Q: I’m really concerned about my husband who is overweight, has diabetes and now the doctor says his HDL cholesterol is low. What is HDL all about? Is there anything he can do?
A: Thanks
for asking this important question. Let’s bring everybody up to speed on HDL
cholesterol.
HDL, the
so-called ‘good cholesterol’, is an acronym for high-density lipoprotein. The
reason that we call it GOOD is because HDL actually acts by removing
cholesterol from artery walls (and other places) where they form and build
plaque.
Normal HDL > 40 mg/dL in
men
> 50 mg /dL in women
Studies
have shown the higher your HDL the lower is the incidence of coronary disease
(plaque build up in heart arteries) and heart attacks (death of heart muscle
due to artery blockages). Conversely, the lower the HDL the higher is the risk
for cardiovascular disease.
There are a number of causes of low HDL (go to http://davemontgomerymd.com/ to read the quick tutorial on cholesterol), including inherited genetic abnormalities, obesity and insulin resistance, diabetes, high triglycerides, anabolic steroids and certain medications. Your husband likely has acquired a low HDL from type 2 diabetes and being overweight. There is a tight link between blood sugar, body weight and HDL cholesterol.
So, here
are the things that we know increase HDL:
1. Daily aerobic exercise (at least 30 minutes a day)
2. Weight
loss and tight control of diabetes (proper diet and taking medications on time
as prescribed)
3. Nuts:
walnuts, almonds, pistachios, etc.
4. Smoking cessation, where applicable
If these
other measures don’t improve his HDL, medications may be necessary.
5.
Niacin—prescription strength (often as high as 2000 mg daily) is one of the
primary medications used to treat isolated low HDL.
6.
Fibrates—another class of medicines that can increase HDL in some
patients.
Ask your doctor about all of these and which are most suitable for your husband. Only your doctor can prescribe prescription strength niacin and fibrates.
The role
of diet, exercise and medications, where applicable, cannot be
over-emphasized. If there's room
to work on any of these, then there’s hope to achieve a higher HDL.
Here's to Mastering Your Health
Dave
Montgomery, MD, PhD is a Cardiologist at Northwestern University and a sought
after Speaker and Health Coach. http://davemontgomerymd.com http://twitter.com/dmontgomerymd
