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?