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]
Fish can be fatty or lean, but it’s still low in saturated fat. Eat at least 8 ounces of non-fried fish each week, which may be divided over two 3.5- to 4-ounce servings. Choose oily fish such as salmon, trout and herring, which are high in omega-3 fatty acids. Prepare fish baked, broiled, grilled or boiled rather than breaded and fried, and without added salt, saturated fat or trans fat. Non-fried fish and shellfish, such as shrimp, crab and lobster, are low in saturated fat and are a healthy alternative to many cuts of meat and poultry.

However, environmental factors also have a significant impact on HDL levels. Factors that elevate HDL concentrations include chronic alcoholism, treatment with oral estrogen replacement therapy, extensive aerobic exercise, and treatment with niacin, statins, or fibrates. [11, 12, 13] On the other hand, smoking reduces levels of HDL-C, while quitting smoking leads to a rise in the plasma HDL level.
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Weight Management. If you are overweight, losing weight can help lower your LDL (bad) cholesterol. This is especially important for people with metabolic syndrome. Metabolic syndrome is a group of risk factors that includes high triglyceride levels, low HDL (good) cholesterol levels, and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).

Once you know your cholesterol levels, it’s time to discuss a plan with your doctor. Although changing your lifestyle to include a heart-healthy diet and plenty of exercise is usually the first step to lower cholesterol, some types of cholesterol problems like familial hypercholesterolemia may require medication right away. Work with your doctor to come up with the best cholesterol goals for you and the best ways to get there.


Along with exercising, eating a healthy diet is one of the most important things you can do to reach and maintain healthy cholesterol levels. Learn how to read nutrition labels and know the difference between healthy and unhealthy fats. Calories, calories from fat, total fat, saturated fat, and trans fat numbers are all right there on the nutrition facts label to help you make heart-healthy choices.
Controlling your weight is an important part of getting to healthy cholesterol levels, so it’s crucial to know your portion sizes if you're trying to lower cholesterol. A portion of starchy carbohydrate, like potato or pasta, should be only about half the size of a baseball. A heart-healthy portion of meat should be about the size of a deck of playing cards, or about three ounces.
Resistance training is a form of physical activity that forces your muscles to contract, building up strength and endurance. Some research also shows that resistance training could have beneficial effects on heart health as well and may decrease total and LDL cholesterol. (31) Weight lifting and bodyweight exercises like squats or lunges are some examples of resistance training that you can add to your routine.
Large doses of vitamin B3, or niacin, have been found to raise HDL as much as 20 percent and are often prescribed for people with cholesterol problems. But keep in mind that a daily multivitamin contains all the niacin most people need. Supplementing beyond that can have a variety of side effects, including facial flushing, heartburn and even liver damage, so don’t try it without consulting a doctor.
However, although low levels of HDL predict increased cardiovascular risk, particularly in healthy individuals with no history of cardiovascular events, the relationship between HDL and CHD risk is complex, with HDL-C and cardiovascular disease having a nonlinear relationship. For example, research found that HDL levels above approximately 60 mg/dL showed no further improvement in prognosis, and the EPIC (European Prospective Investigation into Cancer and Nutrition)-Norfolk and IDEAL (Incremental Decrease in End Points through Aggressive Lipid Lowering) studies showed that very high levels of HDL may actually be associated with an increased risk of atherosclerotic disease. [5, 6, 2]
As a result of all this, doctors don’t just want you to lower your total cholesterol count; they want you to change the ratio as well, so you have more HDL and less LDL. “When we looked at the data, we found that the higher your HDL went, the lower your risk of heart attack,” says cardiologist William Castelli, M.D., former director of the Framingham Heart Study in Massachusetts. An HDL level of 75 or more seems to convey extra longevity for many people, while a count of 100 or more is so beneficial that it was dubbed the “Methuselah syndrome” by one researcher. HDL less than 35 or so, meanwhile, can carry significant risk of heart disease. Genetics plays a large role in HDL. A few guys have naturally low levels and need to keep their LDL low as well to make up for it. (As Castelli puts it, you don’t need a substance that removes cholesterol from your blood if you don’t have much to begin with.) But there’s plenty that everyone else can do to pump up their HDL. Never one to shirk from a task that doesn’t involve housecleaning, I managed to find two handfuls of ways to turn my “good” numbers into great numbers.
While this belief is still thought to be almost always true, in recent years a fly has been found in the ointment. Drug companies have spent billions of dollars developing drugs that increase HDL cholesterol levels. However, to the dismay of all, these drugs have failed to reduce cardiac risk—despite the fact that they make HDL levels go up. Development of at least two of these drugs has now been halted. (More on this below.) So the HDL story is more complex than scientists originally had hoped.
An easy way to make the switch from trans fats is by replacing them with unsaturated fats, which don’t increase your LDL cholesterol, according to WebMD. Unsaturated fats are found in olive oil, canola oil, vegetable and sunflower oils, as well as fish, nuts, seeds and avocados. Just as unsaturated fats are healthy choices, unsaturated fats are not. Be sure to limit your intake of unsaturated fats, which are found in fatty meats, cold cuts, whole milk, whole-milk cheeses and many store-bought baked goods and snacks. Instead, enjoy lean cuts of meat, skim milk, low-fat cheeses and yogurt, and wholesome snacks to trim down your cholesterol levels. 
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
Rich in omega-3 fatty acids and all-around delicious, walnuts have also been shown to improve the HDL-to-total cholesterol ratio, according to a study published in the American Diabetes Association’s peer-reviewed journal, Diabetes Care. This ratio is used by physicians to assess overall cardiovascular risk and can provide more information than just one value alone. A desirable ratio is anything below 5:1, but a ratio of 3.5:1 indicates very minimal cardiovascular risk.
Salmon is rich in omega-3 fatty acids, which are healthy fats that can help reduce blood pressure. Eating salmon can improve your "good" HDL cholesterol, but it won't lower your "bad" LDL cholesterol. HDL cholesterol helps sweep cholesterol off your artery walls, preventing dangerous plaque from forming. The American Heart Association recommends eating fatty fish like salmon at least twice per week for heart-healthy benefits. Other fish that contain omega-3s, such as mackerel, tuna and sardines, can also help.
Beans and legumes of all kinds are known to be an asset to a heart-healthy diet pattern because they’re rich in a type of fiber—soluble fiber—which helps to block cholesterol from being absorbed through the intestines into the blood stream. By increasing your intake of beans, like chickpeas, you can decrease LDL levels, which results in a higher percentage of HDL cholesterol. You can blend chickpeas with garlic, tahini, and lemon juice to make the perfect homemade hummus, or mix them with peanut butter and dark chocolate to make a decadent, high protein, edible cookie dough! Blogger Chocolate Covered Kate has a great recipe.
Take fish oil. Fish oil contains an abundance of essential omega-3 fatty acids (omega-3s) that have been shown to lower triglyceride (blood fat) levels, minimize inflammation and clotting, and increase HDL (“good”) cholesterol. Research indicates that omega-3s may help reduce the risk and symptoms of a variety of disorders influenced by inflammation, including heart attack and stroke. You can add omega-3s to your diet by eating more cold water fish such as wild Alaskan salmon, sardines, herring, mackerel and black cod. If that’s not possible, Dr. Weil recommends taking two grams daily of a fish oil supplement that contains both essential omega-3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). When choosing a supplement, look for one derived from molecularly distilled fish oils – these are naturally high in both EPA and DHA and low in contaminants. Also choose a supplement brand that has been independently tested and guaranteed to be free of heavy metals such as mercury and lead, and other environmental toxins including polychlorinated biphenyls, also known as PCBs.

Though the age-old myth stating eggs are bad for our blood cholesterol has been debunked, one thing for certain is that reducing total saturated fats in the diet leads to an improved cholesterol profile. What does this mean in terms of animal protein? The American Heart Association recommends consuming less red meat overall and choosing leaner cuts to lower bad cholesterol and increase good cholesterol. Chicken is a versatile choice that doesn’t have to be boring or dry. Check out our 35 healthy ways to prepare this bird!
HDL cholesterol is “good” because elevated blood levels have been associated with a lower risk of cardiovascular disease. However, clinical trials with experimental medications aimed at increasing HDL cholesterol levels, so far, have been largely disappointing. HDL researchers have gone back to the drawing board to figure out what it is about HDL that may reduce the risk of heart disease.
Weight Management. If you are overweight, losing weight can help lower your LDL (bad) cholesterol. This is especially important for people with metabolic syndrome. Metabolic syndrome is a group of risk factors that includes high triglyceride levels, low HDL (good) cholesterol levels, and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
Saturated fats. Typical sources of saturated fat include animal products, such as red meat, whole-fat dairy products, and eggs, and also a few vegetable oils, such as palm oil, coconut oil, and cocoa butter. Saturated fat can increase your levels of "bad" LDL cholesterol. But it has some benefits, too — it lowers triglycerides and nudges up levels of "good" HDL cholesterol.
HDL is actually more complex than we once thought. Rather than being a single kind of particle, HDL is is now considered a family of different particles. All HDL contains lipids (fats), cholesterol and proteins (called apolipoproteins), but some types of HDL are spherical while others are shaped like a doughnut. Some HDL types remove bad cholesterol from the blood while other types are indifferent to cholesterol. Or even worse, some HDL transfers cholesterol the wrong way (into LDL and cells) or protects LDL in a way that makes it more harmful to the arteries.
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 cup of tea does more than soothe on a stressful day. Both green and black tea can help lower cholesterol levels. Green tea is prepared from unfermented leaves and black tea from fully fermented leaves of the same plant. Researchers believe that catechins, a type of antioxidant found in tea, are responsible for its cholesterol-lowering effect. The more fermented the tea leaves, the lower the catechin content and the higher the caffeine content. 

With apologies to the American Heart Association, which discourages doctors from telling their patients about the advantages of alcohol: one or two drinks per day can significantly increase HDL levels. More than one or two drinks per day, one hastens to add, can lead to substantial health problems including heart failure. And unfortunately, there are many people who are simply incapable of limiting their alcohol intake to one or two drinks per day. Here's more on alcohol and the heart.

Soy isoflavones significantly decreased serum total cholesterol by 0.10 mmol/L (3.9 mg/dL or 1.77%; P = 0.02) and LDL cholesterol by 0.13 mmol/L (5.0 mg/dL or 3.58%; P < 0.0001); no significant changes in HDL cholesterol and triacylglycerol were found. Isoflavone-depleted soy protein significantly decreased LDL cholesterol by 0.10 mmol/L (3.9 mg/dL or 2.77%; P = 0.03). Soy protein that contained enriched isoflavones significantly decreased LDL cholesterol by 0.18 mmol/L (7.0 mg/dL or 4.98%; P < 0.0001) and significantly increased HDL cholesterol by 0.04 mmol/L (1.6 mg/dL or 3.00%; P = 0.05). The reductions in LDL cholesterol were larger in the hypercholesterolemic subcategory than in the normocholesterolemic subcategory, but no significant linear correlations were observed between reductions and the starting values. No significant linear correlations were found between reductions in LDL cholesterol and soy protein ingestion or isoflavone intakes.
Chocolate fans rejoice! You might have heard that chocolate is good for you, and it's true. Dark chocolate and cocoa powder contain powerful antioxidant compounds called flavonoids, which help lower cholesterol. Milk chocolate has less cocoa solids, and thus lower flavonoid levels, and white chocolate is even lower in the good stuff. Reach for small portions of dark chocolate, preferably with a high cocoa content. Or try a sprinkle of cocoa powder in your smoothie or on yogurt to reap chocolate's cholesterol-lowering benefits.

"These fish are best for cholesterol, but any fish is better than red meat," says Pacold. “Every time you have fish as a protein source instead of red meat, you are doing your heart a favor.” If you don't eat fish, you can get your needed dose of omega-3s in the form of a diet supplement pill, he suggests. Flaxseeds, walnuts, and even mixed greens are plant-based options to get more omega-3s in your diet.

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.
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.
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.
As if we needed another excuse to grab a second scoop of guac at the tailgate? Avocados are the poster child for the heart-healthy diet due to their rich abundance of monounsaturated fat, high fiber, and potassium. Monounsaturated fats from avocados, in particular, have been connected to an increase of HDL cholesterol and decreases of total cholesterol, LDL particles, and triglycerides, as shown in an Archives of Medical Research study. These can even be substituted for heart-harmful hydrogenated oils in baked goods as the fruit yields the same creamy texture and mouthfeel. Avocado brownies anyone?!
Saturated fats. Typical sources of saturated fat include animal products, such as red meat, whole-fat dairy products, and eggs, and also a few vegetable oils, such as palm oil, coconut oil, and cocoa butter. Saturated fat can increase your levels of "bad" LDL cholesterol. But it has some benefits, too — it lowers triglycerides and nudges up levels of "good" HDL cholesterol.

Are you pouring up a glass of OJ in the morning? Is your daily caffeine fix a fountain coke at the local gas station? What about that fruity cocktail tempting you at happy hour? Eliminating sweetened beverages from the daily routine is one of the easiest ways to cut thousands of calories or more per week, but will also put years on your life. Water is the best form of hydration and can be flavored with citrus, tropical fruits, and herbs to create a refreshing spa-like oasis that will increase HDL levels when it replaces your typical sugar-sweetened beverages.
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