How do I raise my HDL cholesterol?

How do I raise my HDL cholesterol?

This question comes up fairly frequently as lab tests are reviewed with my patients. One is occasionally heard to say, “The only constant is change.”  When I started into practice, a total cholesterol of 280 mg/dl or less was considered “normal” by most labs.  Before long, the upper limits of “normal” were dropped to 240 mg/dl and more recently to 200.  Most individuals learned that it is desirable to have their lipids in a lower range to reduce their cardiovascular risks.  High Density Lipoprotein (HDL) is the exception.  One’s HDL is a scavenger molecule that acts somewhat like a garbage man and returns peripheral cholesterol deposits back to the liver for processing and disposal.  The higher one’s HDL cholesterol, the lower one’s cardiovascular risks.

I will use a simple acronym to highlight the main points of this blog:

H– stands for heredity.  The standard used to consider any value above 35 mg/dl is “normal”; however, more recent guidelines suggest men < 40 mg/dl and women < 50 mg/dl are at increased risk.  “Desirable” range would be >60 mg/dl for everyone.  The most important determinant for most of our HDL levels are genetic factors. Chances are, if one has a nice high HDL level at baseline, one can ask around and find a parent to thank for it, and if one is lower than desired, the same is often true.  That leaves folks with a low HDL looking to the next two categories at the present time for improvement.

D– stands for drugs.  There are many medications which can effectively lower one’s LDL (bad cholesterol) and triglycerides but a limited number of medications that can significantly raise one’s HDL.  Time-honored meds include niacin, but side effects limit its tolerance by many individuals. Fibrates which are commonly used for significant triglyceride elevations can raise one’s HDL a few points.  Even statins can sometimes raise someone’s HDL, but their main effect is to lower one’s LDL.  Using medications to lower LDL has been proven to reduce cardiovascular events, but it is less clear whether using meds to raise HDL are as effective as the lifestyle modifications listed below.

L – stands for lifestyle.  A prudent low-fat diet is often helpful in raising one’s HDL; stopping tobacco use, getting regular exercise, and losing extra weight can all make an impact.  Studies suggest avoiding trans-fats and using extra virgin olive and coconut oils can help in the effort.

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