You Dont Need To Avoid Eggs And Seafood
Some foods are high in cholesterol but are fine to eat in moderation, as long as your overall diet is low in saturated fats. For example:
- Egg yolks a single egg yolk contains 200250 mg of cholesterol, which is almost the uppermost recommended daily intake . However, reducing egg intake is probably not important for healthy people with normal blood cholesterol levels.
- Seafood prawns and seafood contain some cholesterol, but they are low in saturated fat and also contain healthy omega-3 fatty acids. Seafood is a healthy food and should not be avoided just because it contains cholesterol. However, avoid fried and battered seafood.
Choose Good Fats Over Bad Fats
Fat is an important nutrient, necessary for energy and hormone production, vitamin absorption, maintaining the membrane integrity of every cell in our body, and growth and development. According to the Dietary Reference Intakes published by the USDA, 20% to 35% of calories should come from fat. But when it comes to dietary fat, not all types are created equal.
As noted above, saturated fats contribute to high levels of LDL cholesterol, as do the trans fats in fried foods and baked goods. At the same time, however, monounsaturated fats, which are found in olives, olive oil, and certain nuts and seeds, actually help lower blood cholesterol levels.
Another type of good fat, the polyunsaturated fat in fatty fish like salmon and cod, as well as flaxseeds and walnuts, are rich in omega-3 fatty acids that play a significant role in reducing overall blood cholesterol and triglyceride levels.
How Often To Get Tested
According to the Centers for Disease Control and Prevention , most healthy adults should get their cholesterol checked every four to six years.
Your risk factors also determine how often your cholesterol should be checked. Adults who have a history of high cholesterol, heart disease, diabetes, or obesity need more frequent readings, as do all adults as they age.
Children should have their cholesterol checked at least once between the ages of 9 and 11 and again between 17 and 20 years of age. If a child has a family history of high cholesterol, heart disease, or is overweight or obese, their pediatrician may recommend getting checked sooner and more often.
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Medication May Be Needed
For some people, diet and lifestyle changes are not enough. High blood cholesterol levels often have a genetic component. Some people inherit altered genes that cause high cholesterol and this cannot usually be changed sufficiently by lifestyle or diet.
If you are at risk of coronary heart disease and your LDL cholesterol level doesnt drop after scrupulous attention to diet, your doctor may recommend medications to force your blood LDL levels down. Cell cholesterol levels, however, remain normal, so lowering blood cholesterol has no effect on most cell metabolic processes.
Some people get muscle aches from statins, which are the most commonly used medication to lower blood cholesterol. However, diet and exercise will still be important, even if you are taking medication. Your doctor may also refer you to a specialist who treats cardiovascular disease.
General Guidelines For Eating Heart Healthy
There are some general nutritional guidelines that you should follow in order to stay heart healthy. When you go to the grocery store, pick up the items listed below. Notice that you wont be going on the inside aisles of the grocery store. More likely you will be working the parameter or outside aisle. Thats where you will find whole, heart healthy foods. Leave the frozen foods and packaged foods on the shelf. You will want to pick up some packaged foods from the middle aisles, but they will be whole grain products. This is good. We want you shopping for real, not processed foods for the most part. They are simply healthier for you.
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Cholesterol And Pre Diabetes
A dyslipidemia may clue providers in to the need to test a person for pre-diabetes or diabetes due to the connection between the insulin resistance in Type 2 diabetes and dyslipidemia. A patients A1C may show in the pre-diabetes range of 4.8-5.6 percent. This serves to give the person a heads up related to managing their dyslipidemia and pre-diabetes state with diet and exercise. The goal in pre-diabetes is generally to lose 5-7 percent of overall weight, and to obtain 150 minutes of physical activity in a week, along with healthy eating, in order to prevent Type 2 diabetes.
Triglycerides Hdl Cholesterol And Cardiovascular Risk
The question whether hypertriglyceridemia causes coronary artery disease or is simply a marker for the accompanying lipoprotein abnormalities is still controversial. In a meta-analysis of 17 population-based prospective studies, increased plasma TG levels were associated with increased coronary disease risk in both men and women, after adjustment for HDL cholesterol and other risk factors . A direct atherogenic effect of TG-rich particles, particularly intermediate-density lipoprotein, and remnant particles has been presumed. In a more recent meta-analysis, adjustment for established coronary risk factors, especially HDL cholesterol, substantially attenuated the magnitude of risk associated with high TG levels, leaving an odds ratio of about 1.7 in individuals with TG levels in the top third of the population, compared with those in the bottom third .
The HDL particles induce the removal of cholesterol from cells, including those in atherosclerotic plaques, and carry them to the liver, but the mechanisms by which HDL confer protection from atherosclerosis include more than just reverse cholesterol transport. HDL particles seem to have anti-inflammatory and antioxidant properties, inhibiting the oxidation of LDL cholesterol and the expression of cellular adhesion molecules and monocyte recruitment. The HDL may also reduce the risk of thrombosis by inhibiting platelet activation and aggregation.
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Qualitative Lipid Abnormalities In Type 1 Diabetes
Several qualitative abnormalities of lipoproteins are observed in patients with type 1 diabetes, even in those with good metabolic control, who do not have significant quantitative lipid changes. These qualitative lipid abnormalities are not totally reversed by optimal glycemic control and are likely to be atherogenic.
Your Risk Of High Cholesterol And How It Is Treated
Many people who have type 1 diabetes should be prescribed statin treatment for the primary prevention of heart disease. This means you may not have high cholesterol levels, but statins help to keep them in a healthy range and reduce the risk of heart disease.
Those people with type 1 diabetes who should be offered statins, regardless of their cholesterol levels, include:
- People older than 40 years
- Those who have had diabetes for more than 10 years
- Those with established kidney damage or other CVD risk factors
For people with type 2 diabetes, your overall CVD risk might be calculated using something called a QRISK calculator. Your healthcare team should explain what your risk of CVD is and how best to manage your blood fat levels. For primary prevention of CVD, people with type 2 diabetes who have a 10% or greater 10-year risk of developing CVD should be offered statins.
If you have high cholesterol levels, you should have a blood test to measure total cholesterol, HDL cholesterol and non-HDL cholesterol three months after starting statin treatment, with an aim of 40% reduction in non-HDL cholesterol. Ask your healthcare team what your individual targets are for your cholesterol levels.
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How To Treat And Control High Cholesterol In Diabetes
The UKPDS, or UK Prospective Diabetes Study, showed that tight control over blood glucose is needed to prevent complications of diabetes. However, it was found that tight blood glucose is not enough to prevent cardiovascular disease in diabetics. Overall, there must be significant effort to reduce all risk factors. This can include weight loss, increasing exercise, controlling blood pressure and dyslipidemias.
The Best Healthcare Options To Prevent Diabetes
Health care is expensive. Canada spent an estimated $253.5 billion in 2018, and as the cost of health care increases, so does the cost to you. Pre-existing medical conditions, family history, and BMI are all factors that increase the cost of health care. These factors also increase your risk of diabetes, so you must be covered.
Of course, as a Canadian, you are entitled to some free and subsidized health care, which is great. But many people opt for private healthcare and for diabetes prevention this can be very useful. If you’re shopping around for private healthcare, it’s important to choose the right package.
Basic health insurance will usually cover health care, medical services, and prescriptions, but they tend to lack customizations. If you opt for a premium/guaranteed health insurance you have the bonus of a custom plan based on your needs if you are worried about your risk of diabetes this is like gold dust.
Private healthcare plans can cover the cost of many expenses related to diabetes such as blood tests, blood sugar monitors, specialist referrals, hospital stays, and much more! The most important thing to note about private health care is that it covers costs for preventative care, not just treatment for diseases.
There are many different options available, so make sure you search for the best quotes.
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Insulin And Lipoprotein Metabolism
Insulin plays a central role in the regulation of lipid metabolism . The main sites of action of insulin on lipoprotein metabolism are shown in Figure 2.
In adipose tissue, insulin inhibits the hormone-sensitive lipase. Thus, insulin has an anti-lipolytic action, promoting storage of triglycerides in the adipocytes and reducing release of free fatty acids from adipose tissue in the circulation.
Insulin inhibits VLDL production from the liver. In normal subjects, it has been shown that insulin induces a 67% decrease of VLDL-triglyceride production and a 52% decrease of VLDL-apoB production . Insulin reduces VLDL production by diminishing circulating free fatty acids , which are substrates for VLDL, but also by a direct inhibitory effect in the hepatocyte . Insulin is a potent activator of lipoprotein lipase , promoting the catabolism of triglyceride-rich lipoproteins and reducing, as a consequence, plasma triglyceride level. Insulin not only enhances LPL activity , but has also a direct positive effect on LPL gene, promoting LPL synthesis . Insulin promotes the clearance of LDL, by increasing LDL B/E receptor expression and activity .
Insulin acts also on HDL metabolism by activating LCAT and hepatic lipase activities .
Figure 2.
Main effects of insulin on lipoprotein metabolism.
Dietary Tips To Avoid Cholesterol
The most important thing you can do to reduce your cholesterol level is to maintain a healthy lifestyle. You should try to:
- Increase the amount and variety of fresh fruit, vegetables and wholegrain foods you have each day.
- Choose low or reduced-fat milk, yoghurt and other dairy products or have added calcium soy drinks.
- Choose lean meat .
- Limit fatty meats, including sausages and salami, and choose leaner sandwich meats like turkey breast or cooked lean chicken.
- Have fish at least twice a week.
- Replace butter and dairy blends with polyunsaturated margarines.
- Include foods in your diet that are rich in soluble fibre and healthy fats, such as nuts, legumes and seeds.
- Limit cheese and ice cream to twice a week.
Other storage fats that are transported in blood lipoproteins include triglycerides. When present in high concentrations in the blood, this fat is also a risk for heart attack. Some foods will affect the cholesterol level or the triglyceride level and some will affect both.
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Controlling Blood Glucose Levels
Uncontrolled blood sugar can result in regular episodes of hyperglycemia . This can cause a variety of symptoms including:
- Dry mouth
- Nausea
- Fatigue
These symptoms are uncomfortable to experience but there are things you can do at home to reduce your blood sugar. In terms of drinks, water is the best as it will help to maintain hydration and dilute excess sugar in the blood. Also, try to add more fiber to your diet to reduce your blood sugar apples, bananas, oranges, and strawberries are all fibrous fruits.
However, uncontrolled blood sugar levels can also lead to more severe, long term disease. Poorly managed diabetes leads to vision loss, kidney problems, nerve damage, heart attack, and stroke. Therefore, if your blood sugar level reaches 16.7mmol/L, this could be dangerous and you need to seek immediate medical attention.
What Should My Total Cholesterol Level Be
A blood test is all you need to find out what your cholesterol level is.
Your doctor may recommend that you fast for 8 to 12 hours before that test in order to measure your triglycerides, LDL, HDL, and total cholesterol. Or you may start with a test that shows your total cholesterol level without fasting.
Your doctor may start with a non-fasting test and then recommend a lipid profile, based on your results. You may get more tests later on to see how well treatment is working for you.
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Do I Need Tablets For High Cholesterol
NICE generally recommends that people, with a 10% or greater risk of developing heart disease within the next 10 years, take statins.
This likelihood is worked out by the QRISK2 calculator that doctors use.
For people with diabetes NICE recommends :
- Consider statin treatment for all adults with type 1 diabetes
- Offer statins to anyone with type 2 diabetes with a 10% or greater risk of developing heart disease in the next 10 years
The starting dose of statins should be atorvastatin 20 mg, unless this is not tolerated by the patient.
Statins have been shown to prevent a major heart event in around 1 in 100 people that take the tablets for 3 years. Statins may cause side effects, such as aching muscles, headaches or memory trouble, in some people.
If sides effects occur speak to your doctor. If you have side effects from statins, they should disappear once you stop taking them.
Whether you take statins should be an agreement between you and your doctor and you have the right to accept or turn down the offer to take statins.
What Are The Causes Of High Cholesterol
Many different things can cause a person to have high cholesterol levels. Some we can control, and some we cannot control. The factors that we cannot control are:
- our gender
- certain diseases and conditions that we already have, such as thyroid disorder
Though we cannot control our genetics, how old we are, or whether we are male of female or have a certain disease for the most part, there are risk factors for high cholesterol that can be controlled. Interestingly, the same risk factors that can be controlled to bring down high cholesterol also can bring down our risk for diabetes.
They are
- our nutritional intake, including how much bad and good cholesterol is in the foods we eat
- our weight as extra pounds increase cholesterol levels
- whether or not we are physically active
- whether or not we are taking certain medications
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Untreated Type 1 Diabetes
In type 1 diabetic patients with diabetic ketoacidosis, quantitative lipid abnormalities are observed, due to insulin deficiency.
Triglyceride-rich lipoproteins are increased leading to hypertriglyceridemia. This is mainly due to decreased lipoprotein lipase activity . Diabetic ketoacidosis is a situation of severe insulin deficiency with reduced lipoprotein lipase activity as a consequence, because insulin usually stimulates its activity. Decreased lipoprotein lipase activity leads to profound reduction of triglyceride-rich lipoprotein catabolism . In this condition of severe insulin deficiency, reduced catabolism of triglyceride-rich lipoproteins is, by far, the main factor involved in hypertriglyceridemia. This hypertriglyceridemia resolves rapidly after well titrated insulin therapy .
LDL-cholesterol is decreased during diabetic ketoacidosis . This fall in plasma LDL-cholesterol level is the direct consequence of the reduction of triglyceride-rich lipoprotein catabolism, due to decreased lipoprotein lipase activity .
What Are The Symptoms Of High Cholesterol
Lifestyle factors include:
- an unhealthy diet– eating too much saturated fat is thought to increase levels of LDL or bad cholesterol
- lack of exercise – this can also increase your levels of LDL
- obesity – being overweight often means you also have higher levels of LDL cholesterol and triglycerides, and a lower level of the good HDL.
- drinking too much alcohol
- smoking – if you smoke, a chemical in cigarettes called acrolein stops the good HDL from moving fatty deposits to your liver
Underlying conditions
- kidney disease
- transient ischaemic attack – or a mini stroke
- peripheral arterial disease
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Cholesterol Targets For People With Diabetes
NICE no longer specifies target cholesterol levels for people with diabetes. Your doctors will use a calculator, called QRISK2, to work out your risk of heart disease using a number of factors such as age, BMI, gender, blood pressure levels, cholesterol levels and which type of diabetes you have.
If you want a general guide of how healthy your cholesterol levels are, find out your total cholesterol-to-HDL ratio
To find this, take your total cholesterol figure and divide it by your HDL figure. A result of less than four is healthy.
More Connections Between High Cholesterol And Diabetes
Smaller, denser LDL-C molecules
LDL-C cholesterol levels in people with diabetes can underestimate the cardiac risk that is posed. Borderline high LDL-C levels, along with Type 2 diabetes pose a 2 to 3 times greater risk for CVD than for people without diabetes. The LDL-C particles are proportionally smaller and are denser in people with diabetes. These particles are more likely to invade the walls of arteries and cause a significant cardiovascular problem. This typically leads to more hardening of the arteries in people with diabetes due to the small and dense LDL-C particles.
There is also a relationship between the smaller, denser, LDL-C molecules and an increase in triglycerides. It is the insulin resistance and insulin sensitivity that is the metabolic syndrome of diabetes that causes elevated triglycerides. Insulin resistance in muscles converts carbohydrate energy into triglycerides that are generated in the liver. This tends to make VLDL-C, which means that the LDL is loaded down with triglycerides. It is in persons with greater than 100 mg/dl triglycerides that we see the smallest and densest VLDL-C particles forming. This in turn increases cardiovascular disease since these small particles of bad cholesterol are predominant in the bloodstream.
Is it correct to focus on LDL-C lowering therapy for those with diabetes?
Intensive therapy to lower LDL-C
Higher insulin levels raise LDL-C levels, lower HDL-C levels, and raise triglyceride levels
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