How to Increase HDL Cholesterol
Regular aerobic exercise at moderate intensity for at least 30 minutes, 5 times weekly, combined with resistance training, represents the most effective lifestyle intervention for raising HDL cholesterol levels. 1, 2
Exercise: The Primary Intervention
Exercise demonstrates a dose-response relationship with HDL cholesterol—more activity yields greater increases. 3, 1 The evidence strongly supports structured exercise programs over general physical activity recommendations.
For Healthy Individuals
- Perform prolonged moderate-intensity aerobic exercise at 70-80% heart rate reserve 3, 1
- Combine with low-intensity resistance training at 50% of 1 repetition maximum (1RM) 3, 1
- Aim for at least 30 minutes daily, 5 times weekly as a minimum threshold 3, 1, 2
- Target 1200-1600 kcal per week of exercise expenditure (equivalent to 7-14 miles of jogging weekly) to achieve statistically significant HDL increases 4
For Those with Dyslipidemia
- Progress to higher intensity aerobic exercise at 85% maximum heart rate 3, 1
- Advance to moderate-to-high intensity resistance training at 75-85% of 1RM 3, 1
- The increased volume and intensity produce greater improvements in the overall lipid profile 3
For Limited Mobility Populations
- Implement resistance training progressing from 50% to 75% of 1RM in major muscle groups 3, 1
- Circuit training at moderate intensity can be effective 3, 1
Important caveat: Women may require substantially more exercise volume than men to achieve similar HDL increases due to higher baseline HDL levels. 4
Dietary Modifications
Fats: Quality Over Quantity
- Replace saturated fats with monounsaturated fats (olive oil, canola oil) and polyunsaturated fats (corn oil, peanuts) rather than increasing carbohydrates 1, 2
- Limit saturated fat to <7% of total daily calories 2
- Completely avoid trans-unsaturated fatty acids (<1% of energy), which actively lower HDL 1, 2
- Maintain adequate unsaturated fat intake at 15-20% of calories 5
Critical pitfall: Very low-fat diets (<15% of energy as fat) paradoxically lower HDL cholesterol and should be avoided. 2
Carbohydrate Management
- Minimize refined carbohydrates and added sugars, as high-carbohydrate diets reduce HDL levels 1, 2
- Limit beverages and foods with added sugars 2
- This is particularly important as the dose-response relationship between carbohydrate intake and HDL reduction is well-established 1, 2
Additional Dietary Elements
- Include plant stanols/sterols (2g/day) for overall lipid profile improvement 2
- Increase soluble fiber intake (10-25g/day) 2
- Consume fish, especially oily fish, at least twice weekly for omega-3 fatty acids 2
- Limit dietary cholesterol to <200 mg/day 2
Weight Management
Achieve and maintain a healthy body weight (BMI 18.5-24.9 kg/m²), as excess weight adversely affects HDL levels. 2 Weight reduction is particularly critical for patients with elevated triglycerides and low HDL. 1 Combining healthy diet with weight loss and physical activity can increase HDL by 10-13%. 5
Smoking Cessation
Quit smoking immediately—this single intervention can increase HDL cholesterol by up to 30% and represents one of the most powerful modifiable factors. 1, 2
Alcohol Considerations
Moderate alcohol consumption may raise HDL levels, though this is not recommended solely for HDL benefits given other health risks. 6 If alcohol is consumed, do so in moderation, as excessive intake can worsen triglycerides. 2
Pharmacological Options When Lifestyle Is Insufficient
First-Line Agents
Niacin (nicotinic acid) is the most effective drug for raising HDL cholesterol 3, 1, 2
Fibrates (gemfibrozil, fenofibrate) effectively increase HDL and reduce triglycerides 3, 1, 2
Statins
While statins primarily target LDL cholesterol, they modestly increase HDL by at least 5% 8
Important consideration: Recent evidence questions whether raising HDL cholesterol pharmacologically provides cardiovascular benefit, as multiple drug trials (CETP inhibitors, apolipoprotein A1 infusion) failed to show clinical benefit despite raising HDL levels. 8, 9 This suggests HDL function may be more important than HDL quantity, and lifestyle interventions may improve HDL function in ways that medications do not. 10
Monitoring Strategy
- Measure lipid levels annually in adults with diabetes or cardiovascular risk factors 3, 2
- For low-risk individuals (HDL >50 mg/dL, LDL <100 mg/dL, triglycerides <150 mg/dL), reassess every 2 years 3
- Evaluate lifestyle interventions at regular intervals, with consideration of pharmacological therapy at 3-6 months if targets are not achieved 3, 2