More than one in five American men and about one in fifteen American women live with low HDL cholesterol, the fraction that pulls cholesterol out of artery walls. According to the National Heart, Lung, and Blood Institute, a healthy lipid profile calls for HDL of at least 40 mg/dL in men and 50 mg/dL in women. The most recent CDC survey data, covering August 2021 to August 2023, put the overall prevalence of low HDL at 13.8 percent among US adults.
HDL, or high-density lipoprotein, works less like a number on a lab report and more like a shuttle. It picks up cholesterol from the walls of blood vessels and delivers it back to the liver, where the body clears it. That job is why researchers now pay as much attention to how well HDL functions as to how much of it is circulating.
What the strongest food evidence actually shows
Extra virgin olive oil sits at the top of the list. In the PREDIMED trial republished in the New England Journal of Medicine in 2018, 7,447 people at high cardiovascular risk followed a Mediterranean diet with either extra virgin olive oil or mixed nuts, or a low-fat control diet. The olive oil arm cut the risk of a major cardiovascular event by roughly 30 percent. A PREDIMED substudy in 296 participants then showed that a Mediterranean pattern rich in olive oil improved cholesterol efflux capacity, the very step that lets HDL do its job.
Fatty fish is the second anchor. Salmon, mackerel and sardines are the main dietary sources of the long-chain omega-3 fats EPA and DHA. Meta-analyses of randomized trials find that marine omega-3s produce only a modest rise in HDL numbers, but they shift HDL toward the larger, more functional particles that are most closely linked to cardiovascular protection. Two portions a week is the intake most commonly cited in cardiology guidance.
Also read: A heart drug that costs 10 cents a day may cut hospitalizations by a quarter
Berries are the third. In a Finnish randomized trial published in the American Journal of Clinical Nutrition, eight weeks of moderate berry consumption raised HDL cholesterol and lowered blood pressure. Blueberries, strawberries, blackcurrants and lingonberries are all rich in anthocyanins, the plant pigments that give them their color and appear to drive part of the effect.
Three more foods that help the overall picture
Nuts round out the picture. In PREDIMED, the mixed-nuts arm, mostly walnuts, hazelnuts and almonds, matched olive oil for cardiovascular protection. On the specific question of HDL, systematic reviews of almond trials find clear reductions in total and LDL cholesterol but no reliable HDL rise, so the story is one of a better ratio rather than a bigger HDL number.
Avocados belong on the list for the same reason. They are dense in monounsaturated fat and viscous fiber, and randomized trials at Penn State published in the Journal of Nutrition have linked a daily avocado to lower levels of small, dense LDL particles, the subtype most strongly tied to plaque buildup. That improves the LDL side of the equation without dragging HDL down.
Whole oats work through soluble fiber. An American Journal of Clinical Nutrition meta-analysis of 28 trials found that at least 3 grams of oat beta-glucan a day cut LDL cholesterol by about 0.25 mmol/L without changing HDL. The value here is that oats do not suppress HDL while they push LDL lower, which is precisely what a heart-healthy plan needs.
Also read: How eating cinnamon every day may affect your blood sugar and cholesterol
Dark chocolate with 70 percent cacao or higher rounds out the seven. Systematic reviews of cocoa flavanols find only a marginal HDL rise, but consistent benefits for blood pressure and total cholesterol. It earns a place as an occasional, not daily, addition.
Exercise and one habit to drop
Food is only half of the HDL story. A meta-analysis of 25 trials in JAMA Internal Medicine found that regular aerobic exercise raised HDL by an average of 2.53 mg/dL, with about 120 minutes a week as the practical threshold. Every extra 10 minutes per session added roughly 1.4 mg/dL. Quitting smoking is the single biggest lever in the other direction. A pooled review of 45 studies found HDL rose by about 0.107 mmol/L, roughly 4 mg/dL, after cessation, and much of the gain appeared within the first few months.
If your last lipid panel showed a borderline HDL, this is the point to talk with your doctor about whether food and activity are enough or whether other risk factors need attention.
Also read: On Ozempic or Wegovy? Data shows your daily steps may be dropping without you knowing
Also read: Cycling vs. running: which is better for your heart, joints and longevity?
This article is made and published by Jesper Bengtson, who may have used AI in the preparation.