One drawback of going on a low-fat diet for some people is that it lowers HDL levels. If raising your HDL cholesterol is a primary concern, you should replace carbohydrates in your diet with fats, preferably mono- and polyunsaturated fats. But avoid trans fat, which can lower HDL levels. These steps can lower both total cholesterol and LDL and maintain HDL or boost it slightly, improving the ratio of total cholesterol to HDL.
A study of over 1 million US veterans showed a U-shaped relationship between HDL and total mortality, with 50mg/dL as the level associated with the lowest mortality. [7, 2] In addition, an analysis of the Framingham study demonstrated that LDL and triglyceride levels modify HDL’s predictive value; CHD risk was found to be higher when low HDL was combined with high LDL and/or triglycerides as compared with the presence of low HDL levels alone. [8, 2]  The relationship between HDL and CHD risk is also confounded by the presence of pro-atherogenic and inflammatory markers. [2]
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.
HDL plays an important role in transporting cholesterol from the peripheral tissues to the liver, where it can be excreted; this process is known as reverse cholesterol transport (RCT). (The liver is the main organ for excretion of cholesterol, doing so either directly or by converting cholesterol into bile acids.) It is important to remember that most HDL measured in the blood is derived from the liver and intestine. Therefore, the concentration of HDL in plasma does not reflect cholesterol efflux from blood vessels or the efficiency of RCT. Moreover, HDL function in RCT is not mirrored by HDL measurements. [2]
That’s a ridiculous idea. It would go against every piece of dietary advice about cholesterol that the government and most doctors have pushed for the last 60 years. Fat is supposed to raise your cholesterol and give you a heart attack, not lower it. To lower your cholesterol, the American Heart Association says you’re supposed to cut out saturated fat and eat lots of whole grains, fruits, cereal, vegetable oils, and the leanest cuts of meat possible.
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.
Because increasing HDL levels is thought to be such a beneficial thing, and because there is no easy or reliable way to do so, developing drugs that substantially raise HDL levels has become a major goal for several pharmaceutical companies. And indeed, several of these drugs have been developed, and have led to clinical trials to demonstrate their safety and efficacy.
What is cholesterol ratio and why is it important? There are two types of cholesterol. One is harmful, and builds up in the arteries, but the other can actually benefit the body. In this MNT Knowledge Center article, learn about the difference between 'good' and 'bad' cholesterol. How do they affect the body? How can you manage high cholesterol? Read now
Catapano AL, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias: The task for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitaiton (EACPR). Atherosclerosis. 2016;253:281.
Eating walnuts regularly was linked with a reduced risk of heart disease, according to data from the Nurses' Health Study. Eating as little as one serving of these nuts each week can lower your chances of cardiovascular disease by up to 19%! Consider swapping walnuts for croutons in salads and soups; add ‘em to breakfast cereal or yogurt; or nosh on walnuts with fruit to reap the cholesterol-lowering benefits.

However, environmental factors also have a significant impact on HDL levels. Factors that elevate HDL concentrations include chronic alcoholism, treatment with oral estrogen replacement therapy, extensive aerobic exercise, and treatment with niacin, statins, or fibrates. [11, 12, 13] On the other hand, smoking reduces levels of HDL-C, while quitting smoking leads to a rise in the plasma HDL level.
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. 
A study published in February 2016 in the journal PLoS One concluded as much. For nearly 11,000 adults, researchers found that low to moderate alcohol consumption (20 or fewer drinks a week for a man, 10 or fewer for a woman) led to higher levels of HDL cholesterol. It also helped get them to healthier overall cholesterol levels, decreasing triglycerides (blood fats in blood) and lowering LDL cholesterol.
Because increasing HDL levels is thought to be such a beneficial thing, and because there is no easy or reliable way to do so, developing drugs that substantially raise HDL levels has become a major goal for several pharmaceutical companies. And indeed, several of these drugs have been developed, and have led to clinical trials to demonstrate their safety and efficacy.
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HDL plays an important role in transporting cholesterol from the peripheral tissues to the liver, where it can be excreted; this process is known as reverse cholesterol transport (RCT). (The liver is the main organ for excretion of cholesterol, doing so either directly or by converting cholesterol into bile acids.) It is important to remember that most HDL measured in the blood is derived from the liver and intestine. Therefore, the concentration of HDL in plasma does not reflect cholesterol efflux from blood vessels or the efficiency of RCT. Moreover, HDL function in RCT is not mirrored by HDL measurements. [2]
Dr. Pacold notes that exercise has a greater effect on raising HDL cholesterol, which protects you from heart disease, than on lowering the LDL cholesterol that puts you at risk. It's good to know that even if you don’t see the numbers changing right away, regular exercise strengthens your heart and protects you from heart disease. If you’re not a big fan of exercise and not in great shape to begin with, remember that all you need to do to start reaping the heart-healthy benefits of exercise is 30 minutes of walking at a moderate pace every day. If you have a heart condition, talk with your doctor first about how much exertion is right for you when you begin, and then work your way up to your fitness goals for heart health.
There's no magical food to keep your heart healthy, but there are a lot of foods that can help—including these foods that help lower your cholesterol. In addition to cutting back on foods that can raise total cholesterol and getting enough exercise, make sure to eat more of these foods that improve your cholesterol profile by raising "good" HDL and/or lowering "bad" LDL cholesterol. These foods include some old standbys, such as oatmeal and fruit, plus a few surprising foods that can help lower cholesterol to reduce your risk of heart attack and stroke.
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