Cholesterol, not carbohydrate, is the other “c” word one needs to understand when managing diabetes. It is a term known to most, but tends to come with many questions. How much is too much? Do different types of cholesterol exist? If so, is there such a thing as good cholesterol or is all cholesterol bad for you? What is cholesterol?
Let's take a good look at another important piece of the puzzle for a healthy you - Cholesterol.
What is cholesterol?
Cholesterol is a waxy fat like substance that is made by the liver and travels throughout the bloodstream as spherical particles called lipoproteins. We need cholesterol for daily living to make cell membranes, hormones and vitamin D. However, too much cholesterol can cause blockages in the arteries.
Types of cholesterol
LDL cholesterol (lousy) = aim for Low levels
LDL (low density lipoprotein) cholesterol is commonly known as the “bad” cholesterol. This type of cholesterol clogs arteries and can lead to heart attack or stroke.
HDL cholesterol (happy) = aim for High levels
HDL (high density lipoprotein) cholesterol is known as the “good” cholesterol. This type of cholesterol prevents artery blockage. Think of it as drano for your pipes, cleaning out the clogged arteries.
Besides LDL and HDL, triglycerides are also important to keep in check for heart health. They are a type of fat and provide the body with energy. Their main function is to store excess energy for later use. While helpful, very high triglyceride levels (>500 mg/dl) can cause a condition called pancreatitis. High triglycerides in association with high LDL and low HDL can increase one’s risk for a heart attack or stroke.
Where do cholesterol and triglycerides come from?
Cholesterol and triglycerides are made by the liver. Regular consumption of more calories than one can burn, particularly from highly processed foods, can raise triglycerides.
75% of the cholesterol in the body is made by the liver and 25% comes from the diet. High LDL cholesterol is primarily due to a genetic predisposition where the liver makes too much cholesterol in combination with a diet high in saturated fats and trans fats (the bad fats) and low in dietary fiber. Following a diet low in saturated fats, and high in soluble fiber can reduce LDL cholesterol by 5 to 10%.
Should I be concerned about my cholesterol levels?
People with diabetes are at higher risk for heart disease. Abnormal cholesterol and triglyceride levels increase this risk.
Calculate your risk here ASCVD risk estimator
Knowing your cardiovascular risk profile helps to determine the need for treatment.
How often should cholesterol and triglyceride levels be checked?
- At the time of diagnosis
- 4 to 12 weeks after starting or adjusting a cholesterol lowering medication
- Once a year
Note: Check every 5 years for individuals less than 40 and with normal cholesterol levels
- LDL <100mg/dl
- HDL (women) >50 mg/dl
- HDL (men) >40 mg/dl
- Triglycerides <150 mg/dl
For people with existing heart disease, an LDL cholesterol goal of <70 mg/dl is recommended
What can I do to improve?
- Weight loss if overweight - a weight loss of 5% or more can improve one’s lipid profile
- Adopt a Mediteranean diet
- Consider the Dietary Approaches to Stop Hypertension (DASH) eating pattern
- Reduce saturated and trans fat intake - replacing saturated fats with unsaturated fats lowers the risk of heart disease up to 17%
- Increase plant stanols/sterols
- Increase omega-3 fatty acids
- Increase viscous fibre intake (oats, legumes, citrus)
- Increase physical activity
- Improve glucose control - this especially helps if you have high triglycerides
What about medications?
In addition to changes in diet and physical activity, a group of medications called statins have been shown to be effective in lowering LDL cholesterol and reducing the risk of having a heart attack or stroke by up to 25%. Commonly used statins are atorvastatin (Lipitor), rosuvastatin (Cresetor) or pravastatin (Pravachol). In certain individuals, ezetimibe (Zetia) or PCSK9 inhibitors (Praluent, Repatha) may be added to further reduce LDL levels and risk for cardiovascular events.
Over the counter fish oil or combined omega 3 fatty acids have not been shown to have additional benefit in reducing the risk of a heart attack or stroke in individuals on statins. However, icosapent ethyl (IPE), a highly purified ethyl ester derivative of eicosapentaenoic acid (EPA) has been shown to decrease the risk of a cardiovascular event by 25%.