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More than half of Americans have high cholesterol levels. A quarter of adults in the U.S. take prescription statin drugs to lower cholesterol. Statin drugs lower cholesterol levels, but at a price. The number on your lipid panel does go down. But do lower numbers on your lipid panel mean you will not have cardiovascular disease or a heart attack?

Statins may lower the numbers, but are not without problems. They can cause severe muscle damage and reduce liver function. Statins can cause mood changes including depression, memory loss, headaches, sleep and sexual problems, and fatigue.

Statins sink your coenzyme Q10 level. Low Q10 causes mitochondrial dysfunction, a condition often associated with chronic fatigue. Statins can also inhibit magnesium, vitamin D, and K2 synthesis.

These conditions are considered “low risk” by doctors, so sales continue to boom.

Focus on HDL Cholesterol

Most doctors focus on lowering total cholesterol and LDL, the “bad” cholesterol. Targeting numbers is a correct clinical assumption, but incomplete strategy. For some genetically susceptible people, raising HDL, the “good” cholesterol, is a better target.

Low HDL cholesterol is associated with an increased risk for cardiovascular disease. In contrast to total cholesterol and LDL when lower is better, high levels of HDL benefit cardiovascular health. An ideal HDL level is greater than 65-70 mg/dL.

Lipid Tests

Though a higher HDL level is considered heart protective, it turns out that HDL biology is more complicated than lab test numbers. Ratios between other lipids make a difference. Low HDL coupled with high LDL cholesterol significantly increases your risk. The combination of high triglycerides with a low HDL level also increases your risk.

HDL Calculator

You can calculate your ratios or use an online calculator.

HDL Ratios

Expand Your HDL Profile for Even Lower Risk

In recent years, researchers found other laboratory markers associated with HDL that prove better clinical targets for reducing the risk of cardiovascular disease. The two most useful of these biomarkers are Apolipoprotein A1 (APOA1) and HDL particle concentration (HDL-P). This new view called the HDL function hypothesis takes into account HDL levels, plus APOA-I and HDL-P.

APOA1 is the gene that encodes information for Apolipoprotein A1, the primary protein molecule in HDL. It is a more accurate predictive biomarker for a heart attack than total HDL. High APOA1 levels are also associated with Alzheimer’s disease.

Subpopulations of HDL-P serve as specific risk factors. A high level of small HDL particles is linked to low total HDL level and is associated with an increased risk for cardiovascular disease.

HDL/HDL-P may be a better ratio for discovering cardiovascular risk because it is dynamic and is determined by HDL-P turnover. Researchers found that those with the highest HDL/HDL-P had a significantly greater risk for the progression of atherosclerosis than those with a lower ratio.

HDL Cardio Risk

How to Raise Your HDL With Natural Medicines

Many drugs were developed to increase HDL level, but none worked. Even the few that do increase the HDL number haven’t been found to lower the risk for cardiovascular disease. However, there are other ways to improve HDL and lower your risk for heart disease.

Functional medicine takes a comprehensive approach to help patients lower LDL and raise HDL. Raising HDL is important, and there are several ways to improve HDL and HDL-P.

Diet and exercise are the foundations for cardiovascular health and longevity. To lower your total cholesterol and LDL, try going vegan for five months. However, lowering total cholesterol also brings HDL down with it.

Regular vigorous exercise helps raise HDL. It also lowers systemic inflammation, which is thought to be more important in managing cardiovascular disease risk than lipids.

Foods to Increase HDL:

  • Cold pressed organic olive oil
  • Whole grains
  • Legumes
  • Fatty fish like salmon
  • Flax and chia seeds
  • Nuts like almonds
  • Soy
  • Avocado
  • Red wine

Supplemental Support

Vitamin B3, the humble niacin supplement can increase HDL by 25%. Niacin raises HDL by preventing the liver from removing HDL, thereby blocking the breakdown of HDL-P. To be effective, you have to take a lot of niacin. However, it can cause an uncomfortable flushing effect with reddening and itching of the skin. This reaction is benign to the body but uncomfortable to experience. Extended-release forms of niacin reduce flushing but are less effective in raising HDL than nicotinic acid (niacin).

Start with 250 mg of niacin three times daily with food, or with a full glass of pure water. Gradually increase the dosage. For some, 500 mg three times a day raises HDL. Others need more. The upward limit is 2,000 mg three times daily.

If you can’t take niacin because of flushing effect, don’t worry. Recent studies found that although niacin helps raise HDL, researchers have not found a significant influence in reversing atherosclerosis or reducing risk of a cardiovascular event by taking extra niacin.

Statin drugs like atorvastatin and rosuvastatin only increase HDL by 5-15%. Low-dose simvastatin plus niacin only boost HDL level by an additional 1%. Hardly worth the side effects, in my opinion.

Healthy liver function is central to better lipid management because the liver metabolizes and facilitates the excretion of lipids. Artichoke extract helps improve liver function and lowers LDL. Plant phytosterols and Omega-3 fish oil supplements help increase HDL levels.

Stopping smoking and weight loss can increase HDL. Moderate alcohol consumption slightly increases HDL levels.

Improve Your HDL Profile

If you have persistently low HDL, are male, and have a family history of cardiovascular disease (typical markers of higher risk), get an expanded lipid test. In my practice, I recommend the NMR LipoProfile. Though the focus of this test panel is on LDL, it also measures HDL size and particle number. I use ClevelandHeartLab for my patients, but other specialty labs offer similar panels like Boston Heart Diagnostics and Berkeley Heart Lab, now owned by Quest Diagnostics as Cardio IQ Testing.

Chart your lipid and other cardiovascular risk biomarkers. From the test scores, calculate your HDL ratios. Make HDL friendly lifestyle and dietary adjustments. Take supplements to boost HDL levels. Retest every three to six months to monitor your progress.

Just attacking HDL level may not be the best approach to lowering cardiovascular risk. You need a strategy that lowers total cholesterol and LDL into safe ranges and increases HDL.

Dr. J. E. Williams


Dr. Williams is a pioneer in integrative and functional medicine, the author of six books, and a practicing clinician with over 100,000 patient visits. His areas of interest include longevity and viral immunity. Formerly from San Diego, he now resides in Sarasota, Florida and practices at the Florida Integrative Medical Center. He teaches at NOVA Southeastern University and Emperor’s College of Oriental Medicine.

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