It's all about the HDL

Working in FP I pretty much see hypertension, diabetes, hypercholesterolemia, and geriatrics. In each of our patients we do a cardiac risk assessment (based on the Framingham studies www.framingham.org), and talk a lot about "good" cholesterol vs. "bad" cholesterol. Surprisingly, many of our patients have okay bad (LDL) cholesterol levels, but instead have not enough of the good (HDL) cholesterol. LDL is slightly more easily treated because of statin drugs and diet control. HDL, however, does not have a magic pill. Yes there are medicinal treatments, niacin being the most studied, but they are not as easily tolerated. On my search for ways to raise HDL levels for my sensitive patients who were not interested niacin (which causes an allergic type reaction with flushing and itching when taken) - I found an old article in Men's Health. Although I don't know the science behind their suggestions I figured most of them were reasonable and decided to include the list here:

• Weight loss - for every one pound lost you can raise your HDL by 1%
• Exercise - especially before a meal. Exercising before a meal will hike your HDL levels better than after. MH recommeds at least 4 thirty minute sessions weekly.
• Eat the "right" fats - Monosaturated fats are key (olive oil, nuts, cold water fish). Avoid meats, dairy, margarine, crackers, and snack foods with trans-fatty acids. There is a new prescription called Lovasa that is concentrated fish oil. If you are going to go to the trouble of taking fish oil you should get this Rx because you have to take between 30-40 OTC fish oil supplements to equal the amount of active ingredient in one Lovasa tab. Seriously? Yep, concentrate your cash.
• Cut down on simple carbs and focus on your complex carbs. Complex carbs are slower burning (increase saiety and prevent blood sugar spikes).
• OJ and tangerines. Drinking 3-4 glasses of OJ a day for four weeks raised one groups HDL by 21% (flavonoid hesperidin gets the credit for this). The catch to this is that fruit juices have insane amounts of added sugar. My advice: go for the plain fruit and eat it like dessert (to prevent blood sugar spikes. For more on which foods cause blood sugar spikes read up on the glycemic index).
• Dietary Fiber - whole grains (not wheat bread- this is an important difference), bran, fruits, veggies all raise HDL.
• Red wine and dark beer - Any alcohol should work but these two also have the most antioxidants (cancer fighting).
• Large doses of Vitamin B or Niacin (hence prescription strength medications enhancing the same).
• Stop smoking (no explanation necessary). If you are worried about the weight gain then stop smoking first (take Chantix, Wellbutrin or both if needed); then if you cannot lose the weight on your own you can get prescription diet pills. I am not a huge fan of these because I'd rather have patients that are gym rats than pill dependent. But I think there is a specific place for them in medicine.

I forgot to mention my specific interest in this topic . . . my father-in-law showed me his lab work on Sunday and he has an HDL of 29 (yikes!). This guy better be around when we have grandchildren so I have been on his back :-). Normal HDL levels should be above 40 and if they are above 60 your doc will be thrilled! There is a direct link to high HDL and increased longevity. In fact, one doctor has called an HDL of over 100 "Methuselah syndrome" (Methuselah is the oldest person mentioned in the Bible; he lived to be 969 Genesis 5:7).

So friends, please keep your LDL below 100 and your HDL above 50. I like you all, I want you to live for a very long time :-)