So I go to the doc for my annual physical, everything's looking good (6'0", 158lbs, 45.1% hematocrit, BP looks good, yadda yadda) and so they mail the results from the blood work and include a note that my HDL level was 31, with the recommended range being 40 to something over 40 (the point is I'm under the minimum). On the note it said I should exercise more. Rrrrrright. As a fairly-competitive cat 3 I'm doing more than the average person and don't really feel I should be working out more. So I call them and tell them that I work out between 6 and 14 hours per week throughout the year. They then told me to include an alcoholic drink at night 5-6 nights/week. Rrrrrrrrright again. As an employee at the nation's largest brewery, I've gotten accustomed to drinking either a dark stout, a single malt scotch, or a clean pilsner, oh, about 5-6 nights/week, only having 2 or more about once/month. So I tell the nurse that over the phone, and she's like, "Oh you're fine, just come back in next year." I pull my report from the previous year, and it was 38. So it was already under the minimum, then decreased another ~20% so I'm ~25% under the minimum value, and they don't seem to be concerned. Should I be?

The other interesting thing was that she said "it can't be diet related, so aerobic exercise is the best way to raise it", but then she recommended alcohol intake. Is this weird to anyone else? Should I be making a will?

I just went through a physical a couple of weeks ago. All the stats, HR, Cholesterol, etc. came back pretty well thanks to cycling. The nurse made a comment about the shaved legs which brought up the all-to-familar cycling discussion. When I mentioned that I was a cyclist she suggested getting a bone density test. Now Bicycling Mag published an article about cycling and it's effects on bone density over the summer and, remembering the article, I agreed.

Suprisingly the bone density scan came back stating that I was medium risk. They suggested I take calcium supplements as part of my diet to prevent future issues. Needless to say I was a little freaked out...

I'm not a racer but average over 4k miles/year on the bike. The nurse treated the "cycling and bone density" thing like it must have been common public knowledge but I never dreamed it would apply to me. Just curious if JPRider14 or anyone else has had this issue...

Your HDL number is reflective of your genetics, your exercise patterns, and your diet. Your only "non-drug" option, given what you've stated, is to look for more complex carbohydrates by way of things like whole oats, whole wheat, vegetables and fruits (raw being better than cooked). If that doesn't improve the numbers, then you may want to consider statin drug therapy. Beyond that, there are people who do everything right and still have bad blood numbers, or high blood pressure, etc.

Two other points are that 1) your 31 and 38 may really be the same number given the combination of testing variability and the impact of short term diet on any particular measurement and 2) the desire for a higher HDL is based on a lot of statistics, but those statistics do not really have a cohort that represents those who are very active athletes. IOW, the epidemiological studies have been done on large population groups showing that higher HDL is better, but no one has the data that says what they mean for a particular individual who does not fit the general profile of relatively inactive adult. Also, there are plenty of people with lousy numbers who never have heart problems, as there are people with good numbers who do have heart problems.

The whole bone density and cycling thing came from some work on TdF riders who lost bone density during the race. Being unable to discern the difference between the incredible intensity of an event like the TdF and "normal" cycling, the medical community leapt to the conclusion that cycling causes bone loss. They describe weight lifting as a "weight bearing exercise" but cycling is not. It's easy to understand why walking and running trigger bone density increase, because you are seeing an impact, which stresses the bone. I don't see any more impact in weight lifting than in cycling, so it's hard to imagine why there would be a difference for people engaged at the recreational level. And, sure enough, there was just some recent research that showed that cycling helps bone density (sorry, I can't remember the citation). Your low bone density is like due to genetics or a diet deficient in calcium and/or vitamin D.

It's my understanding that the ratio of your HDL to LDL and Triglicerids is equally if not more important than any individual number, although there are "guidelines" to shoot for. I think it's a 4:1 ratio or less you're shooting for - I'm not sure if that's right so verify the number before you panic. I have high cholesterol - get it checked twice a year, the ratios are good so it keeps me off meds.

If you want to target just HDL, you can do it to some extent through your diet. Include some omega 3 fats, salmon and tuna are good sources, flax seed is another (grind it up and throw it in your cereal) or just take a fish oil pill you can buy at any supermarket these days.

Kerry is right as much of this is your genetic dispostion, but I think you can tweak your numbers some with diet. In my case, the biggest impact on my #'s came from stopping my alcohol consumption - from a sixer a week to about a beer a month. (Still deciding if it's worth it...)

My doc and I have talked a lot about this over the past few years. My cholesterol total has dropped from 280 to 235 through cycle training and diet changes, but I don't know how much lower it will go. There is an interesting article from JAMA detailing a study that showed that the amount and intensity of exercise was more correlated with heart disease then cholesterol levels. The abstract and citation are below.

chris

Source: JAMA: Journal of the American Medical Association; 10/23/2002, Vol. 288 Issue 16, p1994, 7p

Abstract: Context: Studies have shown an inverse relationship between exercise and risk of coronary heart disease (CHD), but data on type and intensity are sparse. Objective: To assess the amount, type, and intensity of physical activity in relation to risk of CHD among men. Design, Setting, and Participants: A cohort of 44 452 US men enrolled in the Health Professionals' Follow-up Study, followed up at 2-year intervals from 1986 through January 31, 1998, to assess potential CHD risk factors, identify newly diagnosed cases of CHD, and assess levels of leisure-time physical activity. Main Outcome Measure: Incident nonfatal myocardial infarction or fatal CHD occurring during the follow-up period. Results: During 475 755 person-years, we documented 1700 new cases of CHD. Total physical activity, running, weight training, and rowing were each inversely associated with risk of CHD. The RRs (95% confidence intervals [CIs]) corresponding to quintiles of metabolic equivalent tasks (METs) for total physical activity adjusted for age, smoking, and other cardiovascular risk factors were 1.0, 0.90 (0.78-1.04), 0.87 (0.75-1.00), 0.83 (0.71-0.96), and 0.70 (0.59-0.82) (P<.001 for trend). Men who ran for an hour or more per week had a 42% risk reduction (RR, 0.58; 95% CI, 0.44-0.77) compared with men who did not run (P<.001 for trend). Men who trained with weights for 30 minutes or more per week had a 23% risk reduction (RR, 0.77; 95% CI, 0.61-0.98) compared with men who did not train with weights (P = .03 for trend). Rowing for 1 hour or more per week was associated with an 18% risk reduction (RR, 0.82; 05% CI, 0.68-0.99). Average exercise intensity was associated with reduced CHD risk independent of the total volume of physical activity. The RRs (95% CIs) corresponding to moderate (4-6 METs) and high (6-12 METs) activity intensities were 0.94 (0.83-1.04) and 0.83 (0.72-0.97) compared with low activity intensity (<4 METs) (P = .02 for trend). A half-hour per day or more of brisk... [ABSTRACT FROM AUTHOR]

I had HDL levels that never got above 45 no matter how much I exercised or how many whole grains I ate or how little saturated fat I ate. I did weights 5 days a week, biked to work and did noon time rides/walks. Now my HDL is averaging 65. The change that caused this was to go on a low-carb lifestyle. I now eat meat, fish, cheese, butter, eggs, vegetables, nuts, berries etc. and feel great. My cycling endurance has increased and my weight has gone down, while I eat any time I feel hungry.

My HDL was 158 & choles. was 239 I ride,no smoke,no drink,6' 190lbs and watch what i eat and have been on meds for 5 years. Mom and dad around 380-390 choles.

The whole bone density and cycling thing came from some work on TdF riders who lost bone density during the race. Being unable to discern the difference between the incredible intensity of an event like the TdF and "normal" cycling, the medical community leapt to the conclusion that cycling causes bone loss. They describe weight lifting as a "weight bearing exercise" but cycling is not. It's easy to understand why walking and running trigger bone density increase, because you are seeing an impact, which stresses the bone. I don't see any more impact in weight lifting than in cycling, so it's hard to imagine why there would be a difference for people engaged at the recreational level. And, sure enough, there was just some recent research that showed that cycling helps bone density (sorry, I can't remember the citation). Your low bone density is like due to genetics or a diet deficient in calcium and/or vitamin D.

My buddy got spooked by the bone density thing and ended up quitting racing (which bit, as he was a strong 3)...though it's worth mentioning his wife absolutely hated the amount of time cycling took up, and we all think that has a lot to do with it.

I don't worry about the bone density issue much. I guess if you're prone to breaking bones and have been your whole life and have little calcium in your diet, I'd look into it, but I don't fit any of those criteria.

Your HDL number is reflective of your genetics, your exercise patterns, and your diet. Your only "non-drug" option, given what you've stated, is to look for more complex carbohydrates by way of things like whole oats, whole wheat, vegetables and fruits (raw being better than cooked). If that doesn't improve the numbers, then you may want to consider statin drug therapy. Beyond that, there are people who do everything right and still have bad blood numbers, or high blood pressure, etc. Two other points are that 1) your 31 and 38 may really be the same number given the combination of testing variability and the impact of short term diet on any particular measurement and 2) the desire for a higher HDL is based on a lot of statistics, but those statistics do not really have a cohort that represents those who are very active athletes. IOW, the epidemiological studies have been done on large population groups showing that higher HDL is better, but no one has the data that says what they mean for a particular individual who does not fit the general profile of relatively inactive adult. Also, there are plenty of people with lousy numbers who never have heart problems, as there are people with good numbers who do have heart problems.

Right on, man. Thanks. I think I'll ask my folks what their cholesterol numbers look like; maybe that can shed some light on this subject. Thanks for the info - the picture you paint is pretty clear.

Btw - KI, what's your field of expertise? Is it your career?

I'm a chemical engineer by training. However, I've been interested in diet and health issues for many years, so I do a bit of reading. Per Yogi Berra "You can observe a lot by watching."

HDL is the number you want as high as you can get it. New data suggests that an HDL over 60 reduces your number of risk factors by 1. Exercise is supposed to raise HDL, some people take Niacin to raise HDL as well. Discuss with your doctor before taking niacin because some people get flushing and hot flashes from it.

Some statin drugs raise HDL as well as lower LDL (Crestor is one). My HDL went from about 38 to 66 in 1 year from a combination of intense regular cardio workouts and taking Crestor for about 6 months. I have been on and off statins twice now (about a year on and a year off) and have not suffered any side effects. There was some concern that I had had a stroke at some point, but that has been ruled out definitively. I am on the fence whether or not to continue on the statins and will be discussion in November with a cardiologist and report back here is there is anything of interest to the group.

If you are doing all you can do (or all you are prepared to do) in terms of exercise, weight control, diet etc. then you should make an appointment with your doctor and discuss the results and together figure out the next step. Don't let the doctor's nurse or secretary make that decision for you. If you are not satisfied with the way your doctor is handling the situation get a second opinion or switch doctors.

While a tendency towards lower HDL in a 1 year period is not going to kill you tomorrow, it should be looked at in more than a passing manner. there is a lot of controversy about what the numbers mean and how to treat healthy people. Myself I would rather do all I could to prevent heart disease rather than treat it after an "event".

I agree with the above post on the HDL:LDL ratio is important.
Basically high LDL is bad because it is believed to form the plaque on the arteries. The HDL's are supposed to protect the heart and they believe HDL's help to carry cholesterol out of the bloodstream. High Triglycerides are bad as well.

Maybe try not to focus on just HDL's and look at your complete cholesterol profile. If you are really concerned, try to talk to the doctor.

I just saw my doc for cholesterol, my total cholesterol and LDL's were slightly above the risk limits. My HDL and Triglycerides were good (high HDL & low triglycerides). He said I could either start low dose drug treatment or maybe watch my diet and exercise. I cycle quite a bit and eat fairly healthy. My folks are both on cholesterol meds and heart disease runs on my dad's side of the family. I told him I'd like to be put on low dose Lipitor and he had no problem with that.
I don't remember my actual numbers but I do know the latest studies are recommending starting antihyperlipidemics more aggressively than previously thought.

Talk to your doctor.

Testosterone lowers HDL. Looks like you're just too much of a man, JP.

Testosterone lowers HDL. Looks like you're just too much of a man, JP.

...wellllll, I was the first kid in high school to have chest hair.......

My doctor gave me three months to lower my numbers. My total dropped from 265 to 239 to give me the 3 month lease on life with moderate running and biking. I could tell he wasn't thinking I could do it. My problem is surely due to genetics since I am a non-smoker, not overweight, a light eater and consistently active. I took it up a notch though from riding a mountain bike on and off trails to serious road biking beginning August 1. I've dropped about 7 pounds and have been taking diet supplements, plant ester sterols and Omega 3. My mileage is over 100 per week at an 18 to 19 mph clip. I do not want to go on the meds as I can't see messing with your liver to fix a possible non-problem in your heart. I've had an echo cardiogram and everything looks good, but you can't gauge the build up on the arteries. I am planning to make a strong case to continue the aggressive exercise program to lower my risk as long as I can physically pull it off. I'm 50 and too young to start the downward spiral of becoming drug-dependent. Doctors are too quick to prescribe statins and the experts keep lowering the thresholds. 239 actually is one point under the old break off point.

My doc did the same thing. I've been graphing it for 3 years now on a spreadsheet and I've dropped about 40lbs (was 6'6", 257; still 6'6" and 218). He pushed drugs initially, but with the shrinking ldl and triglyceride numbers and increasing hdl numbers, he agreed that we could wait. That's why I was so interested in that study in JAMA, the first large study focusing on the effect of intense exercise on heart disease. It is a much bigger factor than cholesterol numbers. Now my doctor thinks 227 and tending down is just fine for me.

chris
ne iowa