Dear Reader,

Hope you are getting ready for spring.

Michigan always has its hiccups, letting the sun shine through. Hopefully, we will see the sunlight and warmth win soon.

I wanted to bring your attention to a question I get asked very often.

My good cholesterol is high, so I don't need to worry about my cholesterol, right?

So today I will delve into when "Good" Cholesterol Isn't Good.

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Judy came in for a second opinion.
Her cholesterol was high, but her PCP had reassured her it was the good kind. Her HDL-C was elevated, and she didn't need to worry.
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Judy had a strong family history of heart disease. She wanted to be sure.
She was right to ask.
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HDL cholesterol earned its "good" reputation for a reason. When it's working properly, it acts like a dump truck pulling cholesterol out of blood vessel walls, returning it to the liver for removal, reducing inflammation, preventing clots, and relaxing the vessels themselves.
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But here's where it gets interesting.
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Every attempt to raise HDL with medication has failed. Not just failed, some trials were stopped early because patients on HDL-raising drugs had more heart disease, not less.
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How is that possible?
Because HDL isn't a number, it's a function.
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When HDL rises in the setting of inflammation, from diabetes, liver disease, or chronic alcohol use, it changes character entirely. Instead of collecting cholesterol, it accumulates sticky proteins. Instead of protecting vessels, it promotes plaque, drives inflammation, and raises the risk of arrhythmias. It becomes a dump truck with flat tires holding cholesterol in the vessel wall.
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​Same number on the lab report. Completely different biology.​
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Advanced testing can distinguish functional HDL from dysfunctional HDL, and that distinction matters far more than the number itself. ( Boston Heart is the only lab doing this today - their HDL panel test)
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What actually improves HDL function: exercise, quality sleep, and metabolic health. Not a pill. (though a new one is in phase 3 trials, but it works by decreasing Apo B and increasing HDL, which is an extended effect)
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Judy's number looked fine.
Her function did not.
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Good cholesterol isn't always good. The question was never how high it was, but it was whether it was actually doing its job.
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In medicine, as we know, context is not everything, but the only thing!

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Live healthily and Iconically.

Nisha Chellam, M.D

PS:Remember: Life's too short for boring weekends and too long for ignoring the cleanup. Party responsibly, recover intelligently, and keep your cells from filing a formal complaint!

Dr. Nisha Chellam is a functional medicine physician at Parsley Health, specializing in making complex medical topics understandable without requiring a medical degree or a sense of humor bypass.