How to increase high-density lipoprotein (HDL) levels?

From the Guidelines

To increase high-density lipoprotein (HDL) levels, focus on lifestyle modifications including regular aerobic exercise, maintaining a healthy weight, and adopting a heart-healthy diet rich in omega-3 fatty acids, monounsaturated fats, and soluble fiber. Quit smoking if you currently smoke, as tobacco use significantly lowers HDL 1. Moderate alcohol consumption (one drink daily for women, up to two for men) may slightly increase HDL, but isn't recommended solely for this purpose. Specific dietary changes should include consuming fatty fish like salmon twice weekly, incorporating olive oil, avocados, nuts, and whole grains while limiting refined carbohydrates and trans fats.

Some key points to consider:

• Regular physical activity, such as aerobic exercise, can help increase HDL levels 1.
• A heart-healthy diet that is rich in omega-3 fatty acids, monounsaturated fats, and soluble fiber can also help increase HDL levels 1.
• Medications that can raise HDL include niacin (vitamin B3, typically 1-3 grams daily, though side effects like flushing may occur), fibrates like fenofibrate, and statins, though these are primarily prescribed for lowering LDL cholesterol 1.

It's also important to note that HDL is important because it acts as the body's "good" cholesterol, helping remove excess cholesterol from the bloodstream and transporting it to the liver for processing and elimination, thereby reducing cardiovascular risk 1.

In terms of specific exercise recommendations, prolonged moderate-intensity aerobic exercise at 70–80 % HR reserve, combined with low-intensity resistance training at 50 % 1 RM, can be effective in improving HDL levels 1. Additionally, increasing physical activity to at least 30 minutes per day, 5 times a week, can also help increase HDL levels 1.

Overall, a combination of lifestyle modifications, including regular exercise, a heart-healthy diet, and not smoking, can help increase HDL levels and reduce the risk of cardiovascular disease.

From the FDA Drug Label

Gemfibrozil is a lipid regulating agent which decreases serum triglycerides and very low density lipoprotein (VLDL) cholesterol, and increases high density lipoprotein (HDL) cholesterol Gemfibrozil increases levels of high density lipoprotein (HDL) subfractions HDL2 and HDL3, as well as apolipoproteins AI and AII The mean increase in HDL-cholesterol among the Type IIb patients in this study was 12.6% compared to placebo. Physical exercise can be an important ancillary measure, and has been associated with rises in HDL-cholesterol.

To increase HDL (high-density lipoprotein) levels, consider the following:

• Gemfibrozil therapy may be effective in increasing HDL levels, particularly in patients with Type IIb hyperlipidemia 2.
• Physical exercise can also help raise HDL-cholesterol levels 2.
• Dietary therapy and management of excess body weight and alcohol intake are important initial steps in treating dyslipidemia 2.
• Treatment of underlying diseases such as hypothyroidism or diabetes mellitus can also contribute to managing hyperlipidemia 2.

From the Research

Increasing HDL Levels

To increase high-density lipoprotein (HDL) levels, several lifestyle interventions and methods have been identified:

• A healthful diet that is low in saturated fat and sufficient in unsaturated fat, as noted in 3
• Regular physical activity, with studies suggesting that moderate-intensity exercise can improve HDL function and lipid/lipoprotein profile, as seen in 4
• Attaining a healthy weight, as part of a comprehensive approach to increasing HDL levels, mentioned in 3
• Moderate alcohol consumption, as part of a balanced lifestyle, referenced in 3
• Cessation of cigarette smoking, which can contribute to increased HDL levels, as indicated in 3 and 5

Exercise and HDL Levels

Exercise has been shown to have a positive effect on HDL levels:

• Aerobic exercise training can increase serum levels of HDL cholesterol, with a minimal weekly exercise volume of 900 kcal of energy expenditure per week or 120 minutes of exercise per week, as estimated in 6
• Moderate-intensity exercise can increase HDL-C and apolipoprotein A-I levels, as well as decrease low-density lipoprotein cholesterol and apolipoprotein B levels, as found in 4
• High-intensity exercise can further increase HDL-C and apolipoprotein A-I levels, as seen in 4
• The volume of exercise required to increase HDL-C levels may be substantially more for women than men, as suggested in 7

Dietary and Pharmacological Interventions

In addition to lifestyle changes, certain dietary and pharmacological interventions may also be effective in increasing HDL levels:

• A diet low in saturated fat and high in unsaturated fat, as recommended in 3
• Niacin, which has been shown to increase HDL levels, as noted in 5
• Fibrates and estrogens, which can stimulate the synthesis and production of HDL-apoprotein A-I, as indicated in 5