Cholesterol: It’s Only Part of the Story

High triglyceride and low HDL cholesterol levels are key indicators increased risk for heart disease

| Apr 1, 2005

Caution: Consult with your diabetes care team before starting a lower-carbohydrate meal plan. Diabetes medications such as insulin or oral drugs that stimulate insulin production (sulfonylureas or meglitinides) will need adjustment to prevent hypoglycemia (low blood glucose) when carbohydrate intake is decreased. In addition, blood glucose levels need to be checked more often.

Until recently, many doctors looked only at a patient’s total cholesterol. These days, it’s more complex, as scientists endeavor to understand the different types of fats found in our blood—and their independent links to cardiovascular disease.

You may be under the impression that it is high levels of LDL cholesterol that virtually guarantee you a heart attack, but this is not always the case. A number of studies show that the combination of low HDL (“good”) cholesterol and high triglycerides may be an equally strong a predictor of cardiovascular disease.

Both of these conditions are almost always present in people with type 2 diabetes.

The Causes of Low HDL and High Triglycerides

It’s clear that a high-carbohydrate diet, especially one high in refined carbohydrates (such as white rice and white bread, soft drinks and fruit juice) and a lack of physical activity are two of the main culprits for both low HDL and high triglycerides. Fortunately, you can change both of those factors.

Controlling carbs has been shown to lower triglycerides and increase HDL.

Medications and Nutrients

The statin drugs routinely prescribed to many people diagnosed with diabetes—as well as to millions of other people—have a minimal impact on HDL and triglycerides.

But eating more of the right nutrients and stepping up physical activity can improve triglycerides and HDL, too. Omega-3 fatty acids, found in cold-water fish, such as salmon and sardines, and in marine algae, flax seeds and some nuts, are known to help prevent heart disease by lowering triglycerides and blood pressure.

Another valuable nutrient for heart health is niacin, also known as vitamin B3. Found in dairy products, poultry, fish, lean meats, nuts and eggs, niacin can have a positive impact on levels of HDL and triglycerides, as well as on LDL (“bad”) cholesterol.

If dietary changes do not improve your numbers, talk to your doctor about taking these nutrients in supplement form.

Try Non-Drug Therapies First

The bottom line is that there are several effective non-drug approaches to getting HDL and triglycerides in line; why not try them first, before resorting to medication?

Next month, we’ll look at another marker for heart disease: C-reactive protein.

To learn about the Atkins Nutritional Approach, visit

What Are HDL and Triglycerides?

HDL (high-density lipoprotein) cholesterol is often called the “good” cholesterol, because it transports cholesterol from your arteries and other storage sites to your liver, where it is recycled. The higher your level of HDL, the better.

Lifestyle factors that lower HDL include smoking, physical inactivity and a high-carb diet, especially one high in refined carbohydrates such as white rice and white bread, soft drinks and fruit juice. An HDL level of less than 40 mg/dl for men, or less than 50 mg/dl for women, is a probable indicator of metabolic syndrome and a major risk factor for heart disease.

Triglycerides are tiny droplets of fat that circulate in your blood. The higher your level of triglycerides, the greater your risk of a heart attack. A diet high in refined carbohydrates as well as physical inactivity raise triglycerides. In addition, alcohol intake may be a factor in elevated triglyceride levels for some. A fasting triglyceride level of 150 mg/dl or higher is a probable indicator of metabolic syndrome.

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