Some tweaks in what you eat can improve cholesterol

Reviewed by Robert Ehrman, MD

Having diabetes means you are more likely to get or have heart disease-especially if you have type 2 diabetes. One way to reduce your risk of, or take care of heart disease, is to get and keep your blood lipids (fats) in control. Blood lipids include your LDL (bad cholesterol); HDL (good cholesterol); and triglycerides. It is common for people with type 2 diabetes who are overweight to have high triglycerides, low HDL and an unhealthy form of LDL: the dense type vs. the light and fluffy type.


For years, the nutrition message you heard was to keep the amount of fat you ate low: about 30 percent of your calories or less. This message has evolved because of newer research. Today’s nutrition message, as written in the Dietary Guidelines for Americans, is to enjoy a bit more fat (if you want), but make sure that the extra fat is the right type.  Eat anywhere from 20 to 35 percent of your calories as fat.  Make sure you eat more polyunsaturated and monounsaturated fats and get your saturated and trans fat intake as low as you can.


Generally, Americans eat too much saturated and trans fat and not enough polyunsaturated fat. It’s easy to understand why. Americans eat too much meat, whole milk, full-fat cheese, creamy salad dressings, sour cream, cream cheese, sweets and fried foods. American also eat too many processed and restaurant foods that contain partially hydrogenated fats, which is trans fat.


Rebalance is the name of the game when it comes to fats today.  This is especially true for people with diabetes, who also are at risk for heart disease.  “It is important and also challenging for people with type 2 diabetes to eat the right types and balance of fat,” says Marion J. Franz, a registered dietitian formerly of the International Diabetes Center in Minneapolis. The Number 1 goal when it comes to rebalancing yours fats is to eat less saturated and trans fat. This will be the most help in getting and keeping your blood lipids in the healthy target zone.


Research shows that if you eat more unsaturated fats -that’s polyunsaturated and monounsaturated fats- you may raise your HDL and lower your LDL to get your blood lipids nearer to the target zones. Americans seem to eat enough monounsaturated fat, but not enough polyunsaturated fat. This means we need to work harder to get in those polyunsaturated fats.

One recent study suggests that people with type 2 diabetes can eat more polyunsaturated fats by eating only a handful (1 ounce) of walnuts each day. Walnuts are a good source of omega-3 polyunsaturated fats. Another good source of omega-3 is oily fish, such as salmon, mackerel and tuna. Lynda Gillen, one of the study’s researchers, notes that “eating 1 ounce of walnuts every day, along with about 12 ounces of oily fish a week, has been shown to help people with diabetes improve their HDL and LDL numbers.”


With this new research in mind, you may want to tweak your healthy eating plan in two ways:

  1. Enjoy 1 ounce of walnuts a few times a week. Choose walnuts as a snack, a topper for hot or cold cereal, mixed into a fresh fruit cup or tossed on a salad.
  2. Eat a 3-ounces serving (cooked) of oily fish at least two times per week.  Prepare it in a low-fat way: grilled, poached, steamed or broiled.  Make a few servings of grilled salmon or tuna at a time.  Have one serving for dinner, then top a salad with a serving the next day.

If you make these two tweaks, consider a few notes of caution from diabetes nutrition expert Franz: Moderation and variety are still important because the best eating plans are those that rely on a wide range of healthy foods, including fruits and vegetables. Make these tweaks while you also eat less saturated and trans fat. If you decide to add walnuts, omit another food to keep your calorie count where it should be. Franz adds, “Be careful to not overeat any food.  Clearly walnuts are good for you, but their calories can add up quickly.”

Today, experts suggest that there are 4 ways -in addition to medicines, if you need them- to get and keep your blood lipids in control:

  1. Get to or stay at a healthy weight.
  2. Eat healthy foods: more fruits and vegetables and whole grains.
  3. Eat foods with more healthy fats (polyunsaturated and monounsaturated) and less unhealthy fats (saturated and trans fat).
  4. Be physically active most days of the week.


  1. Use liquid oil instead of butter, margarine or spreads to prepare food and bake.  Choose well-balanced oil such as canola, soy, corn or vegetable oil.
  2. Make your own salad dressing with healthy liquid oil.
  3. Enjoy a handful of any type of nuts, including walnuts, for a snack.
  4. Use slices of avocado and a few olives as condiments.


  1. Eat less cheese and choose part-skim or reduced-fat cheese when you eat it.
  2. Eat no more than 3 ounces of cooked meat (red meat, poultry or fish) at a time.  Prepare them in low-fat ways.
  3. Choose fat-free milk and yogurt.
  4. Limit processed foods that contain partially hydrogenated fats by reading ingredient lists and the Nutrition Facts panel that now must list trans fat.
  5. Limit fried foods in restaurants. If you fry at home once in a while, use a healthy liquid oil, such as canola or safflower oil.
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Constance Brown-Riggs, MSEd, RD, CDE, CDN—an award-winning RD, certified diabetes educator, and past national spokesperson for the Academy of Nutrition and Dietetics, is the author of The African American Guide to Living Well With Diabetes, which received the Favorably Reviewed designation from the American Association of Diabetes Educators, and Eating Soulfully and Healthfully with Diabetes.

Dr. Lori Shemek, PhD, CNC, CLC, the best-selling author of “Fire-Up Your Fat Burn! and leading health and weight loss expert, is also known as “The Inflammation Terminator.” She has made it her mission to educate the public on the toxic effects of certain foods and lifestyle choices and how they create inflammation in the body. She is a leading authority on inflammation and its role in weight loss, preventing disease and optimizing health.

Rebecca Bitzer – MS, RD/LD, CEDRD is an award-winning Registered Dietitian, writer, speaker, blogger, and REBEL Dietitian business owner. Rebecca and her team of six Registered Dietitians have counseled thousands of clients struggling with diabetes for over twenty-five years. They work closely with each other along with internists, endocrinologists, therapists, and families.

Maureen Sullivan – RN, CDE has worked for many years as a Registered Nurse, most of them in emergency and trauma services. She is a Certified Emergency Nurse, Certified Diabetes Educator, and the former manager of a hospital stroke program. Maureen’s wealth of knowledge, passion for nursing and education, and ability to engage people makes her an excellent teacher and a captivating lecturer. Recently, Maureen has been concentrating on writing, speaking and teaching, as well as working on her award-winning weekly podcast, “The Health and Humor Show.”

Lauren Harris-Pincus, MS, RDN is a nutrition communications specialist, registered dietitian in private practice, social media consultant, speaker, spokesperson and corporate consultant. She is currently the owner of Nutrition Starring YOU, LLC and Lauren strongly believes that we should “Think Healthy, not Skinny”, and “EveryBODY is unique, your diet should be too”. Lauren was co-host of the Family Food Experts Kitchen radio show, available for listening on iHeart Radio and iTunes. Also known as one of the “NutritionBabes”, Lauren co-founded, a popular Health and Wellness website in 2009. was voted one of Healthline’s Top 100 Health Blogs in 2011, 2012 and 2013.

Mark Heyman, PhD, CDE is a clinical health psychologist and the director of the Center for Diabetes and Mental Health (CDMH). In addition to treating patients with type 1 and type 2 diabetes, Dr. Heyman provides training for health care providers on how to identify and address the emotional and behavioral aspects of diabetes in their patients. He also works with pharmaceutical and medical device companies to help them understand these issues and incorporate this information into their sales, marketing, and patient education materials. He is particularly interested in empirically supported behavioral interventions that promote behavior change and improve physical and mental health in people with diabetes.

Katie Ferraro, MPH, RD, CDE is a nationally-recognized registered dietitian, certified diabetes educator and author with an expertise in nutrition communications and curriculum development. She is the co-author of “Diet Therapy in Advanced Practice Nursing” (McGraw Hill, 2014) and an Assistant Clinical Professor of Nutrition at the University of California San Francisco and University of San Diego’s graduate schools of nursing.

Dr. Beverly S. Adler, PhD, CDE (aka “Dr. Bev”) is a clinical psychologist and certified diabetes educator, author and speaker. She specializes treating the emotional issues of people with diabetes. In her private practice, she provides individual, family and/or group therapy utilizing a cognitive behavior therapy orientation, combined with a spiritual approach. Her goal is to empower her patients to manage their diabetes.

Dr. Bev is the author of two self-help diabetes books. She has written numerous articles which are published in print and online – always focused on diabetes from the emotional perspective. She also speaks to audiences of people living with diabetes, as well as, to audiences of healthcare professionals and diabetes educators. Dr. Bev, herself, has been living successfully with type 1 diabetes for 40+ years.

In August 2016, Dr. Bev was honored to receive the “CDE Entrepreneur of the Year” Award from her Metropolitan NY Association of Diabetes Educators.

Jill Weisenberger, MS, RDN, CDE, FAND is an internationally recognized nutrition and diabetes expert with more than two decades experience. Through writing, speaking and one-on-one coaching, Jill empowers people to grab control of their health. She has worked as both a nutrition counselor and a diabetes educator in the hospital and research settings, and now in private practice in Newport News, VA. Jill is known for her practical approach and caring attitude. Her no-nonsense strategies to eating well include foods that both taste good and are good for you.

Marlene Koch (pronounced ‘cook’) is a nationally recognized nutritionist, popular TV personality and New York Times bestselling author. She graduated Magna Cum Laude from UCLA with a Bachelor’s degree in Nutritional Science. She is a registered dietitian and one of a select group of dietitians to hold an advanced certificate in Child and Adolescent Weight Management from the Academy of Nutrition & Dietetics.

Marlene has taught professional chefs from the American Culinary Federation the principles of healthy cooking and eating. She has been adjunct Nutrition professor and cooking instructor for Columbus State College and the Columbus State Culinary Academy, and she is a nationally recognized expert in weight loss, diabetes, child and adolescent nutrition, and sugar substitutes.

Marlene has sold over one million cookbooks, and is a regular guest on QVC.

Barbara Ruhs – MS, RDN is a Registered Dietitian Nutritionist and owner of Neighborhood Nutrition LLC, a consulting firm focused on providing solutions to help food companies and supermarkets improve consumer health & wellness. She’s a former supermarket dietitian and has run a successful business for 17 years. A leader in the field of nutrition, her mission is to help people by impacting the way food is produced, marketed and sold. She’s a strong advocate for supermarket dietitians and believes the retail food industry has the greatest potential to impact public health.

Cheryl Orlansky has over 25 years of experience in health promotion and chronic disease prevention and management. Her first career as a registered dental hygienist led her towards a path of wellness and nutrition! Her expertise is in diabetes, weight management and cardiovascular disease for individuals and groups. She works in a large private practice including endocrinology, internal medicine, rheumatology, neurology and sleep medicine. She is an award winning dietitian with current leadership positions in state and local dietetics organizations.

She has been interviewed and quoted in media outlets for WebMD, Atlanta Sports and Fitness, Georgia Public Broadcasting, and the Atlanta Journal and Constitution. She has partnered with V-103 Radio to lead supermarket tours as part of a community outreach during National Nutrition Month.

Cheryl helps her clients reach balance through lifestyle choices: cooking and eating, activity and purpose in life.

Jackie Newgent, RDN, CDN, is a registered dietitian nutritionist and classically-trained chef. With a passion for helping people (including her father) with diabetes, she’s author of The With or Without Meat Cookbook: The Flexible Approach to Flavorful Diabetes Cooking and the award-winning The All‐Natural Diabetes Cookbook, both published by the American Diabetes Association. Jackie is also author of 1,000 Low-Calorie Recipes and Big Green Cookbook. Her next book, The All-Natural Diabetes Cookbook—2nd Edition, was published in 2015.

Nutritionist Rania Batayneh, MPH is the author of the best-selling book, The One One One Diet. She holds a master’s degree in public health nutrition from the University of Michigan School of Public Health and is also a Wellcoaches Certified Health and Wellness Coach endorsed by the American College of Sports Medicine (ACSM).

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