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HDL: is it always the “good” cholesterol?

In this week’s Clinical Tip, I’m keeping my promise to dive into some surprising truths about HDL.  In today’s video, we’ll take a dive into why we often refer to HDL as the “good” cholesterol and also touch upon when HDL can be not so good and actually be part of a bigger problem.  As with so many things in the body, more and more is not better and better!  This is a powerful truth that your patients need your help to understand.  Another great example of the powerful pearls to be found in everyday labwork.

If you missed the last videos in this series, the links can be found below.

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4 Questions for “HDL: is it always the “good” cholesterol?”

  1. 2
    Frances McElwaine says:

    Hi Tracy, This is incredibly helpful and interesting information – thank you so much! I have a client (38 year old, normal weight, presenting with extreme stress and anxiety. She has a good diet apart from self medicating with a bottle of wine after the children are in bed). She has very high HDL (1.93nmol/L against a RR of 1.03-1.55 nmol/L), and her LDL sits at the high end of the range. Her Triglycerides and CRP are both fine, but her fasting glucose is at the high end of the range (I am thinking this is caused by very high level of cortisol metabolites). She has whopping Oestrogen dominance and is hypothyroid. How would you approach this situation? Thanks so much!

    • 2.1
      SAFM Team says:

      Thanks for your question! Alas, I abbreviated it greatly, as we are not able to support full case study reviews in these threads. Certainly her elevated glucose may be driven by *both* high stress hormones as well as her daily bottle of wine habit, not only due to the sugar itself but also the effect on the liver. For her unique body, that level of alcohol could easily create a high burden of oxidative stress. The elevated LDL may be a reflection of both the hypothyroid function as well as liver challenge due to all the alcohol. Monitoring liver enzymes is prudent, not just ALT/AST but also GGT. Given the level of stress/anxiety, I know you will work with her on crowding out so much alcohol with other soothing, calming habits and choices. The very high HDL may be a reflection of this oxidative stress. Indeed, support with omega-3s is a great idea; it’s effects are normalizing for HDL and may also reduce oxidative stress. I would also consider supportive liver supplementation while she is working through this stage (e.g. B-complex, NAC). Your deeper dive into the root causes of the hypothyroid function (you mentioned infectious possibilities) is also key to addressing this root cause.

  2. 1

    Recently looking at SpectraCell LPP testing. They differentiate HDL-C vs 2B? And want certain levels limited on the graphs. Could you address this??? Thank you.

    • 1.1
      SAFM Team says:

      Yes, this is a good example of the more advanced lipid “fraction” testing I referenced in an earlier video in this series. There are many lab companies (including Spectracell) now offering versions of this testing which include varying levels of detail on subcategories of both HDL and LDL. With all of them, the goal is to understand the particle count of LDL and HDL of various size subclasses. I kept the focus of this video more high-level regarding HDL consideration, but indeed, these panels allow our assessment to go even deeper. The lab measures HDL-C (overall concentration, the conventional marker) but also HDL-P (particle count) and the particular fraction that is HDL-2B. There are actually several other subclasses as well, but HDL-2B is understood to be the largest, most buoyant category. High levels of HDL-2B are believed to correlate well with reverse cholesterol transport capability and would thus be protective against cardiovascular disease. Just as with LDL-C vs. LDL-P and our desire to have larger LDL particles, the same focus applies to HDL. High counts of smaller, dense HDL particles are evidence of poor ability for them to uptake and remove cholesterol for transit back to the liver. (For everyone’s benefit, this is a sample report of the testing to which this question refers, and there is an interpretive guide at the back of the PDF file: . This particular profile includes a number of other cardio-metabolic health markers as well, not just the lipid fraction section at the top.)

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