High Cholesterol And Diabetes

Why do we need glucose?

Glucose is the primary sugar your body uses for energy. We get glucose from foods such as bread, pasta, and root vegetables. Your body breaks down these carbohydrate-heavy foods into glucose, which your small intestine absorbs.

Glucose is the fuel that gives us the energy to maintain our daily functions.

Your cells store glucose when it’s not needed. Glucose moves into your cells using insulin, a hormone your pancreas produces.

Insulin is released when your blood glucose levels rise, acting like a gatekeeper that allows the glucose to move into the cells.

What is diabetes? 

Your doctor will diagnose you with diabetes when you have too much glucose in your blood. A standard test is HbA1c, which measures the number of red blood cells with glucose linked to them.

The cause of your diabetes determines which type you have: In type 1 diabetes, you do not produce enough insulin, while in type 2 diabetes, your cells do not respond to insulin. Both fail to use glucose in the cells, so it remains in the blood. Type 2 diabetes is much more common, making up 95% of cases.¹

Your treatment will depend on the type of diabetes you have. The treatment for type 1 is insulin. For type 2, you reduce your sugar intake, increase your exercise, and monitor your glucose levels.

Keeping on top of diabetes is essential because its complications can be life-threatening. 

Over time, sugar can build up in your blood vessels, kidneys, and nerves. This can result in poor blood circulation, kidney problems, and trouble with vision. It also makes you more prone to infections and viruses. For example, diabetes increases the severity of COVID-19 symptoms.

Why do we need cholesterol?

Cholesterol² is an essential fat-like substance that our bodies use to produce hormones and vitamins, maintain cell walls, and absorb fat. They are covered in protein shells called lipoproteins, so they can travel in the bloodstream and go to the right place.

The body recycles most cholesterol, so we don’t need to consume huge amounts. Since the liver in humans and animals produces cholesterol, meat and dairy products are high in cholesterol. 

What are the different types of cholesterol?

Cholesterol types differ in their structures and functions. The two major types are high-density lipoproteins (HDL) and low-density lipoproteins (LDL). 

• HDL is the ‘good’ form because it takes cholesterol out of the bloodstream.

• LDL is the ‘bad’ form because it brings cholesterol into the bloodstream.

Too much cholesterol in your bloodstream can increase the risk of significant health issues, especially if genetically predisposed to them. Dietary cholesterol is the main modifiable risk factor for atherosclerosis³ (plaque build-up on artery walls) if you’re predisposed to dyslipidemia.

At high concentrations, LDL can stick and migrate into blood vessel walls. Because it isn’t supposed to be there, your body initiates an inflammatory response, creating a plaque in the wall. This is essentially a roadblock to blood flow.

Over time, the size of the plaque can increase, eventually blocking the entire vessel, or the plaque can break off and travel to other areas.

The severity and type of symptoms depend on where the atherosclerotic disease is. If it’s in the heart vessels, there’s a higher risk of heart attacks. You’ll be at increased risk of a stroke if it’s in the blood vessels that supply the brain.

What is dyslipidemia?

Dyslipidemia is when you have high cholesterol levels, particularly LDL. Your doctor might order a lipid panel test, a common blood test to measure the amount of circulating cholesterol. 

They will diagnose you with dyslipidemia if your results look like this:

• Total cholesterol >200mg/dl

• LDL >130mg/dl

• Triglycerides >150mg/dl

• HDL <40mg/dl 

Triglycerides are another important lipid that your body uses as an energy source. As with cholesterol, it is essential to keep it within normal limits.

What is the link between diabetes and dyslipidemia?

Diabetes and dyslipidemia often occur together for many reasons. 

Firstly, both conditions share risk factors. They include:

• Smoking

• Physical inactivity

• Poor nutrition 

  • Low consumption of fruits, nuts/seeds, vegetables

  • High consumption of saturated fats

• Obesity 

Secondly, diabetes can affect the metabolism of cholesterol. Studies⁴ have found that people with diabetes have increased LDL and triglycerides and decreased HDL levels.

How does diabetes affect cholesterol?

Most people with diabetes have type 2. Despite your cells’ insulin resistance, your body will still release insulin in response to high blood glucose levels. 

Chronic levels of insulin increase LDL and decrease HDL. There are many reasons why this occurs. 

When your pancreas releases insulin, it has an inhibitory effect on LDL production. However, this effect is lost when insulin is chronically elevated. This may cause an uncontrolled release of LDL into the bloodstream. 

Insulin also plays a role in lipid metabolism. It stimulates the uptake of lipids and inhibits breakdown by suppressing an enzyme called hormone-sensitive lipase inside fat cells. 

In insulin resistance, insulin can no longer inhibit hormone-sensitive lipase, causing lipid release into the bloodstream. Your liver repacks it into LDL and distributes it to the tissues. This leads to a progressive cycle of increasing cholesterol levels and insulin resistance.

Can you lower your cholesterol when you have diabetes?

There are many options to reduce cholesterol levels when you have diabetes, many of which also improve blood glucose.

Certain lifestyle factors can help:

Watch your numbers

Often, dyslipidemia does not present evident symptoms. Therefore, even if you don’t have any risk factors, you must get screened every five years from age 20.⁵ 

If you have risk factors or have previously had high cholesterol, your doctor should check this more regularly. They will advise how often this should be.

Constant monitoring of your cholesterol levels will allow you to act accordingly. For example, your doctor may recommend medication if you constantly receive results indicating dyslipidemia.

Following your doctor’s advice

Implementing what your doctor has discussed with you is very important. 

Lifestyle changes have an immense effect on lowering cholesterol. This may include changing your diet, watching your weight, reducing alcohol consumption, and quitting smoking. 

Taking your medications

Your doctor may prescribe medications, and you must take them correctly. Statins are often the first-line treatment to reduce LDL production. The low levels of LDL in the liver trick it into thinking it needs more, so it takes cholesterol from the bloodstream. Research claims⁶ that statins reduce LDL levels by 35–55%.

Many people worry about the side effects of medications, but the effects on cholesterol levels outweigh the potential risk. 

A study⁷ published by the Journal of the American Heart Association in 2019 investigated mortality. The researchers followed participants over 18 months and separated them by their adherence to statin treatment: Severely nonadherent, moderately nonadherent, and adherent. 

They found a measurable statistical difference between these groups: People who did not take their medications correctly died earlier. 

The researchers also investigated medication adherence after a heart attack. They discovered that it’s never too late to start taking medications properly to improve health. 

If you are experiencing side effects, your doctor may be able to offer alternative medications, including:

• Ezetimibe (Zetia)

• Bile Acid Sequestrant (Welchol)

• PCSK9 inhibitor (Repatha, Praluent)

• Bempedoic Acid (Nexletol)

• Bempedoic Acid + Ezetimibe (Nexlizet)

Speak to your doctor if you have any questions or concerns regarding your health. Improving your knowledge about high cholesterol is a great way to understand why you are implementing these changes and increase the likelihood of sticking to them.

Doing some exercise

Increasing the amount of exercise you do is very important. Multiple studies show a positive correlation between being active and lower cholesterol levels.

A study⁸ investigated the clinical significance of running on cardiovascular fitness. The researchers chose to examine the link by recording the average amount of kilometers and the best 10-km personal performance.

Both were associated with low cholesterol levels. However, the effect on cardiovascular fitness was far more significant. 

The take-home message from this study is that you should try to increase the intensity of your exercise rather than the duration to achieve a better result.

If you are increasing the amount of your exercise, check your blood glucose levels routinely. If you experience confusion, shakiness, weakness, or intense fatigue, please seek medical help. These are all symptoms of low blood glucose (hypoglycemia) and can become very serious if untreated. 

Improving your diet

What you eat can have a significant effect on your cholesterol levels. Unhealthy food choices such as highly processed foods with saturated fats increase the amount of LDLs. 

The Family Heart Foundation reports that you can expect a 10–15% decrease in LDL if you have a healthy diet. Here are some recommendations from Mary Card, Registered Dietitian, and Senior Clinical Association from the foundation.

Foods to include

Fruits and vegetables, including beans

Adding more fruits and vegetables to your diet is excellent for the digestive system. You should have 6-11 servings per day. While this might sound like a lot, servings are smaller than you might expect. For instance, a typical salad contains four servings. 

Beans are a great source of protein. By increasing your bean consumption, you can lower your cholesterol levels and still sustain adequate protein intake.

Whole grains

Americans typically don’t eat enough fiber, so introducing whole grains into your diet is a great option. Whole grains like barley and oatmeal lower cholesterol. Aim to consume 25-30 grams daily.

Unsaturated fats

You still need to consume some fat in your diet. Scientists have reported that replacing saturated fats with unsaturated fats will lower your cholesterol.

Foods to avoid

Trans and saturated fats

Trans and saturated fats increase LDL. Thus, it’s essential to avoid these foods. The Dietary Guidelines for Americans recommends limiting 10% of your calories to saturated fats or 8-12 grams daily.

Cholesterol

It’s a no-brainer that reducing cholesterol intake will reduce the amount of cholesterol in the body. Interestingly, consuming saturated fats contributes more to cholesterol levels than cholesterol itself.

The lowdown

Diabetes and dyslipidemia are two common medical conditions with similar risk factors. Diabetes, particularly type 2, results in chronically elevated insulin levels, potentially increasing LDL production.

There are many options to reduce your cholesterol levels when you have diabetes. This includes lifestyle factors such as following your doctor’s advice, being physically active, and eating healthier. Doing so could significantly reduce your cholesterol levels and keep your glucose levels in check.