Dr. Katz
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Q: Can you lower your LDL cholesterol without lowering HDL?

A: Certainly. But it's not as simple as eating less fat, which tends to lower both LDL, the harmful kind of cholesterol that contributes to heart disease, and HDL, the protective variety. Because the ratio of LDL to HDL is a far better predictor of heart disease risk than either alone, if they both fall—or rise—your risk may not change much. Shifting the type of fat in your diet from saturated and trans fat to monounsaturated and polyunsaturated fat can have just the effect you're looking for. Olives, avocados, nuts, seeds, olive oil, and canola oil are good sources of healthy fats that raise HDL while lowering LDL. Walnuts, flaxseeds, and fatty types of fish can provide omega-3 fatty acids, which help raise HDL. Exercise will also help boost HDL levels. So will losing weight and eating less sugar and refined starches such as white bread. Finally, soluble fiber in barley, beans, lentils, oats, and fruits can help drop LDL, while antioxidants in fruits and vegetables, as well as in red wine, tea, and dark chocolate, help increase HDL. Add this all up, and you're looking at the Mediterranean diet, an approach to eating that in studies has proven to be an excellent formula for lowering LDL, raising HDL, and reducing cardiac risk. Since Mediterranean countries know a thing or two about great cuisine, for most of us this is an opportunity to indulge in food we love—and that loves us back. If diet doesn't do the job, you can try prescription medications such as statins or ezetimibe, which are specifically designed to improve the ratio of LDL to HDL.
As a reminder, always consult your doctor for medical advice and treatment before starting any program.

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