Your first step is to know your cholesterol levels. You'll need to know three numbers about the cholesterol in your blood so you can discuss them with your doctor and get to a goal that protects your heart health. First, you want to know your total cholesterol number; for most people that should be below 200 milligrams per deciliter (mg/dL). Second, you want to know your LDL (bad) cholesterol number, and you want it to be below 100 mg/dL. Last, you want your HDL (good) cholesterol to be 60 mg/dL or higher, according to the CDC. Even if you have good numbers, you can make heart-healthy choices to prevent high cholesterol in the future.
However, although low levels of HDL predict increased cardiovascular risk, particularly in healthy individuals with no history of cardiovascular events, the relationship between HDL and CHD risk is complex, with HDL-C and cardiovascular disease having a nonlinear relationship. For example, research found that HDL levels above approximately 60 mg/dL showed no further improvement in prognosis, and the EPIC (European Prospective Investigation into Cancer and Nutrition)-Norfolk and IDEAL (Incremental Decrease in End Points through Aggressive Lipid Lowering) studies showed that very high levels of HDL may actually be associated with an increased risk of atherosclerotic disease. [5, 6, 2]
But keep in mind that not all cholesterol is created equally. LDL cholesterol, also known as “bad cholesterol,” is the form that can build up on the artery walls and increase your risk of heart disease. HDL cholesterol, on the other hand, is often dubbed “good cholesterol” because it travels through the bloodstream, removing harmful cholesterol from the arteries to help enhance heart health.
Large doses of vitamin B3, or niacin, have been found to raise HDL as much as 20 percent and are often prescribed for people with cholesterol problems. But keep in mind that a daily multivitamin contains all the niacin most people need. Supplementing beyond that can have a variety of side effects, including facial flushing, heartburn and even liver damage, so don’t try it without consulting a doctor.
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Though the age-old myth stating eggs are bad for our blood cholesterol has been debunked, one thing for certain is that reducing total saturated fats in the diet leads to an improved cholesterol profile. What does this mean in terms of animal protein? The American Heart Association recommends consuming less red meat overall and choosing leaner cuts to lower bad cholesterol and increase good cholesterol. Chicken is a versatile choice that doesn’t have to be boring or dry. Check out our 35 healthy ways to prepare this bird!
The most important mechanism by which HDL exerts its antiatherogenic role is the removal of excess cholesterol from peripheral cells and its transport to the liver, a process commonly termed the reverse cholesterol transport system (RCT). Several proteins are involved in this process, including ATP-binding cassette transporter 1, LCAT, CETP, and hepatic triglyceride lipase (see Pathophysiology). [25]
While cholesterol is normally kept in balance, an unhealthy diet high in hydrogenated fats and refined carbohydrates can disrupt this delicate balance, leading to increased cholesterol levels. This imbalance is manifested in elevated LDL (bad cholesterol) and low HDL (good cholesterol), which increases the risk of heart attack or stroke. Other causes can include physical inactivity, diabetes, stress and hypothyroidism.
Barley contains a powerful type of soluble fiber that helps keep cholesterol levels in check by effectively lowering total and LDL cholesterol without affecting HDL. This beta-glucan fiber works by preventing the body's absorption of cholesterol from food. Look for minimally processed pearled barley, the variety most commonly found in supermarkets.
According to the Mayo Clinic, ideal HDL levels for both men and women are 60 milligrams of cholesterol per deciliter of blood. If a man’s HDL level is below 40 milligrams of cholesterol per deciliter of blood or a woman’s HDL level is below 50 milligrams of cholesterol per deciliter of blood, then disease risk, specifically heart disease, is considered to be heightened. Even if your HDL level is above the at-risk number (but below the desirable number), you still want to work on increasing your HDL level so you can decrease your heart disease risk. (9)
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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.
Fatty Fish Are Your Friends – Omega-3 fats present in fatty fish like salmon, sardines, mackerel, and anchovies give your heart major benefits, including a reduction in inflammation and increased functioning of the vital cells that line your arteries. Eating fatty fish or taking fish oil can also help increase your HDL cholesterol levels, so choose to dine on fish frequently to keep your heart healthy and happy!
There are tons of natural remedies out there for how to lower cholesterol levels, often promising quick results with next to no effort required on your part. But while it’s true that there are tons of options to keep cholesterol levels in check, it can actually be as simple as swapping out a few foods in your diet for healthier options, switching up your workout routine or adding a supplement or two into the mix.
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
Avoid Artificial Trans Fats – We all know how delicious fast food, soda, and cookies are, but they present our bodies with so many negative health effects, including bloating, weight gain, lower HDL cholesterol levels, and higher instances of inflammation. Protect your heart health and your HDL cholesterol by avoiding artificial trans fats as much as possible. Indulging once in a while is okay; just make sure that it remains infrequent and in reasonable portions (enjoy ½ cup of your favorite ice cream – not ½ of the carton, for example).
In randomly screened children aged 6-19 years who had age-, race-, and sex-specific total plasma cholesterol levels greater than or equal to 95th percentile levels, 7.8% of white males, 12.8% of white females, 25% of black males, and 17.2% of black females had hypercholesterolemia due to elevated high-density lipoprotein [HDL] cholesterol levels (but not due to elevated low-density lipoprotein [LDL] cholesterol levels) greater than age-, sex-, and race-specific 95th percentile levels. That is, they had HALP.

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.

But keep in mind that not all cholesterol is created equally. LDL cholesterol, also known as “bad cholesterol,” is the form that can build up on the artery walls and increase your risk of heart disease. HDL cholesterol, on the other hand, is often dubbed “good cholesterol” because it travels through the bloodstream, removing harmful cholesterol from the arteries to help enhance heart health.
Eating seafood twice per week is a surefire way to reduce your risk of cardiovascular disease. Fatty fish like salmon yields some of the greatest anti-inflammatory and heart-healthy benefits, as a Journal of Nutrition study found salmon protein to significantly increase the proportion of HDL cholesterol. One tip: fish should be purchased wild and sustainably caught. For a consumer guide on how to make informed choices you can check out the consumer guides provided by the Monterey Bay Aquarium Seafood Watch.
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. [18] ) 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]

HDL is actually more complex than we once thought. Rather than being a single kind of particle, HDL is is now considered a family of different particles. All HDL contains lipids (fats), cholesterol and proteins (called apolipoproteins), but some types of HDL are spherical while others are shaped like a doughnut. Some HDL types remove bad cholesterol from the blood while other types are indifferent to cholesterol. Or even worse, some HDL transfers cholesterol the wrong way (into LDL and cells) or protects LDL in a way that makes it more harmful to the arteries.
Flavor foods with herbs and spices whenever you can. It’ll help you cut back on condiments high in saturated fat while maximizing flavor. Spices and herbs also pack antioxidants, which can help improve cholesterol levels when combined with veggies. Ones we love: Basil, cilantro, rosemary, sage, ginger, garlic, tarragon, black and red chili pepper, mint, and oregano.

Flavor foods with herbs and spices whenever you can. It’ll help you cut back on condiments high in saturated fat while maximizing flavor. Spices and herbs also pack antioxidants, which can help improve cholesterol levels when combined with veggies. Ones we love: Basil, cilantro, rosemary, sage, ginger, garlic, tarragon, black and red chili pepper, mint, and oregano.
About 80 percent of calories in nuts come from fat, but it's healthy unsaturated fat, not the artery-clogging kind. Nuts also are high in plant sterols, substances that block the absorption of cholesterol. Given these advantages, nuts are a natural for a heart-healthy diet. About an ounce and a half to two ounces a day should do it. Walnuts, almonds, hazelnuts, pecans and pistachios all confer benefits. So do peanuts, although they're technically a legume and not a nut. 

Are you pouring up a glass of OJ in the morning? Is your daily caffeine fix a fountain coke at the local gas station? What about that fruity cocktail tempting you at happy hour? Eliminating sweetened beverages from the daily routine is one of the easiest ways to cut thousands of calories or more per week, but will also put years on your life. Water is the best form of hydration and can be flavored with citrus, tropical fruits, and herbs to create a refreshing spa-like oasis that will increase HDL levels when it replaces your typical sugar-sweetened beverages.
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