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Can Too Much ‘Good Cholesterol’ Be a Bad Thing?

For most people, increasing HDL levels comes with heart health benefits


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Cholesterol conversations tend to focus on the “bad” kind, more officially known as low-density lipoprotein (LDL) cholesterol, which can raise your risk for heart disease, stroke and other serious health problems. But there’s also a “good” type of cholesterol, called high-density lipoprotein (HDL), and unlike its sibling, it can actually lower cardiovascular risks.

On a very basic level, HDL is used to carry “bad” fat through the liver so we can excrete it out of the body, a process known as reverse cholesterol transport, says neurologist Romie Mushtaq, M.D., who is also board certified in integrative medicine, a specialty that focuses on overall wellness and disease prevention. “That then helps to prevent plaque from building up in arteries in the heart and brain,” Mushtaq says.

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The effect of HDL on cardiovascular risks is not insignificant. For example, when LDL (the bad type of cholesterol) goes up 1 percent, the risk for heart attack and stroke goes up 1 percent. On the other hand, when HDL goes up 1 percent, the risk for heart attack and stroke gets lowered by 2 percent, says Stephen Kopecky, M.D., a preventive cardiologist at Mayo Clinic in Rochester, Minnesota.

“It’s more bang for your buck,” Kopecky says. “But we don’t have a pill for it.” The only way to increase your HDL is with healthy habits.

What are optimal HDL levels?

Both men and women should aim for an HDL level that’s at or above 60 mg/dL (milligrams per deciliter), health experts say. (Anything less than 40 mg/dL for men and 50 mg/dL for women is low.) But there is an upper limit to consider.

“If your HDL is over about 80 and you’ve had that all your life, then it actually can be a risk factor for heart disease,” Kopecky says, though it should be noted that an HDL level over 80 mg/dL is considered abnormally high.

Not only for heart disease, but other causes of death as well, according to a 2022 study published in The American Journal of Cardiology. Researchers found that two smaller groups of people with coronary artery disease and HDL levels above 80 had a significantly higher risk of dying in general than those with lower HDL levels.

Another study, published in Hypertension, found that like participants in the low HDL group, who were at greater risk for cardiovascular events, those in the high HDL group also faced an increased risk. And new research published in The Lancet Regional Health found that older adults with HDL levels above 80 had a 27 percent higher risk of dementia.

“But we don’t want to scare people,” says Mushtaq, based in Orlando, Florida. “This is not really an issue we see clinically very often,” she says. And when it arises, doctors will most likely “start chasing down genetic issues or something else that’s going on,” Mushtaq adds. Some genetic mutations can cause your body to produce too much HDL cholesterol. Hyperthyroidism, alcohol use disorders and certain medications can also contribute to abnormally high HDL levels.

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Curious about your cholesterol levels? You’ll have to ask your doctor for a complete cholesterol test, also called a lipid panel or lipid profile, since the warning signs of worrisome cholesterol numbers are silent. This test will measure your LDL, HDL and triglycerides (another type of fat in the blood), and can help predict your risk of heart disease and stroke. Your doctor can also screen you for any genetic-related cholesterol issues.

How to increase your HDL cholesterol

If you’re looking for a few ways to increase your HDL cholesterol to healthier levels, exercise is a good place to start, and Kopecky says interval training is a “bang-for-your-buck” strategy. Pushing yourself harder for 30 or 60 seconds at a time raises HDL more than the same output of continuous exercise at a slower pace, he says.  

An added benefit is that incorporating intervals into your day saves time. When Kopecky wants a bottle of water or banana while at work, he walks from the fifth floor to the break room on the ground floor, then runs back up.

“And when I say run, that’s three stairs per second, which is a lot faster than people are used to doing,” he says. “It takes me only about a minute and a half to go up [four] flights of stairs.” As an added bonus, physical activity can also lower your LDL levels.

Quitting smoking is another way to raise HDL levels. According to Kopecky, that bumps up numbers by 15 to 20 percent within six weeks.

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Then there’s boosting HDL through nutrition. Research shows a diet rich in plant-based foods and healthy fats (like the Mediterranean diet) can raise HDL cholesterol to levels that ward against cardiovascular disease.

Avocados, nuts, and fish linked to healthy omega-3 fatty acids (salmon, sea bass, sardines) are among the diet’s staples.

Jamie Mok, a registered dietitian nutritionist and national spokesperson for the Academy of Nutrition and Dietetics, recommends healthy sources of protein including beans, lentils and peas; dropping coconut and palm oils for olive and avocado oils; minimizing sugar-sweetened beverages and highly processed foods; and limiting or avoiding alcohol, which can have an impact on cholesterol.

Moderation when it comes to alcohol tends to be defined as one drink at the most per day for women and two drinks at the most per day for men.

“I get a lot of patients who ask, ‘Well, if I don’t drink an alcoholic beverage throughout the week, can I add them all up on the weekend?’ It doesn’t work like that,” she says.  

Be careful not to judge fats in food with a broad brush, advises Mushtaq. Too much focus on a low-fat diet, for example, means not enough attention on “the right kinds of fats that are good for brain health, hormonal health and longevity,” she says.

“When it comes to memory and mood,” Mushtaq adds, “healthy fats are critical.”

Mushtaq also cautions against putting too much stock in nutrition advice found on social media. “A lot of folks have really fancy accounts on Instagram and TikTok and sell themselves as health experts, and they’re really pushing multilevel [marketing] supplements,” she says. “It’s really important to work with a registered dietitian or certified nutritionist.”

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