Low HDL (Good) Cholesterol: Causes, Symptoms & How to Increase It

Introduction

Most of us have heard people talk about the dangers of high cholesterol. But have you heard about problems caused by low cholesterol? Yes, that can happen too, especially with low high-density lipoprotein (HDL), often called the good cholesterol, and yes, it deserves attention! 

Cholesterol is a fatty substance that is essential for many important functions in the body. It helps maintain the structure and flexibility of cell membranes. It also plays a key role in producing vitamin D, hormones such as cortisol and testosterone, and bile acids that aid digestion and the absorption of vitamins A, D, E, and K. Since cholesterol does not dissolve easily in blood, it is transported through the bloodstream by lipoproteins (biochemical molecules made of protein and fat) such as HDL, low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL), which together contribute to total cholesterol levels. Abnormal levels of any of these lipoproteins can lead to health problems, particularly those related to heart health¹.

In this blog, we will explore what HDL cholesterol low means, its causes, symptoms, risks, and effective ways to increase it naturally and maintain better heart health. 

What Is HDL Cholesterol and Why Is It Called Good Cholesterol?

As discussed, cholesterol travels through the bloodstream with the help of lipoproteins. Among these, LDL and HDL are the two main types. 

• LDL, or low-density lipoprotein, is often referred to as the bad cholesterol because high levels can cause cholesterol to build up in the arteries. This could increase the risk of heart disease and stroke. 
• HDL, or high-density lipoprotein, also called as the ‘good’ cholesterol helps remove excess cholesterol from different parts of the body and carries it back to the liver. The liver then processes and removes this cholesterol from the body, helping protect the heart and blood vessels².

What Are Normal vs Low HDL Cholesterol Levels?

The following table provides the average values for optimal HDL cholesterol levels⁴. 

Note: Results may vary from person to person and should always be interpreted by a doctor. 

What If HDL Cholesterol Is Low?

Low HDL cholesterol means the body is becoming less effective at clearing excess cholesterol from the bloodstream. This can increase the risk of plaque buildup in the arteries, coronary artery disease, heart attack, and stroke⁵.

Important: Low HDL is considered an independent risk factor for cardiovascular disease⁵.

Low HDL Cholesterol Symptoms

HDL cholesterol low usually does not cause noticeable symptoms in most people and is often detected during a routine blood test. However, certain underlying conditions associated with low HDL may show physical signs that can indicate an increased cardiovascular risk. 

Some low HDL cholesterol symptoms include⁶:

• Excess fat accumulation around the abdomen or waist area 
• Skin tags and acanthosis nigricans (dark, thickened skin patches) (commonly linked with insulin resistance) 
• Xanthomas and xanthelasma, which are yellowish fatty deposits under the skin or around the eyes  
• Corneal opacity (or arcus corneae), which appears as greyish-white rings around the cornea 
• Enlarged tonsils, lymph nodes, liver, or spleen in rare inherited disorders such as Tangier disease 

Low HDL Cholesterol Causes

The answer to why HDL cholesterol is low can lie in several medical, genetic, and medication-related factors. Certain low HDL cholesterol causes include⁶: 

• Type 2 diabetes and insulin resistance: These conditions may affect how the body processes fats and sugars, which can lower HDL cholesterol levels. 
• Metabolic syndrome: A group of conditions including high blood sugar, high blood pressure, excess belly fat, and abnormal cholesterol levels that increase heart disease risk. 
• Hypothyroidism: An underactive thyroid gland can slow cholesterol metabolism and contribute to low HDL levels. 
• Liver disease: Since the liver plays a major role in cholesterol production and removal, liver disorders can affect HDL cholesterol levels. 
• Chronic inflammatory conditions: Long-term inflammation in the body may interfere with normal cholesterol breakdown and reduce HDL levels. 

Some inherited disorders affect cholesterol metabolism and lead to very low HDL levels. These include⁶: 

• Familial hypoalphalipoproteinemia 
• Familial HDL deficiency 
• Tangier disease 
• Fish-Eye disease 

Note: Certain medications may also contribute to low HDL cholesterol levels, including beta blockers and anabolic steroids. 

Risk Factors of Low HDL Cholesterol

Many lifestyle factors can affect HDL cholesterol levels in the body. Common risk factors of low HDL cholesterol include⁶:

• Obesity and excess body weight 
• Physical inactivity or sedentary lifestyle 
• Smoking and tobacco use 
• Unhealthy diet (especially one high in simple sugars and trans fats) 

Diagnosis of Low HDL Cholesterol

 Low HDL cholesterol is usually diagnosed through a fasting lipid profile blood test, which measures⁶:

• Total cholesterol 
• HDL (good) cholesterol 
• LDL (bad) cholesterol 
• Triglyceride levels 

In some cases, additional tests such as nuclear magnetic resonance (NMR) may be used to measure lipoprotein particle numbers, although these tests are not routinely used. 

Doctors may also recommend other investigations to identify underlying causes associated with low HDL cholesterol. These may include⁶:

• Blood sugar tests to check for diabetes or metabolic syndrome. 
• Kidney function tests and urinalysis if genetic conditions such as Fish-Eye disease are suspected. 
• Evaluation for thyroid or liver disorders that may affect cholesterol metabolism. 

Note: Although these signs may occur in some cases, HDL cholesterol low itself is usually ‘silent.’ Regular cholesterol screening is therefore important for early detection and management. 

Low HDL Cholesterol Treatment

There is currently no specific treatment recommended solely to increase HDL cholesterol levels. Instead, management mainly focuses on reducing overall cardiovascular risk and improving heart health through lifestyle changes. 

However, some cholesterol-lowering medications, such as statins, may slightly increase HDL levels while effectively lowering LDL cholesterol. Another medication called niacin might significantly raise HDL cholesterol levels; however, studies have shown limited additional cardiovascular benefit when added to standard statin therapy⁶.

Important: Do not self-medicate or start any cholesterol-lowering medicines or supplements without consulting a doctor. Proper medical evaluation and guidance are important to determine the underlying cause of low HDL cholesterol and the most appropriate treatment approach. 

How to Increase HDL Cholesterol?

Making healthy lifestyle changes can help improve HDL cholesterol levels and support overall heart health. Some effective ways to increase HDL cholesterol include²:

1. Eat a Heart-Healthy Diet

Choose healthy unsaturated fats over saturated and trans fats. We will discuss more dietary options in the next section. 

2. Maintain a Healthy Weight

Losing excess weight (especially around the waist) can help raise HDL cholesterol levels and reduce cardiovascular risk. 

3. Exercise Regularly

Regular physical activity, especially aerobic exercises such as walking, jogging, cycling, or swimming, can help increase HDL cholesterol while lowering LDL (bad) cholesterol. Aim for at least 30 minutes of exercise on most days of the week. 

4. Quit Smoking and Avoid Tobacco Exposure

Smoking lowers HDL cholesterol levels and damages blood vessels. Quitting smoking can improve HDL levels and overall heart health. 

5. Limit Excess Sugar and Refined Carbohydrates

Reducing sugary foods, sweetened beverages, and refined carbohydrates may help improve HDL cholesterol levels. 

6. Limit Alcohol Intake

Excessive alcohol consumption can contribute to weight gain and negatively affect cholesterol levels. So, alcohol should only be consumed in moderation, if at all. 

Foods That Help Increase HDL Cholesterol

Including heart-healthy foods in your daily diet may help improve HDL cholesterol levels and support overall cardiovascular health. Some beneficial food options include: 

• Healthy fats: Olive oil, avocados, nuts, seeds, and fatty fish such as salmon and tuna contain healthy unsaturated fats that may help improve HDL levels^2,7.
• Fiber-rich foods: Oats, whole grains, beans, lentils, fruits, and vegetables help support healthy cholesterol balance and heart health^2,7.
• Omega-3-rich foods: Flaxseeds, walnuts, and fatty fish are rich in omega-3 fatty acids, which may support healthy cholesterol levels^2,7.
• Lean protein sources: Skinless poultry, fish, legumes, and plant-based proteins are healthier alternatives to processed and high-fat meats^7,8.
• Antioxidant-rich foods: Berries, apples, tomatoes, and other colourful fruits and vegetables contain antioxidants that support cardiovascular health⁹.

At the same time, it is important to limit fried foods, processed snacks, sugary foods, trans fats, and excessive saturated fats, as these may negatively affect cholesterol levels and heart health².

Complications of Low HDL Cholesterol

Low HDL cholesterol can increase the risk of several health complications, particularly those related to heart and blood vessel health. Possible complications include⁶:

• Increased inflammation and oxidative stress: Reduced HDL may decrease the body’s ability to protect blood vessels from inflammation and damage. 
• Impaired glucose metabolism and insulin resistance: Low HDL levels are often associated with conditions such as type 2 diabetes and metabolic syndrome. 
• Atherosclerotic cardiovascular disease: Increased buildup of cholesterol and plaque in the arteries, which may raise the risk of heart disease, heart attack, and stroke. 
• Higher risk of cognitive decline: Low HDL cholesterol may also be linked with vascular and neuroinflammatory changes that might affect brain health and cognitive function over time. 

When to Consult a Doctor?

Regular health checkups and lipid profile testing can help detect low HDL cholesterol early and reduce the risk of future heart-related complications. You should consult a doctor if you: 

• Have a family history of high cholesterol, heart disease, or stroke 
• Are overweight or physically inactive 
• Have diabetes, high blood pressure, thyroid disorders, or liver disease 
• Smoke or use tobacco products 
• Notice any low HDL cholesterol symptoms 
• Have abnormal cholesterol levels on a blood test^2,6 

Also Read: High LDL (Bad) Cholesterol: Causes, Symptoms & How to Reduce It 

Conclusion

HDL, or good cholesterol, plays an important role in protecting heart health by helping remove excess cholesterol from the bloodstream. Low HDL cholesterol levels may increase the risk of heart disease, stroke, and other metabolic complications, especially when combined with unhealthy lifestyle habits or underlying medical conditions. 

Although low HDL often does not cause noticeable symptoms, regular cholesterol screening can help with early detection and management. Further, adopting healthy lifestyle habits such as eating a balanced diet, exercising regularly, maintaining a healthy weight, and avoiding smoking can help improve HDL levels and support overall cardiovascular health. 

If you have persistently low HDL cholesterol or other risk factors for heart disease, consult a doctor for proper evaluation, diagnosis, and personalised treatment guidance. 

Frequently Asked Questions (FAQs)

References

1. Huff T, Boyd B, Jialal I. Physiology, Cholesterol. In: StatPearls. StatPearls Publishing; 2026. Accessed May 19, 2026. http://www.ncbi.nlm.nih.gov/books/NBK470561/ 

2. HDL: The “Good” Cholesterol. Accessed May 19, 2026. https://medlineplus.gov/hdlthegoodcholesterol.html 

3. CDC. LDL and HDL Cholesterol and Triglycerides. Cholesterol. March 13, 2026. Accessed May 19, 2026. https://www.cdc.gov/cholesterol/about/ldl-and-hdl-cholesterol-and-triglycerides.html 

4. Cholesterol Levels: What You Need to Know. Accessed May 19, 2026. https://medlineplus.gov/cholesterollevelswhatyouneedtoknow.html 

5. Rezkalla SH, MD RAK. Low HDL—The Challenge. Clin Med Res. 2025;23(2):60-66. doi:10.3121/cmr.2025.1970 https://pubmed.ncbi.nlm.nih.gov/40813253/

6. Van Name JP, Sharma S. Low HDL Cholesterol(Archived). In: StatPearls. StatPearls Publishing; 2026. Accessed May 19, 2026. http://www.ncbi.nlm.nih.gov/books/NBK560749/ 

7. Liu AG, Ford NA, Hu FB, Zelman KM, Mozaffarian D, Kris-Etherton PM. A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion. Nutr J. 2017;16:53. doi:10.1186/s12937-017-0271-4 https://pubmed.ncbi.nlm.nih.gov/28854932/

8. Richter CK, Skulas-Ray AC, Champagne CM, Kris-Etherton PM. Plant Protein and Animal Proteins: Do They Differentially Affect Cardiovascular Disease Risk?12. Adv Nutr. 2015;6(6):712-728. doi:10.3945/an.115.009654 https://pmc.ncbi.nlm.nih.gov/articles/PMC4642426/

9. Rahaman MdM, Hossain R, Herrera‐Bravo J, et al. Natural antioxidants from some fruits, seeds, foods, natural products, and associated health benefits: An update. Food Sci Nutr. 2023;11(4):1657-1670. doi:10.1002/fsn3.3217 https://pmc.ncbi.nlm.nih.gov/articles/PMC10084981/

10. Hartley L, Flowers N, Holmes J, et al. Green and black tea for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;2013(6):CD009934. doi:10.1002/14651858.CD009934.pub2 https://pubmed.ncbi.nlm.nih.gov/23780706/

11. Zuraini NZA, Sekar M, Wu YS, et al. Promising Nutritional Fruits Against Cardiovascular Diseases: An Overview of Experimental Evidence and Understanding Their Mechanisms of Action. Vasc Health Risk Manag. 2021;17:739-769. doi:10.2147/VHRM.S328096 https://pubmed.ncbi.nlm.nih.gov/34858028/

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