How to Increase HDL Cholesterol: What Works and by How Much

By Dr. Muhammad Awais Rabbani, MBBS, physician and US medical-billing operator · Medically reviewed by Dr. Ahmed Humayon, MBBS · Updated 2 November 2026 · Editorial policy

HDL is the “good” cholesterol; below 40 mg/dL in men or 50 mg/dL in women is low. Regular aerobic exercise, losing excess weight, quitting smoking and replacing trans fats and refined carbs with unsaturated fats raise it most.

Jump to: Lever table · Do pills help? · Retesting

What is HDL cholesterol, and what level is too low?

HDL cholesterol is the cholesterol carried by high-density lipoprotein, the particle that moves excess cholesterol from artery walls and tissues back to the liver. That is why it is called good cholesterol. An HDL below 40 mg/dL in men or below 50 mg/dL in women counts as low HDL cholesterol (NCEP ATP III, Circulation 2002; Grundy et al., Circulation 2005).

Your HDL	Men	Women
Low	under 40 mg/dL (1.03 mmol/L)	under 50 mg/dL (1.29 mmol/L)
Target	40 or more	50 or more
Linked with lower risk	60 or more (1.55 mmol/L)	60 or more

Its partner, low-density lipoprotein (LDL), is the bad cholesterol because it delivers cholesterol into artery walls and other blood vessels.

Labs outside the US report HDL levels in mmol/L. To convert, divide mg/dL by 38.67. ATP III treats 60 mg/dL or more as a factor that lowers risk.

What causes low HDL cholesterol?

Low HDL cholesterol usually has several causes working at the same time. Physical inactivity, excess body weight, smoking, high triglycerides, insulin resistance, a diet heavy in refined carbohydrates, some medicines and genes all lower it. Most of them can be changed (NCEP ATP III, Circulation 2002).

• Lifestyle: little physical activity, smoking, mostly refined-carb calories
• Metabolic: excess weight, metabolic syndrome, type 2 diabetes and raised blood sugar levels, high triglycerides
• Medicines: beta-blockers, anabolic steroids, progestins
• Genes: rare inherited conditions that keep HDL very low

Low HDL and raised triglyceride levels tend to travel together. In overweight adults, a triglyceride-to-HDL ratio of 3.0 or more (mg/dL units) identified insulin resistance in one study (McLaughlin et al., Ann Intern Med 2003). Treat it as a clue that needs a proper workup.

Which changes raise HDL the most?

Aerobic exercise, losing excess weight, quitting smoking and swapping trans fats and refined carbs for unsaturated fats raise HDL the most without medicine. Each adds a few mg/dL, and the effects stack. Raising HDL cholesterol this way needs no prescription.

Lever	Typical HDL change	Effort	Source
Aerobic exercise	+2.5 mg/dL	120+ minutes a week	Kodama et al., Arch Intern Med 2007
Weight loss	+0.35 mg/dL per kg lost, after weight stabilizes	Moderate to high	Dattilo & Kris-Etherton, Am J Clin Nutr 1992
Quitting smoking	+4 mg/dL	High	Maeda et al., Prev Med 200300110-5)
Unsaturated fat replacing refined carbs or trans fat	small rise; trans fat lowers HDL	Low to moderate	Mensink et al., Am J Clin Nutr 2003; Mensink & Katan, NEJM 1990
Alcohol, 30 g a day	+4 mg/dL	Not a reason to start	Rimm et al., BMJ 1999
Niacin or CETP inhibitors	large rise	Prescription	Heart attacks did not fall (see below)

Each figure is an average from a meta-analysis; your change depends on your starting point.

To increase HDL by about 10 mg/dL, stack levers: exercise (+2.5), losing 10 kg (+3.5) and quitting smoking (+4) add up to roughly 10. The planner above adds these averages to your own result.

How much aerobic exercise raises HDL?

Regular aerobic exercise raised HDL cholesterol by about 2.5 mg/dL on average across a meta-analysis of randomized controlled trials, and the gain followed a dose-response pattern. The effect appeared once people reached roughly 120 minutes a week or 900 kcal burned (Kodama et al., Arch Intern Med 2007).

Brisk walking, cycling and swimming all count at moderate intensity or harder. The American Heart Association recommends at least 150 minutes of moderate-intensity physical activity a week, which clears that threshold.

Regular exercise does more than boost HDL; it also lowers blood pressure.

Does losing weight or quitting smoking raise HDL?

Yes. Losing excess body weight and quitting smoking both raise HDL without medicine, and they sit at the core of any plan to increase HDL cholesterol naturally. Expect a smaller number during active weight loss, because HDL tends to dip while you are losing and rise once your weight holds steady (Dattilo & Kris-Etherton, Am J Clin Nutr 1992).

Weight loss

HDL rose about 0.35 mg/dL per kilogram lost after weight stabilized, so losing 10 kg adds about 3.5 mg/dL.

Smoking

Quitting smoking raised HDL by about 4 mg/dL in a meta-analysis of cessation studies (Maeda et al., Prev Med 2003).

Alcohol

About 30 g of alcohol a day, roughly two US standard drinks, raised HDL by about 4 mg/dL in controlled studies (Rimm et al., BMJ 1999). The American Heart Association advises people who do not drink not to start.

Which fats and carbs should you swap?

Swap trans fats and refined carbohydrates for unsaturated fats such as olive oil, nuts and fish. Replacing carbohydrate with unsaturated fat raises HDL slightly and lowers LDL in the same move (Mensink et al., Am J Clin Nutr 2003). Trans fat lowers HDL and raises LDL (Mensink & Katan, NEJM 1990).

• Fried foods and baked goods made with hydrogenated oil → food cooked in olive or canola oil
• White bread and sugary cereal → whole grains
• Butter and fatty meat → nuts, seeds and oily fish

Saturated fats raise HDL a little but raise LDL more, so healthy fats are the better trade (Mensink et al., Am J Clin Nutr 2003).

What foods help raise HDL?

No single food raises HDL much. Olive oil, nuts, fatty fish, avocado and high-fiber foods help as part of the swap above, inside a heart-healthy diet. Their bigger payoff is usually lower LDL, so judge them by your whole lipid panel and not by the HDL line alone.

• Olive oil: use it where you would use butter
• Nuts: a small handful in place of chips or sweets
• Fatty fish such as salmon or sardines: omega-3 fatty acids lower triglycerides
• Avocado: monounsaturated fat in place of saturated fat
• Oats, beans and lentils: soluble fiber lowers LDL and does little for HDL

Eggs are not an HDL lever. In a meta-analysis of 17 randomized trials, eating more eggs raised LDL and the LDL-to-HDL ratio (Li et al., Nutrients 2020).

How fast can you raise HDL?

Expect a measurable change after two to three months of steady effort. The exercise trials in the Kodama meta-analysis ran for at least eight weeks, and weight loss lifts HDL only once weight stabilizes, so one month is usually too soon to tell whether increasing HDL is working.

To raise HDL levels faster, combine levers; no single habit moves HDL far.

Do pills that raise HDL protect your heart?

No. Niacin and CETP inhibitors raised HDL substantially in large outcome trials, yet niacin added to a statin did not reduce heart attack or stroke, and the CETP inhibitors either failed or gave a small benefit that tracked lower non-HDL cholesterol. The 2018 AHA/ACC cholesterol guideline recommends no drug to raise HDL (Grundy et al., Circulation 2019).

Drug	HDL effect	Outcome	Trial
Niacin added to a statin	up	no fewer cardiovascular events	AIM-HIGH, NEJM 2011
Niacin plus laropiprant	up	no fewer major vascular events; more serious side effects	HPS2-THRIVE, NEJM 2014
Torcetrapib (CETP)	large rise	more deaths and cardiovascular events	ILLUMINATE, NEJM 2007
Dalcetrapib, evacetrapib (CETP)	up	no benefit	dal-OUTCOMES, NEJM 2012; ACCELERATE, NEJM 2017
Anacetrapib (CETP)	large rise	small drop in coronary events, linked to lower non-HDL cholesterol	REVEAL, NEJM 2017

Genetics points the same way. In a Mendelian randomization study, people born with a gene variant that raises HDL had no lower risk of heart attack (Voight et al., Lancet 201260312-2)). Low HDL marks risk; pushing the number up with a pill does not remove that risk.

Why does HDL matter at all?

HDL matters mainly as a risk marker. Low HDL often signals a wider metabolic problem, such as insulin resistance or high triglycerides, that raises the risk of cardiovascular disease. What HDL particles do matters more than how much cholesterol they carry, and a standard lipid panel does not measure that function.

One measure of function is cholesterol efflux capacity, the ability of HDL to pull cholesterol out of cells in the artery wall. It predicted atherosclerosis independently of HDL cholesterol (Khera et al., NEJM 2011). HDL particles are built around apolipoprotein A-I, but particle tests remain mostly research tools. Risk assessment leans more on apoB, which counts the particles that clog arteries.

Very large HDL values are not always protective either (Madsen et al., Eur Heart J 2017).

How to retest and read your next lipid panel

Retest 8 to 12 weeks after you change your habits, ideally at the same lab and time of day. The 2018 AHA/ACC guideline uses a 4- to 12-week window to check response to lifestyle change or medicine, and it accepts a nonfasting lipid panel for most adults (Grundy et al., Circulation 2019).

Biological variation means a single HDL level can move by several percent between two draws with no change in habits, so read one result as a range (Smith et al., Clin Chem 1993).

Many US labs print the total cholesterol-to-HDL ratio; lower is better, and the lab’s reference range shows its cutoff. Your LDL level is usually the main treatment target, so read it next to the HDL line and what your triglyceride number means. Other routine blood tests, like creatinine, can come from the same draw.

Test	Result	Units	Reference
Total cholesterol	212	mg/dL	under 200
Triglycerides	180	mg/dL	under 150
HDL cholesterol	38	mg/dL	40 or more
LDL cholesterol (calculated)	138	mg/dL	under 100
Total cholesterol/HDL ratio	5.6	none	set by the lab

Sample layout with invented values, not a real patient. Cut-offs are ATP III’s; your lab’s may differ.

Who pays for the repeat test. A lipid panel is billed as CPT 80061. Medicare covers cardiovascular screening blood tests, including a lipid panel, once every five years when billed with the screening diagnosis ICD-10 Z13.6 (CMS, 42 CFR 410.17). Repeat panels to monitor a known lipid disorder fall under NCD 190.23 and need a diagnosis that supports medical necessity. Private plans set their own frequency rules, so check yours before a short-interval retest.

See a clinician if HDL stays low after three months of steady change.

Quick answers

How do you increase HDL cholesterol in women?

The same levers work, but the low cutoff is 50 mg/dL instead of 40. Progestins can lower HDL (NCEP ATP III, Circulation 2002), so mention hormonal contraception when you review results.

Which is good cholesterol, HDL or LDL?

HDL is the good cholesterol and LDL is the bad one. For HDL, higher is better up to a point; for LDL cholesterol, lower is better.

Can you raise HDL naturally?

Yes. Aerobic exercise, weight loss, quitting smoking and the fat swap raise HDL without pills, and together they can add several mg/dL over about three months.

Sources

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• Barter PJ, Caulfield M, Eriksson M, et al. Effects of torcetrapib in patients at high risk for coronary events (ILLUMINATE). N Engl J Med. 2007;357(21):2109–2122.
• Schwartz GG, Olsson AG, Abt M, et al. Effects of dalcetrapib in patients with a recent acute coronary syndrome (dal-OUTCOMES). N Engl J Med. 2012;367(22):2089–2099.
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• Centers for Medicare & Medicaid Services. 42 CFR § 410.17, Cardiovascular disease screening tests; National Coverage Determination 190.23, Lipid Testing.