How to increase good cholesterol

How to increase good cholesterol

how to increase good cholesterol

Dietary strategies to lower levels of bad LDL cholesterol can negatively affect HDL cholesterol. This is quite common, unfortunately. Therefore, there is a number of clinical strategies for treating atherosclerosis and increasing good cholesterol. Let’s take a look at them, as well as see what foods can help with this.

This article was last reviewed by Svetlana Baloban, Healsens, on January 24, 2020. This article was last modified on 5 April 2022.

How does HDL cholesterol affect cardiovascular disease?

We have written more than once about the importance of a healthy lipid profile, if, in the future, you do not want to experience atherosclerosis, coronary heart disease, and stroke. But why did we decide to write specifically about good HDL cholesterol? Let’s start with numbers.

In prospective epidemiological studies, each 1 mg/dL increase in HDL is associated with a 2–3% reduction in risk of coronary heart disease1. This ratio is not affected by the level of bad LDL cholesterol and triglycerides due to the ability of good HDL cholesterol to reverse cholesterol transport. Let’s see what it means.

So, reverse cholesterol transport (RCT) is a pathway through which cholesterol is transported from the artery walls to the liver so it can be excreted from the body. It is through this process that the body reduces the amount of plaque buildup in vessel walls and reverses atherosclerosis. Not surprisingly, data from the Framingham Heart Study showed that people with the highest HDL levels have the lowest risk of developing heart disease2.

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HDL Normal Range

In Adult Treatment Panel III (ATP III) guidelines, the HDL cut-off for healthy individuals has been increased to at least 40 mg/dl in men and to 50 mg/dl in women3. In general, the following HDL normal range was announced:

<40 mg/dL

≥60 mg/dL

Low HDL cholesterol

High HDL cholesterol

There are several factors that lead to low HDL cholesterol, namely:

  • Overweight and obesity
  • Elevated triglycerides
  • Lack of physical activity
  • Smoking
  • Very high carbohydrate intake (>60% of total energy intake)
  • Type 2 diabetes
  • Certain medicines (beta-blockers, anabolic steroids, progestogens)
  • Genetic factors.

In our previous articles, we talked about ways to reduce bad cholesterol. Now it’s time to talk about how to increase good HDL cholesterol. Let’s start with the analysis of drug treatment.

How to increase good HDL cholesterol?

Medication to increase HDL

Nicotinic Acid or Niacin

The most widely used drug to increase HDL levels is nicotinic acid or niacin. Niacin is thought to reduce the risk of cardiovascular disease by lowering LDL cholesterol and increasing good HDL cholesterol. Therefore, niacin is often recommended for patients with low HDL cholesterol levels. One study reports that niacin can increase HDL levels by 25-35% at the highest doses4. And if we talk about the situation of atherogenic dyslipidemia, then studies show a strong trend towards a decrease in the risk of coronary artery disease. It should be remembered that atherogenic dyslipidemia is characterized by low levels of high-density lipoprotein (HDL), high levels of triglycerides, and a high number of low-density lipoprotein (LDL) particles.

Despite the apparent ability of niacin to increase HDL levels and lower LDL, not everything is so rosy. Studies have also shown that niacin can cause serious adverse events. Thus, among participants who received niacin/laropiprant tablets, there was a 55% increase in diabetes control disorders that were considered serious.

Ezetimibe

Another drug that affects reverse cholesterol transport is ezetimibe. In a recent study, ezetimibe was shown to enhance macrophage reverse cholesterol transport in hamsters. However, as with niacin, ezetimibe as a primary agent has not been shown to improve patient outcomes.

The ezetimibe and simvastatin ENHANCE study was designed to show that ezetimibe can reduce the growth of fatty plaques in the arteries5. Patients with genetically high cholesterol were given only statins or ezetimibe plus simvastatin. The doctors then measured their LDL cholesterol levels and examined their arteries to measure plaque growth.

As a result, LDL cholesterol decreased more with combination therapy, it did not improve the condition of the arteries. In fact, after 2 years of therapy, intima-media thickness increased more in the ezetimibe/simvastatin group. However, it is worth noting that patients with high cholesterol due to genetics may not represent the entire population.

One way or another, but further studies of these drugs are currently being conducted. The results will help doctors conclude whether these drugs are an effective strategy for treating atherosclerosis. In any case, for people with high risk for CVD, who have excess weight, diabetes, metabolic syndrome, or a family history of CVD, it is worth discussing medical options with a cardiologist.

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Diet Plan to Increase HDL

One of the most intriguing areas of research within treating atherosclerosis and heart disease is dietary intervention. Most doctors agree that diet is one of the most effective ways to prevent atherosclerosis. This is true in reverse as well. Thus, additional research confirms that a Western diet high in meat, butter and dairy products plays a large role in the high rate of death from cardiovascular diseases.

The most common dietary intervention is the consumption of fish. This is primarily because fish is correlated with an improved omega-3/omega-6 ratio and cardiovascular health. For example, a summary of dietary data showed that saturated fatty acid intake increased good HDL cholesterol without increasing bad LDL cholesterol6.

Other researchers have taken this idea further and even attempted to reverse cardiovascular disease through dietary interventions.

The effect of plant-based nutrition on HDL cholesterol

Vegetables and a vegan diet play a big role in normalizing your lipid profile and prevent atherosclerosis. The American Heart Association have released specific diet guidelines to prevent cardiovascular disease:

  • Eat a variety of fruit and vegetable servings every day. Dark green, deep orange, or yellow fruits and vegetables are especially nutritious. Examples include spinach, carrots, peaches, and berries.
  • Eat a variety of grain products every day.
  • Include whole-grain foods that have lots of fiber and nutrients. Examples of whole grains include oats, whole wheat bread, and brown rice.
  • Eat fish at least 2 times each week. Oily fish, which contain omega-3 fatty acids, are best for your heart. These fish include tuna, salmon, mackerel, lake trout, herring, and sardines.

In addition, studies show that a plant-based diet can help with regression of stenoses. So, in the study, 22 patients with severe coronary heart disease were observed for five years. However, we must also take into account that there is no control group in this study. All participants were volunteers interested in following a plant-based diet.

Another study published in the Atherosclerosis Journal found that green leafy vegetables help restore healthy endothelium.

Another benefit of plant-based diets on our health is their effect on the gut microbiome. The microflora has been found to enhance health by improving digestion, absorption, vitamin synthesis, and reducing gas production. The foods we eat form our own microflora. A recent article in the New England Journal of Medicine shows that choline in eggs, poultry, dairy, and fish produces the same toxic TMAO as carnitine in red meat7. This further explains plant-based protection from heart disease.

So, which dietary changes have the most impact on HDL cholesterol levels? To find this, we turn to research.

Fun Fact

The Norwegian experience between 1938 and 1948 showed a strong relationship between cardiovascular mortality and changes in fat intake in the form of butter, milk, cheese and eggs. Between 1940 and 1945 Germany occupied Norway and the German occupying forces confiscated their livestock. So they restricted the Norwegians in their diet and they switched to a plant-based diet. Also during this period, Norwegians consumed 20% fewer calories than during the period of concern. Sugar consumption also decreased, while fish consumption increased by 200%. All this has led to a sharp drop in mortality from strokes and heart attacks. However, once World War II ended and Norwegians started eating animal products again, their death rate from cardiovascular disease increased.

Almonds and nuts

The effects of almonds are well documented in systematic reviews and meta-analyses of clinical trials. A 100g serving of almonds contains about 50g of healthy fats, most of which (40g) are MUFAs and PUFAs, as well as 4g of saturated fats. Almonds are also a rich source of several minerals as well as vitamins such as calcium, copper, iron, magnesium, phosphorus, potassium, zinc, manganese, thiamine, riboflavin, niacin, and vitamin E.

A clinical study conducted in people with initially low levels of good HDL cholesterol found that a low dose of almonds (10 g/day) can increase HDL cholesterol levels. At the same time, patients were offered to eat only 10 g of almonds every day. The almonds were pre-soaked overnight and peeled off in the morning before eating. Lipid profile measurements were checked at 6 and 12 weeks. As a result, HDL cholesterol was higher by 12-16% of the original8.

Several other studies have demonstrated that almonds not only support good HDL cholesterol levels, but also lower bad cholesterol, which is known as a risk factor for coronary heart disease (CHD)9.

The same conclusion was reached in New Zealand when studying the effect of almonds and hazelnuts in various forms (chopped, chopped and whole) on HDL levels. The result showed a statistically significant decrease in LDL levels along with an increase in HDL levels10. Of all the presented forms, the consumption of whole nuts showed the highest result.

But as for walnuts, they have not shown any effect on levels of good cholesterol11. At the same time, walnuts lowered total cholesterol and LDL cholesterol12.

Olive oil

Olive oil is high in monounsaturated fatty acids as well as vitamins, minerals and polyphenols. The health effects of olive oil, including as part of the Mediterranean diet, have been the subject of much research. Antioxidant and anti-inflammatory properties and improvement in endothelial dysfunction and lipid profile have been reported. Most studies have shown that extra virgin olive oil increased HDL cholesterol levels by almost 50%. In the studies, participants received a daily dose of 25 ml of olive oil. The beneficial effect of olive oil was more pronounced in subjects with established metabolic syndrome or other chronic conditions/diseases13.

Avocado

Avocados are a nutrient-rich source of MUFAs and antioxidants. Several studies have shown that 0.5 – 1 avocado per day improved blood lipid profile[efn_note]Hass Avocado Composition and Potential Health Effects[/efn_note]. Some studies have seen decreases in LDL cholesterol and triglycerides and increases in HDL cholesterol. Other studies have observed only a decrease in triglyceride levels. However, all of these trials were conducted among a small number of people. Let’s hope that larger and longer-term tests will be carried out in the near future.

In addition, there are studies that show avocados also contain a wide range of other nutrients and phytochemicals that may have vascular health benefits beyond cholesterol. In particular, the potassium and lutein in avocados may help normalize blood pressure and help control oxidative/inflammatory stress14. Eating avocados with salads or salsa increases the bioavailability of carotenoids many times over, which can increase potential health benefits. Considering all these factors, adding avocados to your diet seems to make a lot of sense.

Eggs

Eggs are a source of cholesterol and choline and may affect plasma lipid concentrations. For healthy individuals, consumption of up to 3 eggs per day results in an overall positive effect on biomarkers associated with cardiovascular disease risk151617. So, in humans, HDL cholesterol increased, while a decrease in the ratio of cholesterol and high-density lipoprotein was observed. But what about people with an unhealthy lipid profile?

In the next study, 28 overweight men aged 40–70 were recruited to assess their cholesterol during an egg diet. Eighteen patients were classified as having metabolic syndrome (MetS). All men followed a carbohydrate-restricted diet during the experiment. All participants were randomly assigned to consume 3 eggs per day (640 mg/day of extra cholesterol from food) or no eggs group (SUB). The SUB group received an 0 egg (0 dietary cholesterol). As a result, in the egg group, HDL cholesterol increased from 1.23 +/- 0.39 to 1.47 +/- 0.38 mmol/l18.

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Aerobic exercise

While diet is the most important lifestyle factor in promotingreverse cholesterol transport, there is mixed evidence that regular aerobic exercise improves cholesterol efflux. At the same time, recent studies have demonstrated that in order to get a positive effect, it is necessary to exceed the threshold of exercise dose19. Overall, exercise represents a potential therapeutic approach to improve HDL function. Preliminary evidence suggests that exercise improves the antioxidant and anti-inflammatory properties of HDL.

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FURTHER READING

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Source: ©️2019 Healsens B.V. All right reserve

  1. Beyond Statins: Emerging Evidence for HDL-Increasing Therapies and Diet in Treating Cardiovascular Disease
  2. High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies
  3. ATP III Report on High Blood Cholesterol
  4. Beyond Statins: Emerging Evidence for HDL-Increasing Therapies and Diet in Treating Cardiovascular Disease
  5. Beyond Statins: Emerging Evidence for HDL-Increasing Therapies and Diet in Treating Cardiovascular Disease
  6. Which Nutritional Factors Are Good for HDL?
  7. What about HDL cholesterol?
  8. Dietary Almonds Increase Serum HDL Cholesterol in Coronary Artery Disease Patients in a Randomized Controlled Trial
  9. Almonds and Cardiovascular Health: A Review
  10. Effects of regular consumption of different forms of almonds and hazelnuts on acceptance and blood lipids
  11. Effects of walnut consumption on blood lipids and other cardiovascular risk factors: a meta-analysis and systematic review
  12. Moderate walnut consumption improved lipid profile, steroid hormones and inflammation in trained elderly men: a pilot study with a randomized controlled trial
  13. Network Meta-Analysis of Metabolic Effects of Olive-Oil in Humans Shows the Importance of Olive Oil Consumption With Moderate Polyphenol Levels as Part of the Mediterranean Diet
  14. Hass Avocado Composition and Potential Health Effects
  15. Intake of up to 3 Eggs/Day Increases HDL Cholesterol and Plasma Choline While Plasma Trimethylamine-N-oxide is Unchanged in a Healthy Population
  16. High-density lipoprotein cholesterol changes after continuous egg consumption in healthy adults
  17. Egg consumption and high-density-lipoprotein cholesterol
  18. Egg consumption and high-density-lipoprotein cholesterol
  19. Effects of exercise on HDL functionality

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