Why is one form of cholesterol considered good and another bad? There are actually as many as 18 kinds of cholesterol, but to save confusion, doctors divide them into two categories: LDL (bad) and HDL (good). Your liver manufactures most of your cholesterol, and small amounts of it go toward a variety of healthy purposes, including creating hormones that help turn food and exercise into muscle. Serving as cholesterol chauffeurs are fat/protein bunches called lipoproteins, and that's where the fun begins: Low-density lipoproteins tend to deposit cholesterol on artery walls, where it builds up and eventually interferes with blood flow. But the high-density variety seems to take cholesterol back to the liver, where it can be eliminated from the body.
As a result of all this, doctors don't just want you to lower your total cholesterol count; they want you to change the ratio as well, so you have more HDL and less LDL. "When we looked at the data, we found that the higher your HDL went, the lower your risk of heart attack," says cardiologist William Castelli, M.D., former director of the Framingham Heart Study in Massachusetts. An HDL level of 75 or more seems to convey extra longevity for many people, while a count of 100 or more is so beneficial that it was dubbed the "Methuselah syndrome" by one researcher. HDL less than 35 or so, meanwhile, can carry significant risk of heart disease. Genetics plays a large role in HDL. A few guys have naturally low levels and need to keep their LDL low as well to make up for it. (As Castelli puts it, you don't need a substance that removes cholesterol from your blood if you don't have much to begin with.) But there's plenty that everyone else can do to pump up their HDL. Never one to shirk from a task that doesn't involve housecleaning, I managed to find two handfuls of ways to turn my "good" numbers into great numbers.
Plain and simple, exercise raises HDL levels. "We looked at doctors and others who ran the Boston Marathon," notes Castelli. "While the average male HDL is 45, men who ran the marathon ranged around 55." One Georgetown University study found increased HDL in those who ran seven miles a week or took part in four moderate 30-minute sessions of any aerobic activity.
Lose Excess Pounds
Where HDL is concerned, "you can't be too thin," Castelli says. One report found about a 1 percent rise in HDL for every pound of fat lost. This doesn't mean you have to turn yourself into a toothpick, but that you should work on getting rid of excess flab as you add muscle. (Use a body-fat monitor rather than a scale to chart your progress.) Fortunately, fat loss is likely to go hand in hand with the exercise and dietary modifications that also raise HDL levels.
Eat the Right Kinds of Fat
Foods high in monounsaturated fats (such as olive oil, nuts, and the oils in many salad dressings) seem to boost HDL best; it's likely that foods high in omega-3 fatty acids (such as cold-water fish) do so as well. Saturated fats, the kind in meat and dairy foods, are likely to drive up harmful LDL, so take this opportunity to cut way back. Worst of all are trans-fatty acids, the hardened oils often found in margarine, crackers and other snack foods-a substance Harvard Medical School nutrition expert Walter C. Willett, M.D., author of Eat, Drink, and Be Healthy, calls "uniquely bad." These foods can do exactly the opposite of what you want, lowering HDL while raising LDL.
Exercise First, Eat Fat Later
If you want to increase the benefits of the fats you eat, work out before you chow down. A study at the University of Missouri found that regular exercise prior to high-fat meals produces a large hike in HDL. I'm not suggesting that your excuse for indulging in high-fat meals ought to be a pre-meal workout, merely that exercise before a meal works to your heart's advantage.
Cut Down on Simple Carbs
People on high-carb diets full of pasta, bread and sugar-even those who exercise frequently-tend to have lower HDL levels than those who eat plenty of protein and good fats along with veggies and whole grains. "Low HDL often results when people are told to get all the fat out of their diets and eat carbohydrates instead," Willett says. A British study showed that people with high HDL levels tend to focus on slower-burning carbs, such as beans and fruit.
In a Canadian study, drinking a few glasses of orange juice every day for four weeks increased participants' HDL by 21 percent, possibly due to a flavonoid called hesperidin that appears extremely HDL-friendly. Subsequent research found that tangerine juice may be even more effective. Unfortunately, that much juice will add hundreds of excess sugar calories to your diet. So stick to a glass a day and be satisfied with lesser results. Or you can buy hesperidin as a supplement, though it won't replace the many beneficial nutrients of orange juice (and certainly won't taste as good).
Dietary fiber, from such foods as whole grains, bran, fruits and vegetables, has been found to raise HDL levels. Of course, it also helps you lose weight, so this could be a side effect of your slimmer profile. A bowl of oatmeal or whole-grain cereal for breakfast makes a good start.
Have a Drink
Part of the "French paradox"-lower heart-disease rates in butter-and-cream-feasting France-may stem from the HDL benefits of wine consumption. For some people, however, alcohol causes more troubles than it cures. "Men should limit themselves to one or two drinks a day," Willett says. "After that, you start worrying about adverse consequences." While any alcoholic beverage will do, the antioxidants in red wine or dark beer may give you an added benefit.
Get Your B
Large doses of vitamin B3, or niacin, have been found to raise HDL as much as 20 percent and are often prescribed for people with cholesterol problems. But keep in mind that a daily multivitamin contains all the niacin most people need. Supplementing beyond that can have a variety of side effects, including facial flushing, heartburn and even liver damage, so don't try it without consulting a doctor.
Hell, if you smoke, you don't really give a damn about your health anyway. In case you're interested, smoking lowers HDL. Quitting now would be the simplest way to give yourself a jump start. Adopting this program is likely to improve your health in all kinds of ways, but higher HDL could be a good marker of how well you're doing.