Question: My HDL always stays in the low 30s range. I exercise and eat right. I can’t take niacin . . . nothing I do will raise it. I am 68 years old. I would appreciate any suggestions.

Dr. Hibberd's Answer:

If only I had the answer to your question! Raising your HDL has been a challenge for both doctors and their patients. Raising a male's HDL from 45 to 60 is generally not yet possible. It used to be said little could be done but to move 2 or 3 points at most, but slowly we seem to be making progress here also. While most women have HDL in the 50s-60s or better, most men see their HDL in the 45-55 range.

We do know that regular exercise elevates HDL by several points. Niacin will elevate HDL up to 2 or 3 points. Some statins may variably improve HDL by 1 or 2 points, while others may actually decrease HDL levels.

Omega-3 fatty acid intake (1 gram and up to 4 grams daily) is reported to raise in some patients usually by 1-3 points. Beware of poor quality omega-3 products. Remember using natural omega 3 from fish oil will leave you with an almost intolerable fishy odor, and the prescription Omega 3 OMACOR is much more palatable, yet also much more expensive.

You will need to optimize your other cardiac risks, given most of your HDL is genetically determined. These elevations in HDL seen with various interventions described above are not usually additive. So a total rise of 3 points and a maximum of up to 5-6 points would be the most you could reasonably expect with the most aggressive management program.