Factors That Affect Cholesterol Management

If you have high cholesterol, there could be a number of possible reasons behind it. Maybe your diet is high in saturated fats and low in fruits and vegetables. Or maybe you’re not getting enough exercise. While simple, these common risk factors are not always easy to remedy.

The first step is making lifestyle changes to reduce the level of cholesterol that’s in your blood and keep more from building up in your arteries and forming dangerous plaque. That starts with:

Making dietary changes. It’s important to monitor how much fat you consume and limit your intake of saturated fats in particular. When you have high cholesterol, you need to limit the amount of cholesterol in your diet to 200 milligrams per day. You’ll also need to monitor your sodium intake — not just what comes out of the salt shaker, but what’s already in packaged foods. Learn to read labels, and don’t consume more than 2,400 mg of sodium per day.

Watching your blood pressure. High blood pressure is another heart disease risk factor, so pay attention to your numbers. A healthy diet and exercise will also help keep blood pressure under control, but check it regularly and make sure it’s no higher than 120/80 mmHg.

Getting active. Exercise is essential for heart health and lowering cholesterol levels. Aim for at least 30 minutes of exercise on as many days of the week as you can, although doing a little bit every day is best. Keep a log of how much you exercise to make sure you’re meeting your goals.

Sticking to a healthy body weight. If you’re obese or overweight, losing weight will help with your cholesterol management plan.

Quitting smoking. Smoking is a huge risk factor for both high cholesterol and heart disease, so start a plan to quit — and finish it.

 

Sticking With Your Cholesterol Management Plan

Now that you know what’s involved in cholesterol management, it’s time to create your plan for making these changes and sticking with them. It may look simple on paper, but these are big changes that will take a little getting used to. Try these tips to help you stay on track and on time getting to better health:

Take your medication. Make sure that you understand how much you’re supposed to take and how often, and any special instructions such as taking them with food or extra water. Set a time every day to take your medication, such as with a meal or when you get up in the morning, and mark the calendar each day after you do it.

Create a meal plan. Get a heart-healthy cookbook or look up recipes on Web sites. Mealtime can still be fun and food still an adventure — just healthier. Make a grocery list of healthy foods to stock up on, and don’t stray down the chip or cookie aisle. Stick to your list so you’re not tempted to fall back into unhealthy eating habits.

Exercise with a buddy. When you just want to relax on the couch, a workout buddy can motivate you to go for a walk or bike ride, or play a game of tennis. Joining a gym or signing up for fitness classes may also give you an extra boost of motivation, and a fitness schedule can help keep you on track.

Set weight loss goals. It’s easier to lose weight if there’s something you’re working toward, like an end goal. Figure out how much weight you want to lose, and set a reasonable schedule. Don’t try to lose 20 pounds in a month and then get discouraged when it doesn’t happen. A pound or two a week is a steady, manageable weight loss that will pay off over time, and stay off, too.

Lowering your high cholesterol and reducing your risk of heart disease requires comprehensive change. It’s not about going on a diet; it’s about changing your unhealthy habits to healthy ones. And once you’ve made these changes and brought down your high cholesterol level, you’ll get to keep practicing those healthy habits for a long time to come.

Diabetes can cause various types of neurological conditions, including carpal tunnel syndrome. This is because persistently high glucose levels can lead to chemical changes that affect nerve conduction and cause structural abnormalities. In fact, about a third of the diabetic population has carpal tunnel syndrome.

Carpal tunnel syndrome is usually caused by median nerve compression at the wrist. Most commonly, carpal tunnel syndrome is associated with obesity, repeated trauma from the use of the wrist joint, build-up of fluid in the wrist space, and hypothyroidism. People who use their wrists for work-related activities such as typing are more likely to have repeated undetected trauma to the nerves at the wrist.

Developing this condition usually takes some time, so because you have just been diagnosed with diabetes, your carpal tunnel syndrome might not be due to diabetes alone. But unlike other neurological conditions, carpal tunnel syndrome is not clearly related to the length of time that diabetes has been present. In your case, it might be a combination of the effect of high glucose levels and mechanical trauma. Because you often work with your hands, protecting your wrists and maintaining a neutral wrist position (keeping your wrists and forearms level) when you work will prevent the continued damage.

Diabetes and Gallbladder Problems: What’s the Connection?

The evidence that people with diabetes are at greater risk of gallstones is clear, but “we still don’t know why,” says Armand A. Krikorian, MD, an endocrinologist at University Hospitals Case Medical Center and an assistant professor of medicine at Case Western Reserve University School of Medicine in Cleveland.

Perhaps it’s because people with diabetes are generally overweight, and obesity is linked to gallstone disease. People with diabetes have higher levels of triglycerides — a type of fat — and it’s theorized that the triglycerides themselves encourage gallstone formation.

Another theory is that stones form because of what is called autonomic neuropathy, or damage from diabetes to the involuntary nerves that control movement of the bowels and gallbladder. According to this line of thought, the bile stored in the gallbladder is not released efficiently because the nerves are damaged, and gallstones form from the resulting sludge.

Also, recent research on insulin-resistant mice shows that FOXO1, a specific protein involved with diabetes, increases the amount of cholesterol that enters the bile, which may lead to the formation of gallstones. Cholesterol is a major component of most gallstones.

Diabetes and Gallbladder Problems: Know the Symptoms

Dr. Krikorian says that for a person living with diabetes, controlling the diabetes is the way to head off gallbladder problems.

When diabetes is under control, it’s much less likely that autonomic neuropathy will become an issue, and your triglyceride levels will be lower — thus decreasing your odds of developing gallstones, according to Krikorian.

Diabetes and Gallbladder Problems: Gallstone Symptoms

This common-sense approach means that people with diabetes should be aware of gallstone symptoms, Krikorian says.

Some gallstones, called silent stones, cause no symptoms and do not require treatment. However, in many people, gallbladder “attacks” may occur, especially after consuming a fat-laden meal.

Symptoms of a gallbladder attack may include:

• Sudden pain in the right upper abdomen that can last several hours
• Pain between the shoulder blades or under the right shoulder
• Abdominal pain centered on the right side that gets worse after eating
• Unexplained nausea or vomiting

Diabetes and Gallbladder Problems: Managing Diabetes

Most people with diabetes who are under a doctor’s care have a plan in place to manage and treat their disease. A management plan should address food intake, exercise, medications, and daily monitoring of blood sugar levels.

Controlling blood glucose levels should not only help you feel better in general, but it may also delay the onset of complications often associated with diabetes, including gallbladder problems.

Diabetes and Gallbladder Problems: Treatment

People with diabetes are usually considered high-risk for any surgery, including gallbladder surgery, says Krikorian. But, in most cases, when gallstones are problematic, the best course of action is to remove the gallbladder. According to Krikorian, controlling the diabetes doesn’t change after the gallbladder is removed.

In general, whether they have diabetes or not, most people can avoid gallbladder problems by eating a consistently balanced diet, getting enough exercise, and managing their overall health.

Over the long term, diabetes can cause various degrees of erectile dysfunction, including impotence. Diabetes interferes with oxygen delivery and the production of the chemical nitrous oxide, which is crucial to having and maintaining an erection. Poor glucose control, along with other diabetes-related complications, such as neuropathy in the feet and retinopathy in the eyes, increases the odds of erectile dysfunction.

Up to 52 percent of diabetic men between the ages of 55 and 59 have erectile dysfunction, or ED. Having said this, there are many other problems that, either in combination with diabetes or on their own, can cause it — these include advancing age, dementia, stroke, spinal cord or back injury, multiple sclerosis, heart disease, injury to the prostate, smoking, and the use of certain types of medicines. Most antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are known to cause erectile dysfunction. Thiazide diuretics, a class of medicines typically given to treat hypertension, are also associated with erectile dysfunction, though their benefits outweigh this risk. Other drugs linked to ED include spironolactone (a diuretic), clonidine (a hypertension medication), cimetidine (an antacid), and ketoconazole (an antifungal medication). It is also important to consider psychological causes of impotence, such as depression and performance anxiety.

Improving glucose control and losing weight, if you need to, might help resolve the problem. There are also various treatments, depending on the cause of the dysfunction. Medications, including sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis), are commonly prescribed and can be effective. These medicines have disturbing side effects, however, including headache, flushing, and light-headedness. Additionally, they are not recommended for individuals taking heart medicines such as nitrates. Other treatments — depending on the cause of the erectile dysfunction — include psychotherapy, prostaglandin injections, vacuum-assisted devices, surgical implantations, and testosterone injections.

Dietary considerations can present a Hobson’s choice in diabetes. Even when the intake is nutritious, assimilating it can be another matter. Then there is the problem of progression of diabetic complications if one ends up with excess glucose or fat in the system. Excess carbohydrates in a meal, and the resulting uncontrolled blood sugar levels can be detrimental to any number of tissues, from the lens of the eye, to the neurons, small blood vessels and the kidneys. Fat is also a problem with increase incidences of atherosclerosis, large vessel disease and cardiac complications. What, then is the appropriate macronutrient for the diabetic population? Enough medical literature exists to suggest that in diabetes, proteins are probably the best bet.

Proteins are the natural choice of the body when faced with diabetes. In uncontrolled diabetes, muscle protein is broken down into amino acids to be converted into glucose by the liver. If left to fend for itself, this can create a commotion within the body. Since proteins have to supply enough energy to substitute for carbohydrates, proteins are broken down faster than they are made. The body ends up with a protein deficit, a situation with subtle, yet far-reaching effects on normal body functions. Importantly, for diabetics, a protein deficit has been shown to impair resistance to infections (Ganong WF). Replenishing the depleting protein stores is a vital requirement of all diabetic diets.

Importance of proteins in a diabetic has been well documented. The American Associations of Clinical Endocrinologists have made it clear that not much evidence exists to indicate that the patients with diabetes need to reduce their intake of dietary proteins. The AACE recommends that 10-20% of the calorie intake in diabetes should come from proteins (AACE Diabetes Guidelines). It is in fact believed that this is one nutrient that does not increase blood glucose levels in both diabetics and healthy subjects (Gannon et al).

Nutrition therapy for diabetes has progressed from prevention of obesity or weight gain to improving insulin’s effectiveness and contributing to improved metabolic control (Franz MJ). In this new role, a high protein diet (30% of total food energy) forms a very pertinent part of nutrition therapy. One of the most important causes for type II diabetes is obesity. Excess body fat raises insulin resistance and higher levels of insulin are required to bring down blood sugars as the weight increases (Ganong WF). Another problem with excess fat is the clogging of arteries with atherosclerotic plaques that is responsible for a wide range of diabetic complications. Any mechanism that reduces body fat decreases insulin resistance and improves blood glucose control. Parker et al have also shown that a high protein diet decreased abdominal and total fat mass in women with type II diabetes. Other studies by Gannon et al. and Nuttall et al have verified that blood glucose levels and glycosylated hemoglobin (a marker of long term diabetic control) reduce after 5 weeks on a diet containing 30% of the total food energy in the form of proteins and low carbohydrate content. It is speculated that a high protein diet has a favorable effect in diabetes due to the ability of proteins and amino acids to stimulate insulin release from the pancreas. Thus, a high protein diet is not only safe in diabetes, but can also be therapeutic, resulting in improved glycemic control, and decreased risk of complications related to diabetes.

The benefits of a high protein diet do not end here. Individual protein components of such a diet, when aptly chosen, can have other advantages as well. Dietary supplements containing proteins like whey and casein come highly recommended. Casein is a milk protein and has the ability to form a gel or clot in the stomach. The ability to form this clot makes it very efficient in nutrient supply. The clot is able to provide a sustained, slow release of amino acids into the blood stream, sometimes lasting for several hours (Boirie et al. 1997). A slow sustained release of nutrients matches well with the limited amount of insulin that can be produced by the pancreas in diabetes. A protein supplement containing casein can thus increase the amount of energy assimilated from every meal and, at the same time, reduce the need for pharmacological interventions to control blood sugar.

Whey proteins and caseins also contain “casokinins” and “lactokinins’, (FitzGerald) which have been found to decrease both systolic and diastolic blood pressure in hypertensive humans (Seppo). In addition, whey protein forms bioactive amine in the gut that promotes immunity. Whey protein contains an ample supply of the amino acid cysteine. Cysteine appears to enhance glutathione levels, which has been shown to have strong antioxidant properties — antioxidants mop up free radicals that induce cell death and play a role in aging.

Thus, development of a protein supplement containing casein and whey can provide an apt high protein diet and its health benefits to individuals suffering from diabetes, obesity and hypercholesterolemia.

Fructose and sucrose worsen lipid profiles compared with similar amount of glucose….

High levels of fructose can affect hepatic insulin sensitivity, while even moderate consumption of fructose and sucrose can significantly alter lipid profiles in healthy young men, according to published research. Isabelle Aeberli, Ph.D., of University Hospital Zurich, and colleagues assessed the effect of moderate amounts of fructose and sucrose compared with glucose on glucose and lipid metabolism in a randomized, double-blind, cross-over study involving nine healthy normal-weight male volunteers. The volunteers, aged 21 to 25 years, were given four different beverages (600 mL/day) sweetened with medium or high fructose, high glucose, or high sucrose for three weeks each. After high fructose, the researchers found that hepatic suppression of glucose production was significantly lower than after high glucose (59.4 ± 11.0 percent versus 70.3 ± 10.5 percent). Fasting glucose, insulin, and C-peptide were not affected after high fructose. Low-density lipoprotein cholesterol and total cholesterol were significantly higher after medium fructose, high fructose, and high sucrose, compared with high glucose. Free fatty acids were significantly higher after medium fructose, but not after high fructose or high sucrose, compared with high glucose. “In conclusion, this study shows that, with regard to glucose metabolism and, specifically, hepatic insulin sensitivity, fructose, even in moderate amounts, seems to be more harmful than the same amount of glucose,” the authors write. “Furthermore, all fructose-containing drinks (including sucrose) showed significant effects on the lipid profile compared with glucose.”