HDL Cholesterol- Is something fishy??

March 8, 2010

Institute For Medical Wellness Healthy Living Report

HDL Cholesterol- Is something fishy??

HDL, otherwise known as the good cholesterol, is one of the types of cholesterol that makes up your total cholesterol measurement. Unlike certain types of LDL (type-B small dense LDL's), HDL cholesterol is generally good for you! While small dense LDL's can go through your bloodstream and get taken into the vessel wall, where it can cause blockages, HDL does the opposite. HDL cholesterol, due to its even smaller size, is able to get through the vessel walls, and acts as a transport vehicle, or bus, to takes the bad cholesterol out of the wall and recirculate it back to the liver for processing. That is why I call HDL, the Happy Cholesterol!!!

So that brings up a nice math problem that I do almost every day at the office.

Almost on Monday, almost on Tuesday, almost on Wednesday.

Sorry bout that. I always liked that joke ; )

One of the first things I look at when reviewing cholesterol values is what I call the Total/HDL ratio. This ratio is defined as the Total Cholesterol divided by the HDL cholesterol. A good ratio is 4 or below, which indicates a less than average risk of developing heart disease. A ratio greater than 5 puts you at above average risk for heart disease.

So who do you think has the lower risk of heart disease based on the below cholesterol levels?

Patient #1)

Total Cholesterol = 240
HDL Cholesterol = 60
LDL Cholesterol = 145
Triglycerides = 110

Patient #2)

Total Cholesterol = 180
HDL Cholesterol = 30
LDL Cholesterol = 115
Triglycerides = 100

Patient #1 has higher levels of all the cholesterol components and triglycerides. Patient #1 also has a ratio of 240/60 = 4.0

Patient #2 has lower levels of all the cholesterol components and triglycerides. Patient #1 has a ratio of 180/30 = 6.0

Patient #1 has a lower risk of heart disease based on the ratio of 4.0 .

As already mentioned, the HDL or good cholesterol, goes through the body and scavenges up or cleans up after the bad cholesterol or LDL. So the more HDL you have, the better. Some medications have been shown to raise HDL. Niacin, sold as prescription Niaspan, has some very good studies showing just this effect. Unfortunately for niacin, the high doses needed to exert this effect, has some very annoying flushing, itching and other skin side effects, and is rarely tolerated. Niacin also has an annoying habit of raising diabetics and prediabetics sugar levels.

My advice on the best way to improve your ratio is to lower your processed carbohydrate intake, increase your healthy fat, protein and fiber intake, increase your exercise, and if able, supplement with fish oils. This will raise the amount of good cholesterol (HDL) and lower your ratio to healthier levels. Our Healthy Weight Program is one way to help you lower your overall risk. A new Healthy Weight Program-Lite edition, will soon be available to help you further.

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Fish Oils and PCB's

That leads to a perfect segway into our next subject.

Fish oil supplements, when used correctly, have been proven beneficial in prevention of heart disease, arthritis and some mood disorders. Other benefits have been reported, but I like to wait for more data to come in before making any recommendations.

I was asked to comment about a recent news story from Good Morning America (GMA) concerning fish oil supplements and PCB content. PCB's have been proven in the past to increase one's risk of cancer. A lawsuit has been filed against some fish oil manufacturers related to PCB's in fish oil supplements.

What is my take on this?

The GMA segment appeared to be well balanced, and the physician interviewed stated that only ten fish oil supplements were studied, which is a very small sample size. Concluding that all fish oil supplements are hazardous, from that sample size, would be equivalent to throwing out all the eggs at your supermarket due to a dozen or so bad eggs. Still, it will be interesting to see how this lawsuit plays out.

I can also take a conspiratorial view of this lawsuit. There is presently talk in Congress about further government regulations on the nutritional supplement industry. This lawsuit may be the trial balloon, pun intended, to drum up support for further government regulations. These regulations would put a big damper on individuals freedom to purchase supplements on their own.

The Institute For Medical Wellness, for the past seven years, has had available for purchase, Carlson's Fish Oil. Here is what is written on the Carlsons Fish Oil label.

THIS PRODUCT is regularly tested (using AOAC international protocols) for freshness, potency and purity by an independent, FDA-registered laboratory and has been determined to be fresh, fully potent and free of detectable levels of mercury, cadmium, lead, PCB's and 28 other contaminants.

I would not let the GMA story scare you away from fish oil supplements. But you should, as I always recommend, do your homework before starting or purchasing a supplement for use.

The Institute For Medical Wellness has a select list of supplements available, chosen based on efficacy, reliability, safety and cost. If a supplement does not meet those specifications, I do not recommend it.
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Funny Times at The Institute For Medical Wellness:

We all have days when we get tongue-tied, myself probably more than others. But here is a funny that I need to mention.

When I asked a long-time patient, who I shall anonymously refer to as "The Man", what insurance he had, for laboratory testing purposes only, the response given was,

"Blue Cross- Blue Cheese"

Maybe I caught him after lunch at Salad Works ????

Special thanks to "The Man" for his good wit and great sense of humor!!

And for all the hassles of health insurance today, maybe they should change their name to Blue Cross-Blue Cheese !!!

To Good Health!


Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311
www.drhorvitz.com