Low HDL, High Triglycerides-How to Treat It : Dr. Zaidi

Low HDL cholesterol and High triglycerides is a common cholesterol disorder. The two go hand in hand. When your triglycerides are high, your HDL goes down. However, many people – as well as doctors – stay focused on LDL cholesterol. Often, they have no clue why someone has low HDL and high triglycerides levels. In addition, they don’t know how to raise HDL cholesterol and lower triglycerides level.

Normal artery and cholesterol blocked artery.

Types Of Cholesterol

There are three types of cholesterol you should know about:

1. HDL (high density lipoprotein) cholesterol, also known as the good cholesterol.

2. LDL (low density lipoprotein) cholesterol, also known as the bad cholesterol.

3. Triglycerides, known as fat in the blood.

HDL cholesterol

HDL cholesterol removes cholesterol from the blood vessel wall and delivers it to the liver for final disposal. In this way, it serves to keep the walls of the blood vessels free of cholesterol deposits. That’s why it’s known as the good cholesterol. Think of it as a roto-rooter for your blood vessels!

LDL cholesterol

LDL cholesterol gets deposited into the blood vessel wall and subsequently leads to narrowing of the blood vessels. That’s why it’s known as the bad cholesterol. Think of it as the growing clog in your pipes!

There are two types of LDL particles:

A. Large, fluffy particles, also known as “pattern A.”

B. Small, dense particles, also known as “pattern B.”

Small, dense LDL particles (pattern B) are more harmful than the large, fluffy type (pattern A). When someone has low HDL and high triglcerides, their LDL pattern is B, which is more harmful than pattern A LDL.

Similarly, when someone has high level of HDL and low triglycerides, their LDL pattern is A, which is less harmful.

As you can see now there is more to cholesterol than just a number that typically your doctor throws at you and tells you, “Oh, Your cholesterol is high. Therefore, I am placing you on a statin drug.”

Triglycerides

Triglycerides are a form of fat circulating in the blood. High triglycerides cause deposition of cholesterol in the blood vessel walls which leads to narrowing of the blood vessels.

Low HDL and High Triglycerides: Sign of Insulin Resistance Syndrome

Patients with Metabolic/Insulin Resistance Syndrome typically have:

1. Low HDL

2. High Triglyerides

Consequences of Low HDL, High Triglycerides

Cholesterol gets deposited easily in the blood vessels of these patients and the build-up of cholesterol cannot be cleansed out efficiently due to low level of HDL cholesterol. Consequently, these patients are at very high risk for narrowing of the blood vessels.

HDL cholesterol and triglyceride level serves as an extremely useful test to diagnose Insulin Resistance Syndrome. If your HDL is low and/or your triglyceride level is high, you have Insulin Resistance Syndrome.

Low HDL cholesterol has been known to be a strong risk factor for coronary artery disease for a long time. In 1977, the results of the famous Framingham Heart Study were published in the American Journal of Medicine. In this study, HDL cholesterol was found to be the most potent lipid predictor of coronary heart disease.

Several other studies including the Coronary Primary Prevention Trial (CPPT), the Multiple Risk Factor Intervention Trial (MRFIT), and the Lipid Research Clinics Follow-up Study (LRCF) further confirmed the strong relationship between low HDL cholesterol and coronary artery disease.

Raising HDL cholesterol reduces the risk for heart attack. A 1% increase in HDL cholesterol is associated with a 3% decrease in risk of heart disease. This impressive role of HDL cholesterol in preventing heart attack was shown in the famous Veterans Affairs HDL Intervention Trial (VA-HIT). The results of this study were published in the New England Journal of Medicine in 1999.

In my extensive 40 plus years of clinical experience as a physician, I have never seen a patient with high HDL cholesterol (more than 60 mg/dl) suffer from a heart attack or stroke. Yet I continue to see a number of patients with low LDL cholesterol suffer from heart attacks and stroke,

How To Raise HDL Cholesterol and Lower Triglycerides

What I have found really works are 2 things:

Stress management: Stress increases cortisol and adrenaline, both of which lower HDL cholesterol. Therefore, get serious about living stress free.
Nutrition: Lower your intake of carbohydrates (including bread, pasta rice, cereals, oat meal, sugar, juices) and increase monounsaturated fats found in nuts, especially almonds.

Increasing the intake of olive oil, avocados and fatty fish such as salmon also helps to some extent. Compared to popular belief, exercise does not help to raise your HDL cholesterol or lower triglycerides.

Personal Note:

Let me share my personal medical history: My HDL used to be around 39 when I was young and following typical American diet. In addition, I was totally immersed in the stress of daily living. Since my awakening at age 50, I stay calm, even under so-called challenging situations. I have also stopped most of the junk foods, reduced my intake of bread, pasta, cereals, and rice. Occasionally, I would “say yes to desserts.” Most importantly, I snack on nuts, especially almonds. As a result, my HDL has been staying in the 60’s range.Medically speaking, this is a 100% increase my HDL level, which is incredible.

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