Many doctors are still focusing on the wrong type of cholesterol. Early on in my career, I made that same mistake. Like many cardiologists I viewed basic cholesterol numbers as a telltale sign of illness. Fortunately, I got wise over time after seeing too many heart attacks among patients who had so-called “normal cholesterol.”
Having given up on the cholesterol theory—at least with the obsession of lowering LDL cholesterol—I’ve focused instead on ridding the body of inflammation, the real cause of arterial destruction and cardiovascular disease.
Many doctors have still focused on ridding the body of LDL cholesterol. Yet, despite aggressive efforts to lower LDL cholesterol many heart patients continue to be at significant risk for cardiovascular events.
This suggests to me that doctors should switch their cholesterol focus away from LDL cholesterol and over to HDL cholesterol. HDL serves the body as a lipid garbage truck, picking up oxidized LDL and excess cholesterol particles and carrying them back to the liver for processing into steroid hormones and bile acids. HDL thus reduces the potential of LDL to get in harm’s way.
What should your HDL levels be? Ideally, your HDL cholesterol should be 50 mg/dL or greater, but less than 90 mg/dL. Research has shown that high HDL cholesterol can be dysfunctional. If your HDL cholesterol is significantly higher than 90 mg/dL (into the hundreds), getting a fractionation test to assess HDL composition may be worthwhile in assessing cardiovascular risk.
If Your HDL Cholesterol Is Low, Here's How to Raise It
- Up your intake of extra virgin olive oil (EVOO). I recommend getting 2-3 tablespoons of extra virgin olive oil a day in your diet. I personally use olive oil frequently in my diet, and douse it on fish, meats, steamed vegetables, and even soup. Remember to choose organic extra virgin olive oil as often as you can.
- Eat fewer high glycemic carbohydrates and trans fats. Instead, opt for foods that are rich in heart-healthy fats and soluble fiber.
- Take niacin (vitamin B3). Niacin is one of the most powerful nutrients available to raise HDL cholesterol. When you take niacin, you’ll likely experience a tingly, pins-and-needles, and sometimes hot flushing or itching of the skin. This typically lasts no more than a half-hour to an hour. The higher the initial dose, the greater the initial flushing effect. My recommendation is that you start with 250 mg of niacin three times daily, and slowly work up to 1–2 grams in divided doses three times a day. Just make sure you're taking regular niacin, not sustained release niacin.
Get regular, physical exercise. Strive for 30–60 minutes of aerobic activity three to five days a week.
- Drink red wine in moderation. Red wine helps to boost HDL cholesterol, plus it contains resveratrol, a phytonutrient with cardio-protective benefits. But I recommend no more than one glass a day, or every other day.
What's Also Important is Your HDL-Triglyceride Ratio
In addition to raising your HDL cholesterol, you want to lower you triglycerides. Ideally, you want to achieve no more than a two-to-one ratio of triglycerides to HDL cholesterol. For example, if your triglycerides are 100 mg/dl, you want your HDL cholesterol to be 50 mg/dl. While the two-to-one ratio is ideal, anything under 3.5 is a good ratio. But I don't like to see a blood ratio that's greater than five.
If your triglycerides are high, you can bring them down by reducing your intake of processed carbohydrates and sugar, and losing weight. Even a modest weight loss can bring your triglycerides down significantly. Omega-3 essential fatty acids, 2-3 grams daily in divided doses, can also help to reduce your triglyceride level.
I'm a personal testament to what a huge difference lifestyle changes can make when it comes to cholesterol. After losing just eight pounds by taking a green tea supplement, I had my cholesterol tested and my HDL was 60 and my triglycerides were 46, which is an ideal ratio.
Now it’s your turn: Have you had your HDL levels tested recently?