NMU – 225 How to Raise the Good Cholesterol: HDL

Nutrition/Natural Medicine Update No 225 (January 5, 2022)

with Dr. James Meschino

Topic: How to Raise the Good Cholesterol: HDL

Main Source: American Journal of Clinical Nutrition (2018)

Over the years I have watched many patients and acquaintances make significant dietary and lifestyle changes that have significantly reduced their total cholesterol and LDL-cholesterol blood levels. LDL-cholesterol is the bad cholesterol that deposits cholesterol in the artery wall leading to blockage. This, of course, greatly increases the risk of heart attack, stroke, the need for bypass surgery, and other cardiovascular problems. Eating less saturated fat, trans-fats, deep-fried foods, pan-fried foods, breaded foods, and high cholesterol-containing foods, and bringing your fasting blood sugar (glucose) down into a safe range, are all strategies shown to lower total cholesterol and LDL-cholesterol. Endurance exercise and reducing body fat can also help. In some cases, drug therapy is required to get LDL-cholesterol into the safest possible range, which is a blood LDL-cholesterol below 1.5mmol/L (58 mg/dl). Consuming more soluble fiber and eating 30 gm of walnuts per day has also been shown to significantly reduce LDL-cholesterol levels. But, having a high HDL cholesterol is also very helpful, as HDL cholesterol acts like a vacuum cleaner to remove some of the cholesterol that has already been deposited into the artery wall. So, HDL helps to reverse clogged arteries to some degree. The ideal HDL blood level to shoot for is at or above 1.6 mmol/L (60 mg/dL).  Unfortunately, the same factors that lower LDL don’t always raise HDL. As I said, many people lower their LDL, which is great, but their HDL may remain low, which is not so great.

So, how can you raise your HDL? In 2018 the American Journal of Clinical Nutrition published a review of all relevant studies testing avocado consumption, as a means to raise HDL-cholesterol. The studies provided some good news for people trying to increase their HDL. In the 7 studies conducted to date that were deemed to be relevant, avocado intake significantly increased HDL cholesterol by 0 .07 mmol/L (or 2.84 mg/dL). That’s not a huge elevation, but it helps. Avocado consumption did not lower total cholesterol, LDL-cholesterol, or blood sugar levels, but simply raising HDL blood levels is an impressive finding.

There are other established ways to raise HDL, besides eating avocadoes more regularly.  These include:

• Regular endurance exercise
• Reducing your waist circumference if you are overweight
• Quitting smoking if you are a smoker
• Using extra virgin olive oils has been shown to improve the efficiency of HDL to remove cholesterol from the artery wall, even though it may not raise actual HDL blood levels.
• Eating 30 gm (less than an ¼ cup) of cashews per day has been shown to slightly increase HDL levels as well as lowering systolic blood pressure in type 2 diabetics.
• Coconut oil has been shown to raise HDL cholesterol levels, but it raises LDL cholesterol to an even greater degree, which results overall, in an increased risk for heart disease. So, I don’t recommend using coconut oil to raise your HDL levels or for any other reason.
• There is also contradictory evidence regarding the ability of fatty fish or omega-3 fats to raise HDL levels. Some studies show they do, and other studies show that they don’t. If they do, it’s not by very much. But fatty fish and omega-3 fats have other properties that improve cardiovascular health, so they can be part of a healthy heart and cardiovascular program in most cases.

Raising HDL is not an easy task for some people, due likely to genetic factors. Reducing your waist circumference, getting regular endurance exercise and quitting smoking are the three big lifestyle factors that can raise HDL by the greatest margin. Consuming avocado, cashews, and extra virgin olive oil may also help.

I have provided the references for this information in the text below.

References:

1. Mahmassani HA et al. Avocado consumption and risk factors for heart disease: a systematic review and meta-analysis. Am J Clin Nutr 2018; 107(4): 523-536 https://pubmed.ncbi.nlm.nih.gov/29635493/
2. WebMD: HDL Cholesterol: the Good Cholesterol (July 2020) https://www.webmd.com/cholesterol-management/guide/hdl-cholesterol-the-good-cholesterol
3. Helal O et al. Extra-virgin olive oil consumption improves the capacity for HDL to mediate cholesterol efflux and increase ABCA1 and ABCG1 expression in human macrophages. Br J Nutr 2013; 109(10): 1844-1855 https://pubmed.ncbi.nlm.nih.gov/23051557/
4. Mohan V et al. Cashew nut consumption increases HDL cholesterol and reduces systolic blood pressure in Asian Indians with type 2 diabetes: A 12-week randomized controlled trial. 2018; 148(1): 63-69 https://pubmed.ncbi.nlm.nih.gov/29378038/
5. Neelakantan N et al. The effect of coconut oil consumption on cardiovascular risk factors: A systematic review and meta-analysis of clinical trials. J Circulation 2020; 141: 803-814 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.043052
6. Abdelhamid AS et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Library 2020 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003177.pub5/full

Eat Smart, Live Well, Look Great,

Dr. Meschino