What is good cholesterol and how can you increase it?

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Cholesterol is a waxy, fatty substance called a lipid. The liver makes all the cholesterol the body needs.

Inside the body, cholesterol travels through the blood on two different types of proteins called lipoproteins.

LDL cholesterol is what makes up most of the body’s cholesterol. People sometimes call it bad cholesterol as very high levels of this substance circulating in the body may raise a person’s risk of heart disease.

In contrast, individuals sometimes refer to HDL cholesterol as good cholesterol, as higher levels of it may lower the risk of heart disease.

HDL cholesterol is known as good cholesterol because of the functions it performs in the body. By circulating in the bloodstream, it helps remove other forms of cholesterol by absorbing it and carrying it to the liver. The liver can then reprocess the cholesterol for use or send it out of the body as waste.

This process helps keep extra cholesterol from attaching to the lining of the arteries and becoming plaque. Plaque is a mixture of cholesterol and other fatty substances that attaches to the walls of the arteries. Over time, this can build up and cause the opening of the arteries to become narrower — a condition called atherosclerosis.

The National Heart, Lung, and Blood Institute notes that atherosclerosis is a risk factor for serious complications. Narrow arteries may lead to risk factors for heart disease, such as high blood pressure. Additionally, narrow arteries may be more susceptible to blood clots, which can put a person at risk of severe events such as heart attack or stroke.

The combination of keeping total cholesterol down while keeping HDL cholesterol high may help reduce this risk and prevent cardiovascular disease.

How is it different from ‘bad’ cholesterol?

The terms “good” and “bad” are useful to help explain the functions of cholesterol. Both types of cholesterol serve a purpose in the body when balanced.

Cholesterol helps the body make new cell membranes. It is also important for making vitamin D and some hormones, such as sex hormones and the stress hormone cortisol. The liver also uses cholesterol to make bile, which digests fats.

LDL cholesterol is bad because it collects as plaque inside the arteries, so additional LDL cholesterol is unnecessary. High LDL levels put a person at risk for atherosclerosis, a major risk factor for heart disease.

In contrast, higher levels of good cholesterol may lower a person’s risk of developing heart disease.

According to the NHLBI, cholesterol does not have any symptoms itself, which is why it is important to get regular checks for cholesterol.

A lipid profile test can show levels of:

• total cholesterol
• triglycerides or fats in the blood
• LDL cholesterol
• HDL cholesterol

For HDL cholesterol, a higher number indicates a lower risk of heart disease. Low (undesirable) HDL cholesterol is anything less than 40 milligrams per deciliter (mg/dl). Anything between 40 and 60 mg/dl is normal, while a reading of 60 mg/dl or over indicates high (desirable) HDL cholesterol.

Foods that may promote healthy cholesterol levels include those that are:

• lower in saturated fats
• higher in unsaturated fats
• higher in heart-healthy fibers

Fiber-rich foods

Fiber-rich foods are healthy for the heart and may help manage cholesterol levels. According to a 2017 review, soluble fiber in the diet reduces the absorption of cholesterol and bile acids that the liver uses to make cholesterol.

Foods naturally high in fiber include:

• oatmeal
• psyllium husk
• beans such as lentils, black beans, and peas
• whole grains
• artichokes
• apples
• avocado

Unsaturated fats

The Centers for Diease Control and Prevention say that choosing unsaturated fats may help prevent and manage high LDL cholesterol while increasing HDL cholesterol.

Foods high in unsaturated fats include:

• avocado
• olives
• nuts and seeds
• vegetable oils such as olive oil and sunflower oil
• oily fish such as salmon, mackerel, sardines, and herring

Other foods to swap

Additionally, a person may benefit from avoiding foods that increase bad cholesterol. The CDC recommends choosing foods low in:

• saturated fat
• trans fat
• sodium
• added sugars

Individuals may also wish to avoid trans fats and saturated fats such as those found in animal products, including:

• processed meats
• high fat red meats
• poultry
• high fat dairy products such as cheese

Tropical vegetable oils that are solid at room temperature may also be higher in saturated fats, such as coconut and palm oil.

Instead, choose low fat or lean products, such as:

• lean meats
• poultry with no skin
• fat-free or low fat dairy products such as milk and yogurt
• whole grains
• fruits and vegetables

Although higher levels of HDL cholesterol have links with a decreased cardiovascular risk, clinical trials that raise HDL levels have not shown results in reducing this risk.

It may be that the ratio of HDL to LDL cholesterol is more important, as HDL cholesterol can only transport so much cholesterol to the liver. The American Heart Association notes that HDL cholesterol only carries about a third to a fourth of blood cholesterol.

This is why interventions for issues with cholesterol typically involve methods to lower LDL cholesterol first. This may improve the balance between HDL and LDL cholesterol in the body.

The CDC says that strategies for improving cholesterol balance include:

• Getting regular physical exercise: Physical activity may help increase good cholesterol and lower triglycerides in the blood.
• Maintaining a moderate weight: Maintaining a moderate weight may help improve cholesterol balance and other modifiable risk factors for heart disease.
• Quitting smoking: Smoking increases many risk factors for heart disease, such as damaging blood vessels, hardening arteries, and lowering HDL cholesterol.
• Limiting alcohol use: Drinking excess amounts of alcohol may raise triglycerides and cholesterol. Therefore, aim to drink moderately, consuming no more than 2 drinks a day for males and 1 drink a day for females. Drinking in moderation may also increase good HDL cholesterol.

Additionally, finding ways to manage stress may be important. Too much stress may increase levels of the stress hormone cortisol and raise levels of LDL cholesterol.

Some stress-relieving activities include:

• breathing exercises
• meditation
• movement activities such as yoga or tai chi
• getting adequate sleep each night

HDL cholesterol plays an important role in the body, such as transporting cholesterol back to the liver for processing out of the body.

Keeping cholesterol levels balanced by reducing bad cholesterol and increasing good cholesterol may help ensure that the body can maintain these roles. It may also help lower the risk of heart disease and its complications. Preventing high cholesterol typically involves changes to both diet and lifestyle.

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