Cholesterol Management

Reducing your Low Density Lipoprotien (LDL or “bad” cholesterol) and raising your High Density Lipoprotein (HDL or “good cholesterol) can help prevent complications in most people with diabetes as well as serve as a preventive measure for the non-diabetic populations.

What is cholesterol?  Cholesterol is a fat-like organic chemical that is an essential part of animal cell membranes and is required for our bodies proper function. Cholesterol converts into bile, which is required for fat digestion and assists in producing the bodies natural steroids as well as proper brain function.

This all sounds great, but problems can occur when your levels get too high.


Who are these good and bad guys?  HDL and LDL cholesterols are essentially the same. The difference is where they go in the body.  Lipoproteins transport cholesterol around the bloodstream so that cells can use it.

HDL takes cholesterol from the general circulation to the liver where it gets reprocessed. It removes extra cholesterol from blood vessels so they can work better.

LDL goes throughout the bloodstream, and if there’s too much of it, it gets attacked by white blood cells and turned into something called “foam cells.” These cells push cholesterol into the linings of arteries and cause plaque. Plaque narrows arteries and reduces blood flow, putting us at risk for heart attacks and strokes.
Generally, then, we want to increase HDL and decrease LDL. We may also want to reduce total cholesterol if we have too much. But how do we do that? We are often told to eat less fat to reduce cholesterol, but this can be misleading.

On the Discover Fit & Health Web site, Dr. Jerry Gordon says that only 15% of our body’s cholesterol comes from food. Eighty-five percent is produced by the cells of our body, in a process called biosynthesis.

Most of this self-made cholesterol is made from carbohydrates. Quite possibly, it’s the excess carbs that raise cholesterol.

Lets chew the fat...There are different kinds of fat. Polyunsaturated fats are found mainly in nuts, seeds, fish, and leafy greens. They lower both LDL and HDL.

Monounsaturated fats can be found in vegetable oils, dairy products, nuts, meats, and whole grains. They seem to lower LDL and sometimes raise HDL, so it seems we should surely eat more of them.

Saturated Fats come mostly from animal sources. They are fats that are solid at room temperature, like butter or meat fat. Substantial evidence has been produced stating red meat trimmed of visible fat does not raise total cholesterol or LDL levels.

Trans fats are mostly processed unsaturated fats that have hydrogen added to them. They raise LDL and lower HDL, exactly what we don’t want.

However, many studies have shown that lowering fat intake is not effective at lowering cholesterol in our blood. Other studies find that eating a low-carb diet raises HDL much better than a low-fat diet.

How can this be? Most of our cholesterol is made within the body. Insulin is a major signaler for cholesterol production. So eating insulin-stimulating foods (such as refined carbs) may raise cholesterol levels and especially LDL levels.

Why do some bodies produce more HDL and others more LDL? These balances are thought to be mostly genetic and are closely linked with diabetes. A study on people with diabetes found that bad cholesterol levels (“diabetic dyslipidemia”) are linked to insulin resistance. Many times the bad cholesterol numbers rise before the rise in blood glucose.

Should high LDL and high glucose be treated as part of the same disorder? Writing on Diabetes Self-Management, dietitian Amy Campbell MS, RD, CDE, gave several ways to bring high cholesterol levels down. You can read them all here, but the short course is:

• Eat a high fiber diet (+25 grams a day)   From both soluble and insoluble sources, although with soluble fiber you have to watch what it does to your glucose levels.

• Taking roughly 15 mg a day of niacin (vitamin B3) — and perhaps as much as 2,000 mg a day, if prescribed — can help. It does have side effects, like severe flushing of the skin in some people.

•Red Yeast Rice has been shown to lower LDL and may act like a low-dose statin drug. It is available online and at health food stores and Asian food stores. (As always, speak with your doctor before taking this or any other supplement.)

• Exercise can raise HDL quite a bit.

•Quitting Smoking has raised HDL in several studies, even when there was weight gain. It had no effect on LDL, though.

According to articles on AARP and other sites,foods that lower cholesterol and improve heart health include avocado, lentils, edamame (green soybeans), nuts, olive oil, pears, green and black tea, garlic, and onions.

In general, a diet low in refined carbs and high in unsaturated fats seems to work for most people. A low-fat diet does not seem the best way to lower cholesterol, according to several studies, which are summarized on this Paleo diet web site.

Hey Chris…What’s a refined carb again?   Glad you asked.  A refined carb is what happens when whole plants are processed and stripped of everything but the highly digestible carbohydrate (starch or sugar). This concentrate is broken down by the body very quickly, generally causing a high rise in blood sugar (glycemic response). It also usually removes the fiber and most of the nutrients in the food.

Refined carbohydrates include anything that is white (save for milk and eggs), anything we call sugar, anything we call starch and generally anything  “flaked, puffed or shredded.”

The bottom line is that bad cholesterol seems caused more by insulin resistance than fat consumption. Focus on a diet that lowers your blood glucose, and your cholesterol will probably follow. Has that been your experience?


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