Cholesterol is the OG bad word in the nutrition world. For decades, people were terrified of any foods that could potentially affect their body’s amount of the substance (like eggs and red meat). But now, it seems like people are obsessed with three little letters pertaining to cholesterol: HDL.
For context: There are actually two types of cholesterol: LDLs (low-density lipoproteins) and HDL (high-density lipoprotein). LDL cholesterol is often called the “bad” kind, and having too much of it can build up in the lining of your blood vessels, which can block blood flow and increase a person’s risk of heart attack and stroke. HDL cholesterol, on the other hand, clears out of the body and high levels of it are associated with a reduced risk of heart attack and stroke. (That’s why it’s…well, the “good” kind.)
Generally, you should be focusing on lowering your LDLs and raising your HDLs, says Robert Rosenson, MD, director of cardiometabolic disorders at the Icahn School of Medicine at Mount Sinai. But that’s where things get a little more complicated.
While there’s lots of evidence linking higher HDL levels to a decreased risk of heart attack and stroke, recent clinical trials of medications developed to increase HDL didn’t actually reduce the likelihood that participants would have heart problems. Dr. Rosenson says that’s because high HDL levels are a marker for healthy living that you can’t directly manipulate. “People with the highest HDL cholesterol levels were ones that were more physically fit, less overweight, less likely to have diabetes, and more likely to drink small to moderate amounts of alcohol.” Translation: Genetics aside, if you’re living a healthy life, you’re likely to have higher levels of HDLs. (You just don’t want to have that number be too high, because some research suggests that’s potentially as problematic as having high LDL levels.)
Dr. Rosenson adds that some doctors focus too much on the ratio of LDL to HDL and not enough on the numbers themselves, which he says is misleading. Just because a person has high HDL levels doesn’t mean that they’re necessarily at a lower risk of a heart attack if they also have high LDLs, he says.
Good and bad, your cholesterol levels can predict your risk for stroke, heart attack, and other heart issues. That’s why Dr. Rosenson says healthy people over 18 should have their cholesterol tested every five years. If someone has a family history of high cholesterol, has diabetes or kidney disease, or has experienced cardiovascular events like a heart attack, he recommends working with your doctor to establish a more regular testing schedule.
Again, while Dr. Rosenson emphasizes that there is no one way to manipulate your HDL cholesterol. However, there are some lifestyle changes people can make that overall can help increase HDL cholesterol levels (along with boosting their overall health).
1. Get your sweat on
We probably don’t need to tell you twice how important regular exercise is, but an added benefit to working out is that it can improve HDL levels. In one small study of 58 overweight men, the group who was asked to perform 50-minute, high-intensity circuit workouts three times a week for three months saw “significantly greater” increases in HDL than the group asked to do less intense forms of exercise. Granted, this is a small study size (and it’s only on men) but it’s still pretty promising. Dr. Rosenson generally advises a combination of vigorous aerobic exercise and strength training to increase HDL particles.
2. Don’t skimp on (good) fats
When it comes to staving off heart disease, olive oil is the real MVP. A 2017 study in the journal Circulation found that people eating an olive-oil rich iteration of the Mediterranean diet had better-functioning HDL than people who ate a nut-rich version of the plan, as well as people who ate a low-fat diet. The theory, researchers told TIME, was that the antioxidant properties of olive oil can help support HDL function. And one 2014 meta-analysis of more than 40 studies with 840,000 subjects found that the oil reduced the risk of heart attack or stroke more than any other source of monounsaturated (or “good”) fat. Dr. Rosenson says people can also increase their HDL cholesterol by eating foods enriched in omega-3 fatty acids like salmon, mackerel, or herring.
3. Cut back on (excessive) carbs
Fair warning: The science is mixed here. Several studies have shown that for optimal HDL levels, it pays to follow a low-carb, high-fat diet. (It’s what Dr. Rosenson generally recommends for better heart health.) A 2015 study of patients with Type 2 diabetes found that the group assigned to eat a diet high in unsaturated fats with less than 50 grams of carbohydrates a day saw their HDL levels go up almost twice as much as the group following a high-carb, low-fat diet. Another study tracking a group of obese patients found that while both high-carb, low-fat diets and low-carb, high-fat diets resulted in weight loss, the participants eating the low-carb, high-fat diet lost weight and showed significant improvement in their HDL levels and other measures of cardiovascular health.
It should be noted however that the quality of the protein and fat one eats on a low-carb, high-fat diet matters for heart health—multiple studies have shown that women on low-carb diets who eat lots of animal fats or animal proteins don’t get the same heart-healthy benefits as others. There are also other experts (and studies) that advocate for a moderate amount of complex carbohydrates for lower mortality risk and better heart health.
4. Stop smoking
You’re not still doing that, are you? Of course not. But if you were still sneaking the occasional cigarette, here’s reason number 19278 to quit: You’ll have higher levels of HDL cholesterol in your bloodstream. Dr. Rosenson says that 60 days after someone stops smoking, their HDL cholesterol goes up to where it was before they started smoking.
5. Eat more antioxidant-rich foods
Fruits and veggies—especially leafy greens, certain kinds of berries, beets, red peppers, and other colorful produce—are jam-packed with heart-healthy antioxidants, which can increase HDL levels. Dr. Rosenson says antioxidants may also protect the LDL from oxidation (oxidized LDL is a type of LDL that gets into the inflammatory cells and contributes to plaque build up in the arteries).
Additional reporting by Kara Jillian Brown.
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