Listen Up: Here’s How to Lower Your LDL

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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.

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