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
A: Before I answer that question, why bother to increase HDL cholesterol at all? Many studies have found that people with low levels of HDL are at increased risk for heart attacks, strokes, and other complications of arteries diseased by atherosclerosis: that's why we call HDL the "good" cholesterol. Given that, you'd think that raising HDL levels would reduce a person's risk for atherosclerosis. Unfortunately, despite a lot of research, we don't yet know if that's true, nor how best to raise HDL levels.

The lipid profile blood test reports the levels of cholesterol and triglycerides in the bloodstream. Healthcare organizations have established a set range for total, bad LDL and good HDL cholesterol as well as triglycerides, but the most important thing to consider when looking for how to lower cholesterol naturally is the ratio of LDL to HDL cholesterol, which should be around 2:1. (1, 2)
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.
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.
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.
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)
Trans fats increase your LDL cholesterol, reduce your HDL levels and raise your risk of developing heart disease, stroke, diabetes and other chronic conditions. Trans fats lurk in fried foods, stick margarine, cookies, crackers, cakes, pie crusts and frozen pizza. Today, some food manufacturers are removing them from their products, but the only way to tell if a product is trans fat-free is to read labels while you’re shopping. Avoid products that list “partially hydrogenated oil” in the ingredients, since this is just a sneaky name for trans fats.
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. 
Research has shown the health benefits of eating seafood rich in omega-3 fatty acids, especially when it replaces less healthy proteins that are high in saturated fat and low in unsaturated fat. Including seafood high in omega-3 fatty acids as part of a heart-healthy diet can help reduce the risk of heart failure, coronary heart disease, cardiac arrest and the most common type of stroke (ischemic).
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]
In a Canadian study, drinking a few glasses of orange juice every day for four weeks increased participants’ HDL by 21 percent, possibly due to a flavonoid called hesperidin that appears extremely HDL-friendly. Subsequent research found that tangerine juice may be even more effective. Unfortunately, that much juice will add hundreds of excess sugar calories to your diet. So stick to a glass a day and be satisfied with lesser results. Or you can buy hesperidin as a supplement, though it won’t replace the many beneficial nutrients of orange juice (and certainly won’t taste as good).
Foods naturally rich in soluble fiber have proven particularly good at lowering cholesterol. Excellent sources include oats, oat bran, barley, peas, yams, sweet potatoes and other potatoes, as well as legumes or beans, such as pinto beans, black beans, garbanzo beans, and peas. Vegetables rich in soluble fiber include carrots, Brussels sprouts, beets, okra, and eggplant. Good fruit sources are berries, passion fruit, oranges, pears, apricots, nectarines, and apples.

Green, leafy vegetables, esp. kale, collards, swiss chard are a few vegetables which help. Fiber in apples (pectin) may reduce LDL levels. It is VERY important to eliminate all forms of sugar for a few weeks, reintroduce (ONLY one for a month or so) a slightly sweet food, and switch different types of sweet foods to see which sweet food is more tolerable.
Many people don't like to hear it, but regular aerobic exercise (any exercise, such as walking, jogging or bike riding, that raises your heart rate for 20 to 30 minutes at a time) may be the most effective way to increase HDL levels. Recent evidence suggests that the duration of exercise, rather than the intensity, is the more important factor in raising HDL cholesterol. But any aerobic exercise helps.
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.

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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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