How Diabetics Can Reduce Cholesterol Tips From Dietitians to Lower Fat and Improve Health

Love to snack and eat out? Hey, who doesn't? But those habits pack on pounds – and add up to elevated cholesterol, a particular problem if you have diabetes and a high risk of heart disease. We asked the nation's top dietitians how changes in diet and lifestyle may help tame high cholesterol. Read on for their easy tips... If you have diabetes, your daily routine is filled with numbers. Besides taking blood sugar measurements several times a day, you have to count calories and carbohydrates. Add in one more figure to monitor closely: your cholesterol levels. That's because people with diabetes often have low levels of (good) high-density lipoproteins (HDL) and higher levels of (bad) low-density lipoproteins (LDL). This raises your risk of heart disease and makes you more likely to die from coronary disorders, like heart attack, stroke or atherosclerosis. "Research clearly shows that cholesterol leads to formation of plaque, the substance that blocks arteries," says Prediman K. Shah, M.D., director of the cardiology division at Cedars-Sinai Heart Institute and Medical Center in Los Angeles. People with diabetes should maintain an LDL of less than 100 mg/dl [or milligrams per deciliter] and an HDL of higher than 40 mg/dl for men and 50 mg/dl for women, advises the American Diabetes Association. Chronic elevated cholesterol levels can lead to a condition called diabetic hyperlipidemia. Taking statins, lipid-lowering drugs that are widely prescribed, is one easy way to control cholesterol. But you can also tackle the problem by watching how much fat you eat. For example, "limit eating out and look at labels and calories," says Elizabeth Caetano, R.D. "More than likely, if you look at calories, you’ll lower your fat intake." Also, cut back on the amount of fat you use as an added ingredient or in cooking, says Kristine Clark, R.D. and Director of Sports Nutrition at Pennsylvania State University. For more fat-trimming tips, we spoke to Clark and some of the nation's top dietitians at the American Dietetic Association's (ADA) Food and Nutrition Conference in San Diego. Read on for their advice on how to cut fat if you have diabetes or just want to eat healthier. Reduce Cholesterol Tip #1: Ditch fried foods. Fried foods are "the most potent source of fat in people’s diets," warns Pamela Nisevich Bede, R.D., Dayton, Ohio. "Frying means you submerge a food in hot fat," Clark says. So avoid most deep-fried fast foods and sides like onion rings, French fries and crackers, which are high in fat and calories. Reduce Cholesterol Tip #2: Eat lean protein. The easiest way to decrease fat is not to eliminate but limit the fatty meats you eat, says Brierley Wright R.D., Burlington, Vt. Read labels on meat packages, advises Amy Galena R.D., of Weight Management and Eating Disorders, Baptist Medical Center, Jacksonville Beach, Fla. When buying meat, "look at the meat for the marbling – the white lines in the red meat," she says. "Look for cuts that have less marbling" because they have less fat. And choose cuts like beef rounds or ends. "The top rounds are going to be the leanest," Galena says. Other tips to lower cholesterol: Choose white meat pork over red meat pork. Trim fat off the meat. When you cook it, drain the fat. Have low-fat poultry and beef and eat more fish, "which has healthy fats," says Collette Roney, R.D., Washington, D.C. "Bake, broil, roast or grill meat and even vegetables," Clark says. "You’re going to save a lot of fat calories." Reduce Cholesterol Tip #3: Choose low-fat dairy. “Choose low-fat or fat-free dairy products, including cheese and milk,” advises Clark. For example, eat 2% fat, skim or non-fat milk with cereal. That includes your morning latte. "If you love flavored coffee drinks, ask for nonfat milk and hold off the syrups," she says. "A tablespoon of chocolate syrup is 50 calories," and some coffee drinks with chocolate contain as much as 1/4 cup (200 calories), she says. Reduce Cholesterol Tip #4: Replace butter with plant-based or fruit spreads. “Just put honey, jelly or apple butter on bread,” Clark says. “You’re getting moisture and enhancing the taste of the toast, but avoiding fat completely.” She also recommends olive oil-based spreads. "You can use those as butter or margarine replacement, and they actually have plant esters in them that can lower cholesterol," she says. Reduce Cholesterol Tip #5: Eat more fruits and vegetables. "They’re naturally low in fat," Wright says. "If you fill up on those, you’re less likely to want desserts." Reduce Cholesterol Tip #6: Watch out when dining out. Restaurants are potential minefields when you're trying to cut back on fat and calories, nutritionists warn. That's because "you just don't know what you're getting in restaurants," says Manuel Villacorta, R.D., spokesperson for ADA, San Francisco, Calif. Even healthy entrees may be fattening, he says. So ask your server about how the food is prepared and "find out the definition of healthy." Watch out for supersized portions too. For example, "you’re not going to see [meats] the size of a deck of cards on a plate" in a restaurant, Galena warns. "You’re going to see a piece a lot bigger." Extras also can spell diet trouble. When eating out, follow the “restaurant rule of two” and “eat only two additional items” besides your entrée, advises Brian Wansink, Ph.D., author of several books on eating habits and diets, including Mindless Eating: Why We Eat More Than We Think (Bantam). “It can be the bread and dessert or it can be an appetizer and a glass of wine, but not two pieces of bread and coffee and dessert." Other tips to lower cholesterol: If you don't take the time to pack lunch in the mornings, you could be unknowingly boosting fat and calorie intake. "Stop eating processed takeout food," says Maria Pari-Keener, R.D., New York City, N.Y. "Salads can be the worst meal," Villacorta says. "Look at the ingredients. If you have cheese, avocado, nuts, cranberries, sautéed onions, bread crumbs, seeds – all that adds up. Start making choices like, Maybe I should cut out the cheese but leave the walnuts." Reduce Cholesterol Tip #7: Watch portions. Dietitians liked the visual MyPlate portion guidelines revised by the U.S. Department of Agriculture in 2011. "If you eat that way, having fresh fruits and vegetables, you're probably going to hit your mark," says Stephanie Bess, R.D., Springfield, Ill. For foods like steaks or lean beef, stick to 3 ounces. "An extra 2-3 ounces of meat a day is a lot of extra fat," says Jim White, R.D., ADA spokesman, Virginia Beach, Va. Reduce Cholesterol Tip #8: Be smart about desserts. You don't have to give up all desserts. In fact, there's room for indulgences. "Have the full-fat item but don't have it often," says Pari-Keener. "If you want to enjoy cheesecake, you can have it now and then. "But be wary of mini desserts, says Galena. They're small but deceptive. "Even though it’s a shot size or says 'mini dessert,' they pack a punch," she says. "Two mini desserts could add up to 500 calories." Another sweet diet derailer: high-fat pastries. "Go with the lower-fat versions," White says. Another tip to lower cholesterol: “Have fruit for dessert or low-fat frozen yogurt,” says Galena. Reduce Cholesterol Tip #9: Don't give up fats entirely. Don’t fear fat. "Fat tastes good," Galena says. "Don’t deprive yourself; you’ll be depressed by the end of the month." Besides, "fat can really help you when you're trying to diet," she says. "If you eat enough, it satisfies you and keeps you full longer." About 30% of your calories should come from fat," says Lea Russell, R.D., St. Petersburg, Fla. But make sure it’s healthy fat. For example, "nuts are high in calories but they're an important fat," she says. Also watch how much you nosh on nuts. Just 6-9 of them is a serving size. "People like to eat nuts but they consume them by handfuls as many as two, three and four times a day," Villacorta says. "That's a high fat intake." Reduce Cholesterol Tip #10: Heart-healthy fats are better, but don't overdo them. Fish and plant-based foods provide important omega-3 or heart-healthy fats. You can find them in salmon, mackerel, sardines, herring, anchovies, caviar and white albacore tuna canned in water or canola oil, flaxseed oil, walnuts and dark green, leafy vegetables. Eat monounsaturated fats found in most nuts, avocados and olive oil. But don't go bananas over your fats. “Heart-healthy fats don't mean 'all you can eat,’” Villacorta advises. "You still need to watch your portions. A teaspoon of oil is a serving size. One-eighth slice of an avocado is a serving size." Other tips to lower cholesterol: If you know you’re not going to eat for a long time, make a peanut butter and jelly sandwich. It’s the last thing to get digested in your stomach, Galena says. For a filling breakfast, have an egg, peanut butter, cheese and nuts. You can even use light cream cheese on a bagel. For more information and expert advice, visit our Diabetes Type 2 Health Center. How Well Do You Understand Cholesterol? Cholesterol is much maligned, yet many people don’t understand this essential substance and how it works in our bodies. Do you know your HDL from your LDL?