What helps improve High-Density Lipoprotein (HDL) levels?

Effective Strategies to Improve HDL Cholesterol Levels

Regular physical activity and exercise are the most effective lifestyle interventions for increasing HDL cholesterol levels, with at least 30 minutes of moderate-intensity aerobic exercise 5 times weekly recommended as the foundation of HDL improvement. 1, 2

Exercise Recommendations

• Engage in prolonged moderate-intensity aerobic exercise at 70-80% heart rate reserve for at least 30 minutes, 5 times weekly, combined with low-intensity resistance training at 50% of 1 repetition maximum (1RM) for healthy individuals 1
• For those with dyslipidemia, progress to 85% maximum heart rate with moderate to high-intensity resistance training at 75-85% 1RM for optimal HDL improvement 1
• There is a linear dose-response relationship between activity levels and HDL cholesterol levels - more activity generally yields greater HDL increases 2, 3
• A minimum threshold of approximately 1200-1600 kcal of energy expenditure per week (equivalent to 7-14 miles of jogging) appears necessary to significantly improve HDL levels 3
• The combination of aerobic exercise and resistance training provides enhanced benefits for the overall lipid profile compared to either modality alone 1, 2
• For individuals with limited mobility, resistance training progressing from 50% to 75% 1RM in major muscle groups can be incorporated into circuit sessions 1

Dietary Modifications

• Replace saturated fats with monounsaturated fats (such as olive oil) and polyunsaturated fats rather than with carbohydrates to maintain or improve HDL levels 4, 2
• Limit refined carbohydrates and added sugars, as high-carbohydrate diets can reduce HDL cholesterol levels 4, 2
• Consume omega-3 fatty acids through fish consumption at least twice weekly to support HDL function 4, 5
• Avoid trans-unsaturated fatty acids, which can lower HDL cholesterol 2
• If consumed, moderate alcohol intake may improve HDL levels, but this should not be recommended as a strategy to increase HDL due to other health risks 4, 6

Weight Management

• Achieve and maintain a healthy body weight (BMI 18.5-24.9 kg/m²) through caloric control 4
• Weight reduction is particularly important for those with elevated triglycerides and low HDL cholesterol 4, 2
• Combining a healthy diet with weight loss and physical activity can increase HDL-C by 10% to 13% 6

Other Lifestyle Modifications

• Smoking cessation can increase HDL cholesterol levels by up to 30% 4, 2
• Limit dietary cholesterol to <200 mg/day 4

Pharmacological Options

• Niacin (nicotinic acid) is the most effective medication for raising HDL cholesterol, but can affect blood glucose levels, particularly at high doses 1, 2
• At modest doses (750-2,000 mg/day), niacin provides significant HDL benefits with glucose changes that are generally manageable with adjustment of diabetes therapy 1
• Fibrates like fenofibrate and gemfibrozil can effectively increase HDL cholesterol levels and reduce triglycerides 7, 8
• Fenofibrate is indicated as adjunctive therapy to diet to increase HDL-C in adult patients with primary hypercholesterolemia or mixed dyslipidemia 7

Common Pitfalls and Considerations

• Very low-fat diets (<15% energy as fat) can paradoxically lower HDL cholesterol 4
• Relying solely on medication without addressing underlying lifestyle factors will limit long-term success 4
• Exercise intensity must be sufficient - studies suggest that higher-intensity aerobic exercise has more consistent impacts on HDL than lower intensity physical activity 1
• For women, the volume of exercise required to increase HDL-C appears to be substantially more than for men, possibly due to higher baseline HDL-C levels 3
• HDL functionality (how well HDL performs its roles) may be more important than absolute HDL levels, and exercise can improve HDL functionality even when HDL levels don't change significantly 9, 5