Common Health Issues

Cholesterol Abnormalities and Diabetes

• By Rich Health Editorial Team
• November 03, 2021

Cholesterol is a fatty substance the body makes to serve a very important function. Along with other fats, cholesterol helps form the membranes that surround each cell in the body. It also helps form the insulation around the nerves in the body and is needed to make bile, a substance that helps the body digest and absorb fat and fat-soluble vitamins.

 

The cholesterol in your body does not float around freely in your blood and tissues. Rather, it binds or attaches to certain protein called lipoproteins. Cholesterol binds to high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Low-density lipoprotein binds a lot of cholesterol and carries cholesterol from the liver throughout the body. It is this form that is responsible for the buildup of cholesterol in the blood vessels. Because of that, it is often called ‘bad cholesterol.’ You don’t want to have high levels of LDL in your blood. High-density lipoprotein, on the other hand, is the form called ‘good cholesterol.’ It collects excess cholesterol in the blood and brings it back to the liver where it is broken down. You want to have high levels of HDL.

 

Too much LDL cholesterol in the blood can be deadly. It can accumulate along the blood vessels that carry blood throughout the body and eventually form blockages that stop the flow of blood. When blood vessels that supply the heart with blood become blocked, coronary artery disease, including angina, heart attack and sudden death can occur. The process that leads to coronary artery disease is called atherosclerosis, also known as hardening of the arteries. It is a slow process that occurs over years, even decades, in which fatty substances in the blood, such as cholesterol, begin to stick to the blood vessel linings. The opening in the arteries gets narrower and narrower. 

 

When blood flow to the heart is restricted, it can cause the pain known as angina. When the narrowing finally reaches the point where blood can no longer flow to the heart, a heart attack occurs. This accounts for 30% of all heart attacks. Or a piece of a fatty plaque can break off and cause a clot to form instantaneously in the blood vessel. This accounts for 70% of all heart attacks. When the arteries to the brain are blocked, the blood flow to the brain may be cut off and a stroke can occur. When the arteries supplying blood to the legs become restricted, you can develop peripheral vascular disease.

 

Your body needs a good supply of blood to keep all the organs functioning properly. Whenever that blood supply is restricted or blocked, serious consequences can occur. Cholesterol is a major contributor to the slow buildup of plaques that cause arterial blockages. If you have diabetes, have high blood pressure, or smoke, the process of atherosclerosis occurs even faster.

 

DIABETES CHOLESTEROL ABNORMALITIES SYMPTOMS

Some people with a rare hereditary disease of cholesterol metabolism may develop bumps on the skin and tendons near the elbow and ankle. However, if you are like most people, your body can’t tell you when your blood cholesterol level is too high until it’s too late. When your arteries are clogged, you may feel chest pain, or worse, a heart attack or stroke. But you probably want to know well before that point, when you can do something to prevent atherosclerosis and cholesterol buildup.

 

DIABETES CHOLESTEROL ABNORMALITIES RISKS

If you have high levels of LDL cholesterol, you have an increased risk of developing coronary artery disease, especially if you have diabetes. Researchers have shown that lowering cholesterol can reduce the number of deaths by heart attack and the chance of having a heart attack by 40%.

 

Several different risk factors can contribute to high cholesterol levels. They include heredity, age, sex, diet, weight, exercise level, alcohol intake, cigarette smoking, blood pressure and diabetes.

Heredity

Researchers don’t fully understand which genes cause high cholesterol levels, but one thing is clear. If our parents have high cholesterol levels, the chances are greater that you will too. This is especially true with certain inherited conditions such as familial hypercholesterolemia which affects 1 in 500 people and leads to early coronary artery disease.

Age and Sex

The older you are, the more likely you are to have high cholesterol. Men over 45, women over 55, and postmenopausal women of any age are at high risk for coronary artery disease, especially among people with diabetes

Diet

Foods high in saturated fat increases LDL levels. Dietary cholesterol is thought by some to be the major contributor to the high incidence of coronary artery disease in the West, but others think dietary fat intake plays a much more significant role.

 

Weight and Exercise

The more excess weight, usually in the form of fat, that you carry around, the greater your risk of high LDL levels. When you lose weight and exercise more, you not only decrease your LDL levels, but you also increase your HDL levels.

 

Alcohol

Perhaps surprisingly, small amounts of alcohol can raise your level of HDL cholesterol. The key is moderation—a daily glass of wine or beer, for example. Drinking too much alcohol can increase triglyceride levels, affect blood glucose levels, and cause liver damage. Talk to your doctor about the advisability of incorporating small amounts of alcohol in our diet

Other Factors

Cigarette smoking, high blood pressure, and diabetes can increase the risk of high cholesterol and also increase the risk of coronary artery disease on their own

 

What You Should Do

The only sure way to know whether your cholesterol levels is too high is to have your blood tested. If you are over the age of 20, you have your cholesterol tested every 2 years if it is within normal limits. If it is out of the range of desirable limits, consider being tested on a yearly basis. You will first need to take a test that measures your total cholesterol and your HDL level. This test may not require you to fast.

If your test shows that your total cholesterol level is below 200mg/dl and you have no other indication of atherosclerosis or coronary artery disease, you can rest assured. If your total cholesterol is above 240mg/dl or if it is between 200 and 230mg/dl and you have two or more risk factors listed above, or if you already have been diagnosed with coronary artery disease, then you will have to have another test.

 

The second test measures your lipoprotein profile and you will require that you fast before taking it. You will not be able to drink or eat anything except water or black coffee or tea (without milk, cream or sugar) for 9 to 12 hours before the test. Usually a lipoprotein profile should be scheduled first thing in the morning.

 

The lipoprotein profile will tell you what your total cholesterol, LDL, and HDL levels are. You should maintain your triglyceride level below 200mg/dl, HDL above 45mg/dl, and LDL below 100mg/dl if you already have diabetes or heart disease. If your cholesterol levels are not within the desirable range, you may need to take steps to bring them within normal limits.

 

DIABETES CHOLESTEROL ABNORMALITIES TREATMENT

Diet

Depending on your cholesterol profile and LDL and HDL levels, whether or not you have any other risk factors and whether or not you already have coronary artery disease, you may need to modify or even make drastic changes in your diet. If you do not already have a registered dietitian on your health care team, now is the time to recruit someone to help you devise a meal plan that works for you. Your dietitian may prescribe either a Step I or a Step II plan. Step I and Step II plans are designed to lower cholesterol levels by limiting fat and cholesterol intake.

Under a Step I plan, your dietitian will develop an eating plan for you in which no more than 8% to 10% of your calories come from saturated fat and you eat no more than 300mg of cholesterol per day. In a Step II plan, no more than 7% of your total calories come from saturated fat, and you eat less than 200mg of cholesterol per day. A Step II plan should reduce HDL levels by 10% to 15% within 6 months.

 

If you have diabetes or coronary artery disease, your LDL should be less than 100mg/dl. You may be advised to start a Step II plan right away. If your LDL level does not improve within 6 to 12 weeks, your doctor may prescribe a cholesterol-lowering medication.

 

If your LDL level is under 160m/dl and you do not have diabetes, coronary artery disease or more than two other risk factors, then your dietitian will prescribe a Step I plan. The goal is to increase your LDL level to less than 160mg/dl in 3 months. If this does not occur, your dietitian will advise a Step II plan. If there is no reduction in cholesterol levels after following a Step II plan, then your physician may suggest drug therapy.

 

If you don’t have coronary artery disease or diabetes, but you do have more than two risk factors, you should shoot for an LDL level less than 130mg/dl. To do this, your dietitian will suggest a Step I plan. If there is no improvement after 3 months, then you should proceed to Step II plan. Drug therapy should be considered if there is no improvement.

Exercise and Weight Loss

You can reduce your cholesterol even further by losing weight. A weight loss of 2kg to 4kg can lower your blood cholesterol by another 5% to 10%. If you reduce your calorie intake by 500 calories a day, you can expect to lose up to 0.5kg a week. However, be sure you do not go below 1,200 calories a day without medical supervision and that you plan your meals to avoid hypoglycemia. 

Your dietitian should be able to help you with that. You may also consider exercising as another way to lose weight, either with or without a reduction in calories. Make sure dietitian is aware of any change in your exercise plan and helps you devise a meal plan taking into account your cholesterol goals, weight loss goals, blood glucose control and physical activity.

 

DIABETES CHOLESTEROL-LOWERING MEDICATION

Drug treatment should be considered only when diet and exercise fail to lower cholesterol. If you do begin a drug therapy program, you must still maintain a good diet and exercise program. Don’t turn to drugs as a substitute for diet and exercise. Your doctor will prescribe one of the following medications to help lower your cholesterol:

Statins

Statins block an enzyme that your body needs to make cholesterol. They also help the liver remove LDL from the blood. This stabilizes the plaque lining the arteries and prevents the ruptures that leads to clots and heart attack. Some of the commonly available statins are Lovastatin (Mevacore), Pravastatin (Pravachol), Simvastatin (Zocor), Fluvastatin (Lescol) and Atorvastatin (Lipitor). 

 

All of these drugs can lower LDL levels by 20% to 60%. They are usually given orally as a single dose at bedtime. You can expect to see results within 4 to 6 weeks. Your lipid profile should be reevaluated at that time. You may experience mild gastrointestinal symptoms such as abdominal cramps, gas and constipation for the first few weeks, but serious complications are unlikely. In rare cases, some people experience soreness and weakness in the muscles. If this happens, stop taking the medication and call your doctor right away.

 

Bile Acid Resins

Cholestyramine and colestipol are the two major medications of this type. They work by binding cholesterol in the intestines and they reduce LDL cholesterol by 10% to 20%. These drugs can be used in combination with the statins, which limit cholesterol production. They are considered extremely safe, because they are not absorbed into your body. However, they can cause mild gastrointestinal discomfort, such as bloating, constipation and gas. These effects can be minimized by taking the medication with meals. Do not take these drugs with other medications, because they can interfere with their absorption. If you are on oral diabetes and medications, ask your doctor when to take bile acid resins.

 

Nicotinic Acid

If you have diabetes, you will probably not be prescribed this drug because it increases blood glucose levels. It has many beneficial effects, however, such as lowering LDL, lowering triglycerides and raising HDL. If your doctor prescribes this drug, you should take it only under close medical supervision and pay careful attention to monitoring your blood glucose.

 

HORMONE REPLACEMENT THERAPY

Postmenopausal women are at greater risk of coronary artery disease because of the loss of estrogen, which protects against high cholesterol. Therefore, many women will want to consider hormone replacement therapy. Estrogen raises HDL, lowers LDL, gets rid of excess fat in the bloodstream, and keeps blood flowing and blood vessels flexible throughout the body. Estrogen comes in three forms: a skin patch, a vaginal cream and an oral pill. The vaginal cream does not affect cholesterol levels. The patch decreases LDL, but does not affect HDL levels. Your best bet is to take oral estrogen if you want to raise HDL and lower LDL.

 

Major side effects of estrogen include an increased risk of breast and uterine cancer and an increase in blood clotting, which increases the risk of stroke. Estrogen taken in conjunction with progesterone protects against uterine cancer. Low doses of estrogen (0.625mg) do not increase clotting and do not increase the risk of stroke. The risk of stroke is higher in women who smoke and in those with high blood pressure. 

Estrogen can also increase triglyceride levels in some women, which could cancel out the benefit to your heart. You and your physician will want to take all these factors into consideration when deciding whether to take estrogen

 

Sources and References

The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

 

Physiological and pathological implications of cholesterol by Victor Cortes, Dolores Busso et al

 

Lowering LDL-cholesterol through diet: potential role in the statin era by Eric Bruckert and David Rosenbaum