Q My doctor told me my HDL is low. I really don't like to exercise. Are there other ways to raise my HDL? I saw on TV that eating artichokes will help. — T.B., Winterville

A There are proven ways to lower LDL, or the bad cholesterol, with dietary measures. They include eating only small amounts of saturated fat and using plant sterol and plant stanol esters. The science is so strong that these strategies are included in guidelines issued by groups like the American Heart Association and the National Cholesterol Education Program. There are other strategies that are "under study," and Charlene Locklear, a third-year ECU medical student would like to tell you about them. Here is what she wants you to know.

Let me you remind you that cholesterol is a waxy fat-like substance found in every cell of the body. It has several jobs, including strengthening cell membranes, and it is used to make hormones. However, too much of the wrong kind of blood cholesterol is dangerous. It can build up in the artery walls and lead to increased risk for clots, heart attacks and stroke. The good cholesterol is known as HDL. A high HDL, greater than 60 mg/dL gives some protection against heart disease by removing cholesterol from blood. The experts tell us that lower levels of HDL — less than 40 mg/dL in men and less than 50 mg/dL in women — put us at higher risk for heart disease.

There are the well-known lifestyle strategies for raising a low HDL. Increasing physical activity is one strategy that benefits all. Doing some moderate exercising such as swimming, jogging or brisk walking for 20-30 minutes a day most days of the week is good. If you smoke, quitting can raise your HDL. If you are overweight, reducing your weight through physical activity and/or dietary change will lead to an increase in your HDL. For some people, consuming a small amount of beer, wine or spirits can increase HDL.

The food strategies to raise HDL are under study and many look promising. The exact mechanism of how foods contribute to the reduction of cholesterol is unclear, but there are theories. A report on artichokes suggests that eating them can affect cholesterol by impeding the body's production of cholesterol in the liver and/or promoting bile flow. Bile is a substance that carries cholesterol and helps remove it from the body. Some scientists think that eating artichokes can cause an indirect inhibition of the enzyme HMGCoA reductase, which is the key enzyme involved in cholesterol synthesis. This is the same enzyme that medications act on to decrease cholesterol. While this is interesting, it is unlikely that many people in eastern North Carolina can eat artichokes on a daily basis.

It might be more helpful if the studies on the value of eating garlic turn out to be positive. Garlic has been shown to have some effect on cholesterol particularly at high doses. Garlic has an anti-oxidant property that stops LDL from being oxidized, and it increases HDL. The same is true of onions. But at this time it is not possible to know what daily dose of garlic or onion is needed. One expert suggests it would take at least half an onion a day.

Experts are also studying the effect of eating soluble fibers; eating foods rich in niacin; eating monounsaturated fats, fish oils, flaxseed oils, orange juice, tofu, soy and dark green vegetables.

If your HDL is low, your doctor will want you to use proven strategies to raise it and may suggest medicine if lifestyle changes are not possible or not effective.

Remember that regardless if you choose lifestyle or medication to improve your HDL you need to use those strategies daily. Food and exercise can be like medicine — they only work as long as you take them.

Professor Kathy Kolasa, a registered dietitian and Ph.D., works with the Family Medicine Center, Brody School of Medicine at ECU. Contact her at kolasaka@ecu.edu, or C/O The Daily Reflector, P.O. Box 1967, Greenville, NC 27835.