Do you dread opening up the white envelope of lab results after your annual physical only to discover a jumble of numbers, red ink, and arrows pointing every possible direction? Lipid or cholesterol panel results can be confusing to comprehend, and when numbers come back “out of range” it can only further fuel feelings of discouragement and helplessness.
Ground-breaking research published in the Journal of the American Medical Association (JAMA) studied nearly 9,000 European patients. All had previously suffered heart attacks. The trial found that those who reduced their LDL levels to an average 81 with high-dose statins significantly reduced their risk of major coronary events like heart attacks and strokes at the 4.8 year follow-up compared to patients who reduced their LDL to 104 on usual-dose statin therapy.
Avoid trans-fatty acids. These heart-damaging fats can reduce HDL (“good”) cholesterol levels and raise levels of LDL (“bad”) cholesterol. The tip-off that trans-fatty acids are present in foods is the listing of “partially hydrogenated oil” on a food’s ingredient list. Trans-fats are found in many brands of margarine and in most heavily processed foods, as well as in snack foods such as chips, crackers and cookies, and in the oils used to cook fast-food French fries, doughnuts and movie popcorn.
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. 
Where HDL is concerned, “you can’t be too thin,” Castelli says. One report found about a 1 percent rise in HDL for every pound of fat lost. This doesn’t mean you have to turn yourself into a toothpick, but that you should work on getting rid of excess flab as you add muscle. (Use a body-fat monitor rather than a scale to chart your progress.) Fortunately, fat loss is likely to go hand in hand with the exercise and dietary modifications that also raise HDL levels.
Muscle pain, also called myopathy, occurs in 2% to 11% of people treated with statins, reported investigators at the University of Wisconsin Hospital and Clinics in Madison, and although the pain usually subsides once the statin is discontinued, it can take several months to do so. Like previous studies, the Wisconsin scientists also found that the negative side effects of statins increased as dosages increased.
The small HDL particles consist of the lipoprotein ApoA-1, without much cholesterol. Thus, the small HDL particles can be thought of as “empty” lipoproteins, that are on their way to scavenge excess cholesterol from the tissues. In contrast, the large HDL particles contain a lot of cholesterol. These particles have already done their scavenging work, and are just waiting to be taken back up by the liver.
LDL stands for Low-Density Lipoproteins. This type of cholesterol is produced by the liver and is instrumental in the creation of cell walls, hormones, and digestive juices. However, when your LDL level is high, it can start to form a plaque-like substance on the walls of your cardiovascular system, blocking the natural flow of blood and leaving you at severe risk for heart attack and stroke. Put simply, LDL is the bad kind of cholesterol. But fear not – there are several ways in which you can lower your LDL cholesterol and encourage the development of High-Density Lipoproteins (good cholesterol), which actually function to limit the level of LDL cholesterol in your system.
People on high-carb diets full of pasta, bread and sugar-even those who exercise frequently-tend to have lower HDL levels than those who eat plenty of protein and good fats along with veggies and whole grains. “Low HDL often results when people are told to get all the fat out of their diets and eat carbohydrates instead,” Willett says. A British study showed that people with high HDL levels tend to focus on slower-burning carbs, such as beans and fruit.
While diet and exercise should be your two main options for fighting off LDL cholesterol, you can also look into the various dietary supplements that are on the market today. Consider omega-3 fish oils, artichoke extract, and green tea extract. Keep in mind that these natural products have not been fully proven to reduce your level of LDL cholesterol, but they may be able to help along the way.
Although this breakfast choice may not satisfy your kid (or your kid-at-heart), high fiber cereals are an easy way to improve your cholesterol profile. An American Journal of Clinical Nutrition study found that high fiber oat cereals lower LDL particle number without decreasing HDL concentrations, thus improving your ratio and giving HDL levels a percentage increase. Look for a product with a minimal amount of sugar and at least 5 grams of fiber per serving. A great oat-based choice is Barbara’s Morning Oat Crunch, which has 5 grams of fiber and 6 grams of protein per cup.
HDL’s unpredictable actions are one of the reasons why lowering LDL cholesterol often gets more focus as primary defense against heart disease and stroke. However, the medical world, both conventional and holistic, still agrees that raising low HDL is a very smart health move because low HDL cholesterol can be more dangerous than high LDL cholesterol. (8)
A meta-analysis looked at randomized controlled trials for artichoke extract for high cholesterol. They found three studies worth analyzing and two showed some effect in lowering total cholesterol. Adverse events were mild, transient, and infrequent. The study said that larger clinical trials over longer periods are needed. The conclusion was that the evidence was not convincing, and the Cochrane Review discontinued updating its analysis of this research as of 2016.
There are two types of dietary fiber: soluble (viscous) and insoluble. To receive the greatest health benefit, eat a wide variety of all high-fiber foods. Refined foods, like white bread, white pasta and enriched cereals are low in fiber. The refining process strips the outer coat (bran) from the grain, which reduces the amount of fiber that's left.
HDL is plasma’s smallest and densest lipoprotein. The major apolipoproteins of HDL are apo A-I and apo A-II, the alpha lipoproteins. An elevated concentration of apo A-I and apo A-II, known as hyperalphalipoproteinemia (HALP), is associated with a lower risk of CHD. Conversely, hypoalphalipoproteinemia increases the chances of CHD development. [2] HALP generally does not produce any unusual clinical features (although corneal opacity has been associated with the condition), and it should not be considered a disease entity but rather a fortuitous condition that can increase longevity because of the related decrease in CHD incidence. [9]
For women after menopause, a study published in August 2016 in the journal Diabetes & Metabolism found that high intensity interval training (on a bicycle) led to better HDL cholesterol levels as well as significant weight loss. And a study published in May 2016 in the journal Applied Physiology, Nutrition, and Metabolism found that obese men who engaged in aerobic interval training (running on a treadmill) or resistance training (with weights) just three days a week for 12 weeks had significantly increased HDL cholesterol when compared with obese men who did no training.

Research shows that there isn't really a link between how much fat you eat and your risk of disease. The biggest influence on your risk is the type of fat you eat. Two unhealthy fats, including saturated and trans fats, increase the amount of cholesterol in your blood cholesterol and increase your risk of developing heart disease. However, two very different types of fat — monounsaturated and polyunsaturated fats — do just the opposite. In fact, research shows that cutting back on saturated fat and replacing it with mono and polyunsaturated fats can help lower the level of LDL cholesterol in your blood.
Where HDL is concerned, “you can’t be too thin,” Castelli says. One report found about a 1 percent rise in HDL for every pound of fat lost. This doesn’t mean you have to turn yourself into a toothpick, but that you should work on getting rid of excess flab as you add muscle. (Use a body-fat monitor rather than a scale to chart your progress.) Fortunately, fat loss is likely to go hand in hand with the exercise and dietary modifications that also raise HDL levels.
In randomly screened children aged 6-19 years who had age-, race-, and sex-specific total plasma cholesterol levels greater than or equal to 95th percentile levels, 7.8% of white males, 12.8% of white females, 25% of black males, and 17.2% of black females had hypercholesterolemia due to elevated high-density lipoprotein [HDL] cholesterol levels (but not due to elevated low-density lipoprotein [LDL] cholesterol levels) greater than age-, sex-, and race-specific 95th percentile levels. That is, they had HALP.

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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