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How to increase HDL


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Recently I have blood tests done and generally everything looks great, I calculated my biological age through PhenoAge and AgingAI 3.0 and they gave me results lower than my chronological age by 9-10 years. One thing that worries me though is low level of HDL - I had 0.99 mmol/L (38.3 mg/dl) so slightly below the range considered healthy.
I'm doing resistance training 2-3 days a week and walking at least 1h-2h on the other days so I am quite active. I am eating good quality olive oil (1-2 tbsp) nearly every day, nuts, flax seeds,  oily fish,  low in saturated fats and I got a lot of fiber (>50g). Diet is mildly CR. 
So I am doing a lot of things that should elevate HDL and have no ideas what else can I do.
I noticed that this level was quite low in the past as well and I suspect there might be some genetic component in it as my grandmother died relatively early due to cardiovascular disease. Any ideas how to get it higher?

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3 hours ago, tanuki said:

I noticed that this level was quite low in the past as well and I suspect there might be some genetic component in it as my grandmother died relatively early due to cardiovascular disease. Any ideas how to get it higher?

Tanuki, from the numeros podcasts of Peter Attia on lipids, one learns that there have been trials which were successful in elevating HDL, but that fact did not change the cardio-vascular risk. So, rather than elevating HDL, probably it's better to focus on decreasing the LDL fraction

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AFAIR, in older Attia podcasts Tom Springfield told that "good" HDL is not good and is causing problems in a bit other way, (unless there is another view novadays).

I would just forget about HDL and all the noise surrounding, it could be useful only in a limited models from the past that were created to help assess the CVD risks for people with excess weight and high total cholesterol, paired with excessive TG but not excessive from alcohol consumption.

For myself I just don't care about it, rather on total chole as a cheap tool (I would like it low) and much more rare doing more expensive control - apolipoB.

 

Br,

Igor

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That's interesting, I often listen to Attia's podcast and somehow I missed that bit.
Is there some known common ways to optimize ApoB?
Not sure if that's viable to test it regularly, I see it's costing over 150 GBP if I want to do it privately, it's doubtful that NHS will be happy to sponsor it.
 

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Tanuki, they speak about reasonable costs in America, evidently it's not like that in Europe, I didn't even ask. Proxies for ApoB are Non-HDL cholesterol and LDL-C cholesterol.

Non-LDL is total-HDL and should result in numbers lesser than about 130 mg/dL . 

From the MAyo CLinic site:

 

 

Quote

 

How important is cholesterol ratio and non-HDL cholesterol?

Answer From Francisco Lopez-Jimenez, M.D.
 

For predicting your risk of heart disease, many doctors now believe that determining your non-HDL cholesterol level may be more useful than calculating your cholesterol ratio. And either option appears to be a better risk predictor than your total cholesterol level or even your low-density lipoprotein (LDL, or "bad") cholesterol level.

 

Non-HDL cholesterol, as its name implies, simply subtracts your high-density lipoprotein (HDL, or "good") cholesterol number from your total cholesterol number. So it contains all the "bad" types of cholesterol.

An optimal level of non-HDL cholesterol is less than 130 milligrams per deciliter (mg/dL), or 3.37 millimoles per liter (mmol/L). Higher numbers mean a higher risk of heart disease.

To calculate your cholesterol ratio, divide your total cholesterol number by your HDL cholesterol number. So if your total cholesterol is 200 mg/dL (5.2 mmol/L) and your HDL is 50 mg/dL (1.3 mmol/L), your ratio would be 4-to-1. Higher ratios mean a higher risk of heart disease.

 

 

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7 hours ago, tanuki said:

That's interesting, I often listen to Attia's podcast and somehow I missed that bit.
Is there some known common ways to optimize ApoB?
Not sure if that's viable to test it regularly, I see it's costing over 150 GBP if I want to do it privately, it's doubtful that NHS will be happy to sponsor it.
 

I had to look it up real quick to believe it - it seems to be true, that private labs in the UK charge insane prices compared to major US providers. I don't really understand why. But I know for a fact, that private labs in Poland, Germany and Spain are charging prices a lot more affordable (the equivalent of 5-10 GBP), if that's an option for you.

 

You won't really know if you can improve your lipid markers much, without testing it. There are people who respond well to certain diet changes, if they start out with a problematic food composition. But there are also a lot of folks that due to genetic issues just have non-optimal LDL/APOB and changes in lifestyle does not really change that. Again: you have to get tested to find out.

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Few more cents on the things mentioned above

If a person is not overweight and have total chole in a 170-190 range or better then it would make sense to postpone apoB test until it will be possible to do it with reasonable price of few bucks (few tens). There are really little chances to have good total chole (or calculated LDL) and high apoB, this is probably genetic factor and as I understand physicians (in the US?) are now more often prescribe newer kind of drugs in such cases (pkcs9 kinase inhibitors).

If total chole is significantly higher than the lab's range and there is no common reason like tons of fats in the diet and so on - this could on its own make an argument to have an apoB test refunded, or being done as suggested in some European country during vacations.

From my data (I assume I am a typical caucasian specimen w/o rare lipid-related genetic) I discovered that my apoB is oscillating in 0.7-0.75 g/l while my total chole is in 160-200 range, energy intake was 1700-2800kkal/day in the days prepending the tests and with net zero energy balance.

So I am doing cheap lipidogram tests despite their low usability from novaday knowledge points, also sometimes even less usable home total chole fingerprint tests (because I still have some sticks) and rare tests of apoB to see if something will change (I hope it will not, it seems genetically determined somehow).

I also did 2 times lp(a) in two labs in different countries (to lower the chance of errors) and within carbs-based plants only diet with fats coming from nuts/olives/cacao I assume my testing framework is a good tradeoff.

In other words - for many people it could be useful to know apoB but if it costs a lot and other things are not known risks - the traditional lipidogram with total chole and calculated LDL will in most cases still be a kind of 80%-accurate predictor, w/o taking any care of 20-30 years of theorizing and math modeling of parameter ratios etc.

 

Br,

Igor

 

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Thanks for really useful info, didn't expect that test prices can vary so much between countries.
Most likely will do it and probably a bunch of other tests when I go to Europe.

My results were:
Serum chol   - 147mg (3.8 mmol)
non-hdl     -     108 mg (2.8 mmol)
Chol/Hdl           3.8
triglycerides -  124 mg (1.4 mmol)

They seem relatively good so don't know if pushing them down can bring any further benefit in risk reduction
However it might be just that existing studies are too short term to detect it. I am still young and I consider risk in perspective of living for next 100 years so it can matter if the risk is linear and the lower chol and non-hdl chol - the lower risk.

 

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14 hours ago, Guest said:

I had to look it up real quick to believe it - it seems to be true, that private labs in the UK charge insane prices compared to major US providers. I don't really understand why. But I know for a fact, that private labs in Poland, Germany and Spain are charging prices a lot more affordable (the equivalent of 5-10 GBP), if that's an option for you.

 

You won't really know if you can improve your lipid markers much, without testing it. There are people who respond well to certain diet changes, if they start out with a problematic food composition. But there are also a lot of folks that due to genetic issues just have non-optimal LDL/APOB and changes in lifestyle does not really change that. Again: you have to get tested to find out.

Don't forget, that we have an obesity epidemic in most developed Western counties.  That's highly associated with diabetes -- the opposite of good lipid levels.  I think that a bulging tummy is much more often at the root of bad lipid levels than genetic factors.  (Example:  My lipids are excellent; but I had a father and brother with insulin dependent diabetes.  Of course, one example is not a proof.)

  --  Saul

  --  Saul

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9 hours ago, tanuki said:

Chol/Hdl           3.8

The exact value is 38 or 39 mg/dL, according to the other numbers you reported. But, as you see, total Cholesterol is pretty low, so it makes sense that the HDL fraction is low.

Your lipid profile seems a good one, perhaps you are worrying without a cause, I doubt that the APOB fraction would be out of range.

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2 hours ago, mccoy said:

The exact value is 38 or 39 mg/dL, according to the other numbers you reported. But, as you see, total Cholesterol is pretty low, so it makes sense that the HDL fraction is low.

Your lipid profile seems a good one, perhaps you are worrying without a cause, I doubt that the APOB fraction would be out of range.

Actually it's ratio of Total Cholesterol to HDL - one of the things they usually put on report here

I also believe they are not bad though probably there is a room to improvement
My understanding from perspective of CVD is that there is that the lower numbers for non-hdl and triglycrides - the better
 

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1 hour ago, tanuki said:

Actually it's ratio of Total Cholesterol to HDL - one of the things they usually put on report here

OK, I see it now, you think you are too close to the threshold of 4

1 hour ago, tanuki said:

My understanding from perspective of CVD is that there is that the lower numbers for non-hdl and triglycrides - the better

Yes it is like that, but we must be realistic in what we can achieve. What can you do to make the values lesser, since you are eating so little saturated fats? Are you willing to follow the suggestions of the vegan doctors like Esselstyn and avoid all nuts, all oils? Do you think it would be very healthy?

Or are you willing to take PCSK9 inhibitors? Do you think this would be likewise healthier? 

I don't have an answer to the above questions, the first strategy (no oils-no nuts) would be unsustainable to me.

The second strategy (chronic intake of PCSK9 inhibitors) may imply collateral effects, or may not be accepted by insurances, or may be too costly for someone.

Let's wait and see what the book of Peter Attia suggests on the subject. Publication due in March.

 

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  • 3 weeks later...

BTW, a fresh Attia's Drive is about HDL nuances, very interesting in my opinion. My conclusion stays the same - increasing HDL with any known pills is useless and is confusing for people's reading the analysis results. Also there is no direct or indirect way (outside of special setup used by scientists) to assess how efficient is HDL of a particular person and if this is stable in time or fluctuating based on something.

As a guess - one could probably benefit from changing own's absolute value for HDL within the same TC value being more effective at TG utilization but to what degree it could be translated from the ASCVD perspective is an open question. I will be surprised if even for 10% risk reduction.

Br,

Igor

Edited by IgorF
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As elucidated by Dan Rader, often HDL is related to genetic polymorphism and is not always an index of good health:

Quote

High HDL is not uniformly protective, especially so in people of African ancestry. High HDL should not be taken as an excuse not to take statins if needed...

 

Edited by mccoy
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