Good Cholesterol/HDL – What About You Need To Know

HDL gets tested through blood sampling and is commonly determined within a complete lipid profile. Testing in adults requires fasting for 12 hours before sampling, whereas testing is possible without fasting in the youth without risk factors for heart disease. Without fasting, only total cholesterol and HDL are usable. In this scenario, if the total cholesterol is ≥200 mg/dL or HDL is below 40 mg/dL, the NCEP III guidelines indicate a follow-up lipoprotein profile is necessary for management based on LDL.[rx]

A lipid profile, and thus HDL-C, may be ordered for those with risk factors for heart disease, which includes:

• Smoking (cigarettes)
• Sedentary lifestyle
• Being overweight or obesity
• Poor diet
• Men over 45 years or women older than 55 years
• Hypertension (higher than 140/90)
• Positive immediate family history of premature heart disease (under 55 for men and under 65 for women)
• Pre-existing heart condition
• Diabetes or prediabetes

For the youth, the American Academy of Pediatrics recommends that children be tested once between ages 9 and 11 and repeated between the ages of 17 and 21. This screening is recommended for children under the age of 9 if the children’s parents test positive for high cholesterol. The NCEP ATP III guidelines also suggest using agents that will correct the HDL abnormality while also lowering LDL cholesterol, lowering LDL cholesterol being paramount.

Increasing HDL levels

While higher HDL levels are correlated with cardiovascular health, no medication used to increase HDL has been proven to improve health.^[rx] In other words, while high HDL levels might correlate with better cardiovascular health, specifically increasing one’s HDL might not increase cardiovascular health.^[rx] The remaining possibilities are that either good cardiovascular health causes high HDL levels, there is some third factor that causes both, or this is a coincidence with no causal link.

HDL lipoprotein particles that bear apolipoprotein C3 are associated with increased, rather than decreased, the risk for coronary heart disease.^[rx]

• Eat a healthy diet  – To raise your HDL level, you need to eat good fats instead of bad fats. This means limiting saturated fats, which include full-fat milk and cheese, high-fat meats like sausage and bacon, and foods made with butter, lard, and shortening. You should also avoid trans fats, which may be in some margarine, fried foods, and processed foods like baked goods. Instead, eat unsaturated fats, which are found in avocado, vegetable oils like olive oil, and nuts. Limit carbohydrates, especially sugar. Also try to eat more foods naturally high in fiber, such as oatmeal and beans.
• Stay at a healthy weight – You can boost your HDL level by losing weight, especially if you have lots of fat around your waist.
• Exercise – Getting regular exercise can raise your HDL level, as well as lower your LDL. You should try to do 30 minutes of moderate to vigorous aerobic exercise on most, if not all, days.
• Avoid cigarettes – Smoking and exposure to secondhand smoke can lower your HDL level. If you are a smoker, ask your health care provider for help in finding the best way for you to quit. You should also try to avoid secondhand smoke.
• Limit alcohol – Moderate alcohol may lower your HDL level, although more studies are needed to confirm that. What we do know is that too much alcohol can make you gain weight, and that lowers your HDL level.

Diet and exercise

Certain changes in diet and exercise may have a positive impact on raising HDL levels

• Decreased intake of simple carbohydrates.^{[rx][rx][rx][rx]}
• Aerobic exercise
• Weight loss
• Avocado consumption
• Magnesium supplements raise HDL-C.
• Addition of soluble fiber to diet
• Consumption of omega-3 fatty acids such as fish oil^[rx] or flax oil
• Consumption of pistachio nuts
• Increased intake of unsaturated fats
• Consumption of medium-chain triglycerides (MCTs).
• Removal of trans fatty acids from the diet

Most saturated fats increase HDL cholesterol to varying degrees but also raise total and LDL cholesterol.^[rx] A high-fat, adequate-protein, low-carbohydrate ketogenic diet may have similar response to taking niacin (vitamin B3) as described below (lowered LDL and increased HDL) through beta-hydroxybutyrate coupling the Niacin receptor 1.^[rx]

Some cholesterol medicines, including certain statins, can raise your HDL level, in addition to lowering your LDL level. Health care providers don’t usually prescribe medicines only to raise HDL. But if you have a low HDL and high LDL level, you might need medicine.

Recreational drugs

HDL levels can be increased by smoking cessation,^[rx] or mild to moderate alcohol intake.

Cannabis in unadjusted analyses, past and current cannabis use was not associated with higher HDL-C levels.^[rx] A study performed in 4635 patients demonstrated no effect on the HDL-C levels (P=0.78) [the mean (standard error) HDL-C values in control subjects (never used), past users and current users were 53.4 (0.4), 53.9 (0.6) and 53.9 (0.7) mg/dL, respectively].^[rx]

Pharmaceutical drugs and niacin

Pharmacological therapy to increase the level of HDL cholesterol includes use of fibrates and niacin. Fibrates have not been proven to have an effect on overall deaths from all causes, despite their effects on lipids.^[rx]

Niacin (vitamin B3) increases HDL by selectively inhibiting hepatic diacylglycerol acyltransferase 2, reducing triglyceride synthesis and VLDL secretion through a receptor HM74^[rx] otherwise known as niacin receptor 2 and HM74A / GPR109A,^[rx] niacin receptor 1.

Understanding the amounts of cholesterol and fats found in foods

Here are some examples of foods and approximately how much cholesterol and fats you can find in each: