High Cholesterol: Raising Your HDL Level

Cholesterol is a type of fat in your blood. Your body needs it for many things, such as making new cells. Your body makes all the cholesterol it needs. But you can also get cholesterol from some of the foods you eat.

HDL, or high-density lipoprotein, is the good kind of cholesterol. It is made mostly of protein and a small amount of fat. HDL helps move cholesterol out of your body. High HDL levels help keep cholesterol from clogging your arteries and help lower your risk of heart attack or stroke.

Having low levels of HDL can increase your risk of having a heart attack or stroke. Your HDL level should be at least 40 (measured in milligrams per deciliter, or mg/dL), but higher is better.

Low HDL usually is caused by a poor diet and a lack of exercise. You may raise your HDL level and lower your risk of heart attack by eating less animal fat and more vegetables. Getting plenty of exercise and quitting smoking can also help. But for some people, low HDL runs in the family. If changes in diet and exercise don't raise your HDL level, you may need medicine.

Continue to Why?

When your doctor says that you have high cholesterol, it's because you have too much of the bad kind in your blood. A high level of LDL raises your risk of heart attack and stroke.

Having a high HDL level, which is the good kind of cholesterol, can help. HDL helps your body get rid of LDL. And the lower your LDL, the lower your risk of heart attack and stroke. Here's a good way to remember it:

• HDL = Healthy. Keep it High.
• LDL = Lousy. Keep it Low.

The table below shows you where your HDL levels should be.

HDL cholesterol

Best	60 or higher protects against heart disease
Good	40 or higher
Bad	Below 40

Continue to How?

The first steps toward raising your HDL involve making changes to your lifestyle.

1. Eat healthy foods.
2. Stay active.
3. Lose weight if you need to.
4. If you smoke, quit.

If these changes don't raise your HDL enough, you may need to take medicine also.

It may seem simple enough, but the truth is that making lifestyle changes takes some work. And making lifestyle changes that become part of your normal routine is harder still. The key is to make small changes and make them a habit. And when you've turned one small change into a lifelong habit, start again with another small change.

Below you'll find some tips for making small changes that can help you get started on healthy changes. Over time, these things will help you raise your HDL. When you're ready, try the Therapeutic Lifestyle Changes (TLC) Program. It can help you lower LDL as well as raise HDL.

1. Eat healthy foods.

Here are a few tips to get you started on making small changes at home:

• Eat one more serving of fruits or vegetables every day. Add an apple or some carrots at lunch, or double your helping of vegetables at dinner.
• Avoid deep-fried foods. Swap the fried chicken for baked chicken. Or skip the french fries and have a salad instead.
• Think of meat as a side dish, not the center of the meal. You can still eat meat. Just be smart about it. Eat leaner meat and less of it.
• Try a vegetarian meal each week. You’ll be surprised at how delicious and filling a meal without meat can be.
• Switch to fat-free milk. If you’re drinking whole milk, try the step-down approach. Change to 2% milk for a month, then to 1% for another month, and then move to fat-free. Use it in your coffee too.
• Eat healthy fats such as monounsaturated fat and polyunsaturated fat. Monounsaturated fats are found in vegetable oils such as canola and olive oil. Polyunsaturated fats are found in fish and in vegetable oils such as safflower and corn oil.

At the grocery store:

• Buy less red meat and more white-meat chicken or turkey. Don’t forget to remove the skin before you cook or eat it.
• Buy more fresh fish and shellfish. When you cook it, try baking, poaching, or grilling. Don’t batter or fry it.
• Use soft or liquid margarine instead of butter or stick margarine. Check the label to make sure liquid (not hydrogenated) vegetable oil is the first ingredient.

Eating out:

• Don’t order deep-fried foods. Ask your server how the items on the menu are cooked. Avoid the chips and salsa, and skip the bread and butter too.
• Pay attention to serving size. Don't eat everything on your plate just because it's there. Restaurant portions very often contain too much food. Eat a reasonable amount, and take the rest home.
• Watch out for high-fat salad dressings and toppings at the salad bar. If your salad comes prepared, ask for the dressing on the side.
• Order meats that are roasted, baked, blackened, broiled, or boiled. Trim off the fat. Ask for gravy or sauce on the side, or don't get it at all. Avoid fried, grilled, sauteed, stewed, braised, or breaded meats.

2. Stay active

You don't have to run out and join a gym to get active. Start small, and try to make exercise a part of your daily routine.

For some people, some forms of physical activity might be unsafe or should only be started after talking with a doctor. If you have any concerns, talk to your doctor before starting any exercise or fitness program.

Here are a few tips if you're just starting out:

• To start,just walk more. Take the stairs instead of the elevator. Park farther away at the grocery store. Walk your dog for longer than usual.
• Then find times in your day when you can fit in a half hour of exercise. And find something that you enjoy doing. Make it fun and easy for yourself to do it, and you will be more likely to keep doing it.
• Work your way up to getting moderate activity for at least 2½ hours a week or doing more intense exercise for at least 1¼ hours a week.

Remember that getting more active to raise your HDL is not a one-time thing. Activity is something to build into your daily life, for the rest of your life.

Here are a few tips for taking the next step.

• Go longer. If 20 minutes of activity a day feels good for a while, try for 30. Or 40. You can do this all at one time, or you can break it up into chunks. For example, get 15 minutes of activity in the morning before work, 10 more during your lunch hour, and 15 after work. Or break it into four 10-minute sessions.
• Go harder. Spending more time exercising is one way to increase activity. But it’s not the only way. If you walk now, try walking faster, or walking on hills or stairs. Maybe even carry a couple of light weights while you walk. The extra energy you use for harder activity will increase your muscle mass and make you stronger.
• Try something new. Dust off that bicycle and go for a ride. Or try swimming. Going for a swim gives your body a great workout without any impact on your bones, joints, or feet. Add dancing to your routine, paddle a boat, or give yoga a try. Talk to your doctor about activities that might be right for you.

3. Lose weight if you need to

If you need to lose a few pounds to reach a healthy weight, don't think you have to try a radical fad diet. You can eat more than grapefruit and still lose weight.

The best way to lose weight is to eat better and move more. Eating smaller portions of healthier food will make you feel better. And along with exercise or even light activity, eating better can help you lose extra pounds if you have them.

Look back at the tips for healthy eating and staying active. Make these changes into a habit, and you'll be on your way to a healthy weight.

4. If you smoke, quit

Quitting smoking can help you raise your HDL. It's one of the best things you can do for your health. But it isn't easy. Here are a few tips for when you're ready to quit:

• Get ready. Set a date to quit. Pick a time when you won't have a lot of stress in your life. Before that date, get rid of ashtrays and lighters. And don't let people smoke in your home.
• Change your routine. For example, if you smoke after eating, take a walk instead.
• Use medicine. It can help with cravings and stress. Your doctor can prescribe medicine that can help you quit smoking.
• Try nicotine replacement products. You can buy nicotine gum, lozenges, or patches without a prescription. Using nicotine replacement products and/or medicine doubles your chances of quitting smoking for good.

Continue to Where?

Now that you have read this information, you are ready to start making changes to raise your HDL.

Talk with your doctor

If you have questions about this information, print it out and take it with you when you visit your doctor. You may want to mark areas or make notes where you have questions.

Organizations

American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone:	1-800-AHA-USA1 (1-800-242-8721)
Web Address:	www.heart.org
Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.
National Cholesterol Education Program (NCEP)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone:	(301) 592-8573
Fax:	(240) 629-3246
Email:	nhlbiinfo@nhlbi.nih.gov
Web Address:	www.nhlbi.nih.gov/about/ncep
The National Cholesterol Education Program (NCEP) provides education and tips for patients about how to lower high cholesterol. The NCEP provides clinical practice guidelines for health professionals to treat high cholesterol. The goal of the NCEP is to help people lower high cholesterol because this can lower their risk of coronary artery disease. The NCEP is part of the National Heart, Lung, and Blood Institute (NHLBI) and the National Institutes of Health (NIH).
National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone:	(301) 592-8573
Fax:	(240) 629-3246
TDD:	(240) 629-3255
Email:	nhlbiinfo@nhlbi.nih.gov
Web Address:	www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating: Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases). Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia. Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.