Diabetes Self-Management Blog

I likely don’t have to tell you this, but having diabetes often means more than just having high blood glucose. Sometimes other “issues” come along for the ride, such as eye problems, nerve damage, high blood pressure, and yes, high cholesterol. Health experts advise people with diabetes to focus particularly on one type of cholesterol, called low-density lipoprotein, or LDL.

Also commonly called the “bad” cholesterol, LDL is really the number to zero in on, more so than total cholesterol. And while HDL, or “good” cholesterol is important in that it seems to have a protective effect against heart disease, there’s not as much that you can do about changing HDL, other than exercising and stopping smoking. But LDL you can do something about.

Why is LDL “bad”? It’s a big contributor to plaque buildup inside artery walls. Plaque can lead to blockages, meaning that blood has difficulty getting through arteries. This is problematic because it means that vital organs (like your heart and brain) don’t get enough blood. Plaque can also rupture, and that’s no good either, because it can trigger a blood clot. What should your LDL be? Guidelines are a little stricter for people with diabetes as compared to people without diabetes. In general, the goal is to keep your LDL under 100 mg/dl. If you already have heart disease, your doctor may set your goal lower at under 70 mg/dl.

Getting That LDL Down
Like many Americans, you may be taking a statin, a type of drug that effectively lowers LDL cholesterol. According to the National Center for Health Statistics, half of men ages 65 to 74 and almost 40% of women ages 75 and older take statins. All drugs have side effects, however, and some people can’t tolerate statins. If your LDL cholesterol isn’t at your target, you should talk with you doctor about whether a statin is right for you. In the meantime, don’t underestimate what a healthful diet and a few sessions with a dietitian can do.

Last week, Canadian researchers published a study on the effect of certain foods on LDL cholesterol. In this study, which was published in The Journal of the American Medical Association, 351 people in their 50s were place into three groups: a control group, that was given advice on a low-saturated-fat, high-fiber diet; a routine “portfolio” group that included healthy eating advice plus tips on how to fit cholesterol-lowering foods into their eating plan; and an intensive portfolio group who got the same advice but also received five extra visits during a six-month period.

Not surprisingly, the intensive group experienced the greatest LDL drop: almost 14%, compared to the routine group (13%) and the control group (3%). Granted, statins may lower LDL cholesterol by up to 50% or more, and for this reason, you may benefit from both a heart-healthy eating plan and a statin. However, depending on your LDL level, you may be able to drop it by making some dietary changes.

Foods That Drop Cholesterol
In the study I mentioned above, the subjects were given specific foods as part of the “portfolio” plan. These foods included plant sterols, soy protein, viscous fiber, and nuts. What’s surprising is that the control group, who followed a low-saturated-fat diet didn’t enjoy the same LDL-lowering benefit. So where can you get these portfolio foods? It’s actually pretty easy.

Plant sterols. Plant sterols are natural substances found in fruits, vegetables, grains, legumes, nuts, and seeds. They block cholesterol from being absorbed in the body. An easy way to get plant sterols in an amount that will actually do some good is to use a sterol-fortified margarine such as Benecol or Promise Activ. Two to three tablespoons a day can do the trick.

Soy protein. Try tofu. You’ll like it. Really! It’s great in a stir-fry dish or in a casserole. If you can’t quite stomach it (although it’s very mild and I’m pretty sure you might like it), you can try nonfat or low-fat soy milk. Eight ounces of light, plain soy milk has only 8 grams of carbohydrate and 70 calories. Two servings of soy a day is the goal.

Viscous fiber. This one’s pretty easy: Eat oatmeal, but not the fakely sweet instant kind. Take the few minutes to cook your own, or consider making a batch in a slow cooker and you’ll have a tasty, high-soluble-fiber treat for breakfast. Other sources of viscous fiber include barley (great in soups and stews), apples, oranges, carrots, and dried beans and peas (chickpeas, black beans, lentils). Aim to eat two servings each day.

Nuts. Unless you’re allergic to nuts, here’s another food that should be easy to fit into your eating plan. Almonds, walnuts, pecans, pistachios, and peanuts are particularly helpful. But go easy with them: a small handful a day is the goal. Nuts are high in calories and fat.

It’s still a good idea to limit your intake of saturated fat, which is found in butter, stick margarine, red meat, cheese, and whole milk. But if your LDL isn’t where it should be, try adding these “portfolio” foods to your eating plan and see what happens! And if you need more help on switching over to a heart-healthy eating plan, ask your doctor for a referral to a dietitian.


  1. Whatever happened to the textured soy protein sold many years ago as a meat substitute? It was produced by the same manufacturers which make pasta, and was very good as a substitute for ground beef in dishes like chili. It’s a LOT more palatable than tofu, soy yogurt, or soy milk, and would have the double benefit of helping to reduce saturated fat in one’s diet.

    Posted by Ken Bush |
  2. My Husband has been a Type II Diabetic for almost 30 years. He still takes oral meds. We are very cognizant of diet and excercise and how it effects the Diabetic. He also takes a cholesterol drug. However, in the past five years he has had an ounce of nuts after lunch every day and his LDL and HDL have been great. He is 80 years of age but is told by everyone he meets he doesn’t look it.

    Posted by Ann M |
  3. Hi Ken,

    Textured vegetable protein (TVP) is still available and is often used by vegetarians as a ground meat substitute. It’s made from soy flour and 1/4 cup contains 80 calories, 7 grams of carbohydrate, and 12 grams of protein. So, it’s definitely an option. But, I also recommend keeping an open mind about tofu, too!

    Posted by acampbell |
  4. Hi Ann,

    Thanks for sharing your husband’s success story!

    Posted by acampbell |
  5. Hey,what about Red Yeast Rice Extract? A few months back I had my cholesteral checked at a health food store and it was 219 and this was before I turned 65 and gained Medicare and medical coverage. I started the Red Yeast Rice Extract and when I started back with my doctor, a few months later. After my doctors initial tests that 219 score had lowered to 163. My doctor and I were both extremely happy with the results.

    Posted by John Donohue |
  6. Also please be aware that studies are also showing the low blood sugar can raise blood pressure and also raise cholestrol levels. If you have low bg’s once in a while it wont be a big deal. But if one has them quite often - it can also do alot of other things to the body.

    I dont think doctors even think about the stress of having this disease which can contribute to stress and higher blood pressure.

    Posted by GiGi Brakeville |
  7. Thanks for this. I’ve been really working on reducing my LDL through diet. I’ve been eating oatmeal (even though I think it is food only fit for equines) with flax seeds and walnuts. I should make a point to eat more apples, as well get over my fear of tofu.

    What about Omega 3’s from cold water fish? Don’t they play a part in the reduction of LDL?

    Posted by Cathy R |
  8. Good advice, although when recommending soy products I feel it’s always appropriate to mention that soy contains a substantial amount of estrogen, which may impact hormone therapy in women and be inappropriate for males.

    Posted by Joe |
  9. all the above written by the investicators is part of the so called mediterranean died.In the med/died we had no soy protein neither we had any consumed products from soya.I am talking about some years back when my people the metiterraneans used what they produce which are now the above said consumption products and their red wine included.But now we do not use that died any more and use the so called fast foods and more meat and it’s products.In this died change the population specifically in my country, school kids are over weight and adults are now diabetics,which in the past we did not known of any almost diseases.

    diab person..

    Posted by zach |
  10. All that sounds fine but I’m allergic to Soy, Walnuts, and am a Celiac. What can I eat? Luan

    Posted by Luan |
  11. Hi Luan,

    There are other foods that you can eat that can lower your cholesterol, including other types of nuts, beans, and grains. My advice is to meet with a dietitian who specializes in celiac disease.

    Posted by acampbell |
  12. Hi Joe,

    Thanks for your comment. It’s always wise to check with your physician before eating soy products, especially if you are on any kind of hormone therapy. However, the benefits of soy foods seem to outweigh any risks. Eating soy foods (tofu, soy milk, edamame, tempeh) has been shown to lower the risk of heart disease, osteoporosis, and prostate cancer and may help some women better manage symptoms of menopause. Also, new research shows that it’s safe for breast cancer survivors to include soy foods in their diet. The jury is still out on soy supplements, however, so it’s best to stick to eating whole soy foods rather than taking supplements.

    Posted by acampbell |
  13. Hi John,

    Thanks for asking about red yeast rice extract. Red yeast rice is often used as a food coloring in Chinese food. You do need to be careful if you’re taking this as a supplement, however, because the active ingredient in this product is the same as what is found in statins, which are prescription drugs. This means that it may lead to the same side effects as statins, such as liver damage, muscle pain, and muscle damage. Also, because this product is a dietary supplement, it’s not under FDA regulations, so product quality can be variable. If you take this, make sure that your doctor is aware that you’re doing so, and that you have liver function tests done regularly (the same as you’d have done if you take a statin). Also, if you note any side effects, especially muscle pain, stop taking it. Finally, make sure you purchase this or any supplement from a reputable source.

    Posted by acampbell |
  14. Hi Cathy,

    Great job with your diet! Don’t be afraid of tofu, either. But also give edamame (green soybeans) a try, too. As far as fish oils (omega-3 fatty acids), they mainly work to lower triglycerides, which are blood fats. High triglycerides are a risk factor for heart disease. It’s possible that omega-3’s can lower LDL, but that’s not their primary role. However, omega-6 fatty acids, found in corn oil, soybean oil, olive oil, and canola oil can lower LDL cholesterol.

    Posted by acampbell |
  15. I have ground up nuts into an empty margerine cup and put a tablespoon full on my oatmeal or cherrios every A.M. This not only helps lower LDL but the protein helps sooth the spike in blood sugar from the carbs in the cereal!!! I use ground Pecans most of the time cause here in Bama we have lots of then! Ground peanuts are also good. Really spices up the taste of oatmeal too! A Tbls of cinnamon also helps the blood sugar but after a while it gets “old” eating the cinnamon so I do it about 1/3rd of the time!!

    Posted by Dan K |
  16. Amy,

    Loved your diet suggestions for lowering LDL.
    I have been wondering ,however, about the sodium content of TVP;is any fat or oil added to these products?

    Posted by Meghan S. |
  17. Thanks for the clarification, Amy! My triglicerides need some work, too, so I guess I’ll keep on with those Omega threes.

    I will make it a point to try some tofu something this weekend.

    Posted by Cathy R |
  18. Hi Meghan,

    TVP is actually quite low in fat and sodium, at least in its pure state, so it’s fine for those needing to limit fat and sodium.

    Posted by acampbell |
  19. Sorry–serious topic aside… I was amused by “Try tofu. You’ll like it” followed very soon by “If you can’t quite stomach it”–I don’t know ANYONE that likes tofu (personally, anyway). Of course, never having tried it myself, it’s probably not right for me to judge. I think I might give it a shot.
    Thanks, Amy for a great article.

    Posted by Jen |
  20. Hi Jen,

    Oops — I guess I didn’t set myself up very well on that one! I actually like tofu, though, and think that most people would like it too if it’s prepared the right way. Thanks for your comment and for giving me a laugh today!

    Posted by acampbell |

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