Monday, April 11, 2011

High HDL is good for you!

Public health bodies are adamant that low fat foods are healthier, and that we should be eating plenty of whole grain carbohydrates in order to avoid a whole host of problems, heart disease being one of the main ones.

You've probably heard this all your life, and it's difficult to imagine it not being true.  However, it is the exact opposite of what many low-carb proponents maintain.  They say we should be minimizing our carbohydrate consumption, favouring quality protein foods like meats instead, and that they don't have to be lean to be good for us.

Let's look at something that is not controversial:  HDL or high density cholesterol, otherwise known as "good" cholesterol.  Most of us are now aware that it's not so much our total cholesterol that is important, but the ratio of the total to "good" cholesterol.  In other words, we want HDL to be as high as possible, and the ratio to be as low as possible.

Furthermore, it is widely recognized that low HDL is a potent predictor of coronary heart disease, even more so in women than in men.  This is an even better predictor than the ratio of total to HDL.

For example, this is from the Jewish Hospital of Cincinnati:
There is considerable evidence that low levels of high-density cholesterol (HDL-C) are a contributory factor in the development of atherosclerosis and coronary heart disease (CHD). Low HDL-C is one of the most common lipid disorders in patients with premature coronary artery disease. In the Framingham study, for example, low HDL-C values were associated with increases in risk for CHD of approximately 70% in men and of more than 100% in women.  (my emphasis)
Edit (2014):  This link is no longer working.  Here is another link to the same quote.

High triglyceride levels are the other uncontroversial measurement:  the higher your triglycerides, the higher your risk for cardiovascular disease.

You would think this would be an easy nut to crack.    Focus on increasing HDL and lowering triglycerides, and you'll have your health under control.  For some people this is genetic, and sometimes there is an underlying medical condition, but for most of us, it's determined by our diet.

So how to go about increasing HDL cholesterol and reducing triglycerides?

This is what the New England Journal of Medicine has to say:
When fat is replaced isocalorically by carbohydrate, high-density lipoprotein (HDL) cholesterol decreases in a predictable fashion.
Going back to the Jewish Hospital of Cincinnati website quoted above, we read that:
Triglyceride-rich particles derived from dietary fat, chylomicrons, are not themselves associated with CHD
It goes on to list the following 6 most common causes of high triglycerides:
excessive alcohol intake, exogenous estrogens or estrogen agonists, poorly controlled diabetes, beta blocker drugs, corticosteroids, and uremia.
The most common causes of low HDL:
Patients with hypertriglyceridemia usually have lower HDL cholesterol and a higher risk of heart attack and stroke. Beta blockers, poorly controlled diabetes, uremia, anabolic steroids, corticosteroids, male sex hormones (testosterone), excessive zinc intake, and severe physical inactivity lower HDL cholesterol levels. 
I don't see dietary fat anywhere in that list, do you?  Never mind, let's continue....

The textbook, High Density Lipoproteins, Dyslipidemia, and Coronary Heart Disease, edited by Ernst J. Schaefer also has this to say:

So now we know that poorly controlled diabetes is a factor in high triglycerides and lower HDL.  We also know that  diabetes is a disease that results from the body's inability to properly manage carbohydrates.  And we have also learned that low fat, high carbohydrate diets lower HDL.

This might leave you wondering why we are encouraged to replace fats in our diet with carbohydrate.

It's not clear to me either.  I can tell you one thing for sure:  while there are plenty of  studies that show that people who eat lots of fat have more coronary heart disease, it's unclear how much carbohydrate they eat.  Put another way, how do we know it isn't the carbs, rather than the fat, that caused their heart disease?

How many people do you know with heart disease or low HDL but who don't eat plenty of grains and sugars?


  1. I recognized 20 years back that my cholesterol was related to my weight; when it went up or down 20# so did the cholesterol. I've had three doctors want to put me on statins, and always had some instinct saying it was using a sledge-hammer to drive a tack. Treating just the cholesterol without treating the source of overweight always seemed foolhardy. Perhaps being an academic made me more skeptical, but I'm very glad I've not been led down that path. My overall numbers are in the upper 200s, but my hdl is also high. Medicine is still in relative infancy--just think pre-1930s, and I think we are still a long way from really understanding all the ins and outs of human bio-chemistry. Thanks for the post.

  2. maggie.danhakl@healthline.comSeptember 25, 2014 at 2:15 AM


    Healthline recently put together an infograph showcasing heart disease statistics and facts to help someone understand their risk for a heart attack or other heart-related issues. You can see the infograhic here:

    I am writing to you to see if you can help spread awareness about heart disease by sharing this with your followers or including it as a resource on your page:

    Please let me know if you would be interested in helping to raise awareness about heart disease.

    Thank you for your time reviewing. Please let me know if there are any questions I can answer.

    Warm regards,
    Maggie Danhakl • Assistant Marketing Manager
    p: 415-281-3124 f: 415-281-3199

    Healthline • The Power of Intelligent Health
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    1. Hi Maggie, Thanks for sharing your infographic. However, I don't think you understand what this blog is about. Your infographic advises people to eat a diet low in fat and cholesterol and whole grains (we do agree on the sugar, which is why I wish you wrote about veggies and fruit, not fruit an veggies) - that's totally contrary to what I'm saying. Please also do some reading on dietary cholesterol - it really isn't the problem you think it is. Of course saturated fat doesn't cause heart disease either - please check your facts - there are now quite a few studies that show no causal relationship. Good luck!