Sunday, September 23, 2012

The Nutrition Debate #67: HDL Cholesterol and the Very Low Carb Diet

DATE
HDL
5/7/1980
42
10/14/1987
39
5/10/1991*
41
11/5/1992
39
8/17/1993
38
10/18/1994
38
2/17/1996
37
6/4/1996
38
9/5/1996
39
2/11/1998
41
8/15/2001
42
12/12/2001
50
2/14/2002
53
4/9/2002
61
6/12/2002
44
8/6/2002
48
9/3/2002
47
10/3/2002
43
11/4/2002
45
12/4/2002
46
1/2/2003
48
2/4/2003
44
3/4/2003
49
4/2/2003
48
4/29/2003
54
5/28/2003
47
7/1/2003
47
8/6/2003
50
9/10/2003
54
10/8/2003
58
11/4/2003
59
12/3/2003
62
1/6/2004
52
4/15/2004
50
6/17/2004
53
8/18/2004
52
11/10/2004
46
4/22/2005
47
6/21/2005
48
9/7/2005
53
12/5/2005
48
4/19/2006
53
6/14/2006
55
8/2/2006
51
10/9/2006
51
12/12/2006
48
5/1/2007
52
7/17/2007
60
11/27/2007
86
5/5/2008
79
7/12/2008
63
10/7/2008
57
12/16/2008
67
4/29/2009
98
8/3/2009
91
11/23/2009
86
4/26/2010
81
7/27/2010
78
12/2/2010
71
4/19/2011
78
8/15/2011
92
12/12/2011
67
4/17/2012
na
8/14/2012
68


The table on the left displays my HDL cholesterol for the last 32 years. Okay, I’m a compulsive record keeper, but sometimes that’s a good thing. Anyhow, talk (i.e. advice) is cheap; but lab reports are evidence, and mine are worth taking a look at. There is definitely a ‘takeaway.’

I was 39 years old when I first had an HDL test in 1980. My HDL was 42, just above the border line “bad” of 40. Eleven years later (on my 50th birthday) my HDL was just 41. Of the first 10 HDLs (blue) recorded, 7 out of 10 were under 40, and the average and mean were both  39. Not good. This is the time in my life when I ruined my metabolism, or rather, by this time I had already ruined it. I was diagnosed  a Type 2 in 1986 (using the OLD criteria)!

For the next 16 years I went on eating as before, gaining weight and taking more and more diabetes meds. Before I started on Atkins in September 2002, my baseline HDL was 48. My doctor, an internist/cardiologist, had departed from “the standard of practice” by recommending Atkins. But everything else he had asked me to try in my repeated attempts to lose weight had failed. Because I was a heavily medicated Type 2 diabetic when I started Atkins, he decided to see me every month for the first year. My average HDL for the next 12 months (yellow) was 47. Atkins had no benefit on my HDL. It did, however, have a marked benefit on my weight and blood sugar control. During the first nine months of that year, all on Atkins Induction (20g of carbohydrate a day) I lost 60 pounds and stopped or reduced virtually all of the 3 oral diabetes medications that I had used in ever larger doses over the years.
  
For the next three years I coasted along, counting carbs and maintaining my weight until the summer of 2006. I regained 12 pounds. It must have been those midnight raids on the freezer. Anyway, after lurking on Dr. Bernstein’s Diabetes Forum and reading his books, I recommitted to losing weight on his Way of Eating. Over the next year I again ate just 20 grams of carbs a day, and I lost 100 pounds. I also got off the last 5mg of micronase (a sulfonylurea), my HDL shot up to 86 and my blood pressure plunged to 110/70 (with no medication changes). My HDL average was 63 (green) for this time period. In the following year I lost another 20 plus pounds, and for the next 2 years my HDLs were all in the 70’s, 80’s and 90’s including a 98.

The rolling average of the last 10 HDL lab reports (red) is now 81. Still, over the last 10 years my HDL average (oldest 10 vs. most recent 10) went from 39 to 81, more than doubling. That’s the hard evidence. My diet is 5% carbohydrate, 25% protein, and 70% fat, including saturated.

Last year, my doctor (who reads this blog looking for tips and “practice pearls” – just kidding doc -- suggested, “Foods that Raise HDL” as a topic for this blog. I thought that was a great idea, so I wrote a column about it (#34) last January. It didn’t occur to me at the time that my doc was curious about the dramatic improvement in my HDL and perhaps looking for a way to improve his own. No kidding, doc. Was it?

The problem is I don’t know what foods raise HDL. So, my answer to the question “What foods raise HDL?” is A VERY LOW CARBOHYDRATE diet – and I mean VERY low carbohydrate (see above). It is this Way of Eating as a whole that has produced the HDL improvement for me.

One thing for sure: there is no “magic bullet,” no pharmacological solution to raising HDL the way there is for lowering LDL. You can’t just write a script to raise HDL, the way you can to lower LDL with a statin. You have to do it by choosing the foods you eat, VERY carefully.
But that’s okay with me. I think individuals (including patients) should take control of their own health. Eat right, avoid as many carbs as possible, and be healthy again. It’s possible, as the evidence in the chart on the left demonstrates. It’s all in your hands now, folks. Just do it!
© Dan Brown 9/23/12

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