Certain foods, niacin can raise HDL level

Question: My cholesterol numbers: total cholesterol, 125; LDL, 69; HDL, 32; and triglycerides, 119. My liver enzymes have been slightly high for years, and I recently was diagnosed with type 2 diabetes. Is there a safe, effective way to increase my HDL through specific foods or ­supplements?

Answer: Most people would gladly take those lipid numbers and run. They are very good except for the HDL level of 32, which is lower than the recommended minimum of 40.

HDL cholesterol (the good kind) is the type you want more of because it helps mop up cholesterol that might otherwise find its way into artery-narrowing plaque.

Women tend to have a higher HDL than men. The average in women is 55 and in men 45.

Having type 2 diabetes is considered the equivalent of heart disease. Except for the HDL, your current lipid levels meet established recommendations. Because your LDL cholesterol is low already, you don't need a cholesterol-lowering statin drug. That's fortunate, because you mentioned that your liver enzymes are slightly high, which might indicate liver impairment. Statin drugs are a no-no for those with liver disease.

Foods and supplements that help boost HDL include English walnuts, avocados, barley, macadamia nuts and rice-bran oil. You'll also nudge up HDL by increasing physical activity and losing weight (if you're overweight or obese).

As for drug therapy, niacin is the most effective for raising HDL cholesterol. But with diabetes, niacin in high doses can significantly push up levels of blood sugar. However, recent studies indicate that HDL-raising doses of 750 to 2000 mg. daily are generally acceptable. The boost in glucose levels can be managed by adjusting your diabetes medicine.

Another option is a fibric acid-type drug such as fenofibrate (TriCor) or gemfibrozil (Lopid), although both lag behind niacin's HDL-raising potency.

By some estimations, every 1 percent increase in HDL cholesterol reduces heart disease risk by 2 percent to 4 percent. That's plenty of incentive to keep researchers hot on the trail of new drugs that surpass niacin's powers.