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Tips to Lower Cholesterol

People with diabetes are at high risk of developing abnormal blood lipid (cholesterol) levels, which can put them at risk for heart disease. To help prevent, delay, or care for existing abnormal cholesterol levels, try these lifestyle tips, plus talk to your health care provider about medication options.

What to Know About Cholesterol & Diabetes

People with diabetes are more likely to experience abnormal cholesterol levels, typically elevated and unhealthy LDL (bad)cholesterol, low HDL (good) cholesterol, and elevated triglycerides. High cholesterol is one reason people with diabetes have a higher risk of cardiovascular disease, which includes heart attack and stroke.

What is total cholesterol?

Cholesterol is a waxy, fatty substance in your blood that's naturally produced by your liver. Your body must have some cholesterol to make hormones, build cells and tissues, and digest foods.

Cholesterol is also found naturally in some foods from animals, such as egg yolks, meat, fish, poultry, and whole-milk dairy products.

When your doctor orders a blood lipids check, one of the numbers is total cholesterol.

Two types of cholesterol: LDL and HDL

LDL: Low-density lipoprotein (LDL) cholesterol is known as the bad or unhealthy cholesterol. When too much LDL cholesterol is in your blood, it can aid the development of plaque on the inner walls of your arteries, which makes them hard and narrow. This can increase your risk of heart disease.

Recommended LDL level for people with diabetes:

The American Diabetes Association (ADA) recommends that people with diabetes and no existing cardiovascular disease have an LDL level of 100 mg/dl. For people with diabetes and a history of cardiovascular disease, the LDL goal is 70 mg/dl.

HDL: High-density lipoprotein (HDL) cholesterol is called the good or healthy 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 ADA, your HDL level if you are a woman should be above 50 mg/dl. If you are a man, the recommendation is above 40 mg/dl. For HDL cholesterol, a higher number is better.

Take control of your cholesterol

Eating better, exercising regularly, and taking cholesterol-lowering medications, such as statins, can help lower LDL and raise HDL. Our expert doctors and dietitians show you how you can make some changes to live a heart-healthy lifestyle with diabetes.

Eat More Fiber

Soluble fiber helps lower LDL cholesterol by reducing the absorption of cholesterol in the intestines. Your fiber goal should be at least 25 grams a day, the amount that all healthy Americans should eat, according to the American Diabetes Association.

"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:

• Apples

• Bananas

•  Brussels sprouts

•  Broccoli

•  Carrots

•  Grapefruit

•  Oranges

•  Peas

•  Pears

•  Spinach

•  Strawberries

Soluble fiber can be found in these foods:

•  Oats

•  Barley

•  Rye

•  Lima beans

•  Kidney beans

•  Black beans

•  Pinto beans

Psyllium fiber supplements, such as Metamucil, Citrucel, and FiberCon, are other ways to increase your fiber intake.

"Psyllium fiber has also been shown to be helpful in lowering cholesterol levels," says Kelly O'Connor, R.D., LDN, CDE.

Limit Saturated Fat

Saturated fat, most commonly found in red meat and full-fat dairy products (especially cheese), raises total cholesterol and LDL cholesterol. "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 strongest cholesterol-raising potential. The ADA recommends cutting your saturated fat intake 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, sausages, and hot dogs

* Sauces and gravies made with animal fats

* Bacon fat

* Fried foods

* Tropical oils including coconut oil, palm oil, and palm kernel oil

* Desserts made with lard, shortening, or 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 or fat-free dairy products, and foods that contain monounsaturated fats, such as nuts, avocados, and olive, peanut, and canola oils. Plus, monounsaturated fats and polyunsaturated fats can help reduce triglycerides. Replace saturated fats with small portions of monounsaturated and/or polyunsaturated fats to help raise your HDL cholesterol.

Add Plant Sterols or Stanols

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, vegetables, 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 2 grams of plant sterols or stanols 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:

•  Salmon

•  Albacore tuna

•  Sardines

•  Lake trout

•  Mackerel

•  Herring

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:

•  Walnuts

•  Almonds

•  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.

Get Moving

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 heart disease.

According to the ADA, people with diabetes who exercise for at least 30 minutes a day have better blood sugar 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

•  Lowers blood sugar levels

•  Improves insulin sensitivity/decreases insulin resistance

•  Helps maintain weight loss and reduces body fat

•  Helps manages stress

 

Our favorite 30-minute workouts:

•  Take a walk

•  Work in the garden

•  Ride your bike

•  Take a dance class

•  Golf 

Stop Smoking

"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.

Visit smokefree.gov today!

Cook Creatively

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 dietitian 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 on meat.

•  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:

•  Baking

•  Broiling

•  Roasting

•  Grilling

"It's best to avoid deep-fried foods most of time," says dietitian Kelly O'Connor. "If frying, use canola oil."

A diabetes- and heart-healthy eating plan that is low in cholesterol doesn’t have to be bland. There are cooking methods that infuse great flavor and keep the nutrition part smart. 

Avoid Trans Fat

Limit 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 can hide 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 the label lists partially hydrogenated oil among the ingredients.

"The key is to limit trans fats to nearly nil. At this time, no amount has been shown to be safe," says dietitian Kelly O'Connor. "Remember that a lot of processed foods, particularly desserts, contain trans fats, so it's best to make your own desserts."

Shop Smart

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 aisles 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 dietitian 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 going to the supermarket with your grocery list in hand. Plan meals ahead of time, which will help you prepare healthful foods that help keep your cholesterol low.

Consider a Prescription

While making changes in your eating habits and getting more exercise can help to improve your cholesterol levels, many people with diabetes need a prescription to reach LDL and HDL cholesterol goals.

If you don’t have cardiovascular disease or have low risk of developing it, consider a statin medication if LDL cholesterol remains above 100 mg/dl or you have multiple risk factors. If you have existing cardiovascular disease, your goal should be 70 mg/dl. You may need a high dose of statin medication to reach this goal.

To get your LDL level to your goal, health care providers usually start with a medication in the category called a statin. Commonly prescribed statins include Lipitor, Lescol, Mevacor, Altocor, Pravachol, Crestor, and Zocor.

How statins work: 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 side effects are mild muscle and stomach pain, according to the 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: Sticks to cholesterol in the intestines and prevents it from being absorbed. (Colestid, Prevalite, Questran Light, Welchol)

Fibrates: Mainly reduces triglycerides and may also increase HDL levels. People with type 2 diabetes often have elevated 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 health care provider to have your cholesterol checked and for more information about cholesterol-related drugs.

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