Cholesterol, High Cholesterol

Weickert reviewed the following dietary changes and described the expected results from some of these changes (9):

• Fat intake: Reduction in total fat intake (<30%) has a modest benefit on weight loss but is less effective than low-carbohydrate, high-protein diets and probably reduces insulin resistance, diabetes risk, lowers LDL cholesterol and reduces the risk of cardiovascular disease (CVD).
• Dietary monounsaturated fatty acids: An increase in monounsaturated fatty acids (>10%) lowers LDL cholesterol, triglycerides, and blood pressure.
• Low carbohydrate diets, a.k.a. a ketogenic diet: Low-carbohydrate diets with a minimum of 130 grams of carbohydrates daily have a modest benefit on weight loss, improves HDL cholesterol and lowers triglycerides.
• High protein diets: A high protein intake was reported to increase satiety, result in short term weight loss, plus results in beneficial effects on HDL, LDL cholesterol, and blood pressure.
• Low glycemic index diets: Low glycemic index diets, such as the American Diabetic Association Diet commonly includes foods without concentrated sweets to avoid causing spikes in blood glucose. This diet has a modest benefit on weight loss, improve LDL cholesterol, and probably reduce cardiovascular risk.
• Soluble fiber: Soluble fiber from fruit and vegetables has a modest benefit on weight loss, lowers glycemic index, LDL cholesterol, and triglycerides.
• Insoluble fiber: Insoluble cereal fiber including cereals, wheat bran and whole grain products has a modest benefit on weight loss and a strong benefit on insulin resistance.
• Mediterranean style diets: Mediterranean style diets have a modest benefit on weight loss and have beneficial effects on insulin resistance and diabetes risk. Mediterranean style diets are associated with reduced risk for cardiovascular disease, lower inflammatory cytokines, improved lipid profiles and increased survival.

Dietary changes for diabetes patients with hyperlipidemia:

• Low glycemic index diets with a 500 kcal restriction have been known to improved glycemic control, lower hemoglobin A1C by 0.5%, help reduce diabetes medication, and result in a weight loss of 6.9 kg (10).
• A low carbohydrate diet without restriction other than 20 grams of carbohydrates per day for 24 weeks was known to improve glycemic control, reduce/eliminate medication, reduce hemoglobin A1C in diabetics by as much as -1.5%, reduce body weight by -11.1 kg, and increase HDL by 5.6 mg/dL (10).

American Diabetes Association diet vs. vegan diet:

The effects of diet on glucose control, body weight, and plasma lipids were examined among individuals with type 2 diabetes for 74 weeks. Participants were randomly assigned to a low-fat vegan diet (n=42) or a standard diabetes diet based on the 2003 American Diabetes Association guidelines (n=50). Glycated hemoglobin (HbA1c), plasma lipids, and weight were measured. At the end of the study period, weight significantly decreased by 4.4 kg and 3.9 kg in the vegan and conventional groups, respectively. For participants on the vegan diet, total cholesterol and LDL cholesterol decreased by 20.4 mg/dL and 13.5 mg/dL, respectively. Corresponding values for those on the conventional diet was a decrease of 6.8 mg/dL and 3.4 mg/dL. In conclusion changes in overall lifestyle that include a vegan or nearly-vegan diet may be effective in improving the health of patients with diabetes. (11)