HDL levels are determined by lifestyle and genetics. A variety of approaches can help increase HDL levels including exercise, stress management, nutrition intervention, and abstinence from tobacco and alcohol products.
Recall that the HDL lipoprotein is effective in reverse cholesterol transport, an anti-atherogenic process that carries cholesterol from tissues and from the arterial wall back to the liver where it can be prepared for excretion. HDL is also thought to promote endothelial health and reduce inflammation. An insufficiency of HDL increases the progression of atherosclerosis and cardiovascular disease risk. Investigate sources of inflammation and other metabolic disorders in the event of a low HDL (Marz 2017).
Strategies to increase HDL and improve its function include exercise, increased physical activity, and high-dose niacin in the form of nicotinic acid (though niacin use did not translate into a reduction in adverse cardiovascular events). A healthy balanced diet that incorporates an abundance of plant-based foods (e.g., fresh fruits, vegetables, legumes, whole grains, nuts, seeds, herbs, and spices), as well as fish and lean meats and dairy, can promote a healthy lipid profile as well (Farrer 2018).
Additional nutrition interventions that may help increase HDL levels include minimally refined “virgin” olive oil, as well as supplements of red yeast rice, bergamot, and artichoke leaf extract (Rondanelli 2016). The addition of soy products, omega-3 fatty acids, and monounsaturated fatty acids may also increase HDL without increasing LDL (Yanai 2018).
It should also be noted that high levels of HDL promote additional risk. An HDL above 60 mg/dL (1.5 mmol/L) may not have additional clinical benefit and a level over 100 mg/dL (2.6 mmol/L) may increase risk of all-cause mortality (Marz 2017). An HDL above 100 mg/dL has also been associated with a significantly higher risk of abnormal liver enzymes compared to an HDL of 61-80 mg/dL (1.6-2.1 mmol/L) (Jiang 2014).
References
Farrer, Sterling. “Beyond Statins: Emerging Evidence for HDL-Increasing Therapies and Diet in Treating Cardiovascular Disease.” Advances in preventive medicine vol. 2018 6024747. 9 Jul. 2018, doi:10.1155/2018/6024747
Jiang, Zhenghui Gordon et al. “Low LDL-C and high HDL-C levels are associated with elevated serum transaminases amongst adults in the United States: a cross-sectional study.” PloS one vol. 9,1 e85366. 15 Jan. 2014, doi:10.1371/journal.pone.0085366
März, Winfried et al. “HDL cholesterol: reappraisal of its clinical relevance.” Clinical research in cardiology : official journal of the German Cardiac Society vol. 106,9 (2017): 663-675. doi:10.1007/s00392-017-1106-1
Rondanelli, Mariangela et al. “MediterrAsian Diet Products That Could Raise HDL-Cholesterol: A Systematic Review.” BioMed research international vol. 2016 (2016): 2025687. doi:10.1155/2016/2025687
Yanai, Hidekatsu, and Norio Tada. “Which Nutritional Factors Are Good for HDL?.” Journal of clinical medicine research vol. 10,12 (2018): 936-939. doi:10.14740/jocmr3646