From Richard N. Fogoros, M.D.,
Your Guide to Heart Disease.
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What about a low-fat diet?

While Americans traditionally have ingested too much fat in the diet, and while limiting total fat in the diet is useful not only for cholesterol control but also for weight reduction, evidence is emerging that too little fat in the diet can be dangerous. A diet in which fat has all but been eliminated can result in a deficit in the essential fatty acids - certain fatty acids that are essential to life, but which the body cannot manufacture itself. Furthermore, ultra-low-fat diets have been reported to result in a significant reduction in HDL cholesterol in some individuals.

The best advice regarding fat in the diet appears to be this: 1) reduce the fat intake to 30 - 35% of the total calories in the diet - but probably no lower than 25% of total calories; 2) try to eliminate saturated fats and trans fats from the diet, and substitute monounsaturated and polyunsaturated fats instead. (That is, eliminate animal and dairy fat, and substitute unprocessed vegetable fats. Click here for a quick review of the various types of fatty acids.) Such a diet will avoid the problems seen with an ultra-low-fat diet, and should help raise HDL cholesterol levels.

What about drugs for raising HDL cholesterol?

Drug therapy for raising HDL cholesterol levels has, so far, been less successful than for reducing LDL cholesterol. Statins, in particular, are often not very effective at increasing HDL levels.

Of the drugs used to treat cholesterol, niacin appears to be the most effective at raising HDL levels. Niacin is one of the B vitamins. The amount of niacin needed for increasing HDL levels are so high, however, that it is classified as a drug when used for this purpose. Furthermore, "niacin" takes several forms, including nicotinic acid, nicotinamide, and inositol hexaniacinate - and all of these are labelled as "niacin." Unfortunately, only nicotinic acid raises HDL cholesterol, and this drug can be difficult to take because of its propensity to cause flushing, itching and hot flashes. In general, taking niacin to treat cholesterol levels should be supervised by a doctor. ( Read about niacin here.)

A three-drug regimen of niacin, cholestyramine, and gemfibrozil has been shown to increase HDL cholesterol substantially, but this drug combination can be particularly difficult to tolerate.

Now that HDL levels are attracting more and more attention, several drug companies are attempting to develop new drugs aimed specifically at increasing HDL. Unfortunately, there have been early disappointments and it will be several years before we can expect to see such drugs on the market.

Sources:

Rosenson RS. HDL metabolism and approach to the patient with low HDL-cholesterol. UpToDate. May, 2007. (UpToDate.com)