HDL cholesterol is “good” because elevated blood levels have been associated with a lower risk of cardiovascular disease. However, clinical trials with experimental medications aimed at increasing HDL cholesterol levels, so far, have been largely disappointing. HDL researchers have gone back to the drawing board to figure out what it is about HDL that may reduce the risk of heart disease.
Extra pounds increase your odds of having high LDL cholesterol levels and can lead to the development of heart disease, so you shouldn’t wait to lose weight. But you don’t need to lose a lot to improve your cholesterol levels. According to Healthline, any weight loss can increase your HDL cholesterol, while decreasing LDL levels. No matter how much you want to lose, start by making small changes. Reach out to a friend when you’re upset instead of reaching for Ben & Jerry’s. Munch on fresh fruit or vegetables instead of chips or cookies. And park at the farthest spot in the parking lot to sneak in a bit more activity. All of these little changes can add up to big results.
Ask for tomato sauce with your pasta if you want to keep your cholesterol under control. Tomatoes are a significant source of a plant compound called lycopene, which reduces levels of LDL cholesterol. Research shows that the body absorbs more lycopene if the tomatoes are processed or cooked, so drink tomato juice and add tomatoes to your minestrone soup as well.
HDL is more tightly controlled by genetic factors than are the other lipoproteins (ie, LDL, very–low-density lipoprotein (VLDL), intermediate-density lipoprotein [IDL], chylomicrons). For example, in certain families, especially some families with Japanese ancestry, a genetic deficiency of cholesteryl ester transfer protein (CETP) is associated with strikingly elevated HDL-C levels. 
HDL’s unpredictable actions are one of the reasons why lowering LDL cholesterol often gets more focus as primary defense against heart disease and stroke. However, the medical world, both conventional and holistic, still agrees that raising low HDL is a very smart health move because low HDL cholesterol can be more dangerous than high LDL cholesterol. (8)
An under-valued element of bone and cardiovascular health is the role of Vitamin K2, which many individuals are unknowingly deficient in. Found in the Japanese breakfast delicacy “natto” (fermented soybeans), vitamin K2 not only helps remove calcium from the arteries and soft tissues to prevent atherosclerosis, but it also draws calcium into the bones to prevent the risk of fracture. Nattokinase, an enzyme found in natto, may help to increase HDL levels while lowering total cholesterol and LDL cholesterol levels, according to an Asia Pacific Journal of Clinical Nutrition study.
Niacin can be taken at lower doses rather than prescription levels, but supplementation can cause unwanted niacin side effects, especially when taking at high dosages. Some negative results of taking niacin include experience flushing, an uncomfortable feeling of heat, itching or tingling in the skin. Other side effects can include gastrointestinal, muscle and liver problems.
DAVID MONTGOMERY: The ways to reduce your bad cholesterol have a lot to do with your lifestyle. So your diet is really important. And although this kind of sounds trite, really one of the best and most effective ways to reduce cholesterol is by having a low fat diet, particularly saturated fat. We find saturated fat in eggs, dairy, and red meat. If you're able to reduce those, you reduce your bad fat, which reduces your bad cholesterol. Another really effective way that I use with my patients all the time to reduce your cholesterol is regular exercise. If you're doing aerobic type exercises, most days a week, four days a week, 30 minutes at a time, then you're doing your body the best amount of good, not just from lowering your cholesterol standpoint, but from so many different ways. There are other ways that we can reduce the fat. It may have to do with supplementations or medications. In some people, they are born with genetic conditions that predispose them to have very, very high cholesterol. And as a result of that, they have different problems like heart attacks or strokes. In those people, they really do benefit from cholesterol lowering drugs. But there are other things that you can get from over-the-counter, like omega fatty acids, omega-3 fatty acids in particular. They come in krill oil or fish oil. We've all heard of these before. And those help reduce parts of your cholesterol.
Sugar and spice and everything nice… except for the fact that recent data has shown that added sugar is not so nice for our cardiovascular health or waistlines. In fact, a study published in Circulation found that people with the highest consumption of added sugars show significantly lower HDL levels. To cut back on your added sugar intake and increase HDL levels, consider replacing sugar with dates when you’re making baked goods like homemade granola bars, cookies, and cakes. It’s one way to slice total added sugars in half and will also give your sweet treat extra fiber, vitamins, and minerals.
Avocados are an excellent source of monounsaturated fatty acids, which boost HDL and lower LDL. In a 2015 study published in the Journal of the American Heart Association, eating one avocado a day while following a moderate-fat diet was associated with a 13.5 mg/dL drop in bad cholesterol, or LDL, levels. Several other blood measurements were also improved in the participants who consumed an avocado a day, including total cholesterol, triglycerides, small dense LDL, non-HDL cholesterol, and others.
Take fish oil. Fish oil contains an abundance of essential omega-3 fatty acids (omega-3s) that have been shown to lower triglyceride (blood fat) levels, minimize inflammation and clotting, and increase HDL (“good”) cholesterol. Research indicates that omega-3s may help reduce the risk and symptoms of a variety of disorders influenced by inflammation, including heart attack and stroke. You can add omega-3s to your diet by eating more cold water fish such as wild Alaskan salmon, sardines, herring, mackerel and black cod. If that’s not possible, Dr. Weil recommends taking two grams daily of a fish oil supplement that contains both essential omega-3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). When choosing a supplement, look for one derived from molecularly distilled fish oils – these are naturally high in both EPA and DHA and low in contaminants. Also choose a supplement brand that has been independently tested and guaranteed to be free of heavy metals such as mercury and lead, and other environmental toxins including polychlorinated biphenyls, also known as PCBs.
A meta-analysis looked at randomized controlled trials for artichoke extract for high cholesterol. They found three studies worth analyzing and two showed some effect in lowering total cholesterol. Adverse events were mild, transient, and infrequent. The study said that larger clinical trials over longer periods are needed. The conclusion was that the evidence was not convincing, and the Cochrane Review discontinued updating its analysis of this research as of 2016.
There is some research suggesting that artichoke leaf extract (Cynara scolymnus) may help to lower cholesterol. Artichoke leaf extract may work by limiting the synthesis of cholesterol in the body. Artichokes also contain a compound called cynarine, believed to increase bile production in the liver and speed the flow of bile from the gallbladder, both of which may increase cholesterol excretion.
Ground-breaking research published in the Journal of the American Medical Association (JAMA) studied nearly 9,000 European patients. All had previously suffered heart attacks. The trial found that those who reduced their LDL levels to an average 81 with high-dose statins significantly reduced their risk of major coronary events like heart attacks and strokes at the 4.8 year follow-up compared to patients who reduced their LDL to 104 on usual-dose statin therapy.
Swap extra-virgin olive oil for all your other oils and fats when cooking at low temperatures, since extra-virgin olive oil breaks down at high temperatures. Use the oil in salad dressings, sauces, and to flavor foods once they’re cooked. Sprinkle chopped olives on salads or add them to soups, like in this Sicilian fish soup. Just be sure to use extra-virgin olive oil in moderation, since it’s high in calories.
HDL levels below 40 mg/dL are associated with an increased risk of CAD, even in people whose total cholesterol and LDL cholesterol levels are normal. HDL levels between 40 and 60 mg/dL are considered "normal," and do not very much affect the risk of CAD one way or the other. However, HDL levels greater than 60 mg/dL are actually associated with a reduced risk of heart disease.
I just moved and had to go to a new doctor. At my first annual exam and lipid panel, she called me back for a consult because she wanted to put me on a statin due to “high” ldl cholestoral levels. I am female, 54, height 5’4” and weigh 130 lbs. My ldl was 123 – my triglycerides were 58. My hdl was 68. I had basically the same lipid panel 2 years ago at my last annual exam (before moving) and my doc there was not concerned other than suggesting I start a CoQ10 and Omega 3 regimen. I don’t smoke, I exercise at least 45 minutes a day (running, cycling, golf, walking, etc.) – my major weakness is sweets. Plus no heart disease in immediate family (both parents still alive at 79 & 80 – no history of stroke, etc.)
Black beans, kidney beans, lentils, oh my! All are rich in soluble fiber, which binds to cholesterol in the blood and moves it out of the body. Recent studies show eating 4.5 ounces of beans a day can reduce LDL levels by 5 percent. Try black bean burritos, or dip some veggies in hummus, which is made with chickpeas, for an afternoon snack. Or try this Caramelized Onion and White Bean Flatbread -- beans are so versatile, the possibilities are endless.
HDL serves as a chemical shuttle that transports excess cholesterol from peripheral tissues to the liver. This pathway is called the RCT system. In this system, plasma HDL takes up cholesterol from the peripheral tissues, such as fibroblasts and macrophages. (A study by El Khoury et al indicated that in persons with HALP, macrophages have an increased plasma cholesterol efflux capacity.  ) This may occur by passive diffusion or may be mediated by the adenosine triphosphate (ATP)–binding cassette transporter 1. The latter interacts directly with free apo A-I, generating nascent, or so-called discoidal, HDL. Cholesterol undergoes esterification by lecithin-cholesterol acyltransferase (LCAT) to produce cholesteryl ester, which results in the production of the mature spherical HDL. Cholesterol is also taken up from triglyceride-rich lipoproteins in a process mediated by a phospholipid transfer protein (ie, CETP). [19, 20, 21, 22]
Treatment of high cholesterol usually begins with lifestyle changes geared toward bringing levels down. These include losing weight if you’re overweight, and changing your diet to emphasize vegetables and fruits, fish, particularly cold water fish such as wild Alaskan salmon, mackerel, herring and black cod that provide heart healthy omega-3 fatty acids. If lifestyle changes don’t help or if you’re unable to make the changes your doctor recommends, cholesterol-lowering drugs may be prescribed. These include statins, which effectively lower LDL cholesterol; bile acid sequestrants that may be prescribed along with statins to lower LDL; nicotinic acid to lower LDL cholesterol and triglycerides and raise HDL; drugs called fibrates that may be prescribed to lower cholesterol and may raise HDL; and a drug called Ezetimibe to lower LDL by blocking the absorption of cholesterol in the intestine.
Once you know your cholesterol levels, it’s time to discuss a plan with your doctor. Although changing your lifestyle to include a heart-healthy diet and plenty of exercise is usually the first step to lower cholesterol, some types of cholesterol problems like familial hypercholesterolemia may require medication right away. Work with your doctor to come up with the best cholesterol goals for you and the best ways to get there.
Starting a simple exercise routine is another way to help lower your elevated LDL cholesterol level. And if you compound working out with the dietary tips listed above, you could potentially lower your LDL level by over 37 percent and increase your HDL cholesterol by over 5 percent in just two months. Not to mention the added benefits of losing weight, decreased stress, and higher energy, exercising is an all-around great activity to incorporate into your life. Aim for 30 minutes of physical activity, four to five times each week, and you’ll be well on your way.
The small HDL particles consist of the lipoprotein ApoA-1, without much cholesterol. Thus, the small HDL particles can be thought of as “empty” lipoproteins, that are on their way to scavenge excess cholesterol from the tissues. In contrast, the large HDL particles contain a lot of cholesterol. These particles have already done their scavenging work, and are just waiting to be taken back up by the liver.