Question: I have very low good cholesterol (23). What can I do to get it up? I can’t take Niaspan, and I tried Tricor, but it didn’t help.

Dr. Hibberd's Answer:

Increasing your HDL (the "good") cholesterol will provide huge gains for you. HDL protects us from heart disease and stroke. It scours our blood vessels for fragments of LDL and transports it back to the liver for reprocessing. A normal HDL is above 40 mg/dl for men and above 50 mg/dl for women. The higher this HDL reading is, the lower your risk for heart disease and stroke. There is a tenfold difference in heart degree risk between those with low HDL and those with higher HDL readings INDEPENDENT of their LDL ("bad") levels.

HDL is the particle that "mops up" the small damaging LDL cholesterol and transports it out of our circulation. Given this is a genetically inherited factor, large changes are difficult to obtain.

Your LIFESTYLE will have the largest positive impact. Avoid smoking, inactivity, weight gain, excess alcohol, and low fiber junk diets. Smoking will lower your HDL which is not a good thing! Remember, you want a high HDL. Avoid saturated fats, especially the "trans" fats that have been shown to lower HDL and increase LDL. Omega-3 supplementation is useful.
A six pound weight loss is associated with a 1 mg/dl gain in HDL in most people, so aim to achieve your ideal body weight. This does not apply to those who are underweight.

Regular aerobic exercise of 60 minutes daily will increase your HDL by 3-9%. Start slowly and gradually aim for this time over several weeks or months.

Moderate alcohol intake (especially of red wine) of no more than 2 drinks daily will often improve your HDL. Excess is harmful. The association with alcohol is not sufficient to recommend alcohol for treating low HDL, but enjoy moderate intake if you wish, as it appears to be beneficial.

Increase the soluble fiber in your diet. You will notice improved HDL and LDL readings by as much as 10%. Avoid processed and "junk" food if possible.

For many years, we had little to offer in the way of specific treatment, but this is changing now. There is drug treatment available, but as you have noticed, the results are small. Niacin in prescription doses (such as Niaspan) is the most useful. Fibrates (such as Tricor) are often very useful. Some of the statins will also increase your HDL. You will need to see your doctor for these medications, as they are not free of side effects and monitoring will be necessary. Also, some people do not respond as well as others, as you have experienced. NO SUPPLEMENTS have been shown to improve HDL with the exception of omega 3 supplementation. Do not waste your money on advertised products available without prescription. Specific medicine to increase HDL is not yet available.