22 replies to this topic

[nameless]

I'm curious if anyone out there has ideas as to why a person may have low HDL, besides the obvious factors (or at least what I consider obvious): diet, exercise, genetics, Vit D, etc.

I've had low HDL for a while, it generally comes in around 35-40 or so.

Things I've tried:

Reduced carbs, restricted/eliminated wheat .... perhaps a very minor benefit

Increase serum D .... got a boost of a couple of pts, maybe

Niacin (Niaspan and also tried IR)... couldn't last very long on this due to palpitations. I did make it about 5 months or so on 500mg Niaspan, and my HDL dropped a point (35 to 34)

Exercise... increased riding my exercise bike to about an hour a day, 5x week. Did this for several months before my test. My HDL dropped a point.

Red Yeast Rice... tried this briefly under the advise of my cardiologist, years ago. My LDL/Trigs dropped, but so did my HDL (about 2 pts). Had to stop due to elevated liver enzymes.

Krill oil... I was doubtful it'd work, but figured I'd give it a shot. After two trials, I noticed no correlation at all between krill oil intake and HDL (or any lipid numbers).

Fish oil... never noticed any major increase in HDL from it. But too much fish oil has risen my LDL in the past.

What else... dark chocolate possibly could have helped, but can't be certain. Blueberries... no difference.

This time I figured I'd try something that should work. Olive oil. So I used 1-2 tablespoons daily, for several months.

My most recent HDL just came back today: 29

It was 34 (or thereabouts) around five months ago, before starting the olive oil.

So.... I'm all out of ideas... anyone else have any?

[Sillewater]

What do your other numbers look like?

[nameless]

My other numbers are so-so.

For this most recent test:

LDL was 112, Trigs were 118. Not ideal, but not really super terrible. Lp(a) is usually fine, around 3-5.
I don't have my VLDL or particle sizes yet, as I just got this most recent test results over the phone.

In general, my LDL usually varies between 110-125ish, Trigs tend to be around 115-135 . VLDL... usually borderline normal. My HbA1c has been tested several times, and is considered good (at least by my doc), with a low of 4.5, although on one test I recall it was 5.1. There has been no correlation between my HbA1c and my trig/HDL numbers so far (that I have noticed). So even when sugar/carb intake was low, my lipid numbers more or less remained the same.

Edited by nameless, 28 October 2011 - 05:50 AM.

[niner]

So.... I'm all out of ideas... anyone else have any?

Have you tried adding coconut oil to your diet? It would probably raise your ldl some too... What's your 25-OH-D3 level?

[nameless]

My D3 is usually around 40ish. Although it's been 50+ in the past. I may have noticed a slight bump of several pts from a higher D3, but I can't be certain.

I am hesitant to try coconut oil because I'm an apo E 3/4 person. Those with the apo E 4 allele tends to do poorly with saturated fats.

One thing I recently considered as a possible cause for low HDL.... well, not the root cause, but a contributing factor, is medication. Besides olive oil, the other change I made this month was a 4 week trial of Zyflo CR for asthma (which didn't help my breathing at all, by the way). However, I ran across this study:

http://chestjournal..../132/3/868.full

Now, it used Singulair, not Zyflo, but they may be similar enough to cause the same result. Those using singulair had a 20% drop in HDL, which correlates pretty well to the HDL drops between my last two tests. I also use Flovent, which may raise my LDL/Trigs slightly on its own.

But that's just a guess.

Edited by nameless, 02 November 2011 - 05:25 PM.

[niner]

My D3 is usually around 40ish. Although it's been 50+ in the past. I may have noticed a slight bump of several pts from a higher D3, but I can't be certain.

I am hesitant to try coconut oil because I'm an apo E 3/4 person. Those with the apo E 4 allele tends to do poorly with saturated fats.

One thing I recently considered as a possible cause for low HDL.... well, not the root cause, but a contributing factor, is medication. Besides olive oil, the other change I made this month was a 4 week trial of Zyflo CR for asthma (which didn't help my breathing at all, by the way). However, I ran across this study:

http://chestjournal..../132/3/868.full

Now, it used Singulair, not Zyflo, but they may be similar enough to cause the same result. Those using singulair had a 20% drop in HDL, which correlates pretty well to the HDL drops between my last two tests. I also use Flovent, which may raise my LDL/Trigs slightly on its own.

But that's just a guess.

Sorry, I wouldn't have mentioned upping the fats if I knew you were apo E 3/4. Bill Davis would probably tell you to raise your D level. Do you ever read his Track Your Plaque site? It's pretty good for this sort of thing. Good call on the Zyflo. It's a 5-LO inhibitor just like Singulair, so I'd expect the same result. I'm glad I dropped Singulair; it wasn't doing much (if anything) for me. My allergist tells me that for some people, the 5-LO inhibitors are like magic, for others not so much.

[nameless]

I used to read 'Track your Plaque' all the time. Then is started reading like a standard blog... then it started reading like a standard blog by a doctor trying to sell his book...

I know Dr. Davis recommends a D3 level much higher, I think 60+. But I'm not sure if the evidence really supports it. I didn't notice any major difference in my HDL with a D3 of 35 or a D3 of 50. It's possible a D3 level of 60+ may not boost it up a point or two more, just that based on my own levels, I haven't seen any major correlation there.

I've tried most of the things Dr. Davis recommends anyway. Cutting/restricting wheat, healthy fats, D3, etc. I never got the results he writes about for most of his patients. Then again, I was never an overweight person indulging in tons of sweets daily either.

The biggest things I've noticed, now that I think of it, is lowered HDL when I was on a leukotriene inhibitor. I previously was on Accolate years ago, and also had an HDL in the low 30s. After I dropped it, my HDL went into the 35-40 range. At the time I assumed it was from dark chocolate, changes in diet, or perhaps D3. But now I'm wondering if it simply was the leukotrine inhibitor.... or lack thereof.

Or it could have been a coincidence.

Anyway, anything left for me to even try? Should I try dark chocolate again? I dropped it due to oxalates, iron and possibly lead... and the fact chocolate isn't exactly stomach friendly. I had a kidney stone around 2 years ago, so oxalates aren't my friend.

I expect my cardiologist will just recommend Crestor, hoping I'm a hyper responder, but besides the fact I'm not keen on taking yet another medication for the rest of my life, ApoE 4 people don't respond super great from statins... minor benefit, yes, but I wouldn't count on any enormous rise in HDL from it.

[triplecrown]

This may be a stupid question. But how do you find out If your apo E 3/4? After reading this thread I would really like to know, since I consume coconut oil on a regular basis.

[nameless]

I asked my cardiologist to write a script, and I simply went to the lab to get tested. You'd want Apo E tested, which can come in various genetic flavors, 2/2, 2/3, 3/3 (most common), 3/4, or 4/4 (by far the worst). I sort of landed in the lousy, but not super terrible, category.

If you have insurance, most standard labs can test for it. I think I used Labcorp or Sunrise. You can check the labs your insurance allows online and go through their test menus too. Sunrise can also use Mayo, if they don't have a specific test themselves.

If you don't have insurance, I suppose you'd need to pay for genetic testing out of your own pocket (wait until they have a sale).

And if you consume coconut oil regularly yet your lipids remain good, I expect you don't have the 4 allele. But if you don't regularly check it, or if you are dismissing sky-high LDL, then... yeah, you may have at least one.

Edited by nameless, 03 November 2011 - 05:35 AM.

[triplecrown]

Thanks for the response Nameless:)
The last blood test I got was last april. It had showed that my HDL was at 82 (reference level >39) and my LDL was 99 (Reference level 0-99).
I'll probably get another blood test soon because I just recently started taking the coconut oil and I'm curious as to how that will affect my levels. I also added garlic extract since the last blood test because of the research showing it lowers LDL.

Edited by triplecrown, 03 November 2011 - 07:23 AM.

[JLL]

Interesting thread. Looks like you've already tried most of the things I've written about on my blog without much results -- I guess this just goes to show the importance of genetics, at least in this case.

I suppose things like coconut oil show good results in studies is because most people are in the Apo E groups that respond favorably to some saturated fats, and the genetic outliers get mixed in the means and averages.

What does alcohol do to your HDL levels? In general, it raises HDL and trigs. You could also check out sage tea, although you'd have to be careful not to take too much. Still, the increases in HDL in this study were pretty big:

While total cholesterol decreased only marginally after two and four weeks of drinking sage tea, there was a 16% drop in total cholesterol two weeks after the treatment ended. HDL cholesterol, on the other hand, increased after just two weeks. After four weeks, HDL levels were up by ~50%. Two weeks later, they were still ~38% higher than at baseline.

Then there's also hibiscus tea, which is a safer option. You mention having tried blueberries with no luck, so maybe berry anthocyanins don't work for you; however, you could also try other berries with a higher anthocyanin content to see if that makes a difference.

[mikeinnaples]

Niacin caused your palpitations?

[nameless]

As for Niacin and palpitations... yep. I also generally felt sort of lousy on it, which (I am guessing) may have been due to increased stomach acid from it -- my stomach didn't feel so great and I slept even worse than usual. Niaspan was much more tolerable than IR niacin, but after some time passed, the same symptoms that I got from IR niacin occurred with Niaspan. And since my HDL actually dropped while taking it, I'd assume I'd need a much higher dose for it to do much. I also have a weird heart, so that could be the reason for niacin = palpitations.

@JLL

I can't drink alcohol. I have cardiomyopathy (idiopathic). Arteries are all clear (last time I had that checked), but alcohol is strongly not advised by my docs. It'd probably interfere with my Coreg too.

I recall reading about some teas on your blog. That could be worth considering. Although to complicate matters, my stomach is very sensitive, so I typically avoid teas. I know green tea and my stomach don't get along very well.

Higher anthocyanins... hmm... maybe. Although I used to eat a lot of blueberries (daily) and I think all it did was raise my trigs slightly. Now I just eat them maybe several times/weekly.

The thing I don't get is why olive oil didn't work. I mean, it should have, right? Perhaps not a giant HDL increase, but something. Even if paired with a 20% drop from a leukotriene inhibitor, I would have thought my HDL would have come back higher than it did.

[mikeinnaples]

I do find it odd that your HDL dropped from the Niacin given its mechanisms. I suspect it was probably due to something else going on. I cant attribute all of my HDL change to niacin (1.5g) as there were other factors, but I gained over 20 points in a relatively short period of time.

Interesting on the palpitations. Thanks

[stephen_b]

Low HDL is strongly correlated with excess cortisol (Cortisol Effects on Body Mass, Blood Pressure, and Cholesterol in the General Population).

[niner]

Nameless, have you ever checked out the Berkeley Heart Labs site? Their Clinical Implications Reference Manual is pretty useful. Check out chapter 19 for ApoE effects on the various markers. It contains the following chart:

If I understand the ApoE epsilon 4 type correctly, maybe it's better to focus on getting the LDL, particularly the small dense variety, under control, and just let the HDL fall where it may? Anyway, if you haven't seen it, I'd take a look at their manual.

[nameless]

Thanks for that link Niner. I recall seeing a chart like that somewhere before, but don't think I ever looked at that site in detail before.

Just focusing on LDL is something I've considered too. Although I really wanted to get my HDL at least to normal-ish range. Even though a HDL of 40 would seem dinky to pretty much everyone else here, to me it'd feel like an accomplishment. I may just do nothing different for the next 2 months or so, retest, and see if the leukotriene inhibitor was in fact lowering my HDL at all. Then go from there...

That chart is interesting overall, and it does explain some oddness I noticed when trying certain things. Fish oil, for instance... when I first started it, I was on pretty large doses. But if I ever went to 3g or so daily, my LDL really shot up. The highest I recall was it getting to 151, after agreeing to try Lovaza from my cardio (she's mercury-phobic, and kept pushing the prescription fish oil at me). I relented, and 3 months later she calls me, asking if I started eating sticks of butter or something.

My lipids were probably best, or semi-normal, when I tried a highish EPA fish oil, thinking back (Jarrow EPA/DHA). I may try a higher epa ratio next, just to see if it makes a difference. Logically, it shouldn't lower my trigs as much, but it also shouldn't raise my LDL either. Not sure if it'd affect HDL (good or bad), if primarily EPA.

LDL-wise, my diet is already low saturated fat. Most fats I eat are from nuts or olive oil. Not sure if it's a good or bad thing to reduce them or not. If I want my LDL super low, I think a statin or red yeast rice may be the only way to get it down.

[Sillewater]

http://hanswuhealth....-and-goals.html

I just posted an analysis of my lipid profile. Maybe it will help.

Anyway, I am surprised the niacin didn't work. What form did you take? How much did you use?

How much fat do you get in your diet? Since you are E4 I guess saturated fat is out of the question. In studies where people have low HDL to begin with SAFA may provide benefits by raising their low HDL (but in normal folks that may not be good, because the risks we accept outweigh the benefit).

Also how much carbohydrate do you get? Do you know your OGTT?

How much do you exercise?

[nameless]

Thanks for the link Sillewater. I just glanced at it now, but will look it over in more detail later.

For niacin, I originally tried flush-free... and yes, before anyone says anything, it doesn't work. My first cardiologist (who I also dropped rather quickly) recommended it.

Later on I tried IR niacin first, got the flush, etc. but also got palpitations. Then tried Niaspan, managed to take it for about 5 months, but after some time I got the same palpitations I got from IR niacin. And yep, it dropped my HDL a point. No idea why, unless some medication oddness played a role.

Exercise is currently about 3-4x weekly on an exercise bike, say around 30-45min daily. I had to take a break for a while from exercising, due to painful tendons (levaquin), but I don't think that influenced my most recent test, as I got in around 4 weeks of exercise before the VAP.

It's been a while since I did cronometer (which I probably should do again), but if I recall right, my total fats were on the semi-low side, saturated fats were... umm... don't recall exactly, but they were safely below the '100%' marker on chronometer. And that was when I was also eating a square or two of dark chocolate daily, adding in some extra fats. I actually had my entire fatty acid profile tested once upon a time, which I should find again (assuming I haven't misplaced the paper). My O3 to O6 ratio was good bloodwork-wise, with about a 2-1 ratio or so. But I was also taking a larger dose of fish oil then, around 2.4 g/daily. For this most recent test, I expect olive oil to have been my prime source of fats.

Carb-wise... I think it's around 150g/daily. Again, just basing it on memory and from my old chronometer report. I've sort of been lazy and relying on HbA1c to tell me if my carb/sugar intake is too high or not. And I don't know my OGTT... until I just looked it up now, I had no idea what it even was.

Edited by nameless, 05 November 2011 - 06:08 PM.

[Sillewater]

I'm just speculating but from the sounds of it, you could have a low-fat diet right now (as shown by your high TG, and low-HDL), also your carbohydrate intake may be higher then u suspect.

http://wiki.xtronics...index.php/Lp(a)

This is a link with regards to Lp(a), maybe there's something for HDL in there.

[nameless]

It's possible, but I doubt it's a sky-high carb diet, as it's not a whole lot different than it was when I did chronometer. Main changes are more olive oil, some extra nuts perhaps... minus dark chocolate, minus pomegranate juice, minus the occasional larabar. I'd probably classify my current diet as -- moderate fat, low saturated fat.

At what level would carbs greatly increase trigs? And wouldn't HbA1c correlate to trig values (somewhat)? I recall having an HbA1c of 4.5, yet my trigs were pretty much the same as this most recent test.

And thanks for the Lp(a) link, but only things I see for HDL are niacin and thyroid mentioned. Thankfully my Lp(a) is at least okay.

Edited by nameless, 05 November 2011 - 11:37 PM.

[Sillewater]

I am unsure of at what level (I would assume on a calorie maintenance diet that it is probably more than 140g, but that also depends on how it is eaten, with fat, fiber, what size portions etc...). Maybe it correlates, with my numbers the HbA1c and TGs don't correlate that much, but I've only had HbA1c meausured 3 times, while lipid profiles done 5 times.

To be sure, I would be CRON-O-METERing again for 1 week to see what your composition is like. Also what about PUFAs?

[nameless]

Yeah, I should do chronometer again to get up to date info. As for Pufa... not sure, I don't have my old chronometer data handy (on my old PC), and even if I did, I recall having a problem getting accurate data for fats for certain foods.

When I had my fatty acid profile checked, I think my polyunsaturates were on the high side, but I also was taking more fish oil then too. My O6/O3 ratio was fine.