There is much that can done to raise HDL (good) cholesterol and decrease LDL (bad) cholesterol by lifestyle changes alone. In fact, U.S. public health officials recommend that most adults with cholesterol problems change their health habits for 3-6 months before turning to medications.

 Cholesterol is a waxy substance that circulates in the bloodstream. The body manufactures its own cholesterol and also absorbs cholesterol from certain foods, specifically all animal product (i.e., meats, dairy products and eggs). Cholesterol is transported through the blood by carriers call lipoproteins. The type of cholesterol carried in the LDL is often termed "bad" cholesterol because it contributes to the buildup of atherosclerosis or deposits in the blood vessels, increasing heart disease.

For that reason, it's important to keep LDL cholesterol as low as possible. For all age groups, a blood LDL cholesterol less than 100 mg/dL is optimal because heart disease is rare below this level. At the very least, children and adolescents should keep their blood LDL cholesterol less than 100 mg/dL, and adults, less than 130 mg/dL.

The table below shows how LDL cholesterol is classified in adults.

LDL Classification in Adults

Source: Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Cholesterol in Adults (Adult Treatment Panel) 2001

In contrast, HDL cholesterol is popularly known as the "good" cholesterol. The HDL carrier acts as a shuttle as it takes up cholesterol from the blood and body cells and transfers it to liver, where it is used to form bile acids. Bile acids pass from the liver to the intestines to aid in fat digestion.

Eventually, some of the bile acids pass out of the body in the stool, providing the body with a major route for excretion of cholesterol. For this reason, HDLs are sometimes called the "garbage trucks" of the body. Thus, if levels of HDL cholesterol are high (i.e., 60 mg/dL or more), the risk for heart disease is decreased. An HDL cholesterol level of less than 40 mg/dl is considered low or undesirable.

So, how to ensure a good blood lipoprotein profile-low LDL cholesterol and high HDL cholesterol? There are several influential factors;  in order of importance, the factors that increase HDL cholesterol are:

1. Moderate to vigorous aerobic exercise (e.g., brisk walking), at least 80 to 90 minutes per week. (Note: if your risk of heart disease is high, first check with your doctor before initiating an aerobic exercise program).

2. Maintaining a lean body weight and avoiding weight gain

3. Smoking cessation

The most important factors for lowering LDL cholesterol:

1. Reducing dietary saturated fat intake to less than 7% to 10% of total calories (found mainly in meats, dairy products and some tropical oils, such as palm and coconut oil), with a greater emphasis on most plant oils and fish which are high in unsaturated fats.

2. Reducing body weight (if it is high)

3. Reducing dietary cholesterol intake to less than 200 to 300 mg/d (typically found in foods of animal origin)

4. Increasing in carbohydrates consumption to more than 55% of calories and dietary fiber to more than 20 g/L (especially fruits and vegetables, beans and oat products)

5. Incorporating non-hydrogenated unsaturated fats as the prirmary form of dietary fat (e.g., olive and canola oils) whole grains as the main form of carbohydrates, an abundance of fruits and vegetables and adequate omega-3 fatty acids from fish oils will have a strong effect in improving your blood lipids and lipoproteins.

This type of diet combined with regular physical activity, avoidance of smoking and maintenance of a healthy body weight will help control blood lipid levels while reducing the risk of heart disease.

The good news is that these changes show robust, relatively fast acting improvements to blood lipid and cholesterol profiles. In fact, lifestyle changes often result in meaningful improvements in HDL cholesterol and LDL cholesterol within the first month.

The relatively new "statin" drugs (e.g., lovastatin [Mevacor], simvastatin [Zocor], and astorvastatin [Lipitor]) are easy to use and have a powerful effect in lowering LDL cholesterol and raising HDL cholesterol. They act by blocking an enzyme needed to produce cholesterol in the liver. Typical improvements with these drugs includes an 18% to 55% decreasing LDL cholesterol and 5% to 15% increase in HDL cholesterol and 7% to 30% decrease in triglycerides.

But weight loss, exercise and a healthy diet low in animal fats and high in fruits and vegetables and whole grains work just about as well while providing many other health benefits.

All drugs have undesirable side effects, and for the statin drugs, this can include nausea, diarrhea, constipation, muscle pain and tenderness, as well as elevated liver enzymes in some individuals. In comparison, the desirable "side effect" of an improved life style is feeling better, both mentally and physically.

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