The Amazing New World of HDL Cholesterol

Tuesday, February 19, 2013
By: Byron J. Richards,
Board Certified Clinical Nutritionist
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The new scientific toolbox is poking around in HDL’s house1, only to find good news and bad news. HDL has been labeled “good” cholesterol because it helps remove damaged LDL cholesterol from your arteries, and has generally been associated with having less cardiovascular disease. It is coming to light that the quality of the HDL you have is just as important, if not more so, than the amount of HDL you have. This means there is both “good HDL” and “bad HDL.” If you have too much of the bad HDL then it no longer protects you and actually helps cause heart disease. How do you know if you have good or bad HDL? Read on…

The Purpose of HDL Cholesterol

HDL cholesterol is small in comparison to LDL cholesterol, and higher in protein. It functions like a tow truck.  It latches on to spent or damaged LDL cholesterol and returns it to your liver for recycling and/or clearance. The two main proteins that make up HDL are called apoA-I (75 percent) and apoA-II (25 percent). ApoA-I is the good guy; its structural integrity is vital for HDL’s ability to clear damaged LDL from your circulation, and the walls of your arteries. 

New discoveries are showing that apoA-I is also vital for the HDL enzyme functions that give it anti-inflammatory and antioxidant activity. The role of apoA-II is much less understood, other than to say that it is implicated as being part of problems with fat metabolism, and too much of it causes poor HDL function.

Triglycerides and HDL Cholesterol

One aspect of HDL fitness is that as it does its work, its supply of apoA-I is temporarily diminished and replaced by apoA-II. If HDL then fails to replenish apoA-I it loses its ability to function in a helpful cardiovascular way and actually becomes a problem to cardiovascular health. One key sign that a person lacks apoA-I and has too much apoA-II is elevating triglycerides.

I have long advised that your triglycerides should never be more than twice your HDL cholesterol, a relationship that in my opinion is far more important than your LDL/HDL ratio. The new science helps clarify why this is the case, explaining that as triglycerides go up, HDL quality goes down. In this handicapped condition HDL cholesterol loses its ability to remove LDL, quench inflammation, and perform antioxidant functions.

HDL Cholesterol Communicates

What really has the science world buzzing is a newly recognized function of HDL cholesterol as a major signaling molecule in your circulation, one that acts as a communication platform to help instruct other cells around it what to do. Researchers have proven direct communication from HDL to the endothelial cells that line your arteries, the smooth muscle that comprises your arterial walls, the macrophages that are involved with LDL-related plaque formation, and T cells of your immune system.

These new insights came from several lines of research. Advanced proteomic analysis of HDL found that it had approximately 100 small protein peptides that were previously unknown. These small proteins use the cell membrane of HDL cholesterol as a communication platform. This means that HDL is involved in all sorts of communication that regulates the world around it – a function that has never before been understood and one that is just now being investigated.

Other research has more accurately defined the nature of the fatty substances that make up the HDL cell membrane. These are rich in phospholipids (phosphatidylcholine, phosphatidylserine, phosphatidylethanolamine, and phosphatidylinositol). These phospholipids are linked to a unique cell membrane fat called sphingomyelin, which is used to make a major signaling molecule (Sphingosine-1-phosphate). 

The discoveries of these multiple research efforts show that HDL is a dynamic communication platform, and has at least 100 different signaling proteins it can use to orchestrate what is going on around it. You might say that HDL cholesterol is a mini-brain floating around in your circulation. It is like having a manager on the production floor.

Damaged HDL Cholesterol

Now for the bad news. HDL can become damaged or “spent,” at which point it no longer does any of these good things. Instead it actually contributes to cardiovascular disease, and LDL winding up in plaque. This happens for three main reasons:

1) Failure to provide adequate nutrition to re-energize HDL after it has been working. This leads to a lack of apoA-I and an HDL cell membrane that has lost functionality.

2) Oxidative damage to apoA-I, caused by inflamed and overheated immune cells. This means individuals with inflammatory health issues will have poor quality HDL. The greater the inflammation, the worse the HDL quality. 

3) Sugar glycation of HDL, rendering it “cemented” so that it can’t work. The more uncontrolled the blood sugar, the worse the HDL problem.

This new knowledge gives you three important areas to work on to not only boost your HDL cholesterol number but also boost your HDL quality. It is interesting indeed that HDL-building nutrients like niacin and pantethine also help lower triglycerides and improve cardiovascular health, giving more proof to this new field of emerging HDL science.

How to Improve HDL Quality

Key nutrients that support HDL cholesterol health:

Niacin - Niacin has been shown to directly boost your levels of apoA-I while lowering triglycerides. I recommend non-flushing inositol hexanicotinate.

Pantethine - Pantethine provides the energy to help form HDL cholesterol, while also providing energy to assist triglyceride and LDL cholesterol metabolism.

PhosphatidylSerine - This nutrient contains a mix of the key phospholipids that are often lacking in the diet and needed to construct the healthy cell membrane of HDL.

Along with HDL-building nutrients, it is vital to take anti-inflammatory nutrients that calm down immune cells that induce free radical damage to the apoA-I protein. The basis of this approach is a diet rich in fruits and vegetables. Many nutrients may be of assistance. Some top choices include grape seed extract, resveratrol, tocotrienols (vitamin E), vitamin C, DHA, pomegranate, and blueberries. Stress management and getting adequate sleep are essential.

Ensure your fasting blood sugar never gets above 90. If it does, use “anti-glycating” nutrients that help protect your HDL from sugar-induced damage. Top choices include R-alpha lipoic acid, grape seed extracts, carnosine, and resveratrol.

HDL cholesterol is a pivotal molecule that protects your circulation and directly manages its health. It is no longer adequate to simply have an HDL score above 40. You need high quality HDL cholesterol that is energized and ready for duty.


Referenced Studies:
  1. ^ The New World of HDL Cholesterol  The FASEB Journal.   Angelo M. Scanu and Celina Edelstein.

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