Lee Chung Horn
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   DIABETES MELLITUS

 

I HAVE HIGH LIPIDS!

Blood lipids are substances in your blood stream. They include cholesterol (there are two main types: bad cholesterol or LDL-cholesterol, and good cholesterol or HDL-cholesterol), and triglycerides. Too high a level of LDL-cholesterol, or too low a level of HDL-cholesterol, or high triglycerides can predispose you to developing heart disease and stroke. Persons with diabetes often have lipid problems.

Checklist for eating to lower your cholesterol

It's generally not difficult to lower your blood cholesterol. You need the correct information, and lots of will power. You should eat more foods that are low in saturated fat and cholesterol, and cut down on high-fat ones, especially those high in saturated fats. Here are some simple daily guidelines:

1 Watch your caloric intake by eating a wide variety of foods low in saturated fat and cholesterol.

2 Eat more vegetables and fruits every day. Persons with diabetes should first find out what fruits may be too "sweet" for them to take safely. Examples may include durians and mango and grapes!

3 Eat more servings of cereals, plain breads, pasta and other whole-grain products.

4 Eat fish, poultry without skin and leaner cuts of meat instead of fatty ones.

5 Eat nonfat or 1% milk (low fat) dairy products rather than whole-milk dairy products.

6 Increase exercise.

7 Maintain a healthy weight.

If you need to eat out in restaurants or entertain a lot, you should think carefully before ordering! Examples of local foods that are generally "bad" if you have a lipid problem: char kuay teow, fried rice, mee goreng, curries, nasi lemak, rendang, lontong, chicken rice, fish head curry, roti prata, among others.

Who needs cholesterol-lowering drugs?

If your cholesterol is not dangerously high, you should try to reduce it by altering your lifestyle. Drug therapy is usually considered for patients who, in spite of adequate dietary therapy, regular physical activity and weight loss, still need more treatment to lower their blood cholesterol levels. The presence of other coronary heart disease risk factors influences the use of cholesterol-lowering drugs:

Age -- This includes men 45 years or older, or women 55 years or older.

Family history -- This includes anyone having a father, brother or son with a history of coronary heart disease before age 55, or a mother, sister or daughter with coronary heart disease before age 65.

Smoking -- This includes anyone who smokes or who lives or works every day around people who smoke.

High blood pressure -- This includes anyone with a blood pressure of 140/90 mm Hg or higher, measured on two or more occasions.

HDL cholesterol --This includes anyone whose HDL cholesterol level is less than 40 mg/dL.

Diabetes --Diabetes is a very strong risk factor for heart disease and stroke. If you have diabetes and high lipids, you need to pay attention to keeping your lipids down.

There are a variety of medications available for lowering blood cholesterol levels. They may be prescribed individually or in combination with other drugs. Some of the common types of cholesterol-lowering drugs include statins, resins and nicotinic acid (niacin), fibrates.  

Gemfibrozil (Lopid) This drug lowers blood triglycerides and raises HDL cholesterol levels.

Nicotinic Acid/other derivatives This drug works in the liver by affecting the production of blood fats. It's used to lower triglycerides, lower LDL cholesterol and raise HDL ("good") cholesterol. It may cause flushing and itching.

Resins  Resins are also called bile acid-binding drugs. They work in the intestines by promoting increased disposal of cholesterol. There are three kinds of medications in this class. Resins include cholestryamine (Questran, Prevalite, Lo-Cholest), colestipol (Colestid), coleseveiam (WelChol). Resins often come in a powder that you mix with water or juice. Side effects may include constipation, bloating, nausea and gas. To reduce these effects, eat more fiber and drink more fluids.

Statins   Statins have shown themselves to be very effective for lowering LDL ("bad") cholesterol levels. They are very safe and have very few side effects. They work by interrupting the formation of cholesterol from the circulating blood. Commonly prescribed statins include: atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor).

Common Misconceptions About Cholesterol

1.      Using margarine instead of butter will help lower my cholesterol.

Both margarine and butter are high in fat, so use both in moderation. From a dietary perspective, the major factor affecting blood cholesterol is how much fat (particularly saturated fat) is in the food — not the amount of cholesterol. Reducing your intake of saturated fat is key to helping control cholesterol. Most soft margarines have less saturated fat and so are preferable to the stick forms for a heart-healthy diet. However, eat all fatty foods in moderation.

2.      Thin people don’t have to worry about high cholesterol.

This is not true. Yes, overweight people are more likely to have high cholesterol from eating too many fatty foods, but thin people should also have their cholesterol checked regularly. Often people who don’t gain weight easily are less aware of how much fat they eat. Nobody can “eat anything they want” and stay heart healthy. Have your cholesterol checked regularly regardless of your weight, exercise habits and diet.  

3.      My doctor hasn’t said anything about my cholesterol, so I don’t have to worry.

Unfortunately, not all physicians are as proactive about healthy lifestyles as they should be. Your health is your responsibility. Make sure that you have a blood cholesterol test and learn how to interpret all the numbers, including HDL (“good”) cholesterol, LDL (“bad”) cholesterol and triglyceride levels. If you’re in a high or borderline-high range, discuss options with your physician. You may be able to control the levels by eating a diet lower in saturated fat and cholesterol, getting 30–60 minutes of physical activity on most days and quitting smoking. If lifestyle changes alone don’t work, your physician may prescribe a cholesterol-lowering medication.  

4.      Since the nutrition label on my favorite food says there’s no cholesterol, I can be sure that it’s a “heart-healthy” choice. 

Nutrition labels on food are very helpful when choosing heart-healthy foods, but you need to know what to look for. Many “low-cholesterol” foods contain high levels of saturated fat or trans-fatty acids — both of which contribute to high blood cholesterol. Even foods that claim to be “low-fat” may have a higher fat content than expected. Look for the amount of saturated fat, total fat, cholesterol and total calories in a serving of the product. Also check how much a serving is. Often, it’s smaller than you think. The first ingredient listed is the one used most in the product, so choose products where fats and oils appear later in the ingredient listing. Currently, trans-fats aren’t required to be listed, but if the product has hydrogenated oils, it has a high level of trans-fatty acids, which can raise your cholesterol level. Know your fats.

5.      Since I started taking medication for my high cholesterol, I don’t have to worry about what I eat.

Modern medications have come a long way in helping to control blood cholesterol levels, but making lifestyle changes along with taking medication is the best way to help prevent heart disease. Reducing the amount of fat and cholesterol in your diet and getting 30–60 minutes of exercise on most or all days of the week is recommended, even if you’re taking cholesterol-lowering medication. It’s also very important to take your medication exactly as your doctor has instructed so it can work most efficiently. Most modern medications are very safe when used with your doctor's instructions. 

6.      I recently read that eggs aren’t so bad for your cholesterol after all, so I guess I can go back to having my two eggs for breakfast every morning.

One egg contains about 213 milligrams of dietary cholesterol. That’s a lot given that the daily recommended cholesterol limit is 300 milligrams. An egg a day can fit within heart-healthy guidelines only if cholesterol from other sources, such as meats, poultry and dairy products, is limited. For example, eating one egg for breakfast, drinking 2 cups of coffee with one tablespoon of creamer, lunching on lean turkey breast without skin and one tablespoon of mayonnaise, and having a 6-ounce serving of broiled, short loin porterhouse steak for dinner would account for about 510 mg of dietary cholesterol that day — nearly twice the recommended limit. If you love eggs and have to eat an egg every morning, substitute vegetables for some of the meat, or drink your coffee without creamer. Learn more about cooking for lower cholesterol.

7.      I’m a woman so I don’t have to worry. High cholesterol is a man’s problem.

Pre-menopausal women are usually protected from high LDL (“bad”) levels of cholesterol, because the female hormone estrogen tends to raise HDL (“good”) cholesterol levels. Postmenopausal women may find that even a heart-healthy diet and regular exercise aren’t enough to keep their cholesterol from rising. If you’re approaching menopause, it’s especially important to have your cholesterol checked and talk with your doctor about your options. If you are a woman with diabetes, your risk of heart disease is roughly 4 times higher than a woman without diabetes.

8.      You don’t need to have your cholesterol checked until you reach middle age.

It’s a good idea to start having your cholesterol checked at an early age, as even children can have high cholesterol levels. And evidence exists that these children are at greater risk for developing heart disease as adults. Lack of exercise, poor dietary habits and genetics can all affect a child’s cholesterol levels. You’re never too young to develop a heart-healthy lifestyle by eating foods low in fats, getting 30–60 minutes of physical activity on most or all days, and avoiding tobacco products.

How do I know if my treatment is working?  

Your doctor will test your blood cholesterol level when needed. You should keep track of your cholesterol level, perhaps using a chart or writing it on your calendar. Together with your endocrinologist, set a goal and ask how long it may take to reach that goal. Be sure to follow up with your doctor after reaching your goal. Don’t stop medication unless your doctor tells you to. Be wary of folk cures and alternative medicines.


 

Copyright of Lee Chung Horn Diabetes & Endocrinology 2009