What can you do to improve your good cholesterol?

I had a question from a patient today - ‘How can I improve my 'good cholesterol' without drugs?’

Having a good cholesterol profile is important to reduce the risk of cardiovascular disease (CVD), i.e. strokes/heart attacks. 

Cholesterol profile looks at all the different types of cholesterol we have in our bodies and is far more important than looking just at the total cholesterol. 

A simple/ basic profile shows us:

  • the total cholesterol (TC) - this is the total amount of cholesterol in your blood. Ideally, it should be 5 mmol/L* or less.

  • triglycerides (TG)- this represents your body's ability to clear fat from the blood after a meal. Ideally, it should be less than 1.7 mmol/L* on a fasting sample or less than 2.3 mmol/L on a non-fasting sample)

  • HDL 'good' cholesterol - the amount of good cholesterol, ideally it should be over 1 mmol/L* (men) and over 1.2 mmol/L* (women).

  • LDL 'bad' cholesterol - this is the amount of LDL-cholesterol), ideally it should be 3 mmol/L* or less

  • Cholesterol ratio, which is TC divided by HDL(very important ) - A ratio above 6 is considered high risk - the lower this figure is the better. According to the American Heart Association (AHA), you should aim to keep your ratio below 5, with the ideal cholesterol ratio being 3.5

Cholesterol is complicated on many levels.A good/beneficial ratio prevents (?) furring of the arteries, a problem which can lead to strokes and heart attacks. One should be aiming for a high HDL cholesterol (> 1.3mmol/l / 60mg/dl ) and a ratio of less than 4.

What can you do to improve your cholesterol profile?

  1. Stop smoking. An approximate 10% increase in HDL can be seen.

  2. Weight loss. Around 1 kg loss can increase HDL by 0.3mg/dl.

  3. Aerobic exercise. Aim for 30mins at least 5 times per week. Fast walking, biking, swimming.

  4. Limit red meat (aim for one portion per week).

  5. Aim for a minimum of 2 litres of water per day (helps to stay regular and improves elimination.

  6. Good quality Omega-3 (not cod liver oil supplements as too much vitamin A). Ocean fish like Salmon is great 2-3 times per week. Also consider a fish oil supplement containing EPA and DHA, which reduce triglycerides and probably protect the heart. They also have many other proven health benefits.

  7. Garlic supplements can increase HDL and lower LDL. Recommended 500mg per day.

  8. Psyllium husk capsules (dietary fibre supplement) are good for bowel health and increase HDL levels.

  9. Niacin/vitamin B3. High doses (500mg-1g per day) are needed to improve cholesterol profile. However, at this dose, other medications can be affected and can cause unpleasant side effects. Speak to your doctor before taking.

What about statins?:  

  • Statins reduce/improve cholesterol profiles and most people have no side effects taking them.

  • They should be prescribed in certain situations (e.g. if your individualised CVD risk score is above a certain level or you have type 2 diabetes).

  • They are not something to be scared about.

  • They are important to consider if a 3-month adjustment in lifestyle and diet has not reduced your cardiovascular disease risk.

Keith Nicholl Medical Centre