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Measures to raise HDL in white man with increased paticle number

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I am trying to raise my HDL number. I have a family history of heart disease (father). A year ago, my bloodwork yielded a HDL of 48, LDL of about 93, and Trig. of 110. My LDL count was high at that time, too (around 1,400). I have been exercising very rigorously over the past several months (180-200 mins per week, running and resistance training), and take fish oil once per day. I've also lost over 40 lbs in under 2 years and have cut out trans fats, white flour, and corn syrup from my diet. A couple of months ago, my bloodwork yielded a LDL of 90, a Trigl. of 80, and HDL of 49. Particle counts were not measured. I only drink on occasion (1-2 glasses per sitting, 4-5 per week max). I also closely watch my sugar intake. What could I be doing wrong in increasing my HDL??

Category: Cardiologist

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Category: Cardiologist
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Thank you for your query at

There is nothing wrong with your current lipid profile.
Your HDL is 49 which is good. Above 40 for males is a good value . Your ldl below 100 is great. Tg of 80 is good too. Your particle count of 1400 is borderline high. You are leading a good lifestyle with exercises and dietary control. Fish liver oil is another good thing you are on. So there's very little of modifications that are left for me to advise you.

Thyroid diseases can occasionally lead to high ldl counts as per literature.
In Asians small dense ldl and hdl particles are due to their genetic make up. So if you are an asian or indian then likely your small ldl particle size and large particle number despite normal ldl cholesterol concentration is genetic in etiology. This type of ldl particle puts people at risk despite their normal ldl concentration. Right now there are no recommendations for risk reduction based on the particle numbers. But I would recommend you to get a hscrp test done.

If that is elevated then you could be started on rosuvastatin to reduce your risk.

Sent from my phone. Please Excuse the typos and formatting.

Dr Vivek Mahajan
DM Cardiology

Patient replied :

I am a white male, never smoked. I apologize for not mentioning that. Also, I am currently taking 40 mg of Protonix twice a day per my gastroenterologist for Acid reflux. I have been on this for almost 9 years, starting taking 2X/day about a year ago. I also take 2,000 mg MSM per day (mainly to prevent joint pain and tendinitis from running). Would taking MSM help with C-Reactive protein and is there anything to indicate that long-term PPI usage would affect any risk for heart disease or cholesterol levels?


Thanks for the follow-up.

I cannot think of any other reason for your small dense ldl particles count being high except for a genetic technology. Other factors like obesity, metabolic syndrome, faulty diet, smoking, alcohol are not applicable in your case. You need to rule out any thyroid disorders though.

Pantoprazole may lead to a high ldl/hdl ratio in a minority of patients but in your case this ratio is not a problem.

I am not sure of MSM dosage as I am not an expert on osteoarthritis but MSM has a generalized anti inflammatory effects on the body but this does not translate into reduction in hscrp as seen in trials. So msm use is not likely to reduce your hscrp levels.

On the contrary rosuvastatin has been shown to have dramatic effect on hscrp levels. So if hscrp levers are elevated I would recommend rosuvastatin.

Hope this helps, please feel free to discuss further.

Dr Vivek Mahajan
DM Cardiology

Patient replied :

I realize this may be outside your discipline, but my A1c test was normal (5.2, with 5.7+ being abnormal). However, I often feel very tired and weak after heavy meals. And, I sometimes get unexpected sugar cravings in the evening. I am able to take care of the cravings with raw, unsweetened cacao powder. I do not have any immediate relatives with diabetes. My urinalysis showed trace ketones and abnormal specific gravity, but the doctor didn't mention them. My fasting blood glucose was 89. Should I ask my doctor for a fructosamine test or is there a more reliable test for diabetes? Is it true that a heavy breakfast, medium-sized lunch and small dinner ("breakfast as a king, lunch as a prince and dinner as a pauper") will help with insulin resistance?


I am extremely sorry as this is beyond my expertise and even if I have some ideas about your condition it would be inappropriate for me to guide on this as a wrong advice may jeopardize your health and well-being. I suggest you take an opinion from an endocrinologist or a diabetologist for the same.

Sorry again
Dr Vivek Mahajan

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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