Ellen Slotkin is a registered dietitian specializing in heart-healthy nutrition, weight management, and pregnancy nutrition.
Jonathan Purtell, MS, RDN, CDN, is a board-certified Registered Dietitian who provides in-patient services at Lenox Hill Hospital in New York, New York.
Type 2 diabetes often goes hand-in-hand with unhealthy cholesterol levels. Even someone with diabetes who has good control of their blood glucose is at a higher than average risk of having cholesterol problems that increase the risk of atherosclerosis and other cardiovascular problems.
If you have diabetes, you’ve already made changes to your diet and lifestyle that are targeted to keeping your blood glucose (blood sugar) levels steady. But given the increased risk of heart problems associated with diabetes, you may want to also take steps to keep your cholesterol levels steady as well.
In and of itself, cholesterol is not a bad thing: It's present in every cell in the body and does a lot of good—supporting the production of hormones, digestion, and converting sunlight into vitamin D. Approximately 75 percent of the cholesterol present in the blood is produced by the liver, but the rest is derived from the diet, which is why making dietary changes is an effective way to keep cholesterol levels healthy.
There are two types of cholesterol:
In addition to cholesterol, the levels of triglycerides (fats) in the body are important to heart health and are considered a key aspect of a person’s overall blood cholesterol profile.
Managing both diabetes and cholesterol levels is a matter of being careful about the amounts of carbohydrates, cholesterol, and saturated fats in your diet, as well as making sure you're getting enough of the nutrients that can help improve your blood sugar and cholesterol levels.
There are several types of carbs: Of particular importance are complex carbs (a.k.a. starches), found in foods like legumes, whole grains, starchy vegetables, pasta, and bread. Simple carbs are, simply, sugars.
For most people with diabetes, especially those who take insulin and are monitoring their blood sugar levels before and after meals, there’s no hard-and-fast number of ideal carbs per day: That will depend on the results of each meter reading.
However, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the recommended carbohydrate intake for most people is between 45 percent and 65 percent of total calories from carbohydrates, with the exception of those who are physically inactive or on low-calorie diets.
For someone following a 1,800-calorie diet, that would mean getting 202.5 grams of carbs each day, based on the fact that there are four calories per one gram of carbohydrate.
Sugar crops up in the diet in two ways: It's a natural component of fresh fruit, for example. But it also shows up as an additive, often surreptitiously, in items like fruit drinks and even condiments such as ketchup and barbecue sauce.
The 2020-2025 USDA Dietary Guidelines, developed by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, recommends keeping added sugar to fewer than 10 percent of calories each day.
Saturated fats, found in foods such as animal protein and processed meats, certain plant oils, dairy products, and pre-packaged snacks, are known to raise the levels of LDL cholesterol in the body.
The Dietary Guidelines for America advise getting fewer than 10 percent of total daily calories from saturated fat, while the American Heart Association (AHA), recommends that less than 5% to 6% of daily calories consist of saturated fat. For someone following a 2,000-calorie diet, that would come to no more than 120 calories worth of saturated fat, or around 13 grams.
This is an especially bad type of saturated fat that results from the heating of liquid vegetable oils (hydrogenation), a process done to unnaturally give foods a longer shelf life. It's used in margarine, processed snack foods and baked goods, and for frying.
In addition to following the dietary guidelines set out for general health and also monitoring your glucose to determine how certain foods, especially carbs, affect your blood levels, there are other effective ways to manage diabetes and maintain healthy cholesterol levels.
Fiber is the part of plants that can’t be digested. Although it’s very filling, it won’t add calories because the body can’t absorb it, making it useful for weight loss. What’s more, soluble fiber, found in foods like beans, apples, and oatmeal, helps lower LDL cholesterol and keep blood glucose levels steady.
A good rule of thumb for getting ample fiber at each meal is to fill half your plate with non-starchy vegetables—anything from artichokes and asparagus to turnips and zucchini. These are rich in fiber (as well as phytonutrients that can further help protect your overall health).
Aim to increase the amount of fiber you eat every day gradually, to at least 25 grams per day if you're a woman and 38 grams per day if you're a man.
Fat is an important nutrient, necessary for energy and hormone production, vitamin absorption, maintaining the membrane integrity of every cell in our body, and growth and development. According to the Dietary Reference Intakes published by the USDA, 20% to 35% of calories should come from fat. But when it comes to dietary fat, not all types are created equal.
If you’re overweight or obese, losing just 5% to 10% of your weight can have a tremendously positive effect on both your diabetes and your cholesterol levels by helping to lower your blood glucose, blood pressure, and improve your blood fat levels. You may even be able to cut down on your medications.
One of the best ways to begin a safe and effective weight loss plan tailored to you is to keep a record of what you eat, how much you eat, and around what time you eat for three days, ideally two weekdays and one weekend. You can then have a registered dietitian analyze it (or use an online program) to determine the average number of calories you are eating and how many vegetables you're eating (or not eating), and the main kinds of fat in your diet.
Armed with this information, you'll be able to see how many fewer calories you should eat in order to lose weight at a slow and steady rate, and what foods you should cut back on or steer clear of in order to eat less added sugar and saturated fats.
Physical activity burns calories, which is why exercise is always recommended as part of a weight-loss plan—particularly for someone with diabetes.
Exercise also has been found to help lower total cholesterol levels. What kind? In studies, a combination of aerobic exercise and strength-training has been found ideal.
As for how much and how often you should work out, the AHA advises 150 minutes per week of moderate-intensity aerobic activity, or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week. You'll gain even more benefits by being active at least 300 minutes (five hours) per week. Add moderate- to high-intensity muscle-strengthening activity at least two days per week.
If that sounds like a lot to start, don't be discouraged: Any physical activity is better than nothing, even if it's just taking the stairs instead of the elevator, or walking around the block. And if you find it hard to exercise for long periods at a time, divide it up into shorter sessions—10 or 15 minutes—throughout the day.
If you smoke, quitting will impact both your HDL and LDL cholesterol levels for the good. Cigarette smoking is linked to higher cholesterol levels, as well as the formation of a damaging form of LDL called oxidized LDL, which contributes to atherosclerosis.
In fact, as soon as you stop smoking, your cholesterol levels will begin to decrease, research shows. With each month after quitting, LDL levels continue to drop, even partially reversing the effects of smoking on cholesterol after just 90 days.
Diabetes can contribute to high cholesterol, a condition called diabetic dyslipidemia. It can cause HDL, or "good," cholesterol to decrease and LDL, or "bad," cholesterol to increase.
Common risk factors for developing type 2 diabetes include obesity, age over 45, a family history of diabetes, leading a sedentary lifestyle, and a history of gestational diabetes. People who are of certain races are also more likely to develop diabetes, including Black, Hispanic, American Indian, and Alaska Native people.
Aside from having diabetes, other risk factors for developing high cholesterol include obesity, a family history of high cholesterol, eating a diet high in saturated fat, leading a sedentary lifestyle, age over 55, and smoking.
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Ellen Slotkin is a registered dietitian specializing in heart-healthy nutrition, weight management, and pregnancy nutrition.
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