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Cholesterol and Diabetes
Cholesterol, we’ve all heard the term, unless you are living under a rock! As a person with diabetes, cholesterol is one of the key health metrics you need to keep track of to make sure you don’t suffer some of the complications of diabetes.
But what is cholesterol? Why is it important for our health?
Cholesterol is a waxy substance found in our blood and in body cells. Cholesterol comes from two sources: your body and food. Your liver and other cells in your body make about 75 percent of blood cholesterol. The other 25 percent comes from the foods you eat. We need cholesterol and use it to make some hormones, vitamin D and it is also a component of our cell membranes. Cholesterol is found only in animal products like meat, eggs, dairy and shellfish.
Humans evolved eating a primarily plant rich diet. Some of those foods block the absorption of cholesterol, so humans had to be very good at conserving it in our bodies. When our diets were richer in fruits and vegetables this ability to store cholesterol was not a problem.
Today, many of the foods we eat are high in cholesterol, and too much of the wrong kind of cholesterol in our diet may contribute to heart disease.
Cholesterol travels through the blood attached to a protein called a lipoprotein. Lipoproteins are classified as high density, low density, or very low density, depending on the ratio of protein to fat.
There are several different types of cholesterol and one of them is actually good for you!
• Low density lipoproteins (LDL): Also referred to as "bad" cholesterol, can cause buildup of plaque on the walls of arteries. The more LDL there is in the blood, the greater the risk of heart disease.
• High density lipoproteins (HDL): Also referred to as "good" cholesterol, helps the body rid itself of “bad” cholesterol in the blood. The higher the level of HDL cholesterol, the better. If your levels of HDL are low, your risk of heart disease increases.
• Very low density lipoproteins (VLDL): This is similar to LDL cholesterol because it contains mostly fat and not much protein.
• Triglycerides: Triglycerides are another type of fat that is carried in the blood by very low density lipoproteins. Excess calories, alcohol, or sugar in the body are converted into triglycerides and stored in fat cells.
People with diabetes should have their cholesterol checked at least once yearly and more often if they have high cholesterol or heart disease.
Your cholesterol results can be confusing because there are several different numbers and they are measured in milligrams per deciliter. (Who says America doesn’t use the metric system?).
In general, you want your total cholesterol number to be below 200, bad cholesterol (LDL) between 70 - 129 mg/dl, depending on your risk for heart disease. Good cholesterol levels (HDL) should be 50 mg/dl or higher.
The first number is your total cholesterol. This is the sum of all the types of cholesterol listed above.
Below 200 mg/dl Desirable
200 – 239 mg/dl Borderline High
240 mg/dl and above High
Below 70 mg/dl Target for people at very high risk of heart disease
Below 100 mg/dl Target for people at risk of heart disease
100- 129 mg/dl Near ideal
130 – 159 mg/dl Borderline high
160 – 189 mg/dl High
190 mg/dl and above Very high
Below 40 mg/dl (women)
Below 50 mg/dl (men) Poor
50 – 59 mg/dl Acceptable
60 mg/dl and above Best
Below 150 mg/dl Desirable
150 – 199 mg/dl Borderline High
200 – 499 mg/dl High
500 mg/dl or higher Very High
Unfortunately, there are a lot of factors that can affect your cholesterol levels. These include:
Diet – Diets high in saturated fat and cholesterol and low in fruits and vegetables can increase cholesterol levels. Try to reduce the amount of saturated fat and cholesterol in your diet, add servings of whole grains and plenty of fruits and vegetables from a full palette of colors.
Weight - Being overweight can increase your cholesterol levels and increase your risk for heart disease. Losing weight can help lower your LDL and total cholesterol levels, as well as increase HDL cholesterol.
Exercise – Studies have shown regular exercise can lower LDL cholesterol and raise HDL cholesterol. Aim to be physically active for 30 minutes on most days.
Age and Gender - Unfortunately, cholesterol levels rise as we get older. Gender can be a factor, too. Women tend to have lower total cholesterol levels than men of the same age, until after menopause, when women's LDL levels tend to rise.
Diabetes - Poorly controlled diabetes increases cholesterol levels. With improvements in control, cholesterol levels can fall.
Heredity - Your genes partly determine how much cholesterol your body makes and how well you store it. High blood cholesterol can run in families.
Other causes - Certain medications such as some HIV drugs and medical conditions can cause high cholesterol.
Too much cholesterol may cause a thick hard deposit (plaque) to form on the artery walls, narrowing the space for blood to flow to the heart. Over time, this buildup causes atherosclerosis (hardening of the arteries), which can lead to heart disease or a heart attack.
The Dietary Guidelines suggest we limit cholesterol in the diet. Some health professionals recommend eating no more than 300 mg/day of cholesterol.
"People want some kind of magic powder to sprinkle on their food to lower cholesterol, but the best treatment is weight loss and eating better, exercise, and quitting smoking, which will give you the best results and may allow a person to avoid medications entirely," says Alice H. Lichtenstein, MD, professor of nutrition at Tufts University and spokeswoman for the American Heart Association.
Soluble fiber is very effective at lowering cholesterol. The best way to get fiber is to eat a variety of whole grains and vegetables daily, but fiber supplements work, too. Exactly how fiber reduces cholesterol is not agreed upon, but it appears to bind to cholesterol and bile acids in the intestine, making it unavailable for absorption. When the liver needs to replace the bile acids excreted with the fiber, it pulls cholesterol from the bloodstream to make more bile acids. "Throw in the fact that fiber has all kinds of other benefits for your entire digestive system, and fiber becomes one of the best dietary means of lowering cholesterol," says Roberta Lee, MD, medical director for the Center for Health and Healing at the Beth Israel Medical Center in New York.
If those measures are ineffective, your doctor will likely prescribe a statin, a highly effective class of drugs to lower your cholesterol levels.
There are some alternative treatments available, but you should always consult with your physician before using them, since some of them may alter the effectiveness of other prescribed drugs. "Research shows that 70% of patients are reluctant to share information about alternative therapies they may be taking with their doctor," says Lichtenstein. "That's a real mistake in general, but especially when it comes to reducing high cholesterol. You need to let your doctor in on everything you're taking before you take it."
Here are a few alternatives to statins that are beneficial and not all hype:
• Niacin is a B-complex vitamin that at high doses lowers cholesterol. Adding niacin to prescribed statin drugs is also a common practice. This combination can decrease cholesterol more than statins alone and appears to raise levels of beneficial cholesterol (HDL). However, this therapy requires medical monitoring because of the potential for side effects, such as muscle breakdown.
• Stanol esters are in certain margarines, such as Take Control or Benecol; also available in pill-form supplements. This supplement is plant-derived and can reduce cholesterol by as much as 10% by stopping the absorption of cholesterol. They may be used in combination with statin drugs. Lee points out that stanol esters should be used as part of a treatment plan and in consultation with your doctor.
• Red yeast rice contains a natural form of the statin drug Mevacor. Some initial research has shown red yeast rice to be effective in lowering cholesterol but, according to Lee, the FDA has some issues with it because herbal doses can vary widely, which is not something you want in cholesterol control.
National Institutes of Health (NIH)
Centers for Disease Control and Prevention (CDC)
Updated June 10, 2013
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