The Cholesterol Catch
Why you may be getting the wrong advice and even the wrong test.
If you have type 2 diabetes, chances are you know whether or not you have high cholesterol. The two often go hand in hand. You may know your total cholesterol number, or your doctor may have gone a step further and told you your LDL cholesterol number. Either way, if the number was above the healthy limit the last time you had a test, your doctor almost surely told you that it needs to come down. You probably walked out of your doctor's office with a prescription for a statin drug and a mandate to eat less meat and cheese.
However, to think that all LDL is "bad" cholesterol that coats your arteries with dangerous plaque and all HDL is "good" cholesterol that helps scrub your arteries of plaque is overly simplistic. Both LDL and HDL are made up of particles of various sizes and densities. Large, fluffy LDL is not harmful, and small, dense HDL can be dangerous. Total cholesterol of even levels of HDL or LDL measured in a typical round of blood work can't determine the size of the particles, therefore it's incomplete information about your risk factors for heart disease. Instead, your doctor can order a test that measures the various cholesterol particles in your blood. And Medicare and most insurance plans cover this type of test, so ask about it.
Also, depending on your numbers, your doctor may be able tell whether you have small, dense LDL particles based simply on your levels of triglycerides and HDL. Triglyceride levels higher than 120 mg/dL and HDL levels below normal (less than 40 mg/dL in men and less than 50 mg/dL in women) are usually associated with small, dense LDL.
So, what can you do to reduce the number of these small, dense particles? Statin drugs reduce LDL cholesterol, but not triglycerides — not do they raise HDL, or at least not by much. You can make lifestyle changes to lower your triglycerides and raise your HDL levels. These are good things to do even if your levels are not in the at-risk range. Both high triglycerides and low HDL are by themselves risk factors for heart disease.
How to Raise Your Good Cholesterol and Lower Your Triglycerides
1. Curb your carbs. In a study comparing a lowfat diet to a low carb diet, subjects on the low carb diet saw greater reductions in triglycerides (and blood pressure) and greater increases in HDL. It's also well establised that lowfat (high carb) diets raise triglyceride levels. Research shows that the more sugary foods and drinks you consume, the lower your HDL and the higher your triglycerides, too.
2. Walk more every day. Thirty minutes of daily brisk exercise also can decrease triglycerides and increase HDL in as little as two months. If you don't have a free half hour, break it up into three 10-minute brisk walks.
3. Quit smoking if you smoke. It can increase your HDL by 10 percent.
4. Lose weight. For every 6 pounds you lose, your HDL may increase by 1 mg/dL.
5. Drink moderately. Moderate alcohol consumption is associated with higher HDL levels. But beware, too much alcohol is associated with high triglycerides (and reducing alcohol intake can lower them).
6. Ask your doctor about taking the B vitamin niacin. Niacin is the best medication for raising HDL. (Note: At high doses, Niacin can significantly increase blood glucose levels. Talk to your doctor about dosage information and whether an over-the-counter or prescription option is best for you.)
Reviewed by Susan Weiner, RD, MS, CDE, CDN. 05/12.
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