Why We Get Fat by Gary Taubes and was deeply impressed. And Gary has kind of handed the torch on this issue to Peter Attia at eatingacademy.com. If anyone is intrigued by Alex’s experiences, I heartily recommend (no pun intended) the above two sources.

    One of the ironies here is that the remarkable results from these low-carb diets almost always means a higher fat diet. Fat, it seems, is not the bogeyman it’s been made out to be. The evidence is even mounting in favor of saturated fats, and definitely in preference to carbs.

    It feels like the ground is shifting on this one, and that the dietary recommendations of the past 30 years (majority of calories from carbs in a low-fat diet) are in danger of being turned on their head.

  • I was very glad to see this information on cholesterol levels and the low-carb lifestyle in your post. It confirms what I have been living for the past 13 years. I’m morbidly obese, diabetic, 40-something, and female. You’d think I would be a nightmare of high blood pressure, erratic blood sugars, and horrific lipid profiles. (And probably a boatload of other problems, too.) But I’m not. In fact, other than the obesity, which is mostly due to steroid medications taken for a pulmonary condition, I’m in the pink of health.

    I recently wrote a post about my cholesterol test results (you can read it here if you’re so inclined: http://www.editormum.com/?p=1547), and how low-carb keeps me healthy. And it does! I’m not horribly strict—I allow myself the occasional treat, and I don’t obsess over carb grams. I just eat sensibly and monitor my weight, blood sugar, and blood pressure. Not that there’s much need to. As long as I stay relatively low-carb, the numbers stay where they should.

    It’s good to see a doctor considering alternatives to the carb-heavy “food pyramid” (or whatever they call it these days). When I ate by the “pyramid,” I gained weight and lost control of my blood sugar. Went back to low-carbing and within a week had lost ten pounds and regained control of the blood sugar. And the latter is actually more important to me. I control the diabetes with diet and exercise, and I want to keep it that way! Vive la low-carb! And kudos to you for giving it a trial!

  • Lorna Morris

    I always enjoy your posts—thanks for sharing your perspective with the world. I had a similar experience with cholesterol and triglycerides three years ago, and I mostly keep my numbers good unless I’m having trouble with sweets (I go through phases). Could you please specify the types of carbs you chose to eliminate? I got my results with eliminating all but carbs from whole grains and fruits and one or two glasses of wine a week.

    Thanks,
    Lorna

    Lorna: I eat almost no carbs at all during the week, and eat whatever carbs I want on Saturdays. Then Sundays, it’s back to no carbs. I do this by eating mostly the same things during the week: scrambled eggs for breakfast, a chicken caesar salad for lunch, and then rotate meat, chicken, and fish along with lots and lots of vegetables for dinner.

    Alex

  • Pam

    I was floored when my new doctor, (still an intern) told me my total cholesterol was 247. I’ve had a lifetime of much lower (and yes, pre-menopausal) numbers. I’ve always been active, but am less so after two knee surgeries, but I still walk 30 minutes a day. He told me not to be at all worried because my HDL was 97 and it is the “ratio of HDL to LDL” that really matters, mine being “2/5.”

    I did not feel reassured. And why do the numbers not add up to 247? Is the difference the triglycerides?

    Thank you

    Pam: Total cholesterol = HDL + LDL + triglycerides/5. Your doctor is right. All that matters is the HDL, the LDL, and the ratio between them.

    Alex

  • Regarding that picture of carrots and beans (phansi in Hindi)—do the beans have any connection with HDL? I could think of fiber and protein, but that’s it.

    Mira: Nope. Just there for the contrast with carrots.

    Alex

  • Esther Buddenhagen

    I find myself confused. In diets like the Atkins’ Diet aren’t fruits and veggies considered carbs? Could you explain the difference between, say, cookies and bread vs. carrots and apples?

    Esther: Vegetables in general provide many health benefits that sweets do not, and specifically with regard to raising one’s HDL, reducing intake of sucrose-containing carbs (i.e., sweets) has been shown to have a bigger effect on lowering triglycerides than reducing non-sucrose-containing carbs (i.e., vegetables).

    Alex

  • Seri M

    I agree that it’s a great idea to reduce our sucrose-containing carbs (sweets). But you might want to also consider reducing intake of meat & dairy: http://nutritionfacts.org/2012/03/15/harvards-meat-and-mortality-studies/

    Vegetables, whole grains, beans and limited amounts of fruits have helped me lose weight and improve my cholesterol profile.

  • I’ve been doing a great deal of reading lately about the impact of nutrition on health, and I’d like to know your opinion on the use of niacin to reduce cholesterol. While my cholesterol numbers are still in the acceptable range, they have creeped up as I’ve aged—adding insult to injury! 🙂 I eat very little animal product, by the way.

    Thanks for your thoughts.

    Candace: Niacin does improve cholesterol panels, and is in fact one of the few medicines that actually has an effect—albeit a modest one—on HDL. The problem with it is that many people have a hard time tolerating it. It can cause intense flushing (even though aspirin taken 30 minutes before its ingestion can reduce this, many patients still can’t handle it).

    It was so great to meet you this weekend and nice to see you here!

    Alex

  • Rose

    There are only three sources of nutrition: carbohydrates, fats and proteins. If a food isn’t a protein or fat it’s a carbohydrate. The media continually acts as though there is some other food group. There isn’t. Green beans, spinach, carrots, potatoes, lettuce, tomatoes, apples, bananas, etc. are all carbohydrates. Perhaps we need a new designation for good carbs (or bad carbs).

  • I second the others: thanks for branching out, topically. I hope you will continue to intersperse these with your psychology.

    I think the carb-heavy food pyramid was one of the greatest scams perpetrated on the American public. It certainly benefited Big Agra grain producers and Big Pharma; the profits from diabetes meds are nothing to sneeze at.

    I only gain weight when I eat bread and sweets. If I stay to fruits/veggies/meat/fish/fats, no weight gain. Portions size matters, of course. But .. the smallest portion of bread and refined wheat will put on the weight, almost immediately. My HDL is 103, and my doctor smiled when he recognized we shared the same number.

    Interestingly, he did not outright compliment it … he said it was “OK,” and failed to mention the true import of the low LDL. Since then, other docs have even suggested the cholesterol-lowering drugs, the statins—another scam on the public now being touted for everything that ails you.

    “Let food be your medicine …”

  • Elle

    I totally agree with Rose: we need to a new designation for good carbs and bad carbs. That would really help. I’ve been trying to get my diet to a no-bad-carbs state (for other medical reasons) and it’s really, really hard. What is one supposed to do about those intense carb cravings?!! Ugh.

    For what it’s worth, there is a NYT article on Gary Taube’s work and the whole fat vs. carbohydrate dilemma in diet at:

    http://www.nytimes.com/2007/10/09/science/09tier.html?_r=1&scp=2&sq=diet+and+fat%2C+Tierney&st=nyt

    Dr. Robert Lustig, at UCSF medical school, goes so far as to state that sugar should probably be classified as toxic to humans, at:
    http://www.nytimes.com/2011/04/17/magazine/mag-17Sugar-t.html?pagewanted=all

    Maybe if we want food to be medicine we need to pick the right foods?

    Elle: Regarding resisting temptation (i.e., bad carbs) I dedicated a large section in one of the chapters of my new book to exploring the research behind which strategies work and which don’t.

    Alex

  • Nuthin’ wrong with an actual (physical) medical or nutritional post now and again. In fact it’s quite welcome.

  • Catherine

    We eat pretty well in our family—lots of freshly prepared whole grains and vegetables, but proteins are a challenge. We eat eggs, chicken, fish and dairy but my daughter hates eggs (grrr) and is finicky about other proteins and would be delighted if she could live off of fruit and other carbs. We are formerly vegetarian and so I am not so adept with preparing meat and fish. I would be SO grateful if anyone could suggest tasty, kid-friendly, protein-rich meals or point me in the direction of some good sources for that information.

    As always, thanks again for another interesting post.

  • John Slomski

    My late wife was a nutritionist and an orthomolecular pychologist. Her conclusions were that a very-low carb diet was effective for rapid weight-loss but not better over longer time periods. It may also interfere with mood and serotonin levels, which worried her. Is there another way to raise HDL that is not so extreme?

    John: The jury is still out on the long-term effects of a low-carb diet. The only other way to raise HDL that I know of is intense exercise.

    Alex

  • Seri M

    Reply to Catherine:

    Your daughter can get plenty of protein from plant based sources. Grains, seeds, beans, and nuts all contain protein. And there is evidence that plant based proteins do not cause the inflammatory response that proteins from meat do: http://nutritionfacts.org/2012/09/20/why-meat-causes-inflammation/

  • Steph in Oregon

    Alex,
    Thank you for this information. I spend a great deal of time trying to figure out food these days. What’s right for me—what’s really healthy, what’s hype—so much time sifting all the information. I appreciate you sharing your meal plans in response to Esther’s questions.

    I look forward to reading your book.

  • Barbara

    Thank you for putting up important information! It’s a huge overlooked fact.

    While it’s carbohydrates, it’s specifically fructose which is raising the “bad” cholesterol up, and which is also a major influence on obesity. I’m suffering from a fructose-intolerancy (malabsorption to be precise) and I can attest that reducing fructose alone cleanses most of the common associated problems. Nevermind gaining a healthy weight.

    Either way, it’s lengthy and it contains much more extended knowledge, and perhaps a raise of awareness (not always my thing, but this time it is spot-on)

    http://www.youtube.com/watch?v=dBnniua6-oM

    But there are shorter versions and summaries as well out there.

    http://www.youtube.com/watch?v=tdMjKEncojQ

    It has the chemical components in for anyone interested. I trust you can filter the bias out just well.

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