HDL for Dummies

25. May 2008 William Davis (10)
I frequently peruse conventional health websites to keep track of their message. One painfully conventional (read "drug company-supported") website that echoes the standard advice on heart disease and heart health is Everyday Health .

Since I subscribe to the newsletters for many conventional sites, I received an e-mail that took me to this Q & A about HDL cholesterol:

Q: I'm 36 years old and my good cholesterol is too low. What can I do?
– Nilsa, Florida

Dr. Lori Mosca of New York-Presbyterian Hospital responds:

A: A woman's HDL goal should be greater than 50 mg/dL (greater than 40 mg/dL in men). You can raise your HDL levels by eating a diet low in saturated fat and trans fat but high in monounsaturated fats. Lose weight if you need to and get at least 30 minutes of moderate-intensity exercise on a minimum of four days per week. If you smoke, quit. Despite positive lifestyle changes, though, some individuals may still be candidates for HDL-raising drug therapy because they are at increased risk for cardiovascular disease. Discuss your options with your health care provider.


Are you satisified with that answer? I certainly am not.

First of all, is this something you've never heard before? "Eat right, exercise, cut your unhealthy fats." Then why do people who follow this sort of conventional advice often still fail? Is the next step always medication?

Here's the part that Dr. Mosca and other conventional, drug-minded "authorities" have left out:

To raise HDL powerfully--not to 40 mg/dl for males or 50 mg/dl for females, but to 60, 70 or 80 mg/dl--think about the following strategies:

--Eliminate wheat and cornstarch products. I have droned on endlessly about this concept, but it is enormously effective. While the weight loss that inevitably follows elimination of these foods adds to the HDL-raising effect, there is also an independent effect, as well.

--Fish oil--The omega-3 fatty acids in fish oil reduce triglycerides. Triglycerides accelerate the destruction of HDL. Remove triglycerides, HDL goes up. (Though krill oil may share, even surpass this effect, we need more data than the single manufacturer-sponsored study.) Of course, this requires real doses, not the namby-pamby doses you often read about.

--Vitamin D--Achieving normal levels of 25(OH) vitamin D raises HDL with power I have never witnessed from any other strategy before, barring weight loss of 30+ lbs. Readers of the Heart Scan Blog know that just taking vitamin D is not enough. Verification with blood levels is an absolute necessity, particularly if raising HDL maximally is among your goals.

--Adding back saturated fat. I say "adding back" since most of us (including myself) went too far down the "saturated fat is bad" path over the past few years. While I do not advocate a carte blanche approach to saturated fat, I believe that adding back eggs (preferably free-range and/or omega-3 rich), lean meats, and hard cheeses is a good idea. The saturated fat in these foods raise HDL 5 or more mg/dl.

--Dark chocolate--Or other cocoa prepartions. What a cool way to raise HDL! Reach for the lowest-sugar, highest cocoa preparations.

--Alcoholic beverages--I am partial to the red wine/flavonoid-rich concept, being a wine drinker. Although all alcoholic beverages raise HDL due to the ethanol content, for benefits beyond alcohol (as well as to avoid wheat-based drinks like beer), I do believe that the bulk of data argue for flavonoid-rich red wines from southern France, Italy, and California.

--Achieve ideal weight--The toughest of all. But eliminating wheat and cornstarch makes it far easier.


Follow the conventional advice of those like Dr. Lori Mosca, and the majority of people will fail. ("It just so happens that I have a prescription drug just for that purpose!")

Buck the conventional advice, adopt strategies that won't be found in the drug ads, nor be provided by the conventionally-thinking, and you can succeed to heights you never thought possible.


Copyright 2008 William Davis, MD
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Comments (10) -

  • Ross

    5/25/2008 3:55:00 PM |

    I'm very excited to read what sounds like a possible change in your position on saturated fat (agreed: it's only one of a list of many other beneficial dietary practices, and I shouldn't focus too much on that one).  

    My own substantial weight loss, achieved by substituting fat (and saturated fat) for carbs while keeping protein intake moderate, has been such a revelation to me.  It's been quite difficult to believe that what we've been told by dietary authorities is not only incorrect, but is most likely exactly backwards.  Fat has not made me fat.  Fat has and continues to make me full.  Being full got me to a BMI of 23.  Becoming slender again has restored my athletic performance as well as improving the blood markers that most of your readers track.

    Taken as a whole, this list of dietary advice might possibly be summed up as, "Enjoy good eating in moderation."  IMHO, at the end of the day, a balanced approach is an essential part of any sustainable lifestyle.

  • Anonymous

    5/26/2008 12:58:00 AM |

    I have had what I consider great results with raising my HDL from 312 a few years ago following my physician's AHA recommendations to 51 now by doing most of the things you suggest in this blog (I am male).  My question is,  how good is this as a heart health indicator?  Even though your book suggests that only a scan will tell, I am nervous about X-rays and the cost of a scan.  Can I take some solace in my dramatically increased HDL?

  • Alan

    5/26/2008 3:15:00 AM |

    I almost totally agree.

    The only minor disagreement is that I would extend "wheat products" to include the other grains and starchy carbs. I am very cautious about all of that group.

    My major disagreement is the omission of Australia from your list of excellent dry red wine producersSmile

    Cheers, Alan, T2 Diabetic, Australia

  • Dr. William Davis

    5/26/2008 1:31:00 PM |

    Anonymous re: HDL--

    No, sorry, absolutely not. It is an indicator, not the real thing, meaning plaque.

  • Gyan

    5/27/2008 6:51:00 AM |

    If you advise eating saturated fats, then why specify "lean meats"?.

  • Anonymous

    5/27/2008 5:56:00 PM |

    What percentage of your patients don't respond to the HDL boosting therapy you advise?

    I raised my vit D level to 56, dropped wheat, increased exercise, took niaspan (albeit at only 500mg), took 3 grams omega-3/daily, took a wine extract supplement, ate  a small amount dark chocolate daily....

    And my HDL went down 1 point. My weight isn't an  issue, I think, as I'm 6'1"", about 175 lbs. My body fat is approx. 15% (not sure if that's good or not). I eventually had to drop the niaspan, as I was getting heart palpitations, but it didn't seem to be doing much for my HDL anyway.

    What is recommended for patients when their HDL won't seem to budge? And a better question... why isn't it raising on the therapies you recommend, when it does work for most patients? Are there any rare causes for low HDL, outside of genetically low HDL?

  • Anonymous

    5/31/2008 9:37:00 PM |

    I can echo the last post. I have tried all of Dr. Davis' strategies, plus others, and it's resulted in slight reductions in my already low ldl and triglycerides but no change in my low hdl. I'm in great shape, eat well, exercise regularly, no heart issues or risk factors besides the low hdl, which I assume in my case is genetic.

  • Anonymous

    9/13/2009 4:03:11 PM |

    I didn't know where else to post this question.  Is this true?

    "Another way to know if abundant HDL is valuable is to look at its particle size -- smaller is better. A large study has found that people with high HDL (above 70 mg/dL) but very large particles had more risk of heart disease than people with low HDL (under 40), probably because larger particles aren't as active. But again, there's no easy commercial test for that."  This quote appeared today at http://www.oregonlive.com/health/index.ssf/2009/09/you_docs_answering_questions_a_2.html.  Mehmet Oz is usually suspect to me, anyway, but I am still curious about this statement.

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    11/2/2010 8:24:16 PM |

    --Adding back saturated fat. I say "adding back" since most of us (including myself) went too far down the "saturated fat is bad" path over the past few years. While I do not advocate a carte blanche approach to saturated fat, I believe that adding back eggs (preferably free-range and/or omega-3 rich), lean meats, and hard cheeses is a good idea. The saturated fat in these foods raise HDL 5 or more mg/dl.

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Digging for the truth

Digging for the truth

15. July 2007 William Davis (9)
I remain continually amazed how difficult it can be to gain an understanding of what is true and what is not true. I am particularly worried about the messages provided by agencies that stand to make enormous gains by persuading us to believe their version of the "truth".

For a moment, let's strip away the charitable covers of some financially-motivated organizations and see what they really look like:


Hospitals: The dream of hospitals is to shift the proportion of patients towards those with the most profitable diseases in well-insured patients. Heart disease is among the best paying diseases. HOSPITALS WANT YOU TO HAVE HEART DISEASE.

Doctors: Many (though not all) want to deal with diseases that pay well. Implanting a stent can pay several thousand dollars. Putting in a defibrillator can likewise pay handsomely, even better than stents. DOCTORS WANT TO STEER YOU TOWARDS PROCEDURES THAT REIMBURSE GENEROUSLY. Talk is cheap and pays poorly. Heart scans? Useless, since they're cheap. CT angiography? Now we're talking! $1800 dollars is a lot more interesting than $200 or so for a simple heart scan. CT angiograms also lead to catheterization, stents, hospitalizations.

Drug manufacturers: The holy grail for drug manufacturers is a chronic condition that is present in large numbers of people. An antibiotic, for instance, is a drug manufacturers waste of time: Short courses of treatment in relatively few people. Cholesterol drugs, blood pressure drugs, drugs to modify personality or some aspect of behavior--these you take for years, decades, or a lifetime, and millions are persuaded they need them. DRUG COMPANIES WANT CHRONIC CONDITIONS (WHETHER OR NOT THEY'RE DISEASES) IN PEOPLE WHO SURVIVE FOR A LONG TIME, NOT SICK PEOPLE.

Supplement manufacturers: What don't we need in the eyes of sellers of nutritional supplement? While a program like Track Your Plaque makes liberal use of supplements in a focused and, I believe, rational way, supplement sellers want you to take dozens or preparations of dubious value: milk thistle, hawthorne, ribose, hoodia, silymarin, hydroxycitric acid . . . Unlike the larger ambitions and bigger money of the pharmaceutical industry, the supplement industry is often driven by the momentary craze and the quick payoff. THE SUPPLEMENT INDUSTRY IS LOOKING FOR SUCKERS.

Food manufacturers: The holy grail for the food industry are foods that have high markups, are convenient (e.g., eaten right out of the box or package), and are purchased repeatedly. Even better, if a health claim can be added, it can ride the current wave of the public's health consciousness. Thus, Cocoa Puffs can be labeled "Heart Healthy". How about foods that have addictive potential and virtually ensure repeat sales? Eat some and you want more within 2-4 hours! As nutritionist Marion Nestle says, the mantra of the foods industry is "Eat More". It is my firm conviction that the epidemic of obesity in the U.S. is not due to laziness, video games, and computers. It is the fault of food manufacturers. FOOD MANUFACTURERS WANT US FAT AND HUNGRY AND WANT US TO STAY THAT WAY. What pays better, a 110 lb vegetarian woman who shops at the farmer's market and buys locally produced foods, or the 260 lb glutenous and always-hungry woman who fills her supermarket shopping cart with 15 cents worth of flour and sugar priced at $4.59 (cleverly disguised as a healthy breakfast cereal), instant mixes, convenient meals, energy bars, and chips?

Government agencies: User fees for the FDA paid by drug companies have caused the FDA to be beholden to drug company pressures. The USDA, charged with crafting the food pyramid, was created to support the farm industry and distributors of their products, not to disseminate public health. The food pyramid is the watered down end result of food industry lobbying and threats, not the scientific advice of nutritionists. GOVERNMENT AGENCIES SERVE INDUSTRY FIRST, THE PUBLIC SECOND.

Health websites: Read popular websites like WebMD for information and the conversation quickly steers towards drugs. "Natural treatments for cholesterol" talks about reducing saturated fat and then gushes about the wonders of statin drugs. Guess where 80% of WebMD's revenues come from? Yup, the drug industry. The same goes for many magazines, TV shows, and other media. MEDIA IS OFTEN THE TOOL OF BIG INDUSTRY.



I'm sounding like a conspiracy theorist. I don't believe that I am, but I am skeptical of the messages we often receive from the media, advertisements, news reports, websites, etc. It's left to you and me to use our judgment and decide what is truth and what is someone's version of a message crafted towards their hidden agenda.

I am hoping that the real truth will grow through a wiki-like phenomena driven and supervised by a collective knowledge that we all contribute towards. That will happen, most likely, on the internet. Just as Wikipedia overtook the revered Encylopedia Britannica in the blink of an eye at far less cost yet with greater depth and equivalent accuracy, so will it happen in health information. I'm uncertain of the eventual form this health-wiki will take, but it will shatter many smug and deeply-entrenched powers that at present continue to profit from mis-information.
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Comments (9) -

  • JT

    7/15/2007 4:29:00 PM |

    Unfortunately you don't sound like a conspiracy theorist.  I even know of an example of a fortune 500 company receiving air time for one of their products by "respected" news agencies.  

    Back in the summer of 1999 or 00 one would have thought the supplement SAMe was the cure all for depression and arthritis.  Magazines Time, & Newsweek ran articles on it.  My memory isn't so good anymore but I believe one of them even placed SAMe on the front cover.  The nightly news NBC, CBS, and ABC all ran gushing reports on SAMe and its natural curing abilities.    

    I'd like to say that the news reporting was done because SAMe is truly a wonder supplement.  That is not the case.  It is a fine product I suppose but not the kind of product that deserves the enormous press coverage that it did.  The reason it received so much press is because the large multi national company asked them to do so.

  • Rich

    7/15/2007 9:41:00 PM |

    Dr. Davis, these comments are a huge inspiration.

    As a b-school prof, I know that pharma and hospitals are not intentionally exploitative, but the profit motive inexorably works its effects in all aspects of the decision process, and ethical standards are gradually stretched to the minimum limits of acceptability.

    I recently did a casual analysis of the ads in Reader's Digest. About 80% of the ads are for prescription drugs to treat lifestyle-inflicted illnesses, such as high BP, type 2 diabetes, and inability to sleep, as wells other highly questionable illnesses such as "restless leg syndrome, or RLS." Daytime TV is about the same. You may notice that the ads now say "talk to your prescriber" instead of "talk to your doctor" -- in other words, they don't care who prescribes it, only that it gets prescribed.

    THESE ADS ARE THE REVENUE SOURCES FOR THE MEDIA, WHICH MUST CATER TO THE ADVERTISERS IN ORDER TO STAY IN BUSINESS. PHARMA PAYS FOR THE RESEARCH IN UNIVERSITIES, AS WELL.

    People don't bite the hand that feeds them!

  • Dr. Davis

    7/16/2007 12:30:00 AM |

    Wow! I wasn't aware of that.

    Would you know who the company was?

  • Dr. Davis

    7/16/2007 12:36:00 AM |

    Rich--

    I had no idea that the proportion of pharmaceutical ads had grown to such an extraordinary number. The drug industry is not stupid--their direct-to-consumer advertising must be working in a big way.

  • JT

    7/16/2007 12:48:00 AM |

    Yeah, maybe I'm too cautious, but giving the companies name shouldn't be a problem in this case.  The SAMe pills were made by an Italian firm that had/has a contract with BASF.  (They could be a division of BASF.)  

    I was told by a BASF employee that their press department is very good and persuasive.  They wanted to create a buzz for the product.  70% of sales for health foods are generated on new products.  People like to rush out and try the new thing.

  • Anne

    7/17/2007 11:33:00 AM |

    Don't forget to include the "non-profits". Back in the 1950's my father, a physician, told me that the American Cancer Society did not really want to find a cure for cancer. From some of the things the American Heart Associaton promotes, I don't think they really want to stop heart disease.
    Anne

  • Dr. Davis

    7/17/2007 12:00:00 PM |

    I couldn't agree more.

  • Anonymous

    7/17/2007 5:42:00 PM |

    Thank goodness we have someone like you, Dr. Davis, who can help us sort through all these industries who are looking for "suckers".

  • Anonymous

    11/19/2008 3:07:00 AM |

    There is a very interesting 6 part documentary on youtube about marketing and the pharmaceutical industry. "Big Bucks, Big Pharma"
    Here is the link to part 6.

    http://www.youtube.com/watch?v=IVDTo8Rm1rE&feature=related

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