Cholesterol: It’s Only Part of the Story

Caution: Consult with your diabetes care team before starting a lower-carbohydrate meal plan. Diabetes medications such asinsulin or oral drugs that stimulate insulin production (sulfonylureas or meglitinides) will need adjustment to prevent hypoglycemia(low blood glucose) when carbohydrate intake is decreased. In addition, blood glucose levels need to be checked more often.

Until recently, many doctors looked onlyat a patient’s total cholesterol. These days,it’s more complex, as scientists endeavor tounderstand the different types of fats foundin our blood—and their independent linksto cardiovascular disease.

You may be under the impression that it ishigh levels of LDL cholesterol that virtuallyguarantee you a heart attack, but this is notalways the case. A number of studies showthat the combination of low HDL (“good”)cholesterol and high triglycerides may be anequally strong a predictor of cardiovasculardisease.

Both of these conditions are almost alwayspresent in people with type 2 diabetes.

The Causes of Low HDL and HighTriglycerides

It’s clear that a high-carbohydrate diet,especially one high in refined carbohydrates(such as white rice and white bread, softdrinks and fruit juice) and a lack of physicalactivity are two of the main culprits for bothlow HDL and high triglycerides. Fortunately,you can change both of those factors.

Controlling carbs has been shown to lowertriglycerides and increase HDL.

Medications and Nutrients

The statin drugs routinely prescribed tomany people diagnosed with diabetes—aswell as to millions of other people—have aminimal impact on HDL and triglycerides.

But eating more of the right nutrients andstepping up physical activity can improvetriglycerides and HDL, too. Omega-3 fattyacids, found in cold-water fish, such assalmon and sardines, and in marine algae,flax seeds and some nuts, are known tohelp prevent heart disease by loweringtriglycerides and blood pressure.

Another valuable nutrient for heart health isniacin, also known as vitamin B3. Found indairy products, poultry, fish, lean meats, nutsand eggs, niacin can have a positive impacton levels of HDL and triglycerides, as well ason LDL (“bad”) cholesterol.

If dietary changes do not improve yournumbers, talk to your doctor about takingthese nutrients in supplement form.

Try Non-Drug Therapies First

The bottom line is that there are severaleffective non-drug approaches to gettingHDL and triglycerides in line; why not trythem first, before resorting to medication?

Next month, we’ll look at another marker forheart disease: C-reactive protein.

To learn about the Atkins NutritionalApproach, visit

What Are HDL and Triglycerides?

HDL (high-density lipoprotein) cholesterol is often called the “good” cholesterol,because it transports cholesterol from your arteries and other storage sites to your liver,where it is recycled. The higher your level of HDL, the better.

Lifestyle factors that lower HDL include smoking, physical inactivity and a high-carbdiet, especially one high in refined carbohydrates such as white rice and white bread,soft drinks and fruit juice. An HDL level of less than 40 mg/dl for men, or less than 50mg/dl for women, is a probable indicator of metabolic syndrome and a major risk factorfor heart disease.

Triglycerides are tiny droplets of fat that circulate in your blood. The higher your level oftriglycerides, the greater your risk of a heart attack. A diet high in refined carbohydratesas well as physical inactivity raise triglycerides. In addition, alcohol intake may be afactor in elevated triglyceride levels for some. A fasting triglyceride level of 150 mg/dl orhigher is a probable indicator of metabolic syndrome.

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