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