An excerpt from the book, “Your Blood Never Lies: How to Read a Blood Test for a Longer, Healthier Life” by James B. LaValle, RPh, CCN, ND. Read additional excerpts or buy the whole book.
HDL CHOLESTEROL
The “good” cholesterol in your body is high-density lipoprotein, or HDL, cholesterol. It’s highly desirable to have an elevated level of HDL because it carries “bad” cholesterol to the liver, where it is then removed from your system. A helpful way to think about HDL is as a maintenance or cleaning crew that searches for and expels the cholesterol that causes clogged arteries. Keeping your HDL at a favorable level significantly reduces the risk of coronary artery disease. Reference ranges for this value, which differ for men and women, are indicated in the table.
| Reference Ranges for HDL Cholesterol | |||
| At Risk | Normal | Target Range | |
| Men | Less than 40 mg/dL | 40 to 50 mg/d | Greater than 60 mg/dL |
| Women | Less than 50 mg/dL | 50 to 60 mg/dL | Greater than 60 mg/dL |
When it comes to HDL cholesterol, most doctors agree that the higher the number, the better off you are. However, not all HDLs are created equal. Too much of the wrong type of HDL may mean that you are not reaping its cardioprotective benefits. An unfavorable ratio of triglycerides to HDL can also signal a problem, which is why the ratio is included on the lipid profile. A ratio of 1 to 1 is ideal, 2 to 1 is considered good, and 3 to 1 is satisfactory. If a blood test indicates that your ratio may pose heart risks, your physician will recommend an appropriate treatment. In general, a high level of HDL cholesterol is considered a key marker of good health. Low numbers, though, can raise your risk of chronic disease even if your other cholesterol levels are “normal.” If your HDL level is not where it should be, getting to the root of the problem is the first step.
WHAT CAUSES LOW HDL CHOLESTEROL?
There are several causes of low HDL cholesterol, many of which are related to lifestyle. These include:
- Being overweight or obese (BMI of 25 or above)
- Chronic stress
- Diet high in refined carbohydrates and sugars, and very low in fat
- Excessive use of certain medications, such as anabolic steroids (testosterone), antipsychotics, high-dose beta blockers, high-dose thiazide diuretics, and progesterone
- High triglyceride levels
- Insufficient exercise or lack of exercise
- Low levels of magnesium and/or omega-3 fatty acids
- Malnutrition
- Smoking
- Testosterone deficiency (in men)
Like elevated triglycerides and cholesterol levels, heredity may also be to blame for low HDL cholesterol. Studies have shown that certain ethnic populations, such as Asian Indians, may be predisposed to low HDL. There are also rare genetic diseases that can cause low HDL levels. Since HDL cholesterol removes the “bad” cholesterol from your body, a deficiency can increase your odds of developing serious health conditions, including atherosclerosis and coronary artery disease, heart attack, and stroke. Low HDL can also put you at high risk for blood clots, chronic inflammation, kidney disease, liver disease, metabolic syndrome, and type 2 diabetes.
WHAT ARE THE SYMPTOMS OF LOW HDL CHOLESTEROL?
Low HDL cholesterol does not produce symptoms, so a blood test is the only way to know for sure if you have this condition. However, low HDL contributes to heart disease, for which there may be warning signs such as chest pain, dizziness, leg cramps, and shortness of breath. If you experience one or more of these symptoms, medical attention is strongly advised.
HOW TO INCREASE HDL CHOLESTEROL
Even if your LDL cholesterol is low, it’s important for your HDL to be within a desirable range. So if a blood test indicates that your HDL cholesterol is not ideal, you should take the steps necessary to raise your level. Your doctor may want to use medication for low HDL, but dietary and lifestyle measures are usually encouraged first to see if they have any impact.
DRUGS
When a blood test indicates that HDL cholesterol is too low, medication is the first course of action only if the complete lipid profile indicates very high cardiovascular risk. The drugs below are those most commonly recommended by doctors to patients who need to raise their HDL level. Take any drug that is prescribed to you only as directed by your doctor.
| DRUGS FOR LOW HDL CHOLESTEROL | |
| Drug | Considerations |
| Fenofibrate Tricor |
Side effects may include constipation, diarrhea, heartburn, nausea and/or vomiting, muscle aches, headache, retinopathy, anemia, lung problems, and pancreatitis. The drug may also deplete the body of essential nutrients, such as vitamin E, vitamin D, DHEA, and coenzyme Q10. Therefore, it is recommended that you also take 100 mg of CoQ10 once a day, as well as a multivitamin or mineral supplement daily. |
| Gemfibrozil Lopid |
Gemfibrozil may produce side effects such as constipation, diarrhea, heartburn, nausea and/or vomiting, muscle aches, headache, retinopathy, anemia, lung problems, and pancreatitis. This drug may also deplete essential nutrients from the body, including vitamin E, vitamin D, DHEA, and coenzyme Q10. Therefore, it is recommended that you also take 100 mg of CoQ10 once a day, as well as a multivitamin or mineral supplement daily. |
| Loop diuretics (bumetanide, torsemide, furosemide) Bumex, Demadex, Lasix |
Loop diuretics may cause depletion of calcium, magnesium, potassium, vitamin B1, vitamin B6, vitamin C, and zinc. Side effects may include bone loss, confusion, dry mouth, fatigue, headache, irregular heartbeat, mood changes, muscle cramps, nervousness, numbness, and poor wound healing. |
| Niacin (extended-release) | Speak to your healthcare provider before using if you are on blood thinners or diabetes medication. Extended-release usually does not cause flushing. |
| Non-steroidal anti-inflammatory drugs (NSAIDs) Advil, Aleve, Motrin, Naprosyn | Side effects vary among different NSAIDs, but can include constipation, diarrhea, gastrointestinal bleeding, headache, liver and/or kidney problems, and upset stomach. These drugs can also deplete the body of essential nutrients, such as DHEA, folic acid, melatonin, and zinc. You should take a quality daily multivitamin or mineral supplement while using NSAIDs. If you have trouble sleeping, taking 1 to 5 mg of melatonin one hour before bedtime may help. Start at the lowest possible dose and increase as necessary if your sleep cycle does not improve. |
| Phosphate salts (dicalcium phosphate, dibasic calcium phosphate) | Side effects may include upset stomach and/or vomiting. |
| Statins Lipitor (atorvastatin) Crestor (rosuvastatin) Mevacor (lovastatin) Pravachol (pravastatin) | Statin drugs can deplete essential nutrients from the body, including CoQ10, vitamin D, and vitamin E. Take 100 mg of CoQ10 daily along with a multivitamin or mineral supplement to prevent nutritional deficiencies. Side effects may include headache, muscle pain, nausea, weakness, elevated liver enzymes, memory loss, and kidney problems. Inform your doctor or pharmacist if you are currently on cholesterol-lowering drugs to avoid adverse drug interactions. Do not take with grapefruit juice. |
SUPPLEMENTS TO RAISE HDL CHOLESTEROL
You may want to consider taking a supplement to ensure you’re getting all the nutrients your body needs to manufacture good cholesterol and ward off the bad cholesterol. Some supplements that may help boost HDL cholesterol are detailed in the table below. It’s important to note that, as you may have noticed, niacin (vitamin B3) is available as a supplement form as well as a prescription medication. However, prescription niacin—a much more concentrated form of the substance—is used only for lowering triglycerides and LDL cholesterol, and requires a doctor’s supervision, as well as periodic liver enzyme testing. Most over-the-counter niacin products contain 25 to 100 mg per tablet or capsule, and are not extended release. (Extended- or sustainedrelease products are designed to dissolve slowly over a certain period of time.) Extended-release niacin products are available in 500-mg doses, but require regular testing of liver enzyme levels. Also, only niacin—not other forms of vitamin B3 like niacinamide and inositol hexniacinate—is effective for hyperlipidemia. Although supplements do not require a prescription, their use should be guided by a healthcare professional. You should also consult your doctor about appropriate dosing, which may vary according to individual needs and overall health.
| Supplements for Low HDL Cholesterol | ||
| Supplement | Dosage | Considerations |
| Aged Garlic Extract | 600 mg one to three times daily | Aged garlic extract is used to protect the heart and blood vessels, and is reported to help decrease oxidative stress markers, including those related to blood sugar regulation problems. Aged garlic has also been reported to reduce liver enzymes and fatty liver, as well as decrease the formation of advanced glycation end-products (AGEs), which are implicated in various health problems, such as heart disease, kidney problems, and cancer. Aged garlic is not reported to interfere with blood thinners. |
| Magnesium | 250 to 500 mg twice a day | Use magnesium aspartate, citrate, taurate, glycinate, or any amino acid chelate. Supports bone building and balances calcium intake. The ratio of calciumto-magnesium intake should be between 1 to 1 and 2 to 1. This supplement is reported to improve blood vessel function and insulin resistance, in addition to decreasing LDL cholesterol, total cholesterol, and triglycerides. Also essential for phase-I liver detoxification. If you experience loose stools after taking magnesium, cut your dose in half and gradually increase over the course of a few months. Consult your health-care provider for dosage advice. |
| Niacin (vitamin B3, extended-release) | 500-1,000 mg once a day | Speak to your medical provider before using if you are currently on blood thinners or diabetes medication. Extended-release niacin should not cause flushing. Have your liver enzyme levels tested regularly while taking niacin. |
| Omega-3 essential fatty acids DHL and EPA (fish oil) | 1,000 mg two to three times a day | Fish oil is one of the first supplements recommended by doctors for lowering triglycerides. In addition to its anti-inflammatory properties, fish oil is reported to lower total cholesterol levels and decrease oxidative stress, which is associated with LDL, or “bad” cholesterol. Speak to your doctor before taking if you are on blood-thinning medication, as fish oil may increase the risk of bleeding. Be sure to use only high-quality oils that have been tested for contaminants |
| Plant sterol esters | 1.7 g one to two times a day | Plant sterol esters have been shown to improve cholesterol levels and help lower LDL cholesterol. May interact with blood thinning medications, including aspirin. Effects of plant sterols may be counteracted by ezetimibe (Zetia). |
| Probiotics | 5 to 10 billion CFUs two to three times a day | Probiotics help normalize beneficial flora in the gastrointestinal tract, and are reported to decrease triglyceride and cholesterol levels. They are also reported to improve BUN levels and quality of life in people with kidney disease. It’s best to use heatstable products that do not require refrigeration. If using an antibiotic, wait three hours before taking probiotics. If diarrhea occurs, decrease your dosage. If this side effect persists for longer than 48 hours, stop taking the supplement and contact your doctor. Live cultures should be guaranteed through the date of expiration on label. For optimal results, take probiotics with meals, as food improves the survivability of the cultures. |
HOW TO IMPROVE HDL WITH LIFESTYLE CHANGES?
Like other labs on the lipid panel, maintaining a healthy HDL level—as well as preventing an unhealthy level—is influenced by diet and lifestyle. Although there is some debate about whether certain foods are effective for raising HDL levels, a few studies have shown that common dietary recommendations for lowering total cholesterol may also help increase HDL. The most effective dietary measures for raising HDL are the same as those used for lowering triglycerides. When triglycerides are reduced, HDL almost always increases.
First, it’s most important to reduce your intake of inflammation-causing foods that elevate blood glucose, primarily sugary drinks, sweets, and foods made with white flour, like white bread and pasta. Even natural sweeteners like honey and molasses should be used sparingly. Pay attention to every source of sugar in your diet—for example, jellies, jams, ketchup, and hidden sugars in foods like yogurt and sweetened fruit—and cut back on your consumption. HDL cholesterol levels also improve when consumption of foods containing or fried in partially hydrogenated oils is decreased.
As you already know, these oils are loaded with trans fat, a substance that contributes to internal inflammation, heart disease, and other health problems. Instead, take in more monounsaturated fats, which enhance the anti-inflammatory properties of HDL, by using nut oils when cooking or by snacking on raw unsalted nuts. Nuts, along with cranberries and fish high in omega-3s, also help support a better LDL-to-HDL ratio. Boosting fiber intake by eating more leafy green vegetables, beans, low-glycemic fruit, and some whole grains is strongly encouraged as well; you should aim for at least two servings of fiber-rich foods per day.
In addition to providing your body with fiber, these foods are excellent sources of antioxidants, which reduce inflammation. Finally, one or two glasses of red wine per day have been reported to have a positive impact on HDL levels. However, drinking more than this amount is not recommended. In addition to adjusting dietary intake, adopting a few healthy habits will also favorably affect your HDL cholesterol. Aerobic workouts—exercise that increases your heart rate—are especially beneficial for raising HDL numbers, so do some form of cardio in thirty-minute sessions four or five times a week. Running, walking, bicycling, swimming, and sports such as tennis are all great options. Physical activity will also help you lose weight, which is crucial for healthy cholesterol levels as well. If you smoke, quitting can raise your HDL level by 10 percent.
CONCLUSION
You are now familiar with the full lipid panel. These four biomarkers—triglycerides, total cholesterol, LDL, and HDL—along with homocysteine and C-reactive protein, are closely connected, so treating one abnormal lab value may positively affect one or more of the others. When reading your lipid panel blood test results, keep in mind that “normal” and “target” numbers are not always the same for everyone. Your unique biochemistry, genetics, and other individual factors play a role in determining lab values, as well as your risk of heart disease, metabolic syndrome, and other medical conditions. You should strive for your personal best number, which should be as close to the target range as possible. When a blood test indicates that treatment is necessary, you should work with a health practitioner—preferably one who is familiar with your medical history—to correct the problem with medication, lifestyle changes, or both.
Last Updated: June 21, 2021
Originally Published: August 1, 2016
