First, a quick explainer: Cholesterol is a waxy substance that travels through your bloodstream, but not all of it is bad. HDL cholesterol (a.k.a. "good" cholesterol) actually sweeps away LDL cholesterol, or the "bad" kind. A high LDL level puts you at risk for heart attacks and strokes because it can clog arteries with plaque, a condition called atherosclerosis. A blood test can determine whether you have high cholesterol, and your doctor may recommend exercise or medication in addition to a healthier diet.
Salmon is rich in omega-3 fatty acids, which are healthy fats that can help reduce blood pressure. Eating salmon can improve your "good" HDL cholesterol, but it won't lower your "bad" LDL cholesterol. HDL cholesterol helps sweep cholesterol off your artery walls, preventing dangerous plaque from forming. The American Heart Association recommends eating fatty fish like salmon at least twice per week for heart-healthy benefits. Other fish that contain omega-3s, such as mackerel, tuna and sardines, can also help.
Trans fats are a byproduct of the chemical reaction that turns liquid vegetable oil into solid margarine or shortening and that prevents liquid vegetable oils from turning rancid. These fats have no nutritional value — and we know for certain they are bad for heart health. Trans fats increase LDL cholesterol and triglyceride levels while reducing levels of HDL cholesterol.
Unsaturated fats are considered the healthiest fats because they improve cholesterol, help reduce inflammation (a risk factor for heart disease), and help decrease the overall risk of developing heart disease. The main source of unsaturated fats is plant-based foods. These fats are usually liquid at room temperature. There are two types of unsaturated fat: monounsaturated and polyunsaturated.
Furthermore, in epidemiological studies involving over 100,000 individuals, people whose HDL cholesterol levels are below about 40 mg/dL had a substantially higher cardiac risk than those with higher HDL levels. This is the case even when LDL cholesterol ("bad" cholesterol) levels are low. Higher HDL levels have also been associated with a reduced risk of breast, colon and lung cancer.
Different foods lower cholesterol in various ways. Some deliver soluble fiber, which binds cholesterol and its precursors in the digestive system and drags them out of the body before they get into circulation. Some give you polyunsaturated fats, which directly lower LDL. And some contain plant sterols and stanols, which block the body from absorbing cholesterol.
While the world of wellness endlessly touts of benefits of anti-inflammatory foods, who knew eating these could kill two birds with one stone by also improving your cholesterol? Blueberries are rich in anthocyanins, the phytochemical that gives this berry its dark blue pigment and are essential to overall heart health through enhancing anti-inflammatory pathways as well as increasing HDL cholesterol levels, according to a study in The American Journal of Clinical Nutrition. One 2013 study found that consuming blueberries in tandem with exercise can increase HDL levels even more than exercise alone.
Total cholesterol is a measure of the total amount of cholesterol in your blood, which includes HDL, LDL and triglycerides. However, total cholesterol is mainly made up of LDL or “bad” cholesterol. Having high levels of low-density lipoprotein or LDL can lead to plaque buildup in your arteries, increasing your likelihood for heart disease and stroke. LDL also raises your risk for a condition called peripheral artery disease, which can develop when plaque buildup narrows an artery supplying blood to the legs. The good news is that the higher your HDL level, the lower your body’s LDL level or “bad” cholesterol.
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Fatty fish is not the only source of heart-healthy omega-3s! In fact, flaxseed is one of the richest sources of the anti-inflammatory fat. In animal models supplementation of flaxseed has shown to increase HDL levels which is why cardiologists and dietitians recommend it be incorporated into a balanced diet. Consumers beware though—in order for the gut to fully absorb the vitamins, minerals this seed provides, the ground version needs to be purchased.
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society
HDL particles are heterogeneous. They can be classified as a larger, less dense HDL2 or a smaller, denser HDL3.  Normally, most of the plasma HDL is found in HDL3.  To add to the complexity of HDL classification, HDL is composed of 4 apolipoproteins per particle. HDL may be composed of apo A-I and apo A-II or of apo A-I alone. HDL2 is usually made up only of apo A-I, while HDL3 contains a combination of apo A-I and apo A-II. HDL particles that are less dense than HDL2 are rich in apo E.
Obesity results not only in increased LDL cholesterol but also in reduced HDL cholesterol. If you are overweight, reducing your weight should increase your HDL levels. This is especially important if your excess weight is stored in your abdominal area; your waist-to-hip ratio is particularly important in determining whether you ought to concentrate on weight loss.
People on high-carb diets full of pasta, bread and sugar-even those who exercise frequently-tend to have lower HDL levels than those who eat plenty of protein and good fats along with veggies and whole grains. “Low HDL often results when people are told to get all the fat out of their diets and eat carbohydrates instead,” Willett says. A British study showed that people with high HDL levels tend to focus on slower-burning carbs, such as beans and fruit.
Pick Purple Produce – Did you know that eating purple-colored vegetables and fruits can potentially increase your HDL cholesterol? That’s because these specific foods contain antioxidants called anthocyanins, which have been shown to help fight inflammation and protect your cells from free radicals. When you can, fill up your plate with purple produce like eggplant, purple corn, red cabbage, blueberries, blackberries, and black raspberries.
To maintain a healthy body, you should exercise on a daily basis. If you want another specific reason to start exercising or increase your frequency of exercise, it’s your HDL levels. Increased physical activity directly helps raise your HDL cholesterol — just another one of the many benefits of exercise. Vigorous exercise is the best choice for boosting HDL, but any additional exercise is better than none. (2)
A 2014 study published in the journal PLoS One found that a diet rich in foods including fish, especially fatty fish, increased the size of HDL particles, which may help improve cholesterol transport throughout the body. The American Heart Association recommends eating fish at least twice a week, especially varieties that contain omega-3 fats, such as salmon, trout, and herring. A serving is considered 3.5 ounces cooked.
Trans fatty acids are likely present in many of your favorite prepared foods— anything in which the nutrition label reads "partially hydrogenated vegetable oils" — so eliminating them from the diet is not a trivial task. But trans fatty acids not only increase LDL cholesterol levels, but they also reduce HDL cholesterol levels. Removing them from your diet will almost certainly result in a measurable increase in HDL levels.
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Muscle pain, also called myopathy, occurs in 2% to 11% of people treated with statins, reported investigators at the University of Wisconsin Hospital and Clinics in Madison, and although the pain usually subsides once the statin is discontinued, it can take several months to do so. Like previous studies, the Wisconsin scientists also found that the negative side effects of statins increased as dosages increased.
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.
Population studies have shown that low levels of HDL cholesterol—less than 40 mg/dL for men and less than 50 mg/dL for women—increase the overall risk of coronary artery disease (CAD) and heart attacks. A person whose HDL level is lower than 35 mg/dL has eight times the risk of CAD as someone with an HDL level of 65 mg/dL. Experts have long thought that boosting HDL levels promotes heart health. But while low HDL is a strong and well-established risk factor for heart disease, the evidence for raising HDL remains uncertain. But experts agree that taking these heart healthy steps are still worthwhile.
Hayek T, Chajek-Shaul T, Walsh A, Agellon LB, Moulin P, Tall AR, Breslow JL. An interaction between the human cholesteryl ester transfer protein (CETP) and apolipoprotein A-I genes in transgenic mice results in a profound CETP-mediated depression of high density lipoprotein cholesterol levels. J Clin Invest. 1992 Aug;90(2):505–510. [PMC free article] [PubMed]
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.
While this belief is still thought to be almost always true, in recent years a fly has been found in the ointment. Drug companies have spent billions of dollars developing drugs that increase HDL cholesterol levels. However, to the dismay of all, these drugs have failed to reduce cardiac risk—despite the fact that they make HDL levels go up. Development of at least two of these drugs has now been halted. (More on this below.) So the HDL story is more complex than scientists originally had hoped.
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.
So far, these studies have been disappointing, to say the least. The first major trial (concluded in 2006) with the first CETP inhibitor drug, torcetrapib (from Pfizer), not only failed to show a reduction in risk when HDL was increased but actually showed an increase in cardiovascular risk. Another study with another CETP inhibitor - dalcetrapib (from Roche) - was halted in May 2012 for lack of effectiveness. Both of these related drugs significantly increased HDL levels, but doing so did not result in any clinical benefit.
While it has been proven via multiple studies that elevated levels of low-density lipoprotein (LDL) contribute to the development of atherosclerosis, high-density lipoprotein (HDL) is widely thought to have atheroprotective effects. Results from multiple epidemiologic studies of healthy populations (most importantly, from the Framingham Heart Study) have given rise to the idea that high HDL levels protect against coronary heart disease (CHD). Patients with known CHD have been found to have lower levels of HDL. [1, 2]
Weight Management. If you are overweight, losing weight can help lower your LDL (bad) cholesterol. This is especially important for people with metabolic syndrome. Metabolic syndrome is a group of risk factors that includes high triglyceride levels, low HDL (good) cholesterol levels, and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
3. Beans. Beans are especially rich in soluble fiber. They also take awhile for the body to digest, meaning you feel full for longer after a meal. That's one reason beans are a useful food for folks trying to lose weight. With so many choices — from navy and kidney beans to lentils, garbanzos, black-eyed peas, and beyond — and so many ways to prepare them, beans are a very versatile food.