Tips to Lower Cholesterol
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What You Should Know About Cholesterol
While it's true that people with diabetes are more likely to experience cholesterol-related problems, simple lifestyle changes to lower your LDL (bad) cholesterol can reduce cardiovascular complications by 20-50 percent.
What is cholesterol?
Cholesterol has a bad reputation, but it isn't all bad. It's actually essential to your body -- albeit in small amounts. Cholesterol is a waxy, fatty substance in your blood that's naturally produced by your body. It makes hormones, builds cells and tissues, and helps your body digest food.
Cholesterol is also found in foods from animals, such as egg yolks, meat, fish, poultry, and whole-milk dairy products. Serious health problems arise when high levels of LDL circulate in the bloodstream, building up on the inner walls of the arteries and leading to fatty deposits of plaque called atherosclerosis.
Two types of cholesterol: LDL and HDL
LDL: Low-density-lipoprotein (LDL) cholesterol is known as the bad cholesterol. When too much LDL cholesterol is in your blood, it makes the inner walls of your arteries hard and narrow. It can combine with other substances to form plaque and increase your risk of heart disease.
Recommended LDL level for people with diabetes: The American Heart Association (AHA) recommends that people with diabetes have an LDL level below 100 mg/dl. If you have other cardiovascular risk factors, your health care provider may want your level to be below 70 mg/dl. A lower number is better.
HDL: High-density-lipoprotein (HDL) cholesterol is called the good cholesterol. HDL has the opposite effect of LDL -- HDL helps remove cholesterol from the body.
Recommended HDL level for people with diabetes: According to the AHA, your HDL level should be above 40 mg/dl. The American Diabetes Association says HDL should be more than 50 mg/dl in women and 40 mg/dl in men. A higher number is better.
You can take control of your cholesterol
Dietary changes, regular exercise, and cholesterol-lowering medications such as statins can help you lower your LDL and raise your HDL. Our expert doctors and dietitians show you how to live a heart-healthy lifestyle with easy-to-follow tips.
Eat More Fiber
Soluble fiber helps lower LDL cholesterol by reducing its absorption in the intestines. Total fiber should add up to about 20-30 grams a day, the American Diabetes Association says.
"Fiber can reduce LDL cholesterol by 5-10 percent," says Stephen Devries, M.D., a preventive cardiologist at the Northwestern Memorial Hospital Division of Cardiology and the Center for Integrative Medicine and author of What Your Doctor May Not Tell You About Cholesterol (Time Warner, 2007).
Examples of high-fiber fruits and vegetables:
- Brussels sprouts
Soluble fiber can also be found in these foods:
- Lima beans
- Kidney beans
- Black beans
- Pinto beans
Though whole foods pack higher nutritional values than supplements, psyllium fiber supplements such as Metamucil, Citrucel, and FiberCon are another way to increase your fiber. "Psyllium fiber has also been shown to be helpful in lowering cholesterol levels," says Kelly O'Connor, R.D., LDN, CDE.
Limit Saturated Fat
Reduce the amount of saturated fat in your diet to lower your cholesterol.
Saturated fat, most commonly found in red meat and dairy products, raises total cholesterol and LDL cholesterol. "It's simple: Reducing saturated fat reduces total cholesterol," says Nessie Ferguson, R.D., CDE, of the University of Nebraska Medical Center Department of Clinical Nutrition. According to the Cleveland Clinic, the country's top-ranked heart center, saturated fats have the most potent cholesterol-raising potential. The American Diabetes Association recommends cutting your intake of saturated fats to less than 7 percent of daily calories.
The Cleveland Clinic suggests avoiding or limiting these high-fat foods:
* Dairy products, such as whole milk, butter, cream, and regular cheese
* Processed meats, such as bologna, salami, and hot dogs
* Sauces and gravies made from animal fat
* Bacon fat
* Fried foods
* Tropical oils, including coconut oil, palm oil, and palm kernel oil
* Desserts made with lard, shortening, and butter
"Saturated fats should be very limited," says Kelly O'Connor, R.D., LDN, CDE, of the Diabetes Center at Mercy in Baltimore
Choose lean cuts of meat, low-fat dairy products, and monounsaturated fats (found in nuts, avocados, and olive, peanut, and canola oils) for healthy alternatives to saturated fats. For instance, top your salad with heart-smart olive oil vinaigrette and almonds. Plus, monounsaturated fats and polyunsaturated fats help reduce triglycerides. Replace saturated fats with small portions of monounsaturated and/or polyunsaturated fats to raise your HDL cholesterol.
Add Plant Sterols
Lower your cholesterol by more than 10 percent by eating foods fortified with plant sterols. Plant sterols and stanols help block cholesterol absorption and are naturally found in fruits, veggies, legumes, and other plants.
When plant sterols are incorporated into orange juice, margarine spreads (think Benecol, Take Control, or Smart Balance Plus), and yogurt, your body utilizes them to lower levels of LDL cholesterol.
Include two grams of plant sterols in your daily diet to successfully lower your cholesterol, says cardiologist Stephen Devries. For example, drink one 4-ounce glass of plant sterol-fortified orange juice, and eat plant sterol-fortified margarine spreads and yogurt.
Opt for Omega-3s
Not all fats are bad! Eat foods rich in omega-3 fatty acids to lower your LDL cholesterol. Omega-3s raise HDL cholesterol as well.
Find omega-3s in these fish:
- Albacore tuna
- Lake trout
High consumption of fish and other sources of omega-3 fatty acids is associated with lower incidence of coronary heart disease and mortality in women with diabetes, according to a 2003 study in the American Heart Association's journal Circulation.
More good sources of omega-3s:
- Ground flaxseed
- Canola oil
- Fish oil supplements
Omega-3 fats are great for heart health: They lower triglycerides and blood pressure. Another bonus? This type of fat helps prevent blood clots.
Studies show that exercising up to three times a week for 30 minutes can reduce LDL cholesterol, increase HDL cholesterol, and lower your risk of serious heart complications.
According to the American Diabetes Association, people with diabetes who exercise for at least 30 minutes a day have better glucose control and a much lower risk of complications from cardiovascular disease than those who don't exercise.
More health benefits of exercise:
- Lowers triglycerides
- Reduces blood pressure
- Improves blood sugar tolerance
- Controls weight and reduces body fat
- Manages stress
Our favorite 30-minute workouts:
- Take a walk
- Work in the garden
- Ride your bike
- Take a dance class
Quit smoking to increase your HDL cholesterol.
"While smoking can depress good cholesterol, stopping smoking can raise good cholesterol," says cardiologist Stephen Devries.
Ditching the cigarettes doesn't just raise HDL cholesterol -- it's good for your heart in other ways, too. According to the Mayo Clinic, just 20 minutes after quitting smoking your blood pressure decreases. Within 24 hours, your risk of a heart attack decreases. Within one year, your risk of heart disease is half that of a smoker. Within 15 years, your risk of heart disease is similar to someone who never smoked.
"HDL cholesterol is extremely important. The higher your HDL, the more protection you have," says Steven Edelman, M.D., PWD type 1, founder of Taking Control of Your Diabetes, a nonprofit health organization.
It's not just what you eat that affects your cholesterol -- the way you prepare your meals matters, too. But using low-cholesterol cooking methods doesn't mean your menu has to be bland or boring.
"It's pretty easy to learn how to cook lean," says nutritionist Nessie Ferguson. "There are very basic things you can do all the time to lower your cholesterol."
Low-cholesterol cooking tips and tricks:
- Brush heart-healthy olive oil on vegetables or lean meats.
- Use a cooking spray to give your food flavor without adding saturated fat.
- Saute foods in broth or wine.
- Cut visible fat from meat before cooking.
- Remove skin from poultry.
- Marinate meat with fruit juice or fat-free Italian salad dressing.
Best cooking methods for low-cholesterol meals:
"It's best to avoid all deep-fat-fried foods," says nutritionist Kelly O'Connor. "If frying, use canola or olive oil."
"We shouldn't assume that a diabetes diet low in cholesterol is going to be a boring diet," says cardiologist Steven Edelman. "Just be smart about what you eat and how you prepare it."Roasted Asparagus Parmesan Recipe
Avoid Trans Fat
Eliminate trans fat from your meals and snacks to lower your total cholesterol. Trans fat raises your LDL cholesterol and lowers your HDL cholesterol.
What you should know about trans fat:
- It hides in fried foods and processed convenience goods such as cookies, crackers, doughnuts, and snack cakes.
- Even if the package says "trans fat-free," the food can still contain 0.5 gram per serving.
- You can spot a food with trans fat if it contains partially hydrogenated oil.
"The key is to avoid all trans fats. At this time, no amount has been shown to be safe," says nutritionist Kelly O'Connor. "Remember that a lot of processed foods, particularly desserts, contain trans fats, so it's best to make your own desserts."
It can be tempting to load your cart with processed snacks and convenience foods. But as we know, most aren't heart-healthy. The next time you go grocery shopping, try these simple tricks for picking healthful foods to help you lower your cholesterol and manage your diabetes.
"Shop around the perimeter of a grocery store first. These items usually include produce, dairy, and fresh meats and poultry. All of the processed, packaged foods tend to be in the middle aisles, so make these items only a small part of your shopping," says nutritionist Kelly O'Connor. "If you're tempted by high-fat snacks or items, buy them in individual portions. They may cost a bit more, but it's generally easier to limit yourself to one serving."
Avoid temptation by crafting a grocery list now. Our diabetes menus (below) take the hassle out of shopping, allowing you to prepare healthful meals that help keep your cholesterol low.
Consider a Prescription
Though lifestyle changes, diet, and exercise can naturally lower your LDL cholesterol and increase your HDL cholesterol, sometimes you need a prescription to help your body lower your total cholesterol even more.
To get your LDL level below 100 mg/dl, doctors usually prescribe statins first. Commonly prescribed statins include Lipitor, Lescol, Mevacor, Altocor, Pravachol, Crestor, and Zocor.
How statins work: According to the American Heart Association, statins work in the liver to prevent the formation of cholesterol. Statins effectively lower LDL levels, but they also have modest effects on lowering triglycerides (blood fats) and raising HDL levels.
Statin side effects: The most common are mild muscle and stomach pain, according to the American Diabetes Association (ADA). Statins also can raise the levels of some liver enzymes, so take a liver test before starting a statin.
More medications to help you manage cholesterol:
- Niacin: Lowers LDL cholesterol and triglycerides while raising HDL cholesterol. (Niacor, Niaspan, Nicolar)
- Bile acid resins: Stick to cholesterol in the intestines and prevent it from being absorbed. (Colestid, Prevalite, Questran Light, WelChol)
- Fibrates: Mainly reduce triglycerides and may also increase HDL levels. People with type 2 diabetes often have too-high triglyceride levels, and some need a drug to lower triglycerides in addition to (or instead of) an LDL cholesterol-lowering medicine, according to the ADA. (Lopid, Tricor)
Talk with your doctor to get your cholesterol checked and for more information about cholesterol-related drugs.