It is time to discontinue referring to HDL as "good" cholesterol.

It's a widely accepted myth among doctors and the public that lowering cholesterol significantly affects heart disease.

There is debate over whether it has any impact at all, but due to the substantial investments in statins and other cholesterol-lowering medications, it is unlikely to change soon.

Overview

• Having extremely high HDL cholesterol levels (over 60 mg/dL) is associated with an increased risk of death and heart disease, challenging the belief that higher HDL is always better.
• The safest range for HDL levels seems to be between 41-50 mg/dL. Risk of heart attacks or death rises below and above this range, contradicting traditional medical advice.
• Implementing lifestyle modifications like exercise, weight loss, and a diet rich in healthy fats, purple fruits, and vegetables can help boost low HDL levels without elevating them excessively.

The Issue with HDL Cholesterol

The emphasis has primarily been on reducing LDL "bad" cholesterol, despite some major studies showing no benefits from doing so. Meanwhile, the focus on increasing HDL, known as "good" cholesterol, is also being questioned.

In essence, the concept of "good cholesterol" is likely a misconception...

Extremely High HDL Increases Mortality Risk

HDL is viewed as beneficial because it removes cholesterol from blood vessel walls and transports it to the liver for disposal or recycling.

The National Institutes for Health (NIH) indicate that having an HDL level of 60 mg/dL or higher is favorable. They consider anything below 40 to be a significant risk factor for heart disease.

However, a study from Denmark involving over 116,000 individuals found that very high HDL levels more than doubled the risk of death in men and increased it by over two-thirds in women.

The lead author Børge Nordestgaard summarized, "These findings change our understanding of 'good' cholesterol significantly. Previously, doctors would commend patients with very high HDL levels, but this study reveals a substantially higher mortality rate."

"...the focus on HDL as a crucial health indicator should be reassessed."

Dr. Sekar Kathiresan, a cardiologist and professor at Harvard, has conducted extensive research in this field.

In 2012, he and an international network of researchers compared 20,913 heart attack patients with 95,407 controls. They discovered that individuals with a gene variant that significantly raises HDL did not have fewer heart attacks. Despite expectations of a 13% risk reduction, it did not materialize.

Another study identified a mutation in a protein that binds to HDL cholesterol, facilitating its transport to the liver. Those with this mutation were found to have a higher risk of coronary heart disease.

Dr. Kathiresan stated, "When I began medical school in 1992, the teaching was that anything that boosted HDL cholesterol was beneficial. We can now dismiss that notion."

Recommended HDL Levels Pose Greater Risks for Heart Patients

At the largest cardiovascular congress globally held in Munich in August, Dr. Marc Allard-Ratick from Emory University School of Medicine, Atlanta presented research on the heart attack and mortality risk in 5,965 adults, most of whom had some form of heart disease.

Participants were categorized into five groups based on their HDL cholesterol levels: less than 30 mg/dl, 31–40 mg/dl; 41–50 mg/dl; 51–60 mg/dl; and greater than 60 mg/dl. After four years, 769 participants experienced a heart attack or died from coronary disease.

Despite considering numerous heart disease risk factors, the analysis indicated that those with the lowest risk of heart attack or death had an HDL level of 41-50. Risk increased both below and above these levels. Individuals with 60 mg/dL or higher – the target set by NIH -- had nearly a 50% higher risk compared to the 41-50 group.

Dr. Allard-Ratick opined, "There may be a need to revise our perspective on HDL cholesterol. Traditionally, physicians advised patients that higher 'good' cholesterol is better. However, the findings from this study and others suggest this may no longer hold true."

How to Raise Low HDL Levels

For individuals with HDL cholesterol below 40 who are concerned, there are natural methods to increase it. These approaches not only elevate HDL levels but also benefit overall health.

Engage in Physical Activity: High-intensity exercise has the most significant impact, but strength training and aerobic exercises are also beneficial.

Manage Weight: Shedding excess weight is crucial.

Adopt a Diet Rich in Fats and Low in Carbs: A low-carb, high-fat diet typically boosts HDL cholesterol in obese individuals or those with diabetes or metabolic syndrome. Opting for coconut oil and extra virgin olive oil can assist individuals with varying body types and metabolic profiles. Consuming fatty fish multiple times a week also helps raise low HDL levels.

Incorporate Purple Fruits and Vegetables: These foods contain anthocyanins, potent antioxidants that aid in combating free radical damage. Blueberries, blackberries, black raspberries, red cabbage, eggplant, and purple corn are excellent sources of these compounds.

Summary

The longstanding belief that "good cholesterol" (HDL) is universally beneficial is being challenged by recent research. Studies indicate that very high levels of HDL cholesterol may elevate the risk of heart attack and mortality, contradicting the traditional notion that higher HDL levels are always healthier. Experts now recommend maintaining a balanced HDL range rather than excessively high levels for optimal heart health. Furthermore, lifestyle changes like exercise and a balanced diet can naturally enhance HDL levels without resorting to potentially harmful extremes.

Frequently Asked Questions

What is HDL cholesterol?

HDL (high-density lipoprotein) cholesterol, known as "good cholesterol," transports cholesterol away from the arteries to the liver for elimination or recycling.

Is very high HDL always beneficial?

No. Research indicates that extremely high HDL levels (over 60 mg/dL) may heighten the risk of heart disease and mortality.

What is the optimal HDL range?

Studies suggest that maintaining an HDL range of 41-50 mg/dL is ideal for reducing the risks of heart attack and mortality.

How can I naturally increase low HDL?

Participate in high-intensity exercise, maintain a healthy weight, and consume a diet rich in healthy fats, fatty fish, and anthocyanin-rich purple fruits and vegetables.

Why is excessive HDL harmful?

Extremely high HDL levels may disrupt normal cholesterol metabolism or indicate underlying genetic or metabolic conditions that elevate the risk of heart disease.