Wisdom Wednesday: ‘Good’ Cholesterol Might Be Bad Too

HDL cholesterol may be known as the “good” kind, but a new study suggests high levels of it are not always a good thing for women after menopause.

The study, of nearly 1,400 postmenopausal women, found that those with higher HDL levels were more likely to show “plaques” in their carotid arteries. Those arteries supply blood to the brain, and plaque buildup there signals an increased risk of both stroke and heart disease.

“We used to think, the higher the better,” said Dr. Karol Watson, director of the Women’s Heart Health Program at the University of California at Los Angeles. “But we’ve been rethinking HDL in recent years.” Watson, who was not connected to the study said “everyone agrees” that low HDL – below 40 mg/dL – is bad. But studies have also found that very high HDL is liked to trouble, too. For example, a 2016 study of over 630,000 people found that women and men with very high HDL – above 90 mg/dL – were more likely to die (of noncardiovascular causes) during the study period than those whose HDL was in the middle of the pack.

HDL is known as the “good” cholesterol because it does positive things, including clearing fat from the arteries and ushering it to the liver to be removed. But, Watson said, research suggests that HDL function can go awry when its environment is not ideal – such as when a person is obese or has diabetes or other health conditions causing chronic inflammation in the blood vessels. “HDL seems to be like a chameleon, changing based on its surroundings,” Watson explained.



How high is “too high” when it comes to HDL? There is no known cutoff, Watson said. In general, she added, there seems to be an HDL “sweet sport of around 60 to less than 80 mg/dL.

My Take:
A brief review of the biochemistry will bring you some clarity. LDL cholesterol is manufactured and released from the liver in response to inflammation. It is then taken into the cells of the body where chemicals are added to it, changing it from an LDL (low density lipoprotein) to an HDL (high density lipoprotein). Some of the HDL is then released back into the blood stream. It travels to the liver where it is dismantled, becoming and LDL again and the process starts over. This is a complex biochemical cycle. No one part of it is “good” or “bad”. Without LDL, you cannot make HDL.

The key is understanding that the process is driven by inflammation. Modulate the inflammation and both the LDLs and HDLs will return to normal.

Thirty years ago, when I mistakenly believed that lowering cholesterol improved health, I would manipulate the various cholesterol markers. My first choice was fish oil and it worked about 60% of the time. That’s because it modulates prostaglandin inflammation, the most common form of inflammation in the body. When that didn’t work I used a variety of products – gugulipid, niacin flush, and others. They all worked on some people, but none worked on all. It wasn’t until I learned to modulate inflammation that I began to understand the nature of cholesterol.

Today, I identify the active inflammatory pathways, modulate them with natural remedies, like fish oil, ginger, Boswellia, black current seed oil, sesame seed oil, and/or vitamin B12, and monitor the serum lipids for response. The goal is not to lower total cholesterol, LDL or even raise HDL, but rather use these tests as markers of inflammation.

Of course, the hs-CRP, homocysteine, and SED rate are better markers of inflammation and should be run along with the serum lipids.

Bottom Line:
HDL, like LDL and total cholesterol are markers of inflammation, not tests to be manipulated with drugs or natural supplements. HDL is not “good” and LDL is not “bad”. In fact, if your HDL is equal to or greater than the LDL, that’s indicative of autoimmune disease.

One final thought, low LDL has negative health consequences as well. You need it to make hormones and protect the tissues of the body. Just look at a few of the side effects associated with statin drugs – liver damage, cardiac myopathy, retinal detachment, senile dementia – and you will begin to see the problems created by manipulating serum lipids.

Source: October 14, 2018 Health Day