Why do we spend so much time talking about lowering “bad” cholesterol and almost ignore its fraternal twin brother (arguably a more important player in risk of cardiovascular disease)? The answer is quite simple, there are basically two ways that a pharmacologist can impact a biological system, they can either work to add something back to the body (such as thyroid hormone) or they work to decrease the amount of a compound in the blood (such as an antihistamine for allergies). It is extremely difficult for the scientists to produce a drug that gets the body to make more of a particular substance. On the flip side, it is easier to make a compound that inhibits the production of a particular substance. With cholesterol, pharmacologists have designed medications called statins that decrease the amount of cholesterol that the liver can produce. HDL, however, is different than LDL cholesterol in that more HDL is better. Thus, scientists would have to produce a substance that was capable of stimulating the liver to build and release more HDL particles. Not an easy task.
As mentioned earlier, there are two types of cholesterol. LDL, is called “lousy” cholesterol because it is the form that is found in the nasty plaques of the arteries. HDL is considered “happy” because it carries cholesterol from the tissues, such as the arteries, back to the liver where it can be disposed of. That is an oversimplified, albeit sufficient, description of the two main forms of cholesterol.
Once again, the goal with HDL is to achieve a higher level. When I was in pharmacy school, we were told that there were two main ways to impact HDL: exercise and moderate alcohol. I remember my professor jokingly saying “therefore, it would be in our patients’ best interest for them to run from bar to bar.” So for the remainder of this email I will discuss natural ways to increase your body’s own production of this important cholesterol particle. I will start with a discussion on specific lifestyle recommendations because these clearly have the most important and significant benefit to HDL levels and then I will conclude with a discussion of the supplements which act to top off our HDL levels.
Cut Carbohydrates! When we get a significant amount of carbohydrates in our diet, such as, bread, pasta, cake, candy and cereals, our body produces high levels of insulin. Elevated insulin triggers a condition called insulin resistance which has been shown to be a key factor in the development of cardiovascular disease. Part of the risk may be associated with the impact of insulin on the liver’s ability to produce HDL cholesterol particles. A low HDL is a classic presentation in people with insulin resistance and diabetes. By controlling carbohydrate intake you will have a positive impact on all lipids including HDL.
Exercise…LONGER. It is no secret that exercise has a positive impact on HDL cholesterol, however, until recently we didn’t have a clear idea as to how much of an increase could be expected. A Japanese study looked to answer this question. It was determined that the length of an aerobic exercise session was what determined the amount by which HDL would raise. In fact, for every 10 minutes above 20 minutes of aerobic exercise the subjects would enjoy a 1.4 mg/dl increase in HDL. Intensity and frequency were not nearly as important as the length of each exercise session. It is my recommendation that we each get 60 minutes of activity at least 5 days a week. I know it is a tall order, however, if people want extraordinary results in their lives they need to put in extraordinary effort.
It is Time to lose the weight. This one is cut and dried. Even small amounts of weight gain can have dramatic impacts on HDL cholesterol.
Good News for Smokers! The good news is…if you quit, you will enjoy a significant elevation in your HDL cholesterol.
Check Your Medications. Some medications can have a negative impact on HDL such as beta blockers and certain cholesterol lowering medications.
Oils can help. If you do use oils in cooking or salads use extra virgin olive oil as this has been linked to higher HDL cholesterol.
Your Chia Pet May Save Your Life. Chia seeds are a wonderful whole food and may help you achieve a higher HDL. Soluble fiber, found in chia seeds, has been shown to increase your HDL and help protect you from insulin resistance. In addition to the large amount of fiber found in chia seeds, they are also full of healthy HDL-raising fatty acids, nutrients and minerals. Try 1 tablespoon twice daily.
Fish Oil Increases HDL By Two Mechanisms – Omega-3 fats found in fish oil have many positive benefits to the body. One such benefit is increasing HDL cholesterol by increasing production while simultaneously decreasing the body’s dismantling of HDL cholesterol that has already been produced. We recommend 1 tablespoon daily of Carlson Labs or 6 capsules daily of Super Omega-3.
Niacin – No discussion of natural approaches to increasing HDL is complete without a discussion about B3, also known as niacin. Currently there are three main forms of niacin on the market: standard niacin, inositol hexanicotinate and niacinamide. Plain niacin is the form most commonly prescribed or recommended for cholesterol and it has very potent benefits to HDL and has also been shown to decrease heart attack risk and cardiovascular death. Unfortunately, niacin comes with side effects including uncomfortable rash/hot flash and potential liver damage (which occurs more often than I feel comfortable with). If you do use niacin, you should use a slow release and have your doctor test your liver on a regular basis. Inositol Hexanicotinate is a form of niacin that is bound to inositol. This form is believed to enter the blood where it is slowly releases the niacin to the body and may impact cholesterol. The cholesterol lowering benefits of inositol hexanicotinate (no-flush niacin) are inconsistent. It works well for some and is useless for many. There is no way to determine who no-flush niacin will work, for so it has fallen from favor with us. Those who use no-flush niacin with good result should continue, it appears to offer little risk to the liver. Niacinamide does nothing for cholesterol but can be a useful tool for those who suffer with inflammation.
Now I would like to shift directions a bit and move from a discussion of increasing the number of HDL particles that are floating through your blood to a discussion about how to improve the ability of your HDL to pull unwanted cholesterol from the plaques of the arteries. A very interesting study on genetically modified mice shed some light on how HDL works to inhibit plaque formation. HDL is not just a glob of cholesterol, it actually carries numerous enzymes which appear to offer much of the benefit. One such enzyme, called paraoxonase, appears to play a very important role in the blood vessels. When scientists genetically engineered mice to produce HDL cholesterol without this vital enzyme, the mice suffered significant inflammation within the blood vessels. This research suggests that HDL actually becomes harmful and inflammatory when it loses paraoxonase. In humans, acute stress such as surgery or trauma can cause the HDL to be depleted of this anti-inflammatory enzyme. Paraoxonase also appears to play an important role in detoxifying the LDL cholesterol, making it much less likely to deposit into the arteries. So what can we do to protect the paraoxonase and is there anything that can be done to increase the production of this powerful enzyme? The answer is yes! A Greek study evaluated vitamin E’s ability to protect the HDL cholesterol from losing its paraoxonase enzyme after intense exercise in 10 healthy basketball players. Initially the researchers tested the paraoxonase content of the basketball player’s HDL before and after intense exercise and found the enzyme levels plummeted after the exercise. They then began having the players supplement with vitamin E. After one month of supplementation with alpha tocopherol (vitamin E) the researchers tested the blood before and after intense exercise and found that the supplementation protected the HDL from losing the paraoxonase. This certainly does lend support to the protective effect of vitamin E for cardiovascular disease. If you do supplement with vitamin E, I recommend that you take a natural formula such as Unique E. 1 softgel (400 iu) daily should be plenty.
Recently, scientists have found that a class of compound found in many natural foods may actually activate your genes to produce more paraoxonase! This class of compound called polyphenols is found in many fruits, herbs and teas. Two specific polyphenols stand out in the research literature for their ability to increase the production of this enzyme: quercetin and resveratrol. These two products can be found in a formula called Resveratin by Xymogen. I recommend 1 capsule twice daily. This area of research is a very exciting one and may prove to me a much more important factor than the HDL number. We will continue to follow this issue and report on any new data that comes out.
One final note on cholesterol. As more and more research comes out we are seeing a change in the thought process of cholesterol and its impact on heart disease risk. The most recent literature suggests that the quantity of the cholesterol is far less important than the quality of the cholesterol produced. On your next doctor’s appointment, ask your doctor to order a blood test that assesses the quality of the cholesterol produced in addition to the quantity. This test is called the VAP test and it is available at most labs. If your doctor is not familiar with this test then it may be in your best interest to contact a holistic minded physician to follow this and other tests that may give you insight into your true risk of heart disease. To see a listing of these tests, please see the Heart Disease protocol in our Health Issues section.