Managing High Cholesterol in People with Diabetes
Type 2 diabetes often goes hand in hand with unhealthy cholesterol levels. Even people with diabetes who have good blood sugar control are more likely than other healthy people to have one or more cholesterol problems, which can increase their risk of developing atherosclerosis and other cardiovascular diseases.
People with diabetes have made dietary and lifestyle changes to keep their blood sugar (glucose) levels constant. However, because diabetes increases the risk of heart disease, you can also take steps to keep your cholesterol levels constant.
Aspects of the cholesterol problem
Cholesterol itself is not bad; it is in every cell in the body and serves many good purposes, such as helping to produce hormones, digestion and converting sunlight into vitamin D. About 75 percent of the cholesterol in your blood is made by the liver, but the rest comes from your diet. That’s why changing your diet is an effective way to maintain healthy cholesterol levels.
There are two types of cholesterol
- Low-density lipoprotein (LDL) cholesterol is considered the “bad” cholesterol. It is a soft, waxy substance that builds up in the blood and interferes with blood flow.
- High-density lipoprotein (HDL) – the “good cholesterol” – helps keep blood vessels clean by transporting LDL cholesterol to the liver for removal.
Healthy Eating Guidelines
To manage diabetes and cholesterol, you need to watch the amount of carbohydrates, cholesterol and saturated fat in your diet and make sure you are getting enough of certain nutrients that can help improve blood sugar and cholesterol levels.
Sugar can be found in food in two ways. However, it is also sneakily found as an additive in fruit drinks, ketchup, barbecue sauce and other condiments. The 2020-2025 Dietary Guidelines developed by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture recommend limiting the intake of added sugar to no more than 10% of daily calories4.
Saturated fats are found in foods such as animal protein, processed meats, vegetable oils, dairy products and snacks and can raise LDL cholesterol levels in the body. The U.S. Dietary Guidelines recommend that no more than 10% of total daily calories come from saturated fat, while the American Heart Association (AHA) recommends that no more than 5-6% of total daily calories come from saturated fat. The maximum number of calories from saturated fat is 120 calories, or about 13 grams.
This is a particularly bad type of saturated fat that comes from the heating (hydrogenation) of liquid vegetable oils, a process that is used in an unnatural way to give foods longer shelf life. It is used in margarine, processed snacks, baked goods, and fried foods.
Managing cholesterol and diabetes
In addition to following established general healthy eating recommendations and monitoring blood sugar to determine the effects of certain foods, especially carbohydrates, on blood levels, there are other effective ways to manage diabetes and maintain healthy cholesterol levels.
Eat more fiber
Fiber is the part of plants that cannot be digested. It is satiating but is not absorbed by the body, so it does not add calories and helps with weight loss. Soluble fiber in foods such as beans, apples, and oatmeal can also help lower LDL cholesterol and keep blood sugar levels stable.
A good rule of thumb for getting enough fiber at every meal is to fill half of your plate with fat-free vegetables, from artichokes and asparagus to radishes and zucchini. They contain a lot of fiber (and health-protecting phytonutrients).
Try to gradually increase the amount of fiber you eat each day to at least 25 grams a day if you’re a man6 and 38 grams a day if you’re a woman.
Choose the right fats
Fat is an important nutrient that is necessary for energy and hormone production, vitamin absorption, maintaining the integrity of every cell membrane in the body, and growth and development. According to the Dietary Reference Intakes published by the U.S. Department of Agriculture, 20 to 35 percent of calories should come from fat. However, when it comes to dietary fats, not all types of fats are created equal.
As mentioned earlier, saturated fats contribute to elevated LDL cholesterol levels, as do the trans fats found in fried and baked goods. However, the monounsaturated fats found in olives, olive oil, nuts and seeds can help lower blood cholesterol levels.
Polyunsaturated fats found in fatty fish such as salmon and cod, and flaxseeds and nuts are rich in omega-3 fatty acids, which are important for lowering blood cholesterol and triglycerides.
If you are overweight or obese, losing just 5-10% of your body weight can have a very positive impact on your diabetes and cholesterol levels, help lower blood sugar and blood pressure, and improve blood lipids. It can also reduce the amount of medication you use.
One of the best ways to start a safe and effective weight loss program tailored to you is to keep track of what you eat, how much you eat, and when you eat for three days, preferably two weekdays and one weekend day. You can then have a registered dietitian (or use an online program) perform an analysis to determine the average number of calories you consume and learn about other habits, such as the number of vegetables you eat (or don’t eat) and the major types of fats in your diet.
With this information, you’ll know how many calories you need to eat to lose weight slowly and steadily, and what foods to cut back on or avoid to add less sugar and saturated fat.
How to get started
Physical activity burns calories, so exercise is always recommended as part of a weight loss program, especially for people with diabetes.
Exercise has also been shown to help lower total cholesterol levels. How? Studies show that a combination of aerobic exercise and weight training is ideal.
As for the amount and frequency of exercise, the AHA recommends 150 minutes of moderate-intensity aerobic exercise per week, or 75 minutes of vigorous aerobic exercise per week, or a combination of both, preferably spread out over the week. At least 300 minutes (5 hours) of exercise per week can provide additional benefits. Do at least two days per week of moderate-to-high intensity strength training.
Any physical activity, even if it’s just taking the stairs instead of the elevator, or walking around the block, is better than no activity at all. And if you have trouble exercising for long periods of time, break it up into short 10- or 15-minute sessions throughout the day.