What does an HDL level of 38 mg/dL mean? Are there symptoms associated with this HDL level? 

An HDL cholesterol level of 38 mg/dL is considered very low. Very low HDL cholesterol is associated with an increased risk of heart disease and stroke. 

Very low HDL cholesterol doesn’t have symptoms, which is why it’s good to know your levels. Increasing your HDL cholesterol to >60 mg/dL will likely help lower LDL “bad” cholesterol and triglyceride levels, as well as your risk for developing heart disease and other health issues.

Factors that could contribute to an HDL level of 38

Several factors can affect HDL levels, including your diet, weight, activity level, age, sex, race, genetics, and whether or not you smoke. Certain medications and diseases can also impact HDL levels.

• Diet: Diets high in saturated fats, trans fats, added sugar, and low in fiber can lower HDL levels.

• Weight. Having excess fat, particularly around the abdomen, can also lower HDL.

• Physical Activity. Being physically active can increase HDL cholesterol levels and lower LDL levels. 

• Smoking. Smoking lowers HDL cholesterol which can contribute to higher LDL (bad) cholesterol.

• Medications: Certain medications can lower HDL levels. These include beta-blockers (a common blood pressure medicine), anabolic steroids (including testosterone), progestins (found in some birth control pills and hormone replacement therapy), and benzodiazepines (used for anxiety and insomnia). 

• Metabolic disease/ uncontrolled diabetes: Metabolic disease and uncontrolled diabetes can lower HDL levels.

• Age and Sex: Women tend to have higher HDL levels than men, though levels typically decrease after menopause. 

• Genetics (heredity): Family members commonly have similar cholesterol levels, suggesting your genes can raise your risk of unhealthy cholesterol levels. Though rare, very low HDL cholesterol levels can also be inherited. Medical conditions that severely lower HDL levels include Tangier’s disease and familial hypoalphalipoproteinemia.

• Race. Hispanic Americans are more likely to have lower HDL levels, whereas Blacks/African Americans are more likely to have higher levels [8]. However, other risk factors, such as high blood pressure, obesity, or diabetes, may outweigh the health benefit of higher HDL levels.

• Alcohol: Some evidence suggests moderate alcohol consumption may increase HDL levels [6]. For women of all ages and men >65 years of age, one drink per day. For men <65 years of age, up to 2 drinks per day. [6].

What to do if your HDL level is 38?

If your HDL level is 38 mg/dL, consult your doctor so they can evaluate your total cholesterol level and determine the best treatment plan for you. If your LDL (“bad”) cholesterol and triglycerides are high, your doctor may prescribe you cholesterol-lowering medications that may also help increase your HDL.

Making changes to your diet and adopting healthier habits can help raise HDL levels. Here are some things you can do to increase your HDL: 

• Be active every day. Aim for 30-60 minutes of exercise 5x/week.

• Eat more fiber-rich beans and whole grains.

• Avoid trans fats (like hydrogenated oils) and limit saturated fats to  < 10% of total calories.

• Eat small, fatty fish such as salmon, sardines, and mackerel at least twice a week.

• Lose weight if you are overweight or obese.

• Quit smoking.

• Manage stress and get adequate sleep. Stress triggers inflammation that can lower HDL.

Medications and supplements used to improve HDL results

Medications

Medications are not typically prescribed for low HDL levels alone because most medications target “bad” LDL cholesterol and triglycerides. However, HDL levels can increase from drugs used to lower LDL and triglyceride levels. Some of these include: 

• Fibrates: May help raise HDL in addition to reducing triglyceride levels.

• Statins: Statins reduce cholesterol production in your liver, lowering blood cholesterol. Common statins include atorvastatin, simvastatin, and rosuvastatin. Because they typically need to be taken for life, statins are only prescribed if diet and lifestyle changes aren’t enough [3].

Supplements

• Niacin: Niacin is a B vitamin that can block the enzyme responsible for making cholesterol in the liver. When taken at prescription doses, niacin can improve HDL levels and lower triglyceride levels, although it does not appear to reduce heart disease events, like heart attacks or strokes [9].

• (Algal) Omega-3: Made from certain marine algae, DHA-rich algal oil might help increase HDL cholesterol while lowering triglycerides, though it also seems to increase LDL (bad) cholesterol [10].

• Turmeric: A spice commonly used to flavor and color curry dishes, turmeric may help increase HDL and lower pro-inflammatory markers, LDL cholesterol, and triglycerides [11]. More research is needed to determine optimal form and dosage but supplementing with 500 mg/day appears safe and potentially beneficial cholesterol.