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Cholesterol Health: Increase HDL Cholesterol

By James O’Keefe, MD

September is National Cholesterol Education Month.  If you don’t know your numbers, now is a great time to have them checked and learn how to keep them healthy. 

One of my favorite mentors during cardiology training used to tell me that cholesterol was overrated and essentially useless as a risk factor because almost everyone he saw with coronary artery disease had “normal” cholesterol levels. What he didn’t appreciate was that virtually no one he saw had a truly normal cholesterol level.  The ideal LDL cholesterol level is in the range of 50 to 7-.  This is what your LDL was when you were born.  Currently, only about 2 percent of adult men and five percent of adult women have LDL cholesterol levels below 7-; and the average LDL is about 135, which is approximately twice the optimal level.  Coronary disease in our population remains an epidemic; about 40 percent of us still die from it.  In contrast, an LDL level above 70 is uncommon among animals and humans living in their natural environment, and so is atherosclerosis-the disease of the arteries that kills so many of us today. 

We have great medications, dietary supplements, and diet and lifestyle interventions for lowering the LDL cholesterol. When bad cholesterol drops below 70, the inflamed and dangerous lesions in your arteries begin to melt away.  Heart attacks, strokes, and deaths from coronary disease dramatically decrease when we achieve and maintain LDL cholesterol of 40 to 70, which corresponds to total cholesterol of about 100 to 140.  While many people worry about lowering bad cholesterol, they often overlook the benefits of raising good cholesterol.  However, the pharmacologic options for raising HDL (good cholesterol) levels are much more limited. HDL is helpful in preventing plaque buildup and heart attacks. 

Certainly, your HDL is strongly influenced by your genes, yet lifestyle and diet are also very important in determining your HDL level. The bottom line is that although your HDL level is a crucial number in predicting your long-term health and longevity, at least for the next several years, boosting this level into a healthy range is mostly up to you. Here's what works.

How to Raise Good HDL Cholesterol

Curb the Carbs - Eliminate sugar and other processed carbohydrates like white bread, rolls, white flour, white rice, cookies, and other sweets. These high-glycemic index foods spike triglycerides and blood sugar and drag your HDL down.

Change Your Oil - The omega-3 fats in fish oil can raise HDL about 8 percent. Other healthy oils that foster higher HDL levels can be found in natural foods like avocados, ground flaxseed, extra-virgin olive oil, green leafy vegetables, and nuts (especially tree nuts like walnuts, pecans, almonds, and Brazil nuts). On the other hand, trans fats, like those in French fries and commercial baked goods, will lower the protective HDL levels.

Achieve and Maintain a Healthy Weight - Excess body fat, especially around the waist, will depress your HDL, and increase your risks for diabetes, heart attack and stroke. For every six pounds of excess weight you can shed, your HDL will rise 1 mg/dL.

Clean Up Your Act - Smoking tobacco will lower your HDL by 5 mg/dL; whereas kicking this lethal habit will quickly bounce your HDL back up to baseline. Drinking one alcoholic drink per day will raise your HDL by about 4 mg/dL. More alcohol will raise your HDL even more, but will increase your risk for other problems like cancer, stroke, and accidents.

Move Your Body - Exercise, especially aerobic exercise like walking, running, swimming and cycling, will raise the HDL level in a dose-dependent fashion-the more exercise you do, and the more intense the effort, the higher your HDL will rise. Ideally, we like to see people exercising aerobically 40 to 60 minutes daily, and doing strength training at least 20 to 30 minutes at least twice weekly.

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