Low HDL Cholesterol

Diet and Nutrition
1

It seems that I have naturally very low HDL Cholesterol. I have been taking salmon oil and exercising regularly. I’m also taking Advicor 1000/20mg nightly. My HDL is still at 39. Before taking the medication, my HDL never got higher than 25-30. My total cholesterol in 128. Does anyone have any suggestions?

I am currently doing Waterbury’s TBT, I ride a road bike 20 miles 3X per week and I am 36 years old. By the way, all male relatives on my father’s side have the same problem. Maybe 39 is about as good as it’s going to get.

2

[quote]Sarge131 wrote:
It seems that I have naturally very low HDL Cholesterol. I have been taking salmon oil and exercising regularly. I’m also taking Advicor 1000/20mg nightly. My HDL is still at 39. Before taking the medication, my HDL never got higher than 25-30. My total cholesterol in 128. Does anyone have any suggestions?

I am currently doing Waterbury’s TBT, I ride a road bike 20 miles 3X per week and I am 36 years old. By the way, all male relatives on my father’s side have the same problem. Maybe 39 is about as good as it’s going to get.[/quote]

When it comes to the healthy fats it is possible that you aren’t getting enough.

Do you also drink alcohol? A bit of red wine during the week might be a good addition. Alcohol is known to increase HDLs.

Also, do some reasearch on Niacin. Niacin is being used as an addition or alternative to many “heart medications” because it has been shown, in numerous cases, to increase HDLs while decreasing LDLs.

The amount that was taken in these studies is way above any amount you’d be able to acquire in your daily diet.

The only complaints I have heard of is the “flushing” that occurs. Generally, your face will turn a nice bright red for a few minutes after taking it.

Can you give a synopsis of your daily diet?

3

Hey Sarge,

from what I see, you’re basically already on the most powerful HDL-elevating agent available (the niacin in Advicor).

Besides that, the other pharmacological agents that are relatively effective are fibrates, which are counter-indicated with statins (the lovastatin in Advicor) except in the most severe cases of hyperlipidemia.

Still, it seems that with your current therapy you are hitting recommended targets for LDL below a 100 for at risk individuals.

So at the moment, beyond the possible glass of wine here and there and strenous cardiovascular exercice (luckily for the lazy, the wine seems more efficient than exercice in the HDL elevating domain), there is not that much you can do.

I would be possible to increase your dosage of niacin, it is possible to go up to 6g/day (some go up to 9g/day when using niacine alone) divided in 2-4 doses with aspirin an hour before to limit flushing issues when not taking the extended-release formulas (the extended-release formulas are better tolerated but have higher hepatotoxicity, so usually they are limited to 2g/day on this formula). Maybe you could go with a crystalline version (basic standard niacin, but the flushing and pruritus are a damn bitch…and that’s no understatement)

Then again, niacin is implicated in raising blood sugar levels (not that much, but still) which is not something you really want to do. Therefore, before going with the niacin supplements in your local pharmacy, I would question my physician about my glycemia and propose the option (if you can even manage that amount of crystalline niacin, even with food to soften the ‘‘itching’’ blow).

So I hope this helps a bit.

AlexH

4

My rise in HDL I attribute to eating steel-cut oats every morning and supplementing with flaxseed oil–pure HDL.

5

Um . . . fish oil, and lots of it. My HDL is rediculously high (99) and became that way solely with the addition of lots of fish oil capsules.

6

As for fish oils, their effects, research-wise, seems to be limited mostly to diminishing triglycerides, something that they do rather effectively.

However, LDL and HDL wise, it is a much more subtle and limited effect. Basically, there is no rise in HDL, even a possible slight drop, but is accompanied with modifications of the HDL2a-HDL2b/HDL3 subsets, and other modifications to VLDL. So its still beneficial, but for raising HDL, it is not a major player.

Then again, basically everyone should be increasing their EPA/DHA intake. and decreasing their n-6 intake

AlexH

7

I brought my HDL up from 35 to 50 by eating oatmeal and taking up to 8gms of Fish Oil per day.

HDL is very important, you really want to get that up to 50( or higher) as fast as possible.

8

Dandalex,

I’m surprised to hear that; my doctor said that fish oil could have a definate positive effect on HDL, and mine was a pretty controlled experiment. It was THE only thing I did differently with regard to diet or excercise, and the two tests were about 6 months apart. HDL went from the high 40’s to 99.

9

Damici,

I understand your point and have honestly no explanation for it.

Basically, most of the research I’ve read concerning HDL and fish oils is basically either slight decrease, slight increase or nothing depending on the study. On the other hand, they do lower TGs a lot, so that’s good.

Personnaly, I remain a very strong proponent of fish oils for the TG-lowering effects as well as their anti-inflammatory and anti-aggregatory and so on and so on effects.

From what I have seen on PubMed, there can be a positive shift within the HDL categories, but quatitatively, the jury is still deliberating. Therefore, your doctor is not wrong and depending how the cardiologist who gave the continuing medical education lecture oriented the talk (he probably got the information from one of those)the message might have been simplified has Fish Oil for HDL = Good, which seems to be true (but on the HDL subset basis, not actual numbers at least, not at the moment).

I too take my 6-12 caps of fish oils a day and am eating a big can of mackerel as I write this and have high HDL, but I could not say if it helps since I was already on the caps before my first blood work.

I still think he should supplement, but I highly doubt that he could get that kind of results you’ve experienced since even niacin is for most people unable to generate a 50 point increase like that.

The oatmeal mentionned above is a good point, the soluble fibers in it do help HDL, psylium supplements probably would be the choice ‘‘par excellence’’ and ‘‘clean you up real good’’. Also, reducing or even eleminating trans fats from the diet could help.

Either way, fish oils are beneficial for different components of coronary heart disease, so whether or not it raises HDL, if its mecanism of action, whatever it is, is positive on CHD, I don’t see why it could not be helpful to Sarge overhere, even though it would not show on a numerical test such as HDL concentration.

Take care guys,
AlexH

10

Thanks a lot for the input, guys. The Advicor that my doctor prescribed consists of 1000mg of Niacin and 20mg of lovastatin. Prior to this I was taking Niaspan, a time released 1000mg Niacin supplement. It seems that the Advicor is working a little bit better. The flushing I experience only wakes me up on occasion, I normally sleep through it.

How much is too much fish oil? I am currently taking Salmon Oil 120mg EPA and 80mg DHA from the Vitamin Shoppe. I take 3 caps per day, even though the reccommended dose is one per day. The capsule contains 1000mg of Salmon Oil.

Thanks again for all the advice.

11

Just a little more background info. I didn’t start taking the prescription medication until the fall of 2001. Sometime in 2000, I had a blood test, and found that my HDL was dramatically low. On my doctor’s advice, I increased my cardio work to the point where I stopped lifting all together and dedicated myself to running. I was running 40 miles per week and ran in the 2001 NYC Marathon. After the marathon, I had another blood test to find that my HDL rose to about 25.

I’m not a big fan of medication, but I didn’t see a lot of alternatives knowing my family history.

12

For the fish oil question, there is a good couple of articles by Berardi on this site about them.

However, unless you have a blood thining condition, there really is not an actual limit on the amount you can take beyond the adverse effects it could have on your caloric intake.

Technically, ‘‘primitive’’ nutrition had a significantly higher content in EFAs than what presently the norm in developped countries (less fish and less if any free-ranging animals who have better lipid profils in their meat).

Most people seem to go between 6-12 g (with the same concentration of EFAs you are currently taking or a bit more depending on the company, mine is 180mg EPA, 120mg DHA with recommendations of 3 to 6 per day). But again, EFAs could constitute a very significant portion of your fat intake without much adverse effects (many anti-depressant and increased cognitive fuctions are being investigated right now, so that’s all good also).

One of the recommendatins I saw for fat intake was a maximum of 30% in the ‘‘recommended’’ diet with 10% max for saturated, 10% max from mono-unsat and 10% max from poly-unsat fats. But then again, these are recommendations based on absence of evidence so they couldn’t really recommend to eat a lot of anything, they only thing at that point that the scientific community knew was that saturated fats have negative effects on health. So 10% of 2500 Cals for poly unsats is some 28 g of EFA…which in my case would imply some 93 capsules a day (28g of EFA and 65 of other fats in the capsules)

Like I mentionned above, probably the only real option would be to increase your niacin intake with ordinary, not extended release formulas. Beyond that, you my friend, are stuck with relatively bad genes in that department and medication is the only way to go.

Also, maybe a switch to Crestor as a statin might be considered, since its a more power LDL lowering and more HDL increasing then the lovastatin you are presently taking, which would imply that you would have to go back to a 2-pill regimen instead of the 2-in-1. It might be more expensive also, considering its ‘‘newness’’. The effects would probably be moderate with a limited increase in ‘‘possible’’ liver toxicity, just something to look into.

Something you might want to look into since if you can’t increase your HDL significantly, you might try to reduce your LDL as low as possible to modify your HDL/LDL ratio in a favorable manner (that’s why the Crestor might be interesting since it seems to bit more potent on a mg per mg basis than previous statins.

Hope any of this can help.
Since you are at risk for CHD, maybe looking into all those little thing such as aspirin, green tea, psyllium fibers, cinnamon, increased fish consumption (other benefits beyond EFA in its amino acid profile, mainly increase arginine as a NO precursor for improve endothelial function as opposed to high-methionine meat)…getting all the benefits you can get.

AlexH