People with diabetes generally have similar total cholesterol levels and similar rates of the 'good' (HDL) cholesterol as the general population. However, people with diabetes, on average, have higher levels of 'bad' (LDL) cholesterol and higher levels of triglycerides than people without diabetes. This is because diabetes can upset the balance between 'good' (HDL) and 'bad' (LDL) cholesterol levels in a number of ways.
- People with diabetes tend to have 'bad' cholesterol particles that stick to arteries and damage their walls more easily.
- High levels of glucose in the blood can result in 'bad' cholesterol staying in the blood stream for longer
- People with diabetes tend to have low HDL and high triglyceride (another blood fat) levels, both of which boost the risk of heart and artery disease.
- This means that people with diabetes are at a higher risk of:
- Heart disease, including heart attack and stroke
- Circulation problems which can lead to damage to hands, feet and legs
Improving Blood Cholesterol
There is strong evidence to suggest that lifestyle changes, like following a healthy diet and doing regular physical activity, can significantly improve the blood cholesterol levels of people with diabetes.
In Australia, eating less saturated fat is one of the most practical ways to lower cholesterol. Low cholesterol or cholesterol free foods may be useful for some people, but check that they also low in saturated fat.
You should focus on eating less saturated fat rather than eating less cholesterol, because saturated fats more often effect blood cholesterol levels and many of the foods that are high in saturated fat are also high in cholesterol anyway.
If a food does make a low cholesterol claim, check the amount of saturated fat in the nutrition panel.
- For oils, margarines and other similar foods that are nearly 100% fat, look for those with less than 20 g of saturated fat per 100 g.
- For other foods, if they have less than 2 g of saturated fat per 100 g they are probably a good choice for your blood cholesterol.
It is worth noting that most of the foods that are high in cholesterol are from animals, because cholesterol is manufactured in the liver. So low cholesterol claims on rice and bread are pretty meaningless! However, some plant-based foods have animal fats added to them when they are prepared, like many biscuits and cakes, so some can contain significant amounts of cholesterol.
If you try a low saturated fat diet for a few months and it doesn’t improve your blood cholesterol levels enough, you should try reducing your dietary cholesterol for a further couple of months.
Food to Improve Blood Cholesterol
People with diabetes living in Australia get around 35% of their total energy from fats and oils, although the optimal intake has been recently suggested as less than 30%. Reducing your total fat intake will help lower your total blood cholesterol level, provided you don’t replace the fats with high glycaemic index (GI) carbohydrates.
Eating less fat is not sufficient in itself to achieve optimal cholesterol levels. It is equally important that the right kinds of fats are consumed on a regular basis. On average Australians with diabetes get about 13% of their total energy from saturated fats, when ideally they should be consuming less than 10%. Practical ways of reducing the amount of saturated fat you eat include:
- Choose reduced fat or low fat milk, cheese, yoghurt, ice-cream and custard
- Choose lean meat and chicken and trim/remove any fat before cooking
- Avoid butter, lard, cream, sour cream, copha, coconut milk, coconut cream and hard cooking margarines
- Limit pastries, cakes, puddings, chocolate, cream biscuits and savoury packet snacks to special occasions
- Limit the use of processed deli meats for example devon, polony, fritz, luncheon meat, chicken loaf, salami and sausages
- Avoid take away foods such as chips, fried chicken, battered fish, pies, sausage rolls and pastries
- Choose tomato and soy based sauces rather than creamy sauces and avoid creamy style soup.
Dealing with Triglycerides
Triglyceride is a type of fat found in the blood. It is the main constituent of vegetable oil and human and animal fats. People with diabetes typically have higher than normal levels of triglycerides as increased glucose in the blood makes it harder for the body to absorb fat from the bloodstream.
Dietary factors that raise triglyceride levels include:
- Eating too many high GI carbohydrates
- Drinking too much alcohol - that is more than 2 standard drink a day for women and 4 for men (while lower alcohol limits are recommended to prevent liver and organ damage, keeping alcohol intake below these levels will minimise the impact on triglycerides).
- Not having enough omega-3 fat. Omega-3 fats can be found in oily fish, such as herring, mackerel, sardine, salmon and tuna. They are also found in certain nuts and seeds and products made from these, such as flaxseed, canola, walnut, wheat germ and soybean oils as well as margarines. Aim to consume two to three serves of fatty fish a week. Try using canola or soy based spreads and oils including a couple of handfuls of nuts a week, preferably walnuts.
Other Diet-Related Factors
Body weight and blood glucose levels have independent effects on cholesterol levels. Therefore, losing a moderate amount of weight (5-10% of your initial body weight) and eating the right amount and type of carbohydrates will help you achieve optimal results.
For more information: contact the Heart Foundation.