HDL: “H” is for “happy”

What role do emotions play in HDL cholesterol?

I’ve often observed a peculiar phenomenon: People who come to the office or hospital in the midst of a difficult emotional situation-e.g., stress at home, financial struggles, hospitalization (usually an unhappy occasion)- can show dramatic drops in HDL cholesterol. Not uncommonly, HDL drops 20 or more mg/dl.

Take Agnes’s case. Agnes had to go to the hospital for an elective procedure, one she’d been dreading for months. Previously, Agnes had been proud of the fact that she’d incrased HDL from 42 mg/dl range all the way up to 71 mg/dl. She accomplished this dramatic increase by eliminating wheat and cornstarch from her diet (which helped her lose 24 lbs), taking vitamin D and omega-3 fatty acids from fish oil, exercise, 2 oz of dark chocolate per day, and a glass of red wine with dinner.

Although I wouldn’t have bothered checking a cholesterol panel for such a procedure, the hospital had a checklist that included a cholesterol panel regardless of necessity. (Such checklists are common in hospitals, meant to ensure that certain basic issues are not overlooked.)

Agnes’ HDL: 29 mg/dl-a 42 mg drop.

Agnes will recover and her HDL will rebound, but the same effect can occur with other stressful situations, such as death in the family, financial worries, marital stress, etc., as well as physical illness.

Interestingly, the opposite may also hold true: Low HDL may increase risk for depression and stress. A study from Finland of 124 depressed persons, for instance, showed a 240% increased likelihood of depression in those with lower HDL cholesterols.

In other words, there seems to be a curious interdependence between HDL and emotions.

Why? Does it represent the indirect effect of adrenaline, cortisol, or other “stress hormones”? Do factors that relate to low HDL, such as unhealthy diet full of carbohydrates and physical inactivity, also tend to cultivate depression?

It certainly seems to be a chicken-egg situation, with one often leading to the other.

Moral of the story: Maintaining a sense of optimism and engaging in activities that bring you satisfaction and enjoyment can help raise HDL, as can strategies such as those followed by Agnes. Avoiding unnecessarily stressful situations can help. HDL is important, since higher levels are associated with much reduced risk for heart disease . . . and perhaps depression.

Comments (10) -

  • Anonymous

    10/16/2008 5:22:00 AM |

    Add wheat and carbs to that interaction.  I used to think I got anxious and/or depressed in response to challenges I was facing in my life.  My experience with low (and zero) carbing has shown me that I get anxious or depressed in response to eating carbohydrate the day before.

    No carbohydrate, life is wonderful, full of promise, joy and excitement.

    I never would have believed it.  (Would have saved me a TON on therapy.)

  • westie

    10/16/2008 6:13:00 AM |

    "Does it represent the indirect effect of adrenaline, cortisol, or other “stress hormones”? Do factors that relate to low HDL, such as unhealthy diet full of carbohydrates and physical inactivity, also tend to cultivate depression?"

    Answer to these questions is YES. Lowered HDL is a result of lipoprotein metabolism in plasma and it is related to increased VLDL secretion from liver.

  • Anne

    10/16/2008 8:19:00 AM |

    I suppose there's always going to be exceptions to the rule and I'm one of those. My HDL is high at 89 mg/dl, but I'm under a considerable amount of stress, not only because of ongoing health problems but also because my son has an autistic spectrum disorder and is *hugely* stressful to live with.


  • Zbigniew

    10/16/2008 12:33:00 PM |

    wow, over half a bar of chocolate and wine drank daily - I switch to that from my unbranded low-carb style
    (and I'm being serious in that "low-carb" logo is pretty worn out today, but if you write a book titled "Choco diet" with a subtitle that can be similar to that of Agatston's "SBD: The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss" then you will reach far greater an audience than those getting interested in just a coronary plaque (not that I personally think the heart is "just" a peculiar detail.)

  • JPB

    10/16/2008 3:39:00 PM |

    Just a quick question:  If stress can affect lipid levels, what about thyroid levels?  (Related to my kitty with hyperthyroidism that seemed to be brought on by great stress.)

  • Anonymous

    10/16/2008 6:43:00 PM |

    You hit the nail on the head, Dr. Davis!

    I was recently hospitalized during a "vacation" to California with "takotsubo syndrome", or stress induced cardiomyopathy.  I had chest pain after 5 intense days of dealing with a particularly difficult and nutty relative.

    The hospital did the usual testing, including a cholesterol panel, which showed HDL of only 46, which puzzled me greatly.  Utilizing the Track Your Plaque principles, I have succeeded in raising my HDL to consistently around or over 60, so was quite puzzled by such a big drop to pre-treatment levels.  Now it all makes sense!  

    BTW, I have fully recovered and an echocardiogram shows ejection fraction and heart wall motion have returned to normal.  I was very lucky, and the interventional cardiologist probably was a little disappointed he didn't get to place any stents. Oh well, he'll live, and I've still got plenty of medical bills to show for the experience!

    My advice?  Nix the stressful situations and the nutty, negative people... it's a lot better for YOU and much cheaper in the long run, too.

    As always, thanks for the great and informative blogs!

    Houston, TX

  • Anonymous

    11/6/2008 4:13:00 PM |

    I've been on Atkins for almost a year, so I've already done all this. I had a hdl level of 105 for almost a year, but the last panel showed a hdl level of 84 ! Yikes! WHat happened? So I was very happy to find your blog ( thanks Jimmy Moore) as I read that emotional stress can cause a drop of 20 points or more. Since I've been out of work since mid August I'd say yes, I've been under some stress. Looking forward to my next blood work! Thanks for the info, great reliever of my pain!

  • Anonymous

    11/16/2008 12:33:00 AM |

    I'm severely intolerant to red wine - not just the flushed face a lot of people get but knockout rhinitis, asthma, rheumatic joint pain, diarrhoea, and so on. Frown Are there any other foods or beverages that I can substitute? I'm not terribly worried, but it'd be nice if there was something.

  • Ricardo Carvalho

    1/24/2009 3:18:00 AM |

    Dear Dr. Davis, what about synthetic HDL? Does it works? And does it makes any sense? Would you please write us an article about this subject? - http://www.healthcentral.com/cholesterol/news-280802-66.html

  • buy jeans

    11/3/2010 6:25:50 PM |

    Why? Does it represent the indirect effect of adrenaline, cortisol, or other “stress hormones”? Do factors that relate to low HDL, such as unhealthy diet full of carbohydrates and physical inactivity, also tend to cultivate depression?

Roger's near-miss CT angiogram experience

Roger's near-miss CT angiogram experience

Heart Scan Blog reader, Roger, described his near-miss experience with CT coronary angiograms.

Hoping to obtain just a simple CT heart scan, he was bullied to get a CT coronary angiogram instead. Roger held strong and just asked for the test that we all should be having, a CT heart scan.

I posted yesterday that I was about to have my first CT heart scan...well, it was an interesting experience for reasons I coudn't possibly have anticipated. Dr. Davis has commented in the past on the confusion in the media about the difference between a CT calcium score scan, and a CT angiography, the latter requiring a far higher dose of radiation. I assumed this was a source of confusion only among patients and lay folks, but, lo and behold, I discovered today that doctors--or at least their helpers--can be just as confused.

Here's my story:

After checking in, I asked the receptionist to see if she had any information on whether my medical insurance was covering the scan. She called someone, and I heard her say over the phone, "He's here for a CT angiogram." At that point my ears perked up. I explained I wasn't here for a CT angiogram, only a regular CT scan. "Well, do you want to call your doctor and talk about this?" she asked. No, I said, I would like to ask one of their folks to verify exactly what test my doctor had ordered. As luck would have it, the technician was walking by at that point. "Is this a CT angiogram?" the receptionist asked. "No, it's just a CT calcium score scan" was the reply. But apparently the technician had been unclear herself, and had called my doctor just to verify. In other words, the "default" procedure they were accustomed to doing at this august Houston vascular clinic was a CT angiogram.

In fact, my appointment was even listed on their calendar as a "CT angiogram." For all I know, my insurance will be billed for the same. Later, during the procedure, the technician acted surprised I wasn't doing the "full test." I explained I had minimal risk factors (actually only one, an HDL of 34 a couple of years ago, which has since been raised to 50 partly as a result of taking advice from this site), but that my doctor was progressive (he is an MD for the Houston Astros) and thought it was a good idea since there is heart disease in my immediate family. My doctor did indeed prescribe only a CT calcium score scan, but it seems to have been an order that this clinic, at least, wasn't all that used to seeing.

So, I guess the message is: we have a lot of educating to do. Had I not been a faithful reader of these pages, I certainly wouldn't have known what kind of test I was about to get, or what questions to ask!

As for the heart scan itself, a piece of cake. If you can hold your breath, you can take this test. Just be sure it is the right one!

Why the "push" towards CT coronary angiograms and not "just" a CT heart scan? Well, I know it's shocking but it's . . . money!

CT coronary angiograms yield around $1800-$4000 per test. CT heart scans yield somewhere around $200. Though the scan center support staff might not care too much about the money themselves, their administrators likely make the cost distinctions clear to them.

Another reason: Most scan center staff, ironically, don't understand what a heart scan means, nor do they understand how it might serve to launch a program of prevention. They do understand that severe blockage by CT angiogram "needs" to be stented or bypassed. So they push patients towards things they understand.

Nobody makes money from CT heart scans, just as nobody makes money from a mammogram. Heart scans also don't lead to heroic, "lifesaving" procedures. They just lead to this sleepy, unexciting, inexpensive thing called prevention.

Comments (13) -

  • Mark K. Sprengel

    6/28/2009 11:35:08 AM |

    I had a friend that recently went for a heart scan. He said his score was zero. Is that possible?

  • Anonymous

    6/28/2009 4:31:52 PM |

    I hope the USA can see its way to some sort of national standards for State run medicare. As recent events show, if you have the will, the money will be found.

    I live in Ontario, Canada and only had to ask my primary care physician in order to get a CT angiogram (did not know about the Calcium score at the time) It's cost is covered under our social medicine program OHIP.

    A new study shows 30% drop in mortality from CD


  • Anna

    6/28/2009 5:30:18 PM |

    Sure it is.  My score was 0.  That's despite doing quite a bit in direct opposition to the AHA recommended dietary advice:

    -no wheat/gluten at all (whole or refined)
    -very few, if any grains (whole or refined)
    -very low sugar and starch consumption (low carb)
    -pastured red meat several times a week (bison, beef, or pork)  with normal ferritin level
    -high saturated fat consumption (grassfed butter, coconut oil, home-render lard)
    -whole fat dairy (incl raw whole milk and raw milk aged cheese)
    -no attempt to artificially increase fiber, though there's probably a fair amount of fiber in the ample fresh non-starchy veggies I consume
    -2 to 3 "backyard" eggs cooked in ample butter nearly daily for breakfast

  • fred88

    6/28/2009 7:04:06 PM |

    i am 72 years old my calcium score is zero.2 yrs ago i was diagnosed with angina.i took the linus pauling protocol and cured my heart disease.on march 20th 2009 i had a calcium score scan and astounded my cardiologist as my arteries were completely cleared.vitamin c and amino acid is cheap and available. no money in it for doctors.discredited by medical profession.

  • Jim the Guacamole Diet guy

    6/29/2009 5:54:45 AM |

    "Why the "push" towards CT coronary angiograms and not "just" a CT heart scan? Well, I know it's shocking but it's . . . money!"

    No, surely not.

  • billye

    6/29/2009 11:12:29 AM |

    Rogers experience brought back an unpleasant near miss CT Angiogram memory of an episode that I had while being in the hospital 5 years ago. I was  brought in with congestive heart failure-EF 20/25,  Now Don't think you are soon to lose a faithful reader, my EF is now 45/50, due to Aranesp injections, that I am doing exceptionally well on.  My anemia is now under fabulous control.
    But, I digress, one day while in the hospital a beautiful young lady with long flowing hair wearing a white coat and stethoscope came in to see me and identified her self as the cardiologist assistant. She quickly started to promote me to have an angiogram.  I refused. The hospital cardiologist came to see me and I told him not to send me any more sales reps. (he must have learned this technique from big Pharma with all their beautiful drug sales reps). I never did have that apparently unnecessary needless invasive procedure done.  Guess what?, I lived to tell the story.

  • Jim, Guacamole Diet

    6/29/2009 1:03:19 PM |

    One morning last year, I drank way too much strong tea. A few hours later, I had chest pains and tachycardia. I had forgotten about the tea, which with hindsight  was the obvious cause, and I went to an emergency room.

    By the time I got there, the pain had gone, and I should never have stepped into the ER waiting room.

    As soon as they got their hands on me, they wouldn't let me go, claiming that insurance wouldn't pay if I left against doctors' orders. They quickly ran up any thousands of dollars of expensive tests, all of which came back fine.

    They were very unhappy that I refused a coronary artery stent.

    My ejection fraction was 65.

  • Anna

    6/29/2009 6:09:24 PM |

    Anonymous in Canada,

    "A new study shows 30% drop in mortality from CD"

    Yes, modern medicine "saves" more people all the time.  

    But is the *incidence" of CD dropping? or is medicine just getting better at treatment.  I want to avoid CD, not just be saved from it.

    I used to be a strong believer that the US needed a universal medical care system similar to Canada and the UK.  Now that I have had a closer look at the UK's system over the last 14 years (in-laws are there) and have experienced the profound lack of primary prevention under a US HMO system (healthcare rationing), I'm not-so-sure.  

    Sure, we are a rich nation and we should be able to afford decent healthcare for everyone.  The current system is for haves and have-nots with the in-betweens really getting pinched.  And furthermore, the haves don't get nearly the quality of care that they pay through the nose for anyway (though many don't realize it).  

    But I can't see how turning over the decisions to government is going to be any better than it has been to turn over decisions to HMP insurance companies and accountants.  In fact, it could get worse.  Especially since government has turned into the handmaiden for special interests.  As much as I think it should happen, I have a hard time getting behind the proposals.  Be careful what you wish for, you might get it.

  • Anonymous

    6/30/2009 12:51:29 AM |

    ok fred88, you almost got me excited....until I saw the oral EDTA chelation.... I'm calling BS by association

  • Kent

    6/30/2009 1:54:06 AM |


    I've heard a mixture of reports on the Pauling protocol with varied success. Can you give a little more detail as to how much vitaming C, L-Lysine, etc. you took per day at what intervals, and the time duration you believe it took for the protocol to do it's job?


  • TedHutchinson

    6/30/2009 8:39:34 AM |

    Pauling Protocol in PDF format
    take note of this section
    The half-life of vitamin C in the bloodstream is 30 minutes.  
    Linus Pauling advised taking vitamin C throughout the day in divided doses. The Hickey/Roberts Dynamic Flow theory predicts that taking vitamin C  every four hours will produce the highest sustained blood concentrations. Take more before bedtime.

    I use a time release formulation

  • buy jeans

    11/3/2010 8:25:24 PM |

    CT coronary angiograms yield around $1800-$4000 per test. CT heart scans yield somewhere around $200. Though the scan center support staff might not care too much about the money themselves, their administrators likely make the cost distinctions clear to them.