6 ways to increase HDL, the "good" cholesterol

As someone with diabetes, you need to work harder than your average person to keep your heart healthy. One way to do that is to keep your cholesterol at healthy levels. We generally talk more about lowering LDL "bad" cholesterol, but raising HDL "good" cholesterol is important, too. HDL removes LDL from the artery walls and ferries it to the liver for processing or removal. HDL also acts as an antioxidant, an anti-inflammatory, and an antithrombotic (reducing clot formation in the coronary arteries).

Here, an article published in the June issue of Harvard Women's Health Watch explains how we can do just that. The best news is that following much of this advice will help keep you healthier overall, too.

There's no "normal" level of HDL — but cholesterol experts suggest we should aim for more than 60 mg/dL. In women, HDL levels below 50 mg/dL increase the risk of heart disease.

Some people are lucky enough to inherit genes that direct a high production of HDL, while others are dealt a less favorable hand. But genes are only part of the story. There are several things we can do to nudge up our HDL:

1.      Aerobic exercise. Moderate-to-vigorous aerobic exercise can boost HDL by 5% to 10%. Aim for five 30-minute sessions per week. Brisk walking, jogging, and cycling are all good choices. The idea is to keep your heart rate up for at least 20 minutes — at a level of 50% to 85% of your maximum heart rate, which is about 220 beats per minute minus your age. For example, a 60-year-old woman, whose maximum heart rate is 160 beats per minute (220 minus 60), should strive for a target heart rate of 50% to 85% of 160 — that is, 80 to 136 beats per minute.

2.      Weight loss. If you're overweight or obese, you can boost your HDL level by about 1 mg/dL for every seven pounds lost, although any amount of weight loss will help. Aim to bring your body mass index (BMI) into the normal range (less than 25), at a rate of about 4.5 pounds lost per month. A word of caution: "yo-yo" dieting — repeatedly losing and regaining weight — can lower HDL. In the Framingham Heart Study, weight cyclers (both women and men) were at increased risk of heart disease and death.

3.      Smoking cessation. Smoking lowers HDL cholesterol. Levels rise by as much as 15% to 20% after you quit.

4.      Healthy fats and carbohydrates. Avoid trans fats, which increase bad cholesterol and decrease good cholesterol. Replace saturated fat and trans fats with poly- and monounsaturated fats from plant oils (olive, canola, soy, flaxseed), nuts (almonds, peanuts, walnuts, pecans), and fatty fish (salmon, tuna, mackerel). The OmniHeart trial showed that a diet that derives 37% of its calories from unsaturated (mostly monounsaturated) fat serves to lower LDL cholesterol and triglyceride levels while raising HDL levels. Avoid highly refined carbohydrates, such as white-flour products; instead, choose whole-grain products.

5.      Alcohol consumption. One drink per day (five ounces of wine, 1.5 ounces of liquor, or 12 ounces of beer) can boost HDL by about 4 mg/dL.

6.      Medications. If low HDL is a serious problem, you may need medications in addition to lifestyle therapy. Niacin, available over the counter, is the most effective HDL-raising medication currently available. It improves cholesterol levels across the board, increasing HDL by 15% to 35% while reducing triglycerides by 20% to 50% and LDL levels by 10% to 20%. The most common side effects, flushing and itching, are less likely if you take it after a meal, or an hour after taking an aspirin. So-called flush-free niacin products are available, but they have no effect on cholesterol levels. Look for a USP-approved niacin, or better yet, ask your clinician about prescription intermediate-release niacin (Niaspan). Niacin can be strong medicine, particularly at the doses needed to change cholesterol levels (500 to 1,000 milligrams or more per day), so it's important to work with your clinician if you want to try it.

Have you tried any of these HDL-boosting strategies? What were your results?

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

High Cholesterol
High cholesterol is a major contributor to heart disease, but how can you tell how much cholesterol is too much? What is the difference between "good" and "bad" cholesterol, and how can you achieve a healthy level of each? What to do about High Cholesterol is a special report from Harvard Medical School that gives you a step-by-step plan to set and reach your own cholesterol-level goal. Get tips on diet and exercise, medication options, and everything else you need to start lowering your cholesterol today.

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