High Cholesterol and Diabetes Diet Plan

Dr. Jedha, Host

Hello wonderful people, thanks for tuning in today for episode 44.

In episode 42, we delved into understanding cholesterol and our body. Plus, we focused on busting a few of the predominating myths about cholesterol. 

September is National Cholesterol Education Month in the US, which is why covering the topic of cholesterol seemed like the perfect time to release a couple of episodes. It is of course a relevant topic at any time of the year. 

When surfing the wild west web, the common narratives surrounding cholesterol will rear their ugly heads – LDL is “bad” or that saturated fats are bad and will increase your LDL so you should limit red meat and cheese, and you might even hear somewhere that you should limit your intake of cholesterol-rich foods and eggs. These are largely outdated perpetuating narratives, as we covered in episode 42. It’s important to understand the myths and misunderstandings about cholesterol so you can make informed choices about your nutrition plan, lifestyle and medications.

The objective of today’s episode is to chat about practical nutrition strategies to rebalance your cholesterol levels and to bring high cholesterol levels down so let’s dive straight into this as we’ve got a fair bit to cover.

02:32

Previously we have talked about how Pre and T2Diabetes are conditions of altered metabolism – high blood glucose, high insulin levels and insulin resistance. The altered metabolism and all of these things contribute to altered cholesterol levels, which often manifests as high triglycerides, low HDL, and potentially harmful small, dense LDL particles. An altered metabolism means that your body’s process of converting food into energy is not functioning optimally, leading to imbalances in the way nutrients are utilized and stored. 

Keeping that in mind, the primary goal for improving cholesterol levels is to correct the underlying metabolic imbalances, particularly by lowering blood sugar, which in turn lowers insulin levels, improves insulin sensitivity and helps to rebalance nutrient utilization in the body. 

How do you do that? You eat to treat diabetes. We covered this in episode 6 and what types of foods to eat and what types of foods to avoid or minimize, so you can go back and listen to that episode for all of the details or get a copy of our food list yet, go to Type2DiabetesTalk.com/foodlist. If you’re one of our members you can find the food list inside the members site, with the ‘Guides,’ along with other resources to use alongside the food list. 

So here’s the thing, a low fat diet will not help rebalance your altered metabolism or to lower cholesterol. Research demonstrates that low carbohydrate diets have the most significant effect on rebalancing an altered metabolism. Systematic review and meta-analyses of randomized controlled trials are the highest form of evidence, as they examine all data from those clinical trials collectively to determine the effects. When these reviews and meta-analyses look at low carbohydrate diets compared to moderate or high carbohydrate diets in people with T2diabetes, we always see more significant improvements in blood sugar and HbA1c and in clinical biomarkers related to cardiovascular disease – increases in HDL cholesterol, decreases in triglycerides, improvements in LDL particle number and size, indicating that switch from those harmful small dense particles to the neutral large buoyant particles. We also commonly see medication reductions, which indicates the significant metabolic improvements that a low carbohydrate diet accomplishes. 

These results demonstrated in studies are the exact things we see most commonly in our members as well, so we can confirm the outcomes of studies are indeed accurate. By following a whole foods, nutrient dense lower carbohydrate nutrition plan, you can rebalance your altered metabolism and since everything is connected, you’re not only reducing blood glucose and A1c, you’re reducing circulating insulin in the body, you’re improving insulin sensitivity and this helps to reset the way your body metabolizes nutrients, rebalancing cholesterol as well, among other things – blood pressure weight and so forth. 

What you need to focus on first is getting the fundamentals of your nutrition plan in place. Again, we covered this in episode 6 or you can get started with a copy of our food list, go to Type2DiabetesTalk.com/foodlist. Members, find the food list in the members site under Guides. 

06:41

Let’s go over some of the foods to focus on cutting out of your diet if you want to improve cholesterol. 

1. Trans Fats

Trans fats are artificially created through the process of hydrogenating vegetable oils, which makes them solid at room temperature. They are found in many processed and fried foods, including margarine, baked goods like cookies, pastries, and cakes, and snack foods. Trans fats are known to increase oxidized  LDL (low-density lipoprotein) cholesterol while lowering HDL (high-density lipoprotein) cholesterol, which is a harmful combination that significantly increases the risk of heart disease. Additionally, trans fats promote inflammation and oxidative stress, both of which contribute to the development of atherosclerosis, plaque buildup in the arteries.

2. Added Sugars

Added sugars, especially those found in sugary drinks, sweets, and many processed foods, contribute directly to higher triglyceride levels and lower HDL cholesterol. Excess sugar in the diet can lead to fatty liver, increased VLDL (very low-density lipoprotein) production, and a rise in small, dense LDL particles. High sugar intake also promotes insulin resistance.

3. Excessive Omega-6 Polyunsaturated Fats

One blanket statement we often hear is that increasing polyunsaturated fats is better for cholesterol, but that’s not necessarily the case. While consumption of polyunsaturated fats may reduce LDL cholesterol, research shows it can result in oxidized LDL. That’s not what we want as oxidized LDL increases risk of heart disease. The main issue is there are two different types of polyunsaturated fats, omega 6 and omega 3. Omega-6 fatty acids, while essential in small amounts, can become problematic when consumed in excess, particularly in the form of processed seed oils like soybean, corn, vegetable, and safflower oils. These oils are commonly used in processed and fried foods. A high intake of omega-6 fats can lead to an imbalanced omega-6 to omega-3 ratio, which promotes inflammation and can increase the oxidation of LDL particles, contributing to atherosclerosis and heart disease.

So we’ve just covered trans fats, added sugars and omega 6s polyunsaturated fats, and where are all of these things primarily coming from in the modern diet?

In highly processed foods!

Highly processed foods often contain a combination of the above problematic ingredients—trans fats, added sugars, and omega-6 fats, along with refined carbohydrates. Processed foods are typically low in nutrients and high in empty calories, contributing to poor metabolic health, contributing to an altered metabolism. And we know all the research points to the fact that regular consumption of highly processed foods is associated with increased risks of obesity, insulin resistance, pre and T2diabetes, and cardiovascular disease.

10:39

What you need to do is cut out the majority of processed foods from your diet. 

Focus on getting the fundamentals of your nutrition plan in place, by following a whole foods, nutrient dense lower carbohydrate nutrition plan. A plan based on fresh foods, lots of vegetables, proteins and natural fats found in fresh foods. 

When following a lower carbohydrate nutrition plan, it is common for fat intake to increase and this concerns people as they think their cholesterol levels will go up. To emphasize again, the most common result we see from following a low carb diet is a reduction in cholesterol levels. Triglycerides go down, HDL cholesterol goes up, Total cholesterol either goes down or stays the same, that’s not an issue anyway as it essentially means nothing. LDL cholesterol has a tendency to stay the same. However, the LDL particle size often increases (large, fluffy particles), and the LDL particle number goes down (more large particles equals less overall particles). All of these are good things.

There is a small percentage of people who experience elevations in LDL cholesterol when adopting a low-carbohydrate diet or during other lifestyle changes. If that’s you, there are some avenues you can explore to help determine your risk of heart disease, starting with that extended lipid panel we discussed in episode 42, as high LDL is not necessarily bad. It’s also important to know that if you’re in a weight loss phase, your cholesterol may be all over the place. Since cholesterol is essentially stored in fat cells, when you lose weight you may temporarily have a higher circulating amount of cholesterol. You might also see HDL cholesterol temporarily go down during a weight loss phase. Over time, as your weight stabilizes, your cholesterol levels typically balance out and improve, with normalized triglycerides and increases in HDL, reflecting the overall benefits of your healthier nutrition plan and lifestyle. So, if you see fluctuations in your cholesterol numbers during a weight loss phase, it’s usually a temporary effect that aligns with your body’s adaptation to fat loss. This is definitely something to keep in mind and to discuss with your doctor as well, should the issue arise. 

The message is, focus on getting the fundamentals of your nutrition plan in place, by following a whole foods, nutrient dense lower carbohydrate nutrition plan, and over time that usually resolves the cholesterol issues.

Triglycerides can decrease rapidly when you cut out sugar, refined carbohydrates, and reduce your overall carbohydrate intake. This improvement occurs because lowering your blood sugar and insulin levels reduces the body’s tendency to store excess energy as fat. And interestingly, the production of triglycerides requires a glycerol backbone, which is generated from glucose/sugar. By reducing the availability of glucose in the bloodstream, your body has less substrate to form new triglycerides, leading to lower levels in the blood. This process not only improves your triglyceride levels but also supports better overall metabolic health.

Aside from getting the fundamentals of your nutrition plan in place, are there additional things we can do to improve cholesterol? Of course, the answer is yes!

The majority of cholesterol production occurs internally (inside your body) and has nothing to do directly with the food you eat, for example cholesterol in eggs won’t raise blood cholesterol or lead to higher LDL “bad” cholesterol. With that said, you can manipulate your diet to alter metabolism and therefore influence cholesterol production to some extent. And, there is also evidence to show some foods can manipulate cholesterol production in our body over time. For example, eggs have been shown to raise HDL “good” cholesterol with no negative impacts on other cholesterol parameters. We covered eggs in episode 13, if you want to discover more about that. 

15:54

Down to ways you can further modify your nutrition plan to support healthy cholesterol. 

By eating a healthy low carb nutrition plan, you’re going to naturally be consuming a range of healthier fat sources, from various meats, dairy, seafood, nuts and seeds and so forth. That’s a good thing. 

In terms of meats, there is no research showing fats found naturally in meats negatively impacts cholesterol. That includes red meat, as all meats contain mostly monounsaturated fats – something you’ll learn more about in next week’s episode. 

In terms of dairy products, the current body of research suggests that dairy products, including full fat dairy, have no significant effect on cholesterol levels in the majority of people with type 2 diabetes, especially within the context of an overall healthy nutrition plan, such as we’re covering here today.

A couple of fat modifications you can make however are you can focus on consuming more monounsaturated fat. Foods high in monounsaturated fat are things like olive oil, hazelnut, almond and macadamia oil, avocado and nuts like macadamia, hazelnuts, almonds, and pecans. Evidence on monounsaturated fats show they can be beneficial to raise HDL levels. 

Another beneficial strategy is to regularly include omega-3 fats in your diet, such as those found in salmon, tuna, sardines, chia seeds, and flaxseeds. Omega-3 fatty acids are known to help lower triglyceride levels in the blood, which is crucial because when triglycerides decrease, HDL tends to increase. This dual benefit not only improves your overall cholesterol profile but also enhances heart health by reducing the risk of atherosclerosis and other cardiovascular issues.

Eat lots of non starchy vegetables, lots of them! Studies have shown vegetables improve cardiovascular risk overall, and they can help lower LDL and increase HDL. Vegetables provide us with fiber of different kinds, along with vitamins, minerals and compounds that support improved health. 

Snack on a small amount of nuts each day, around 1-2 oz or 30-60g, which are a good source of soluble fiber, polyphenols and beneficial fats. In people with T2Diabetes, studies have found that walnuts and cashews can help raise HDL, while almonds have been shown to lower LDL. Other nuts, such as pistachios and hazelnuts, are also beneficial for cholesterol and cardiovascular health. 

Including plant sterols in your eating plan is another way to influence cholesterol. Plant sterols, also known as phytosterols, are structurally similar to cholesterol and can block the absorption of cholesterol in the digestive tract. When you consume foods rich in plant sterols, they compete with cholesterol for absorption in the intestines. This reduces the amount of cholesterol that enters the bloodstream, leading to lower LDL cholesterol levels. Almonds, walnuts, pistachios, and sunflower seeds contain significant amounts of plant sterols. Consuming vegetables contributes to plant sterols, particularly cruciferous vegetables like broccoli and cauliflower. Beans and legumes are good sources of plant sterols as well. Just keep these to small portions when included in meals, as they are quite high in carbohydrates. 

In terms of plant sterol supplementation, there are mixed results with some studies showing great benefits for LDL while others don’t and there are also concerns about plant sterols oxidizing in the body from supplementation, along with weight gain in some people. So in this case, getting plant sterols from a wide range of foods is the best strategy. 

Supplementing with soy protein isolate or consuming soy protein has been shown to reduce LDL cholesterol and improve cholesterol ratios. We’re talking foods like tofu, tempeh, textured vegetable protein, or edamame, or a soy protein isolate, which is a type of protein powder. 

Dietary fiber is very important, particularly foods high in soluble fiber, which help lower blood cholesterol by binding bile and removing cholesterol out of the body, helping to lower LDL and increase HDL, along with decreasing triglycerides. Use psyllium husks and whole flaxseeds in a nut-based breakfast cereal or smoothie as these are rich in soluble fiber with proven benefits for cholesterol and improving blood sugar and metabolism too. Soluble fiber can also be found in artichoke, asparagus, winter squash, Brussels sprouts, broccoli, onion, carrots, blueberries, beans, legumes, nuts and seeds.  

Other foods highlighted across research that may also provide benefits for lowering LDL cholesterol are avocados, turmeric and green tea.

Be sure to check your vitamin D status, we know levels can be compromised in many people living with pre and T2diabetes, and studies show improvements in triglycerides, total cholesterol and increases in HDL when vitamin D is supplemented. 

Lastly, one of the overriding benefits of eating a healthy low carb nutrition plan is the diversity of natural whole foods it provides, all of which support beneficial gut bacteria. In the gut we have different bacteria that support better cholesterol by influencing cholesterol metabolism, absorption and excretion. By eating a nutrient rich diet, you encourage a healthy gut microbiome and this can aid in the conversion of cholesterol to bile acids and facilitate the excretion of cholesterol, thereby lowering LDL levels. 

Of course, we’re all individuals, so cholesterol management can vary from person to person and while these recommendations work for the vast majority of people, there are some cases where further adjustments may be necessary. If you’re concerned about your cholesterol, talk to your doctor about getting an extended lipid panel to determine the functionality of your cholesterol and get a clearer picture, because as we shared back in episode 42, a single snapshot of numbers doesn’t give us enough information, especially when thinking about things like LDL cholesterol. 

Overall, when it comes to addressing high cholesterol and an altered metabolism, you want to start by evaluating your current diet and see where you can cut out processed foods. Go back and listen to episode 6 on what to eat to treat diabetes and get a copy of our food list at Type2DiabetesTalk.com/foodlist. 

Begin making small changes to your nutrition plan today, focusing first on the added sugar, refined carbs, and processed foods that contain trans fats or omega 6 fats. Work on the fundamentals of your nutrition plan and use all the recommendations we’ve outlined here today and you will see incredible improvements in your health overall.  

For members listening, you can find our food list and a range of cholesterol resources inside the members site under Guides and by searching the members library. We’ll also include a range of links to those cholesterol resources alongside episode 42 in the members library. 

That’s all for now. Take care until next week. 

Dr. Jedha, over and out.