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]
How much do you know about your cholesterol? You probably know that there are two different kinds – high-density lipoprotein (HDL), which is the “good” cholesterol, and low-density lipoprotein (LDL), also known as the “bad” cholesterol. High HDL levels help carry cholesterol from your arteries to your liver and also possess antioxidants and anti-inflammatory properties, which are linked to a reduced risk of heart disease.
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.
Perhaps most disappointing of all, a new class of drugs (the so-called CETP-inhibitors), which several pharmaceutical companies have been enthusiastically developing for several years to raise HDL levels, has become a great disappointment. While these drugs do indeed increase HDL levels, they have not demonstrated an ability to improve cardiac risk — and on the contrary, studies appear to show a worsening in cardiac risk with some of these drugs. It is unclear today whether any CETP-inhibitors will ever reach the market.
Oatmeal is one of the best cholesterol-fighting foods because it is so high in beta-glucans, the soluble fibers that cause oats to bulk up in liquid when you make oatmeal. Soluble fiber lowers your LDL, or "bad," cholesterol by forming a sticky layer in the small intestine that blocks cholesterol from entering your bloodstream. Make oatmeal and skip the instant packs with lots of added sugar. (In a rush? See our picks for best instant oatmeals.) Add fruit to your oatmeal to naturally sweeten it and boost the soluble fiber content even more.
Barley, oatmeal and brown rice have lots of soluble fiber, which has been proven to lower LDL cholesterol by reducing the absorption of cholesterol into your bloodstream. Try switching out your regular pasta for the whole-grain version, or use brown rice instead of white. To give an added cholesterol-busting kick, top your morning oatmeal with high-fiber fruit like bananas or apples.
Get Moving – Want healthy HDL levels? It’s time to lace up those sneakers and start exercising! Being physically active is essential for a healthy heart. Many types of exercise will help raise your HDL cholesterol, including high-intensity exercise, aerobic exercise, and strength training. Shoot to exercise most days out of the week for at least 30 minutes each session to experience the benefits.
Black beans, kidney beans, lentils, oh my! All are rich in soluble fiber, which binds to cholesterol in the blood and moves it out of the body. Recent studies show eating 4.5 ounces of beans a day can reduce LDL levels by 5 percent. Try black bean burritos, or dip some veggies in hummus, which is made with chickpeas, for an afternoon snack. Or try this Caramelized Onion and White Bean Flatbread -- beans are so versatile, the possibilities are endless.
Fatty fish is not the only source of heart-healthy omega-3s! In fact, flaxseed is one of the richest sources of the anti-inflammatory fat. In animal models supplementation of flaxseed has shown to increase HDL levels which is why cardiologists and dietitians recommend it be incorporated into a balanced diet. Consumers beware though—in order for the gut to fully absorb the vitamins, minerals this seed provides, the ground version needs to be purchased.
Try to eat it two to four times a week. “Not only are the omega-3 fats in fish heart-healthy, but replacing red meat with fish will lower your cholesterol by reducing your exposure to saturated fats, which are abundant in red meat,” Samaan says. The catch? Some types, like shark, swordfish, and king mackerel, are high in mercury. That can increase your risk for heart disease. Instead, choose wild salmon, sardines, and bluefin tuna.
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.
Fatty fish is not the only source of heart-healthy omega-3s! In fact, flaxseed is one of the richest sources of the anti-inflammatory fat. In animal models supplementation of flaxseed has shown to increase HDL levels which is why cardiologists and dietitians recommend it be incorporated into a balanced diet. Consumers beware though—in order for the gut to fully absorb the vitamins, minerals this seed provides, the ground version needs to be purchased.
Starting a simple exercise routine is another way to help lower your elevated LDL cholesterol level. And if you compound working out with the dietary tips listed above, you could potentially lower your LDL level by over 37 percent and increase your HDL cholesterol by over 5 percent in just two months. Not to mention the added benefits of losing weight, decreased stress, and higher energy, exercising is an all-around great activity to incorporate into your life. Aim for 30 minutes of physical activity, four to five times each week, and you’ll be well on your way.

What is the difference between HDL and LDL cholesterol? The body needs cholesterol, but too much bad cholesterol can be harmful and is a major risk factor for heart disease and stroke. In this article, learn about the difference between HDL and LDL — “good” and “bad” — cholesterol, as well as how they are measured. What steps can you take to lower LDL and increase HDL? Read now


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.
Stick to a Low-Carb Diet – Also known as a ketogenic diet, a low-carb diet can lead to several health benefits, including weight loss, reduced blood sugar levels, and, of course, an increase in your HDL cholesterol. This is great for those who suffer from diabetes, metabolic syndrome, or obesity, but in truth, anyone can benefit from this type of diet!
Swap extra-virgin olive oil for all your other oils and fats when cooking at low temperatures, since extra-virgin olive oil breaks down at high temperatures. Use the oil in salad dressings, sauces, and to flavor foods once they’re cooked. Sprinkle chopped olives on salads or add them to soups, like in this Sicilian fish soup. Just be sure to use extra-virgin olive oil in moderation, since it’s high in calories.
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
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