Cholesterol, a waxy, fat-like substance found in all cells of the body, is essential for proper bodily function. It's made by the liver and transported through the blood via lipoproteins. There are two main types of cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL is often called "bad" cholesterol because high levels can lead to plaque buildup in arteries. HDL, on the other hand, is known as "good" cholesterol because it helps remove cholesterol from other parts of the body and carries it back to the liver. Maintaining healthy cholesterol levels is crucial for preventing heart diseases. The main treatments for high cholesterol involve heart-healthy lifestyle changes and, in some cases, medicines.
Understanding HDL Cholesterol
High-density lipoprotein (HDL) cholesterol is considered the “good” type of cholesterol. It plays a vital role in cardiovascular health by helping to remove LDL (bad) cholesterol and triglycerides from your arteries, transporting them back to your liver for expulsion from the body. This process can help prevent arterial plaque buildup, which reduces the risk of heart disease and stroke.
HDL cholesterol is made by our body and is in a large part determined by our genes.
What are healthy HDL levels?
To keep your system running at optimal levels, you want to keep your HDL high. Ideally, that’s 50 milligrams per deciliter of blood or higher. (The normal range is 40 to 59 mg per deciliter.) When HDL levels dip below 40 mg per deciliter, your risk of heart disease rises. Doctors measure cholesterol levels in milligrams/deciliter (mg/dL).
Impact of Low HDL-C
Low HDL-C is commonly observed in patients with insulin resistance, obesity and type 2 diabetes. Low HDL-cholesterol (HDL-C) as well as high LDL-C is associated with the development of coronary heart diseases.
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Dietary Strategies to Improve HDL Levels
While food doesn’t directly contain HDL cholesterol, making healthy food choices can significantly affect how your body metabolizes cholesterol. These choices can help lower LDL levels and raise HDL, thereby improving the HDL-to-LDL cholesterol ratio. Eating a well-balanced diet can also help manage other factors associated with rising HDL, such as blood sugar levels, unintentional weight gain, and conditions like obesity and type 2 diabetes.
Healthy Fats
Choosing healthier fats is essential for managing cholesterol levels. You should limit both total fat and saturated fat. No more than 25 to 35% of your daily calories should come from dietary fats, and less than 7% of your daily calories should come from saturated fat. Saturated fat is a bad fat because it raises your LDL (bad cholesterol) level more than anything else in your diet.
Olive Oil
Olive oil contains monounsaturated fat, which may help lower the inflammatory impact of LDL cholesterol on your body. A 2023 review also found that consuming olive oil high in polyphenols significantly increased HDL levels. Try using extra-virgin olive oil instead of other oils and fats when cooking at low to moderate temperatures, since extra-virgin olive oil breaks down at high temperatures. The Department of Agriculture defines 1 tablespoon of extra virgin olive oil as a single serving.
Omega-3 Fatty Acids
Eat foods that are high in omega-3 fatty acids. These special fats can lower LDL and triglyceride levels. They can also help control blood pressure and may lower your risk of heart rhythm problems. If you have heart disease, they may lower your risk of heart attack.
Fish
Eating 2-3 fish meals per week has shown to increase HDL cholesterol. This is linked to the Omega 3 Fatty Acids. Fish such as salmon, tuna (canned or fresh), and mackerel are excellent sources. Most people should try to eat these fish two times a week.
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Omega-3 and fish oil supplements are available. Fish Oil supplements: look at the label and add up the EPA and DHA. Take enough capsules to equal 1,000mg (add EPA + DHA) daily.
Plant Sources of Omega-3
Plant sources such as walnuts, flaxseed, chia seeds, and canola and soybean oils. Flaxseed is a great plant-based source of this heart-healthy fat. However, it’s important to buy ground flaxseed. Whole flaxseeds are almost impossible for your body to break down. This means they pass through your body largely intact and never leave behind any of their nutrients.Ground flaxseed can be sprinkled onto your morning cereal, oatmeal, salads, dips, or yogurt, or added to baked goods. Flaxseed oil is a welcome addition to salad dressings or smoothies. Flaxseed is a great plant-based source of this heart-healthy fat.
Chia seeds are another good source of plant-based omega-3 fatty acids, fiber, and other healthy nutrients. Adding chia seeds to your diet may help increase HDL levels and lower LDL levels. Like flaxseeds, chia seeds are great when added to cereal, oatmeal, dips, salads, yogurt, and smoothies. However, chia seeds may develop a slimy texture when wet. If that’s a problem, consume chia seeds immediately, or add them to baked goods in place of eggs.
Avocados
Research suggests avocados may help increase HDL without affecting total cholesterol, LDL, and triglyceride levels. Avocados are also filled with fiber, which naturally helps keep cholesterol in check.There are many ways to eat avocados, such as by adding slices to salads, chilis, and sandwiches.
Nuts
A bushel of studies shows that eating almonds, walnuts, peanuts, and other nuts is good for the heart. Eating 2 ounces of nuts a day can slightly lower LDL, on the order of 5%. Nuts, including Brazil nuts, almonds, and pistachios, are filled with heart-healthy fats. They’re also high in fiber and contain plant sterols, a substance that blocks the absorption of cholesterol in your body. Just remember to watch your portion sizes, as nuts are high in calories.
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Fiber-Rich Foods
Fiber plays a crucial role in managing cholesterol levels. Soluble fiber helps prevent your digestive tract from absorbing cholesterol. You should try to get 10 to 25 grams of it per day.
Oats
An easy first step to lowering your cholesterol is having a bowl of oatmeal or cold oat-based cereal like Cheerios for breakfast. It gives you 1 to 2 grams of soluble fiber. Add a banana or some strawberries for another half-gram. Current nutrition guidelines recommend getting 20 to 35 grams of fiber a day, with at least 5 to 10 grams coming from soluble fiber.
Whole Grains
Whole grains, including bran, cereals, and brown rice, may lower your LDL and total cholesterol, which may give your HDL levels a percentage boost. Have at least two servings of whole grains per day. This may include a bowl of oatmeal for breakfast, 100% whole grain bread at lunch, and a side of brown rice for dinner.
Legumes
Legumes are great sources of soluble fiber and could help lower your levels of LDL cholesterol. black beans, black-eyed peas, kidney beans, navy beans and lentils Beans work well in dishes like chili, salads, and soups. They’re a great plant-based substitute for meat, too. Soy consumption increased HDL-C and deceased both TG and LDL-C. Eating soybeans and foods made from them, like tofu and soy milk, was once touted as a powerful way to lower cholesterol. Soy-based products can help improve cholesterol levels and reduce your risk of cardiovascular disease. Eating less meat may also help lower your LDL levels and increase your HDL levels. Steamed, unsalted edamame makes a great appetizer, while extra-firm tofu grills well.
Fruits
Eating high fiber fruits can help lower your overall cholesterol levels, which may improve your HDL-to-LDL ratio. Research suggests that consuming 15 grams (g) of fiber each day could help increase HDL levels. Snacking on high fiber fruits throughout the day could help you reach this more easily. Some fruits may include: Raspberries: 8 g of fiber for 1 cup (123 g), Pears: 5.5 g of fiber for 1 medium pear (178 g), Apples: 4.4 g of fiber for 1 medium apple (182 g) Try slicing fruit and stirring it into cereal or oatmeal, or throw it into a blender to create a delicious smoothie. Fruit is great on its own, too.
Plant Sterols and Stanols
Increase plant stanols and sterols in your diet. These are substances that also help prevent your digestive tract from absorbing cholesterol. You should try to get 2 grams of them per day. They can be found in whole grains, nuts, legumes, and oils, such as olive oil and avocado oil. They are also added to some foods, such as certain types of orange juice, margarine, and bread. Sterols and stanols extracted from plants gum up the body's ability to absorb cholesterol from food. Companies are adding them to foods ranging from margarine and granola bars to orange juice and chocolate. They're also available as supplements.
Foods to Limit or Avoid
Certain dietary choices can negatively impact cholesterol levels, particularly by raising LDL and lowering HDL.
Saturated and Trans Fats
You should limit both total fat and saturated fat. Saturated fat is a bad fat because it raises your LDL (bad cholesterol) level more than anything else in your diet. Avoid Trans-fatty Acids: Avoid foods that have partially hydrogenated oils. Read the ingredients list to find them. Try not to include trans fats in your diet. Trans fats can increase LDL cholesterol and lower HDL cholesterol levels. Foods made with shortening, such as cakes and cookies, often contain trans fats. So do most fried foods and some margarines. Saturated fats - such as those in meat, butter, cheese and other full-fat dairy products - raise your total cholesterol. Trans fats, sometimes listed on food labels as "partially hydrogenated vegetable oil," are often used in margarines and store-bought cookies, crackers and cakes. Trans fats raise overall cholesterol levels.
Cholesterol-Rich Foods
Limit foods with cholesterol. If you are trying to lower your cholesterol, you should have less than 200 mg a day of cholesterol. Dietary cholesterol comes from animal-based foods. According to a 2019 AHA science advisory on dietary cholesterol and cardiovascular risk - which Van Horn helped write - high-fat meat, eggs, butter and full-fat dairy products are major sources. Although previous federal dietary guidelines recommended limiting consumption of dietary cholesterol to 300 milligrams per day, the current guidelines instead suggest keeping dietary cholesterol consumption "as low as possible without compromising the nutritional adequacy of the diet." The good news is, that leaves room for flexibility. Anyone with a high LDL cholesterol level should consider reducing sources of both saturated fat and dietary cholesterol, Van Horn said, because together they are considered more likely to contribute to arterial plaque.
Salt
Limit salt. You should try to limit the amount of sodium (salt) that you eat to no more than 2,300 milligrams (about 1 teaspoon of salt) a day. That includes all the sodium you eat, whether it's added in cooking, used at the table, or already present in food products. Limiting salt won't lower your cholesterol, but it can lower your risk of heart diseases by helping to lower your blood pressure.
Alcohol
Limit alcohol. Alcohol adds extra calories, which can lead to weight gain. Being overweight can raise your LDL level and lower your HDL level. Too much alcohol can also increase your risk of heart diseases because it can raise your blood pressure and triglyceride level. Particularly wine has been shown to increase HDL. Drink in moderation (up to one for women and two for men in a day).
Beyond Diet: Lifestyle Factors
While diet is a cornerstone of cholesterol management, other lifestyle factors play a significant role in maintaining healthy HDL levels.
Exercise
Increased physical activity can raise HDL cholesterol levels while lowering levels of triglycerides, the most common type of fat in the body. As little as 60 minutes of moderate-intensity aerobic exercise a week can achieve this. Numerous studies show that moderate- to high-intensity exercise can boost your all-important HDL numbers. As an added bonus, working out also pushes your LDL numbers down. You can work on your fitness however you desire. Try walking or running. If cycling is more your thing, hop on a bike. Or try swimming or yoga or weight training or … well, you get the picture. Even gardening can fit the bill. If you have a medical condition that makes traditional exercises tough, talk with your provider about alternatives and adaptations. Long term, you should be shooting for at least 150 minutes of moderate-intensity physical activity per week, or 75 minutes per week of vigorous-intensity activity. If that feels ambitious - or, frankly, impossible - start slow and build up the time and intensity gradually. Even a little bit of extra activity can make a big difference.
Weight Management
Maintaining a healthy weight is often associated with better cholesterol levels. You’ve probably heard that carrying extra pounds tends to increase LDL levels and push down your HDL count. In many cases, that’s true. But the relationship between weight and heart health is complicated. Not all people with overweight or obesity have high cholesterol, and there are plenty of people with BMIs in the normal range who have hyperlipidemia. We’re learning more about the reasons why every day. For example, we now know that some people’s genetic codes disconnect overweight and obesity from conditions like high cholesterol that we typically associate with heart disease. Work with your provider to determine if your current weight is heart-healthy in light of your specific medical history. If weight loss is the right choice for you, there’s good news: It doesn’t take much to see a measurable difference in your cholesterol. In fact, the American Heart Association says that a weight loss of just 5% to 10% can improve both your HDL and your LDL numbers.
Smoking Cessation
Don’t smoke. Add high cholesterol levels to the list of negative consequences from lighting up. Smoking and vaping drive down HDL levels while increasing your risk of coronary disease, high blood pressure and diabetes. The good news? Quitting smoking brings rapid results: Research shows that HDL numbers typically rise fewer than three weeks after you snuff out that last cigarette.
Managing Blood Sugar and Blood Pressure
Cholesterol issues often go hand-in-hand with high blood sugar (Type 2 diabetes) and high blood pressure (hypertension). A healthy diet, regular exercise and weight management are all key to maintaining - or improving - your health.
Medical Interventions
Medicines used to lower LDL cholesterol and triglyceride levels sometimes improve HDL cholesterol levels. But clinical trials haven't shown that increasing HDL cholesterol levels with medicines reduces the risk of heart attack.
Monitoring Cholesterol Levels
High cholesterol often doesn’t announce itself. Centers for Disease Control and Prevention (CDC). Testing should be more frequent if you or your biological relatives have a history of heart disease or diabetes. It’s not just adults who should be tested either. The CDC also recommends that children have their cholesterol checked at least once between ages 9 and 11. The agency also recommends a test between ages 17 and 21. Test results can open discussions with your doctor about unique risk enhancers such as: Family history, which could lead to a second test to find your Lipoprotein(a), or Lp(a), level, Metabolic syndrome, Preeclampsia and premature menopause (for those who are female), Inflammatory conditions such as rheumatoid arthritis“Improving your cholesterol begins by knowing there’s an issue,” says Dr. Cho.
The Bigger Picture: Overall Dietary Patterns
A largely vegetarian "dietary portfolio of cholesterol-lowering foods" substantially lowers LDL, triglycerides, and blood pressure. The key dietary components are plenty of fruits and vegetables, whole grains instead of highly refined ones, and protein mostly from plants. Of course, shifting to a cholesterol-lowering diet takes more attention than popping a daily statin. It means expanding the variety of foods you usually put in your shopping cart and getting used to new textures and flavors. Just as important, a diet that is heavy on fruits, vegetables, beans, and nuts is good for the body in ways beyond lowering cholesterol. It keeps blood pressure in check. It helps arteries stay flexible and responsive.