HDL: Higher is Good, But is Highest Best?

(I was going to give a how-to guide for raising HDL today, but I’ll do that Tuesday; today I want to address some interesting preliminary matters.)

On Tuesday I raised the possibility that the primary function of HDL particles is immune: HDL gathers anti-pathogenic immune molecules and acts as a “Trojan horse” to attach those molecules to pathogens, helping white blood cells find and kill them.

Another Function of HDL: Toxin Clearance

I probably should have mentioned that HDL has another function: toxin clearance. The primary lipoprotein in HDL, apolipoprotein A-I, not only binds to immune proteins, it also can pick up an assortment of toxins, including oxidized LDL.

The liver is the body’s toxin-destruction organ, and I would propose that its toxin transport function is why HDL tends to return to the liver. As this hypothesis would predict, when HDL has picked up oxidative toxins, its reverse efflux back to the liver is enhanced. [1]

Since toxins cause inflammation, removal of these toxins from the vasculature is anti-inflammatory. This is why HDL is said to be anti-inflammatory.

What are the sources of toxins that HDL clears? One review says reverse efflux, i.e. HDL toxin clearance, is triggered by “genetic mutations, smoking, stress, and high-fat diets.” [2] By high-fat diets they mean high-omega-6 diets which create lots of toxic peroxidized lipids. So if you want your HDL to be devoted to toxin clearance, rather than immune defense, eat a lot of soybean or corn oil.

Interestingly, as aging proceeds and health becomes impaired, HDL becomes less effective at picking up toxins and carrying them back to the liver. [2]

My interpretation of this observation would be that as we age, our burden of chronic infections increases. This causes more of our HDL to pick up immune proteins, converting them into pathogen-fighting HDL rather than toxin-clearing HDL.

These pathogen-fighting HDL particles do not go back to the liver. [3] So when HDL gets converted to pathogen-fighting particles, it can no longer clear toxins. Toxins linger in vascular cells and macrophages for lack of HDL transport.

Conventional Wisdom: “Dysfunctional” HDL

I often criticize mainstream scientists and doctors for an anti-natural view of human biology. Mainstream research paradigms neglect pathogens and toxins as the cause of disease, and presume instead that disease results from some malfunctioning of the human body – from genetic mutations, from autoimmune self-attacks, from kamikaze poisoning by evolved entities like LDL particles.

Last September I mocked this attitude in a parable. This week, I was amused to see this attitude at work in the scientists who study HDL.

When HDL particles pick up immune protein complexes and take on their anti-pathogen functions, some scientists call the resulting particles “dysfunctional” or “pro-inflammatory” HDL. [3, 4, 5] This is contrasted to the “anti-inflammatory” HDL that is light, fluffy, fatty and available to carry toxins back to the liver.

The reasoning seems to be that since inflammation is bad, HDL that participates in the inflammatory response must be “dysfunctional.” To me, this is rather like calling white blood cells “dysfunctional blood cells.” After all, white blood cells are pro-inflammatory.

Aside: Why I Don’t Often Use the Word “Inflammation”

This is why I rarely use the word inflammation:  it has a bad connotation, even though it is a natural process involved in healing and immune defense. Like LDL, it has been demonized for its association with disease. Like firefighters who associate with fires, and ambulance drivers that associate with heart attack victims, inflammation should not be blamed for the dysfunction it attends.

Not all anti-inflammatory therapies are good for you. Clearing your body of “dysfunctional HDL” would temporarily reduce inflammation – but it would let pathogens run wild, potentially leading to the fate of Emily’s great uncle.

Can There Be Too Much HDL?

In biology, it’s a general rule that you can get too much of a good thing. The benefits from something usually follow an upside-down U: they increase for a while, reach an optimum, then they fall. Many nutrients are like this: beneficial in small doses, toxic in large doses.

Indeed, our diet is predicated on the idea that we should try to get all good things into their optimal “plateau range.”

It’s also a good rule of thumb that evolution selects for the optimum. Evolution prefers that we be healthy, so the natural evolutionarily selected levels of biomarkers are usually best for us. In general we should eat a healthy diet, and trust that our body will regulate components, like HDL, to their optimal amount.

So that raises the question:  Is it bad to manipulate the body to raise HDL to unusually high levels? Might HDL, like other good things, have a U-shaped benefits curve – so that there is an optimum and raising HDL above that is damaging? Shouldn’t we just live naturally and let our body adjust HDL to whatever level it wants, trusting evolution to have chosen the optimal HDL level for us?

In concrete terms: Is Richard Nikoley’s coconut oil-induced HDL of 133 mg/dl too high?

It’s a fair question!

What Evolutionary Milieu is Our HDL Particle Number Optimized For?

Evolution did select for an optimal level of HDL – that’s why our HDL level is not infinite.

So why did evolution limit HDL? If higher HDL clears toxins and kills pathogens, what would cause evolution to give us too little of it?

A likely answer is that it is costly to produce HDL, and there are diminishing returns to immunity at high HDL levels.

Let’s imagine the Paleolithic environment. Pathogens then were less dangerous. Because the entire global human population was in the hundreds of thousands, human-human transmission was more rare. Without domesticated animals, zoonotic transmission was rare.

Also, food was less available. Today supermarkets are everywhere and people rarely go hungry; but in the Paleolithic the body had to be careful about preserving resources.

So the evolutionary impulse was to conserve resources: the body wouldn’t make more HDL than necessary, since sources for HDL could be better used to scrimp on food.

If this correct, then the optimum HDL level in the Paleolithic was low.

Then the Neolithic came: animals were domesticated and lived near and with humans. People settled in towns, and population density rose. Feces polluted the local water, facilitating pathogen transmission. Pathogens evolved for greater virulence.

In the medieval period, the world’s great civilizations became densely populated. China, especially, became home to hundreds of millions of people living in close contact. These civilizations were subject to the greatest pathogen loads and must have been under strong selective pressure for enhanced immunity, and thus higher HDL levels.

But evolution doesn’t work overnight. Our natural HDL levels may not yet have evolved to their optimum. They may still be undershooting optimal levels.

HDL Epidemiology

If I’m right, then HDL must be undergoing current evolutionary selection for higher levels.

Historically, HDL levels should have been rising since the Neolithic, and rising the fastest in the most densely populated civilizations.

There are other factors too: geography plays a big role. Pathogens flourish in Africa, and in tropical climes generally. Northerly latitudes with their cold winters are low in pathogens.

So let’s consider what the geographic distribution of HDL levels should be, ignoring contributions from diet.

If my argument is correct, populations who until recently lived as isolated, low-density hunter-gatherers – like Australian aborigines, Melanesians and Polynesians – will have the lowest HDL levels, levels similar to those of our Paleolithic ancestors.

Meanwhile, people who have lived for the last few millennia with the highest population densities – East Asians – or the highest disease burdens – Africans – will have the highest HDL.

Europeans, with a favorable geography and middling historical population density, should be intermediate in HDL levels.

What does the data show?

HDL in Kitava averaged 44.5 mg/dl. [6]

For American populations in NHANES III, African-Americans averaged 53 mg/dl and white Americans averaged 49 mg/dl. This is a good comparison because Americans of different races eat similar diets.

In the Beijing Eye Study, Chinese were found to average 62.3 mg/dl, with one Beijing resident having an HDL over 270 mg/dl! [7] In the InterASIA study, however, Chinese averaged only 51.7 mg/dl. [8]

It’s difficult to infer much from this data, since diet and infectious burden affect HDL levels. The lower HDL in Kitava could be due to their higher carbohydrate intake. But overall, it is consistent with my evolutionary hypothesis. Kitavans have the lowest HDL levels, Americans of European descent are intermediate, and African-Americans and Chinese have the highest HDL levels.

What About Within Populations?

If our optimal HDL levels are higher than our “natural” evolved HDL levels, then the rare people with highly elevated HDL – those blessed with genetic variants that increase HDL, or that live the lifestyles that most elevate HDL – should live longest and be healthiest.

Indeed, that seems to be what is observed. As noted on Tuesday, in the VA Normative Aging Study, “Each 10-mg/dl increment in HDL cholesterol was associated with a 14% [decrease] in risk of mortality before 85 years of age.” [9]


There’s little data to evaluate the healthfulness of very high HDL levels, but what data we have suggests that more is better.

There’s also a plausible (to me) evolutionary story for why our optimal HDL levels may be far higher than the ones selected by evolution.

For most biomarkers I would trust evolutionary selection and let my body do whatever it wants; but for HDL I will make an exception. I think we will benefit from dietary tactics that raise HDL levels above the evolutionary norm. And this is especially true for those with infectious diseases.

So my judgment is: let’s be like Richard Nikoley and aim for high HDL. I’ll discuss how on Tuesday.


[1] Pirillo A et al. Modification of HDL3 by mild oxidative stress increases ATP-binding cassette transporter 1-mediated cholesterol efflux. Cardiovasc Res. 2007 Aug 1;75(3):566-74. http://pmid.us/17524375.

[2] Berrougui H, Khalil A. Age-associated decrease of high-density lipoprotein-mediated reverse cholesterol transport activity. Rejuvenation Res. 2009 Apr;12(2):117-26. http://pmid.us/19405812.

[3] Feingold KR, Grunfeld C. The acute phase response inhibits reverse cholesterol transport. J Lipid Res. 2010 Apr;51(4):682-4. http://pmid.us/20071695.

[4] Undurti A et al. Modification of high density lipoprotein by myeloperoxidase generates a pro-inflammatory particle. J Biol Chem. 2009 Nov 6;284(45):30825-35. http://pmid.us/19726691.

[5] Smith JD. Myeloperoxidase, inflammation, and dysfunctional high-density lipoprotein. J Clin Lipidol. 2010 Sep-Oct;4(5):382-8. http://pmid.us/21076633.

[6] Lindeberg S et al. Determinants of serum triglycerides and high-density lipoprotein cholesterol in traditional Trobriand Islanders: the Kitava Study. Scand J Clin Lab Invest. 2003;63(3):175-80. http://pmid.us/12817903.

[7] Wang S et al. Prevalence and associated factors of dyslipidemia in the adult chinese population. PLoS One. 2011 Mar 10;6(3):e17326. http://pmid.us/21423741.

[8] He J et al. Serum total and lipoprotein cholesterol levels and awareness, treatment, and control of hypercholesterolemia in China. Circulation. 2004 Jul 27;110(4):405-11. http://pmid.us/15238453.

[9] Rahilly-Tierney CR et al. Relation Between High-Density Lipoprotein Cholesterol and Survival to Age 85 Years in Men (from the VA Normative Aging Study). Am J Cardiol. 2011 Apr 15;107(8):1173-7. http://pmid.us/21296318.

Leave a comment ?


  1. Paul, great stuff.

    For several years in a row my HDL has tested in the 110-120 range- at first I was stoked on it, as was my doctor.

    As my skepticism for conventional medicine increased I began to wonder if it was a good thing to have really high HDL all the time… so thank you for addressing this!


  2. Paul,

    Fascinating post as usual.

    I’m also amazed by the failure of many mainstream nutrition scientists to look at aspects of the body as design features instead of bugs. By coincidence I just came across a good line by Dan Dennett is his excellent book Darwin’s Dangerous idea: “There is simply no denying the breathtaking brilliance of the designs to be found in nature. Time and again, biologists baffled by some apparently futile or maladroit bit of bad design in nature have eventually come to see that they have underestimated the ingenuity, the sheer brilliance, the depth of insight to be discovered in one of Mother Nature’s Creations.”

    And yet modern nutrition science would have us believe that it was somehow a design flaw to put saturated fat in mothers milk, or to have the liver make it on purpose to store excess energy. Or worse yet the issue of design is not even considered in the first place, as if the systems of the body were just randomly thrown together and it is now for us to find out how or if they can be made to work together.

  3. 1.very intriguing indeed. I really enjoyed this.


    3.Not to question Paul’s specific cases, but I am not sure if we should get carried away concerning our own perfection.. Given the central bricolage aspect of evolution, it cannot possibly always result in good design. If for example the blind spot in our eye is good design, then the word good design has no meaning any more. The idea of perfect design strikes me as pre-Darwinian or worse.

    4. To adopt a fitting style for this last point: Richard Nicoley’s HDL is boys’ stuff. He should try to get a HDL this high with stage 3 CKD, like I do. Ha. (Never mind.)

  4. Paul – great article. I *do* use the inflammation term quite a lot and refer to it often as *the root of all evil* – though remain open-minded to the actual cause of the inflammation. In medical school you are just used to seeing pathology slides and pictures all the time of the autoimmune stuff – kidneys torched by lupus, fingers scrunched by scleroderma, arteries with foam cells, and frankly when I see red-faced obese people with spotty skin walking around, my first thought is “wow, they look inflamed.”

    It is obvious though that the immune system in general is a glorious thing, and going to strong anti-inflammatory meds (steroids, for example) a desperate act to fight back against a poorly understood condition.

    I think most doctors do not have a cognitive dissonance about this situation – there are things we aren’t smart enough to know yet.

  5. I think it’s important to clarify that the Paleolithic environment had plenty of infectious agents…but of different kinds.

    Since it’s difficult to find a water supply in sub-Saharan Africa that doesn’t have animals bathing and pooping in it, I suspect the Paleo environment was high in water-borne parasites (for which HDL would, presumably, not be protective), and lower in viruses and bacteria. Thoughts?

    Meanwhile, I’m off to eat more arterycloggingsaturatedfat!


  6. With my family history of heart disease, my doctor years ago urged me to try niacin in order to increase my HDL. Prior to that, exercising 12 hours a week and eating a very low fat diet resulted in an HDL of 32. Niacin increased that to 42. A couple of years ago, I stopped niacin for several weeks, and had an NMR lipoprotein test performed. I had started eating higher fat (70%) and cutting carbs. I expected my HDL to decrease to pre-niacin levels, but I was shocked to see it increased to 52 with niacin. However, my LDL particle count was very high, even on a high-fat diet.

    Six months later, after restarting niacin, my HDL increased to 71 and my LDL particle count dropped. At that point, my diet was 78% with saturated fat accounting for 57% of my calories. In order to get that much saturated fat in my diet, I had to consume a lot of coconut oil.

    I have had my cholesterol tested shortly after I severely strained a hamstring, to the point it was black and blue. My HDL dropped significantly. I’ve also had my cholesterol checked immediately after an infection, and again it was depressed.

    I’m also the first male in my family tree not to have a heart attack or stroke before the age of 50, so something must be helping.

  7. Paul, this is very interesting, as are all your posts. I’ve always wondered what was up with high HDL, and whether or not being off the charts is a good thing. My mother and my grandmother both have/had high HDL, as do I. Last I had it checked 2 years ago it was 106, after some time low carbing. Prior to that on a typical american diet it was always in the 80s.

  8. “It’s also a good rule of thumb that evolution selects for the optimum. Evolution prefers that we be healthy, so the natural evolutionarily selected levels of biomarkers are usually best for us.”

    Paul-is this always true? Does evolution “care” about the population who often becomes very interested in their health and is the main target of most drug interventions, namely the elderly? I keep hearing/reading people in the paleo scene say that our bodies main purpose is to pass on our genes, that our body is just a vessel for gene transmission (Devaney comes to mind). This is philosophy for sure, but if this is so(?), a rapid degeneration of the elderly is entirely natural and in-line with evolutionary tactics, which makes a natural approach to “anti-aging” (one based in an evolutionary paradigm-eat like the caveman) a poor choice. I’m not making a statement here, I’m just trying to understand a line of reasoning I hear a lot when reading paleo stuff.

  9. Paul, indeed very interesting! This could explain why runners have higher levels of HDL: to fight infections that abound among them!

    And, the fact that pathogen-fighting HDL particles do not go back to the liver can explain why the half-life of HDL in runners is much higher than in sedentaries:


  10. Hi all!

    The evolution comments are interesting. Thomas, I was a bit more careful about the wording there than you may realize – I carefully didn’t say what evolution was optimizing, and in regard to health only said that evolution “prefers” it! The usual answer for what is optimized is “fitness” but this leaves vague what “fitness” implies for individual health. Most of the time, healthier individuals are more fit, thus a “preference” for good health.

    It’s also clear that evolution has selected for human longevity, as we are relatively long-lived mammals. This may be due to contributions of grandparents to grandchildren, or due to advantages of preserving cultural lore.

    But it is true that humans aren’t optimized for longevity, and individual goals may differ from evolutionary goals. So even if HDL of 80 optimizes evolutionary goals, HDL of 130 may be optimal for personal goals.

    Todd and donat, your comments make a great point-counterpoint.

  11. Mario,

    That’s exactly what I argued in the comments section of the previous post on HDL. I frequently see HDL >100 in patients with several other markers of inflammation, such as elevated CRP, ferritin, WBC, monocytes, etc.

    In these cases, I’d argue that high HDL is a marker for infection or toxicity. So is high HDL good here? It is in the sense that it’s doing it’s job of fighting infection and clearing toxins. But it isn’t in the sense that it reflects the presence of infection or toxicity.

    It’s rarely black or white in medicine.

  12. Hi Emily,

    My take on inflammation isn’t a criticism of those who use the word frequently. Inflammation is actually a very good word for doctors. The classic “calor, dolor, rubor, tumor” is very meaningful at a tissue level.

    But I’m lucky, I never have to look at sick people. I work at the level of diet and overall health outcomes, with an occasional foray into molecular and cellular biology, and to call foods or molecules “inflammatory” or “anti-inflammatory” usually confuses matters more than it clarifies. You always have to ask, “In what context? Why? Is the inflammation beneficial or harmful?” The same food or molecule will be pro- or anti-inflammatory in different contexts.

    Nutritiondata used to (maybe still does) show an “inflammatory index” of foods. Some food researcher had assigned a number to each food, which was claimed to be how inflammatory it was! I got the impression that vegan diets were the most “anti-inflammatory.” This is just nonsense.

    Best, Paul

  13. Hi JS,

    Granted, but I still think the African pathogen environment was much lighter in the Paleolithic than it is today. Population densities were so much lower, there was less poop. Animal densities were also much lower. Agriculture and livestock raising has greatly raised animal population densities.

  14. Mario, fantastic comment. Chris, yours was too – it was so good I am saving it for the introduction to my post on Tuesday. Maybe I’ll have to use Mario’s too. In fact, Ed’s story counts too. You can start to guess my theme for what raises HDL …

    Best, Paul

  15. A few random pushbacks:

    1. I wouldn’t assume blacks and whites eat the same foods. There is plenty of regional variation, concentration of blacks in some states skews the numbers. (i.e. a black person in Boston may have same diet as white person in Boston, but large numbers of blacks in Mississippi, Alabama, Georgia skews the national sample)

    2. Infections and Paleo. Plenty of the “deadly” infection diseases come from animals, not from living with other humans. Very common until 100 years ago to have horses, chickens, etc in your house. Still true in China. We focus on those diseases because they jump over and kill us — not their optimal strategy either. A lot of the more chronic infection are better adapted to us and WON’T kill us – although they might make us miserable.

    3. Are the HDL levels of a Kitavian and black american really that different? 44 vs 55?

  16. Chris, one more thought. Wouldn’t it be interesting to know why that person in Beijing had an HDL of 270 mg/dl? It kills me that medical studies don’t look at these outliers and give us an explanation. The unusual cases may be just as important as the mean and standard deviation.

    Hi Robert,

    Good pushbacks. Let me give your pushbacks a bit of pushback:

    Re 1 and 3: If you look in the HDL manipulation literature, researchers get excited about changes of 4 mg/dl. High-dose niacin, the gold standard here, typically increases HDL about 7 mg/dl, though if you get the dose as high as 4 g/day (huge!) increases from say 40 mg/dl to 60 mg/dl are not uncommon.

    So, yes, the difference between 44 and 55 is at the high end of what is achievable by tested dietary and nutritional interventions. To have these as whole-population mean differences suggests the difference is more than just diet.

    2. Yes.

  17. Commenting on my HDL level of 135, my holistic M.D. said that very high HDL correlates with autoimmune disease. He said it was just a marker, but a significant one that most doctors don’t know about.

  18. Very interesting, Bill, and makes sense. Thanks.

  19. This is fascinating, Paul. Thanks for putting this series together.

    Based on the VA study you sited, higher HDL concentrations seem to reduce the risk of disease and may prolong life. Are there any studies that looked at the occurence of common colds and HDL levels?

    I recall from your book that a diet high in refined sugar and omega 6 oils will lead to lower levels of HDL. Is a low blood HDL concentration due to a fraction of the HDL being tied up in the liver while disposing toxins? If it wasn’t disposing the toxins, then would blood concentrations be higher?

    Could our bodies be programmed to make a certain amount of HDL and that the concentration of what we see in the blood is a reflection of diet toxicity?

    Thanks for your time.

  20. I am the author of an orthomolecular nutrition textbook, HONEST NUTRITION, which you may have heard about. I have been studying for years to find answers to the problems of weight control.
    Now, I think I know enough to write a concise pamphlet on the topic. However, there are difference between PERFECT HEALTH DIET and Gary Taubes WHY WE GET FAT. I also find useful information in MASTERING LEPTIN by Byron Richards and Michael Eades in PROTEIN POWER, which have differing information and advice. The greatest difference is in how much protein is needed. We learn most by communicating with people with contrary claims.
    My wish is that these four could communicate enought to find out why they differ, and come to a concensus on different points.
    Is there a way that could be done? I would like to be involved, though I cannot claim to have standing as an expert.

    I am also writing a booklet on the confusion of nutrition information, with emphasis on what has been lost in the mass of babble. I could use help.

    Ira Edwards, 845 W 12th St. Medford OR 97501
    541-779-2854 medwards@uci.net

  21. I think that we can safely say that if eveything else looks good and someone has massive HDL then it is a good thing. If everything else isn’t all right it’s hardly the fault of the HDL or LDL, and the solution isn’t an attempt to address the production of lipoproteins.

    Eat a high fat diet, reap the results. The second I see evidence of HDL itself being intrinsically pathological or diets high in coconuts killing people dead then I’ll reconsider.

    Eagerly awaiting a glimpse into Paul’s magical bag of biochemical trickery next post.

  22. Hi Erik,

    The best I can come up with are these: HDL radically reduces the risk for lower respiratory infections, http://www.ncbi.nlm.nih.gov/pubmed/19330560. Kids who acquired colds had lower HDL: http://www.ncbi.nlm.nih.gov/pubmed/9326433.

    I do believe that toxin disposal can lead to loss of HDL. But I would need to do more research on disposition of HDL.

    Yes, I do think dietary toxins influence HDL levels, but in complex ways – some toxins increase HDL and some decrease it. I’ll have a bit more on Tuesday.

    Hi Ira,

    I have enough trouble figuring out what I think, it would be hard to have to figure out what Taubes, Richards, and Eades think too!

  23. Paul mentioned a standing desk a while back. Turns out it dovetails with blood lipids. I built a standing desk for my computer over a year ago, other than a minor quibble (possible paralysis, ha ha), it has been a great success and I would never go back to sitting.


    “While sitting…the enzymes responsible for breaking down lipids and triglycerides — for “vacuuming up fat out of the bloodstream,” as Hamilton puts it — plunge, which in turn causes the levels of good (HDL) cholesterol to fall.”

  24. Regarding the NYTimes article: If sitting is lethal, it’s too late for me. But I have to wonder if this isn’t just another health article following in a long line of such “news” articles — each of them warning that this, that, or the other thing is going to do us in.

  25. Thank you, Paul. I appreciate the study links and information. Looking forward to your next post.


  26. Hi Paul, I hate to make question about food choices but sometimes information can cause a lot of confusion…What is yout take on avocado? its omega 6 content is something to worry about?
    Im kind of worried that my vitamin e intake has decreased a lot after going on a more “clean diet”. Seems that a lot foods that are vitamin e sources are also problematic food (seeds, oils, wheatgerm, etc).

    Thanks soo much for your work & help!

  27. Hi Grace,

    We recommend avocados, and eat them ourselves about once a week.

    It’s omega-6 content isn’t that high – rather like olives / olive oil.

    You’re right, vitamin E is most abundant in toxic foods! They need it most.

    I don’t think we need a lot, but food sources are the best.

    • We find that avocados raise our blood sugar for a couple of days, so no longer eat them: “The avocado fruit contains a sugar called mannoheptulose, which has been shown to inhibit both synthesis and release of insulin.”

  28. Great post , I’m going to spend more time researching this subject

  29. Paul, great stuff.

    I’ve always had a higher HDL. It was always over the 110. Last year it was 140 and this year it went down to 94. Although my doctor marked it as a very good number I feel that I should be concerned since its ~35% decrease in a year.
    I have also gained 10 pounds maintaining same activity level and been always eating on healthier side although reduced eating meat(specialy white meat) tremendously this past year.

    Could such a big change be indication of anything? should i be worried and keep monotoring my HDL?


  30. Hi Aiste,

    94 is an excellent HDL and I don’t see any reason to take the decrease as a bad sign. It could be seen more as normalization.

    I assume the 10 pounds is muscle, not visceral fat?

    Unless there were independent evidence for some kind of health problem or infection, I wouldn’t take that as anything negative. 140 is an extremely unusual HDL level.

  31. I recently had my cholesterol checked and my HDL was 133, LDL 66 Trig 42 and my VLDL was a 8…my total chol count was 207…My cousin who is a cardiologist said she has never encountered a patient with that high of a HDL…by what I am understanding of your article I should not be concerned???

  32. Hi Roberta,

    Well, are you doing a lot of HDL-raising things like eating coconut oil etc? Do you have any symptoms of disease?

    On their face your numbers are exceptionally good – almost too good to be true. We certainly can’t infer any ill health from your numbers. But we can’t say they guarantee good health either, since sometimes HDL is raised in inflammation or infection. You would have to look to other symptoms for guidance. If you are eating well and feel good, then I would say, your lipid profile is probably just exceptionally good.

  33. Hi,
    I’m not familiar with coconut oil, but I do eat a lot of veggies and fruit, basically a low fat diet and very little red meat….I do exercise at least six days/week including cardio and weight lifting. I really do enjoy working out and challenging myself too. I don’t smoke and drink occasionally. My Dad died at 60 of heart disease and my Mom died at 67 and suffered with Lupus for over 30 years. So ,I am trying my best to beat my family’s lovely health history! lol

    No real ill symptoms, just the usual aches from exercising and I’m sure my age (almost 50)…so that’s why I force myself to take at least one day off a week from the gym.

    Thanks for your quick response. I really appreciate it!

  34. My money is on “highest is best”. My wife’s family has a long history of living into their late 90’s. Her VAP showed an HDL of 94 **before** she went paleo … it went up to 167 afterwards (320 total). I told her I’m the first of her 3 husbands. 🙂

  35. Can someone point me in the direction of the use of coconut oil and benefits.
    Thank you!

  36. Hi, I’ve read many posts – very interesting. I am a little perplexed by the fact that my labs last week indicated that my HDL was 38 (range 50-55 in the last 2-3 yrs) and there was no change in my activity or diet. If anything, I cut out essentially all meat (eat only chicken and fish 1-2 times/week. I actually eat more veg’s than before and still run 15-30 mi/week, depending on an upcoming race. I take a few supplements – no change with prevoius years. I am very health conscious and this bothers me a little bit. My total cholesterol is excellent (130) so the ratio is still good but I can’t understand the significant drop in HDL.

    • Hi Roman,

      I’m afraid total cholesterol of 130 is terrible. That indicates that either you are eating a severely lipid-deficient diet, or you have a protozoal or parasitic worm infection that is lowering your cholesteorl. Either would account for your drop in HDL as well.

      Optimal total cholesterol is 200-240 mg/dl. You should read our Cholesterol category: http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/, starting at the back with the earliest posts.

      I think you would do well to add more meat back, eat more saturated fats such as dairy, eat 3 egg yolks a day, and if cholesterol doesn’t rise significantly then ask your doctor for diagnostic testing of protozoal or parasitic infections.

      Best, Paul

  37. In a year’s time, my cholesterol went from normal to a high total cholesterol of 300 — of which HDL is 100. Although my total Cholesterol to HDL ratio is a respectable 3. And my triglycerides are low. Is my body increasing its HDL in order to clear out a pathogen that I caught? I’m not doing anything special that would up the HDL other than using coconut oil to oil the pan in stir frying. During that time, I did decrease my carbs. And am not eating any processed foods. Can a low-carb diet cause high cholesterol?

  38. Hi Paul and others,
    Any thoughts on my recent bloodwork for cholesterol?
    Total Cholesterol: 235
    HDL: 117
    LDL: 112
    VLDL: 6
    Triglycerides: 31
    Is it a tad too high? You still think the same about high HDL (higher better)? Maybe my LDL is way too high though…? Does it look like I have any particularly high infectious burden, based on those numbers?
    Of course the doctor wants me to consider statins, and is concerned about my “high” cholesterol. The answer is always “no thank you, I’d rather not harm my liver for now.”I tried to tell her that it had always been lowish (176 total) and so I have actually been trying to raise it a little… they look at me like I’m very crazy and tell me to eat less fast food, fried foods, etc. Oh my gosh! I tried to bite my tongue, but I did politely say I don’t eat fast food or fried food and rarely ever eat out anywhere. It really feels strange when you know that you’re not on the same page as your doctor– like I have to hide what I’m really doing. I even ate less butter and eggs the week before the test specifically becuase I didn’t want the “statin talk.” My only saving grace was the fact that I told her my husband and I are considering trying to get pregnant which ended the argument: you can’t take statins while you’re pregnant. Yay for me! Whew! I escaped by the skin of my teeth once again!
    Are there really any doctors out there who would be fine with my 235 cholesterol?? I can’t imagine the joy of it!! (Besides the fact that I’m diabetic, and unfortunately it seems difficult for some of these doctors to say “diabetic” without also always including the words “statin” and whatever the blood pressure lowering drugs are called. Really not fair!)
    They forgot to check my A1c so I had another blood draw and should know that next week, but I expect it to be around 5.2 or so, based on my glucometer averages.
    Ok, thanks as always for your time! 😀

    • Hi KH,

      Your numbers are excellent, they’re certainly not a reason to take statins. TC is perfect, LDL is great, HDL is extraordinarily high and Trigs/VLDL extraordinarily low, but we don’t know that either of those is harmful.

      I would just thank the doctors for monitoring your health and decline the drugs. You’re doing great!

    • Hi KH,

      Regarding high HDL, consider the high HDL/inflammation connection:


      I tend to view HDL >85 or 90 in the presence of other inflammatory or immunological markers as a potential sign of infection or immune dysregulation.

      I don’t have the reference handy, but I came across a study associating elevated HDL and CRP (occurring together) with INCREASED risk of heart disease….

      I frequently see HDL >100 in patients with several other markers of inflammation, such as elevated CRP, ferritin, WBC, monocytes, etc.

    • Thanks Paul and MarkES,
      Regarding the high HDL, pre-PHD my HDL had always been moderate high (85 avg) with total cholesterol around 176 (I don’t have the labs in front of me at the moment) but now TC and HDL are much higher due to diet… I never really ate butter or eggs before and ate meat more sparingly,etc. So I’m just assuming the increases are from diet alone. But, this might not be relevant, I don’t know since I don’t really know how the body regulates cholesterol levels. Also, I had CRP checked exactly a year ago and it was 0.13!!! (on those labs, Jan 2012, TC was 206, HDL 100, LDL 100) (pre-PHD, my CRP had been 0.17) But they didnt check it on these labs so I asked them to check it from the blood they took yesterday. So I should have that next week. I’m hoping it’s still low… WBC were also all in normal range on the labs.
      Thanks for the inflammation connection– I’ll post back when I get my CRP results. Very curious now…
      Thank you both for insights!

    • Hi again,
      Just wanted to follow up with labwork that I said I would report back about…
      Also, I’m just SOOOOOO super excited about my A1c that I can’t help but tell everyone!!
      HbA1c- 5.1 😀 😀 😀 (more or less equivalent to a reading of 100 on glucometer)
      CRP- 0.31 (last year it was 0.13, so a little higher, but maybe not a significant increase?? I don’t know…)

      Honestly, I do credit myself to some degree because I do try very very hard to keep good blood sugars, in the beginning years I didn’t because I was so angry or in denial or something, but these last 5 or 6 years, I’ve tried really hard. However, this past year or so is the only time I’ve been able to get such great blood sugar stability, so pre-PHD my numbers were pretty good, very acceptable and that was owed to my efforts I suppose. But now, eating PHD, my numbers have gone from pretty good to amazing! It has to be the diet. I really am so grateful for all the information and all the work that you Paul and Shou-Ching have put out here for all of us to read, and thankful to all who contribute here too because we all glean stuff from each other.
      Thank you so much.
      My husband and I have been so blessed by the information, by your caring, and willingness to share your riches of knowledge with all of us.
      Thank you Paul and Shou-Ching,

  39. Question to Paul re: Triglycerides.
    I went on a low Carb diet using most of the principles of the PHD, increased saturated fats, cocoanut oil, lots of veggies, butter, cheese (biggest substitution was 3 eggs and bacon for breakfast instead of flax seed based grain cereal) and my Triglycerides INCREASED (from 65 to 80) along with LDL (from 110 to 144). Can you help me understand why the TGs increased?
    Thank you,

    • Hi TP,

      What were you eating before? Did you increase carbs? How many carbs are you eating now? Have you increased total calories consumed?

      Triglycerides of 80 are in the normal range, and LDL of 144 isn’t far off normal. It could be that you are mildly hypothyroid now, or nutrient deficient, or too low carb or too high carb.

      • Paul:

        I had been eating a few more carbs, including grains, before, but really the major substitution was eggs and meat for breakfast instead of flax seed and flakes cereal, as well as fewer carbs and more meat/fish/veggies instead of other whole grains used occasionally, and cooking with butter/coconut oil instead of olive oil. Also more fish and less chix. Likely calorie neutral or slightly less. 3-4 lb wt loss over past month. Current diet lower in carbs than you like, at about 50 gm/day, tapering back up. Admittedly already at ideal body weight. Healthy, energetic.

        Regarding other factors: Alcohol: 1 glass / day at dinner. 2 squares chocolate most nights. I use iodized salt.

        My understanding is that Triglycerides come from carbs, not fat, so figured they’d go down not up with consumption of saturated FAs, medium chain FAs (eggs, bacon, coconut oil for breakfast). Unlikely nutrient deficient from such a substitution.

        Any other thoughts on etiology of rise in TGs? I was after bigger, fluffier LDLs, not smaller denser LDLs. Are you suggesting higher TGs from a low carb diet?


  40. Hi Paul!

    I’m from Spain. I’m male, fitness lover, 30 years old. I am following the Paleo diet since september, and I think that my blood work has been improved since then.

    These are my numbers:
    – Glucose: 85 mg/dl
    – HDL: 107 mg/dl
    – LDL (estimated): 86
    – Total: 199 mg/dl
    – TGs: 31 mg/dl

    What do you think with these values?? Do you think that they are ok??

    Thanks in advance! 😀

    • Hi Alejandro,

      They’re generally excellent. I would consider the HDL slightly high and LDL and triglycerides slightly low, but they are within shouting distance of optimal numbers. It is the opposite pattern of most people. Unless you had some other symptoms, I wouldn’t consider these diagnostic of a problem.

      Best, Paul

      • Thank you very much for your reply Paul! 😀

        My doctor wasn’t able to give me a diasnogtic with this numbers. He usually see high LDL or TG, but no so high HDL.

        In 2012, following the Mediterranean diet, my values were slightly different. A bit lower HDL, LDL and Total CHl, and high TGs.

        I don’t have any symptoms so now, I will be happy with this b.w.

        Thanks again and best wishes for the new year!

    • Like Alejandro, also on Paleo/Grain Brain Diet. Exercise, take vitamins. Avoid grains, but do eat carbs: fresh fruit; vegetables; sweet potatoes; quinoa; etc. Fasting Glucose: 80 HDL: 100 Total: 200. From what I’ve read, people in third world countries who do not eat processed foods have high HDL. So what is considered “normal” if there is even such a thing? Thanks! 😀

    • I had another blood work recently. The test gave the following numbers:

      – Glucose: 86 mg/dl
      – HDL: 114 mg/dl
      – LDL (estimated): 58 mg/dl
      – Total: 180 mg /dl
      – TGs: 39 mg/dl

      Higher HDL and lower LDL. I still in paleo, but now, I eat more carbs; I usually do a carb reload, and I train harder than ever (but no cardio!).


      • Hi Alejandro,

        Now the LDL is worse. That is way below normal and suggests a parasitic infection, anemia, or hyperthyroidism. Ask your doctor to evaluate what it is.

        • Hi and thanks for your reply, Paul!

          I have a blood work from february 2012, when I was in mediterranean diet (high in grains, fiber, low in red meats and saturated fats), and chronic cardio (thinking that it was healthy). Then, the values were:

          – Glucose: 84 mg/dl
          – HDL: 81 mg/dl
          – LDL (estimated): 45 mg/dl (even lower)
          – Total: 133 mg/dl
          – TGs: 34 mg/dl

          I have read that in ketosis the LDL can be low. Now I am in ketosis some days a week, and some days I do a carb refeed. I usually skip the breakfast. My weight go up from 72 kg then to 77 kg now, primarily muscle gain. Other values like iron or red blood cells count are OK, so I don’t think that I can have hyperthyroidism, anemia or other diseases, but of course I thank you very much your advice and I will ask to my doctor. 🙂

          thanks for your work, and best regards from Spain.

  41. Hi Paul,

    I found this article fascinating, esp the potential link between HDL and inflammation. (Fortunately, my CRP and Sed rate are fine.)

    That said, I wanted to make a comment re: diet and our ability to alter HDL/LDL. Both Hubby and I had our physicals last year, and his (new) doctor remarked to me that Hubby’s lipids were awesome and he was “blessed w/good genes.” Ha! Actually, not true. In ’03, his TC was 220 w/an HDL of 56 and TC/HDL of 4.0. Later that year, we changed the way we ate, increasing protein, banishing margarine for butter, decreasing processed foods, and eating more vegetables and beans. In ’05, his TC was 194, HDL 60, LDL 119 and Chol/HDL: 3.2, Trig 73. By ’07, TC 211, HDL 79, LDL 118, and ratio 2.7 He still rocks a 6 pack and weighs between 137-147 over the course of the year.

    I had similar results. In 1996 TC was 221, HDL 46, LDL 133, Chol/HDL 4.8! I was 35 yrs old. In ’13, at age 52, I got sloppy about my eating, but even so, my numbers were better than most…and certainly better than when I was 35~ TC 245, HDL 93 (down from 105 the year before), LDL 131, Chol/HDL 3.0; trig: 93. This, despite the fact that I am 20-25 lbs overweight. (Working on that!)

    My point being, changes in diet can dramatically change HDL/LDL #’s w/o being burdensome. I’m back to eating healthy and am looking forward to watching the numbers change again! BTW, we’re not gluten free; we don’t use coconut oil; we aren’t Paleo. We just use healthy fats (mostly those high in Omega 3 vs Omega 6), butter as wanted, eat more beef than chicken, altho we’re quite fond of fish too, and eat beans as if someone were going to outlaw them tomorrow.

    I wanted to throw that out there for the folks that think you have to take extreme measures, or niacin, or statins, to change, and find that thought overwhelming.

    Now, for my question. In this article you state: “These pathogen-fighting HDL particles do not go back to the liver. [3] So when HDL gets converted to pathogen-fighting particles, it can no longer clear toxins. Toxins linger in vascular cells and macrophages for lack of HDL transport.”

    Call me confused! I’m an RN, and so I get the whole LDL/VLDL thing (fluffy vs dense), but this is the first time I’ve seen a similar take on HDL. So, I’m wondering–“where” is this HDL? B/c I thought it was carried in the blood-stream, and if so, how could it escape being transported to the liver? It’s been awhile since I had A&P, but I’m not ashamed to admit when I don’t know something. Is it trapped in cells, i.e. fat cells?

    I know it’s been a long time since you posted this, but this, and the one that preceded it, are of great interest to me. I’m off now, to poke around in more of your posts!


    • Hi Teresa,

      Great points! Just healthy eating will lead to healthy cholesterol numbers.

      On the HDL question, the point is that the nature of the proteins on the particle determine which cell types pick them up. When the HDL particle takes on immune functions by adding immune proteins, the liver stops taking it up so that it can continue to circulate in the blood and have a better chance to contact pathogens. This is why some infections lead to high HDL — the HDL particles are getting converted to forms that aren’t cleared from the blood.

      These particles get pulled from the blood by chemical reactions between their proteins and receptors on cell membranes. So when the proteins change or are hidden/coated in other molecules, they no longer get taken up by cells.

  42. Thank you SO much! That makes sense to me!

    I am having a ball bouncing all over your posts. I very much appreciate your links to different studies. And, I liked the lovely pic of the “perfect health diet.”

    That said, I’m now searching for any post that directly addresses legumes–esp since I adore them. I noted a small entry re: toxins, but cannot find a more comprehensive post addressing that. Can you point me to one?

    Last, but not least, do you have any idea WHY physicians–cardiologists in particular–are STILL telling people to eat low-fat diets? It blows my mind!

    • Legumes — most traditional legumes like lentils are OK if properly prepared, but commercial foods aren’t properly prepared and most people at home don’t have time for it, so we put them on our do not eat list. The book discusses their toxicity, the issue is how much soaking and cooking is required to reduce toxicity sufficiently. We prefer to be cautious.

      Physicians are just behind the times. They don’t even try to keep up with nutrition, for the most part. They have their hands full keeping up with the medical literature.

  43. Loading your book to my Kindle now! You have peaked my interest 🙂 Thank you for being gracious enough to answer my questions, not once but twice!

  44. My HDL has always been 110-120. I’ve always been told that I will never have to worry about Heart Disease. Just had Labs yesterday and my HDL is up to 140, Total Cholesterol 240 and Triglycerides of 60. I have a friend who is the Director of Cardiac Rehab at Cleveland Clinic. It sounds like there is now “Good” HDL and “Bad” HDL. I’ve been told I have I have Fibromyalgia… not sure I agree with that. I have Ligamentous Laxity which also causes chronic wide spread pain with Trigger Points. It seems like the more we learn, the less we know. It becomes quite frustrating!! I’ve been Vegan for the past 3 months but have always been healthy and active. After years of thinking I would not have to worry about Heart Disease (my mother had an MI in her early 50’s and I’m approaching 50!!) now I’m concerned that I’m at Greater Risk with there new Studies!!!

  45. Hi, I am in a panic.. I don’t know what to do. I had my blood work done the other day. The dr office called and told me total cholesterol is 235. hdl is 112, ldl is 114 and trygycerides are 43. I also had that c-reactive protein test and they said it was -3. Last time it came back total cholesterol 129 and other numbers were normal. The only dietary changes I made was adding a minimum of 4-6 tbs of extra virgin olive oil. I take a number of supplements, not a multi all separate. What should I do? The doctor says ok but total should be under 200.. I am really worried and don’t know how to pursue this at all. 😥 I know the individual numbers, outside of the ldl are supposedly super good.. Can you help? Thank you for any help you can provide.

    • Hi Leslie,

      Don’t panic. These are excellent lipid numbers. Optimal ranges are: TC 200-240; HDL >60; LDL 110-150; Triglycerides < 60. You are optimal in all categories. However, I wouldn't recommend adding 4-6 tbsp of coconut oil. That is a lot of bare fat without accompanying nutrients (phospholipids, antioxidant nutrients). A good amount of oil is 1-3 tbsp per day. Best, Paul

    • Hi Leslie,

      Don’t panic. These are excellent lipid numbers. Optimal ranges are: TC 200-240; HDL >60; LDL 110-150; Triglycerides < 60. You are optimal in all categories. However, I wouldn't recommend eating 4-6 tbsp of coconut oil. That is a lot of bare fat without accompanying nutrients (phospholipids, antioxidant nutrients). A good amount of oil is 1-3 tbsp per day. Best, Paul

  46. oops.. I made a BIG error!!! I actually eliminated olive oil and it is EXTRA VIRGIN COCONUT OIL that I am eating a lot of.. Also added organic eggs a couple times a week… Sorry for that big mistake.. as I said I am upset by what the doctor told me.. Thank you.

  47. Thank you for your reply. I do take allot of antioxidents. I also checked out the diet u recommend and I would say I am at 90% of what you recommend. Here is what I take. I am not crazy about cutting back on the coconut oil but can if you think I should. As well as oil pulling with it, I take these supplements, a few of which I take cause I lost both my parents to Alzheimers, mom at 69 and dad at 85. I am in late 60’s….
    Evista for my osteoporsis
    B6 100mg
    B12 methyl 5000mcg
    D-3 4000 2000 IU
    L-Carnosine 500mg
    Folate 800mcg
    Phytoceramides 350mg
    baby aspirin 81mg (2x a week only)
    Magnesium 250mg
    Vitamin E 1000mg
    A Probiotic
    Lipoic Acid 300mg
    Vinpocetine 10mg
    Super K (also for the osteo) 1000mcg K1, K2-4,& 200mcg k2-7
    and at dinner time….
    Vitamin C 500 mg with bioflavenoids
    Calcium Citrate 200mg
    D-3 2000mg
    Vitamin E 1000mg
    Lipoic Acid 300mg
    Vinpocetine 10mg

    Anyway, I think I know the C and E are antioxidents. Is that enough to have more coconut oil? I also have 1 oz natural raw almonds and 1/4 ounce walnuts and pumpkin seeds, organic yogurt with strawberries and blueberries in it.
    I thought I was doing well for myself. All my other numbers on the blood tests were ok. I considered myself to be healthy, a lot of energy, partly from the coconut energy, I read it can do that and I am a live wire lol..now I’m not so sure.. very confused if I am treating my “temple” the best that I can.
    I do so appreciate your reply, and would like to sign up for your newsletter.
    Thank you for your time, much appreciated.

  48. Hi Paul, I was notified through my email that I had a reply to the additional comment I made but when I clicked on it and came back to your site there was no comment to see. Is there something I am not seeing? Thank you.

  49. Hi Paul, I just got back the results of a lipid profile taken early Sept 2015: TC 195 (down in 6 months from 203); Trig 40; HDL 85 (up from 75); LDL 94 (down from 125); CRP normal. My card still wants me to take statins b/c I have slight CA disease and b/c he believes everyone with an LDL over 70 should take them. I achieved the above changes with diet (mostly added things like apples, carrots, beets, more walnuts) and exercise (walking up to 5 miles per day) and a 14-pound weight loss. What do you think of these numbers and my doc’s recommendation?

    • I would not take statins. Your numbers are terrific, although LDL is a little low, but that might not be a big deal with coronary artery disease. (People with higher LDL survive heart attacks better but are slightly more likely to get a heart attack.)

  50. Thanks, Paul. By CA, I meant carotid artery disease. I lost the vision in my right eye for 1-2 minutes, in December, and they did an MRI of my carotid arteries, which showed slight narrowing of the right artery. I haven’t had my coronary arteries tested, b/c I don’t want the catheterization. If they could look at it with just an MRI or similar non-invasive test, I would do that to see where I stand. Are you saying my LDL is a little low b/c it’s under 100?

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