Curing Diabetes

The primary role of fat in diet is that of an energy source, either for immediate needs or for storage in adipose tissue for later use. However, excessive fat intake causes elevated levels of blood lipids, which consist of cholesterol, lipoproteins, and triglycerides. Lipoproteins are classified as low-density lipoproteins (LDLs), very-low-density lipoproteins (VLDLs), high-density lipoproteins (HDLs), and chylomicrons. Elevated levels of blood lipids put a person at risk for cardiovascular disease. For your patient with diabetes, high lipid levels are particularly dangerous because diabetes itself is a risk factor for cardiovascular disease.Chylomicrons, which transport fats, break down in the liver and recombine into VLDLs, which consist mainly of triglycerides. Hyperinsulinemia and insulin resistance, common in patients with Type 2 diabetes, can trigger an overproduction of VLDLs, which may in turn trigger hypertriglyceridemia. Because insulin also stimulates the production of VLDLs, patients who use insulin must be particularly careful about eating fats.

LDLs transport cholesterol from the liver to the cells for deposit in peripheral tissues. An elevated LDL cholesterol level is strongly associated with the risk of heart disease. Taking the reverse route, HDLs transport cholesterol from peripheral tissues to the liver for catabolism and excretion. Increased levels of HDL cholesterol protect a person against heart disease.

Because HDL cholesterol levels are inversely related to triglyceride levels, many people with Type 2 diabetes have low levels of HDL cholesterol. This deficiency puts them at increased risk for developing atherosclerosis. As they gain better control over their blood glucose levels, their HDL cholesterol levels rise.

Patients can lower their blood lipid levels by reducing their total fat intake, losing weight, improving blood glucose levels, and changing the types of fat they consume. They should consume less than 300 mg of cholesterol per day. To help reduce cholesterol intake, patients with diabetes should eat no more than four egg yolks, the most concentrated source of cholesterol, per week.

Less than 10% of total daily calories should come from saturated fat. The acceptable amount of total fat per day, however, depends on your patient’s needs. Reducing total fat to 20% to 30% of calories reduces the risk of coronary artery disease for most people. This reduction calls for an increase in carbohydrate calories to 50% or more. While such a high-carbohydrate diet is healthy for people with Type 1 diabetes, it could increase blood glucose and triglyceride levels in insulin-resistant patients with Type 2 diabetes.

Saturated fat increases the risk of atherosclerosis by increasing levels of chylomicrons and LDLs. Most saturated fats come from dairy products, red meats, and other animal sources. Coconut oil, palm oil, and cocoa butter also contain saturated fats. Most of the fat in your patient’s diet should come from monounsaturated fats. Substituting monounsaturated fats for saturated fats may improve hypertriglyceridemia in patients with Type 2 diabetes without raising their LDL cholesterol levels. Sources of monounsaturated fats include canola, peanut, and olive oils. Your patient can also lower her cholesterol levels by substituting polyunsaturated fats-corn, sunflower, safflower, and soybean oils-for saturated fats.

Filed under: Diabetes Treatment