Tuesday, November 26, 2013

Diabetes and LDL Cholesterol: 6 Lifestyle Changes to Lower Your LDL Cholesterol and CVD Risk

Cardiovascular disease, or CVD, is the leading cause of death in diabetics living in the United States.CVD is a general term which refers to people with blockage of the heart's blood vessels (also known as coronary artery disease or CAD), blockage in the vessels of the leg (peripheral vascular disease or PVD), and blockage of the carotid arteries (the blood vessels supplying the brain).Diabetes alone is a risk factor for CVD, increasing your risk 2-4 fold.Another very important risk factor for cardiovascular disease is your LDL cholesterol.When your doctor tells you he/she is obtaining a blood sample to "check your cholesterol" or "measure your lipids," he/she may check your total cholesterol, LDL cholesterol, HDL cholesterol and total triglycerides.If all four measurements are included, it is called the "lipid profile".The cholesterol blood test is typically obtained after an 8-12 hour overnight fast.Although the LDL and HDL cholesterol may be further divided into sub-fractions (basically good and bad LDL and HDL subtypes), this level of sophisticated testing is rarely performed.Given the association of elevated LDL-cholesterol (or LDL-c) levels and CVD, LDL is known as the "bad cholesterol".Since diabetes alone is a risk factor for CVD, the LDL-c goals are lower in diabetics.In diabetics without known CVD, the goal LDL-c is 100 mg/dl (2.6 mmol/l). In a non-diabetic without known CVD, the goal LDL-c is 130 (3.4 mmol/l)In diabetics with documented CVD, the goal LDL-c is typically 70 mg/dl (1.8 mmol/l).Although a prescription medication is ultimately recommended to most people with diabetes, lifestyle modifications play an important role in improving your lipid profile.There are 6 parts to an effective lifestyle program.1) Reduce your saturated fat intake.If you reduce your saturated fats to 7% of total calories, along with reduction of your cholesterol intake to 200 mg per day, you will reduce LDL-c levels by 9-12%.Low saturated fat food options include fruits, vegetables, and grains.Among the fruits, tropical fruits such as watermelon and mango should be avoided given their negative impact on sugar levels.Fruit juices should likewise be avoided.Within the grains, bread, pasta, cereal and rice intake should be minimized/avoided given their negative impact on sugar levels.Tree nuts (almonds, walnuts, pecans) are an easy to use, low saturated fat food option which can reduce LDL-c levels by 2-19%.Nuts also provide fiber, some minerals and vitamins.Nuts are calorie dense, so make sure intake is limited to 1-2 ounces per day.The effects of nuts appears to be most favorable if you have a high LDL-c at baseline, and are not overweight.2) Eliminate trans fats.Trans fats will raise your LDL cholesterol and lower your HDL cholesterol (the "good" cholesterol).The combination of high LDL levels and low HDL levels is not good in people with diabetes who are trying to prevent CVD.You'll find the highest concentration of trans fats in baked goods (cookies, cracker etc.) and fried foods.Other sources of trans fats include fast food, some soups, chips, cereal, candy, packaged food such as cake mixes, some frozen foods, toppings and dips.If a food label mentions "partially hydrogentated vegatable oil", the product contains trans fats.Unfortunately food labels aren't as helpful as they should be regarding trans fat content.If a serving of food is labeled as "no trans fats", it means it has 0.5 g per serving.It could thus have no trans fat or 0.4 g of trans fat!3) Begin an exercise programAerobic exercise (walking, jogging etc.) may reduce LDL-c by 10-15% and raise HDL-c by 20%.The benefits associated with exercise are likely due to weight loss as well as still undefined factors that improve with physical activity.Most studies support a 30 minute per day, 5 days per week exercise regimen.Although this does not have to be intense exercise (many study participants limited their exercise to a leisurely walk), it appears that greater intensity and longer duration exercise will have a greater impact.Given the increased risk of silent heart disease (absence of typical symptoms such as chest pain) in people with diabetes, cardiology consultation and a stress test should be obtained before you begin an exercise program.The combination of diet and exercise is more effective than either approach alone.4) Add fiber to your dietThe addition of fiber to your diet will reduces LDL-c by an average of 5 mg/dl (0.13 mmol/L).High fiber foods include bran, beans, berries, whole grains, nuts, deep green leafy vegetables, squash and fruits.Fiber has the additional benefit of lowering your sugar levels.Although most organizations recommend a daily fiber intake of at least 30 grams per day, the average fiber intake in the United States is only 15 grams per day.5) Consider the Mediterranean "diet"This is a diet which includes many of the recommendations noted above.It is more a lifestyle change than a diet.Benefits of the "diet", with respect to reduced CVD, as well as cancer and Alzheimer's disease, have been supported in several large clinical trials.Increased physical activity/exercise is recommended.Red meat intake is reduced to several times per month.Fish, poultry and plant based food intake is increased.Fruit is included, as are olives and olive oil.Modest alcohol intake (1 drink per day) is optional, and may raise HDL-c levels.A comprehensive review of the diet is beyond the scope of this article, but can be easily found with a Google search.6) Improve your sugar control.This is listed last since steps 1-5 will help you achieve this goal.Improved control of your sugars will improve your lipid profile, especially the triglycerides.If the 6 lifestyle modifications mentioned above don't help you achieve your cholesterol goal, medical therapy will be initiated.Become involved in the management of your diabetes.Take a proactive approach.Make a difference in your life, starting today.



Dr. Michael Dempsey is an endocrinologist with over 20 years of experience caring for people with diabetes. His goal is to improve diabetes control within the parameters of your life. You can learn more about Dr. Dempsey's practice at https://sites.google.com/site/thediabetesdoc/. You can also follow him on his Facebook page for daily updates on diabetes and nutrition at http://www.facebook.com/profile.php?id=100002052992954&ref=tn_tnmn

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