Time to Stop Calling HDL "Good" Cholesterol

It's one of those myths so well established in the minds of doctors and the public it's almost impossible to shift: The idea that reducing cholesterol has a major impact on heart disease.

It's arguable whether it has even the slightest impact, but with so much money and so many medical reputations tied up in statins and other medications to lower cholesterol, don’t look for change any time soon.

Key Takeaways

•  Extremely high HDL cholesterol levels (over 60 mg/dL) are linked to an increased risk of death and heart disease, contradicting the long-standing belief that more HDL is better.  
• The safest HDL range appears to be 41-50 mg/dL. Risk of heart attacks or death increases both below and above this range, challenging traditional medical advice. 
• Lifestyle changes like exercise, weight loss, and a diet rich in healthy fats, purple fruits, and vegetables can help raise low HDL levels without risking excessively high levels.
  

The Problem With HDL Cholesterol

The focus has been on reducing LDL "bad" cholesterol, even though some major drug studies show no benefit from doing so. Meanwhile, increasing the patient’s HDL -- so called "good" cholesterol – has been considered a good thing, but questions are being raised about this idea, too.

In short, “good cholesterol” is most likely a myth. . .

Very High HDL Doubles Risk of Death

HDL is seen as beneficial because it picks up cholesterol from the walls of the blood vessels and carries it to the liver where it’s disposed of or recycled.

The National Institutes for Health (NIH) suggest you’re in good shape if your HDL blood test comes in at 60 mg/dL or more. They consider anything below 40 to be a major risk factor for heart disease.

But last year a study from Denmark assessing over 116,000 people found that extremely high HDL levels more than doubled the risk of death in men and increased it by more than two-thirds in women.

Lead author Børge Nordestgaard summarized it thus: "These results radically change the way we understand 'good' cholesterol. Doctors like myself have been used to congratulating patients who had a very high level of HDL in their blood. But we should no longer do so, as this study shows a dramatically higher mortality rate.

"...we need to remove the focus from HDL as an important health indicator."

Dr. Sekar Kathiresan, cardiologist and professor of medicine at Harvard, has carried out a lot of research in this area.

In 2012, he and a vast network of researchers worldwide compared 20,913 heart attack victims with 95,407 controls. They found people with a gene variant that substantially increases HDL did not experience fewer heart attacks. It was expected to reduce the risk by 13 per cent, but failed to do.

In another study, a mutation was found in a protein that binds to HDL cholesterol, triggering its movement to the liver. Those who carried this mutation were found to be at a higher risk of coronary heart disease.

Dr. Kathiresan said, “When I started medical school in 1992, I was taught that anything that raised HDL cholesterol must be good for you. We can now safely disregard that notion."

Recommended Levels Put Heart Patients at Greater Risk

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

Participants were divided into five groups according to their HDL cholesterol level: 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 suffered a heart attack or died from coronary disease.

Even though the researchers took many risk factors for heart disease into account, when they crunched the numbers, those at the lowest risk of heart attack or death had an HDL reading of 41-50. Risk increased both below and above these levels. Subjects with 60 mg/dL or higher – the goal NIH says we should aim for -- saw their risk increase by almost half compared to the 41-50 group.

In the opinion of Dr. Allard-Ratick, “It may be time to change the way we view HDL cholesterol. Traditionally, physicians have told their patients that the higher your 'good' cholesterol, the better. However, the results from this study and others suggest this may no longer be the case.”

How to Increase Low HDL

For those with HDL cholesterol below 40 who still have concerns, there are natural ways to raise it.  All of them benefit general health, aside from whatever they do for HDL.

Exercise: High-intensity exercise has the biggest effect but strength training and aerobic exercise also benefit.

Lose excess weight.

Eat more fats and fewer carbs: A low-carb, higher-fat diet will typically increase HDL cholesterol in obese people or those with diabetes or metabolic syndrome. Choosing coconut oil and extra virgin olive oil can help people with all types of bodies and metabolic profiles. Eating fatty fish several times a week also helps raise low HDL levels.

Eat purple fruits and vegetables:  Purple fruits and vegetables contain anthocyanins-- powerful antioxidants that help your body fight free radical damage. You can find these in blueberries, blackberries, black raspberries, red cabbage, eggplant, and purple corn.

Summary

The long-held belief that "good cholesterol" (HDL) is always beneficial is being challenged by new research. Studies reveal that extremely high levels of HDL cholesterol may increase the risk of heart attack and death, overturning the traditional view that higher HDL levels are always healthier. Experts now suggest that a balanced HDL range, not excessive levels, is best for heart health. Additionally, lifestyle changes like exercise and a balanced diet can improve HDL levels naturally without resorting to potentially harmful extremes.

Frequently Asked Questions

What is HDL cholesterol? 

HDL (high-density lipoprotein) cholesterol is known as "good cholesterol" because it carries cholesterol away from the arteries to the liver for removal or recycling. 

Is high HDL always good? 

No. Studies show that very high HDL levels (over 60 mg/dL) may increase the risk of heart disease and death. 

What is the safest HDL range? 

Research suggests that an HDL range of 41-50 mg/dL is ideal for reducing heart attack and mortality risks. 

How can I naturally raise low HDL? 

Engage 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 very high HDL harmful? 

Excessive HDL may interfere with normal cholesterol metabolism or reflect underlying genetic or metabolic issues that increase heart disease risk.