"my bloodwork showed high cholesterol - what should I do now?"
Managing type 1 diabetes means keeping a close eye on your blood glucose, but there’s another critical number to watch: your cholesterol.
People with type 1 diabetes are at a higher risk of heart disease, not just because of blood glucose, but due to how diabetes can affect your lipid profile (the levels of different types of cholesterol in your blood).
Cholesterol levels are measured as part of standard T1D care
NICE guidelines state that statin treatment for the primary prevention of CVD in adults with type 1 diabetes should be offered to those who:
are older than 40 years or
have had diabetes for more than 10 years or
have established nephropathy or
have other cardiovascular risk factors.
So clearly cholesterol is important for cardiovascular health in diabetes...
...but what even is cholesterol?
Let’s break it down
Cholesterol is an essential fat (lipid) in the body.
Although it has a bad reputation it has important functions, including building cell membranes and producing essential hormones like testosterone and oestradiol.
Our liver can make cholesterol and it also comes from some of the foods we eat.
📊 Key cholesterol biomarkers to know about
Total cholesterol: this number reflects the total amount of cholesterol in your blood, and is broken down into different parts.
LDL cholesterol: low-density lipoprotein is made of lipids and proteins which transports cholesterol, triglycerides and other fats to tissues throughout the body. Too much LDL cholesterol, commonly called 'bad cholesterol', can cause fatty deposits inside artery walls, potentially leading to heart disease.
Non-HDL cholesterol: you will most likely have heard of HDL (good) cholesterol and LDL (bad), but there are more types of harmful cholesterol in your blood than just LDL - these include VLDL (very low-density lipoproteins). Non-HDL is considered a better marker for cardiovascular risk than total cholesterol and LDL.
HDL-cholesterol: the protective type. It removes cholesterol from the bloodstream and transports it to the liver where it's broken down and removed from the body in bile.
Total cholesterol : HDL: the cholesterol/HDL ratio is calculated by dividing your total cholesterol value by your HDL cholesterol level. It's a useful measure of cardiovascular risk because it shows the portion of good cholesterol.
Triglycerides: a type of lipid that circulates in blood. After you eat, your body converts excess calories (whether from fat or carbohydrates) into triglycerides which are then transported to cells to be stored as fat.
What do they mean?
❌ Your total cholesterol result on its own is a limited marker in understanding your risk of heart disease.
High levels of HDL cholesterol can cause a raised total cholesterol result but may actually be protective against heart disease.
Equally, you can have a normal total cholesterol level but have low levels of protective HDL cholesterol.
✔️ The most important factors are how much HDL and LDL cholesterol you have, and what proportion of your total cholesterol is made up of protective HDL cholesterol.
SHAMELESS PLUG FOR MY T1D SUPPORT GUIDE: ARTICLE CONTINUES IN A HOT SEC…
Look at the bigger picture - what’s driving the cholesterol picture?
Bodily systems are all connected, and what’s especially relevant for cholesterol is:
thyroid health - specifically, underactive thyroidism can increase LDL levels because thyroid hormones, especially T3, play a role in how the liver processes and removes cholesterol. When the thyroid is underactive, the liver's ability to remove cholesterol is reduced, causing it to accumulate in the bloodstream.
liver and bile flow - these support the optimal detoxification and elimination of cholesterol.
gut health - supporting gut barrier and elimination prevents cholesterol re-absorption.
but also lifestage - we know cholesterol levels can increase into menopause and as we age.
what you can do
🧡
what you can do 🧡
Get regular cholesterol panels: at least once a year, as part of your diabetes annual review.
Liver support: include foods like bitter leaves, nettle tea, berries, and beetroot.
Bile flow: include foods like artichoke, rocket leaves, eggs, lemons, and parsley.
Digestive support: make sure there is adequate fibre to help bind and excrete excess cholesterol, especially soluble fibre (2 tbsp of ground flaxseed per day).
Include specific foods: tomatoes, almonds, avocados, turmeric, pulses, hazelnuts, walnuts, green tea all have robust evidence for lowering LDL levels.
High strength omega 3: to reduce triglycerides (2 portions of oily fish is a good start or consider a supplement - algal options available for non fish eaters).
Ensure blood pressure is normal: this should be checked as part of standard T1D care.
Regular exercise: to raise HDL levels.
Vitamin C: this can support endothelial cells maturation and improvements in endothelial function can support lowering LDL cholesterol levels. Think of kiwi, strawberries, oranges, and bell peppers.
Investigate thyroid health: and manage as necessary.
And that’s it.
Cholesterol levels are certainly an extra consideration for us t1ds, but there are lots of nutrition interventions you can think about to prioritise your cardiovascular health. This may also include statin use too, but that is best discussed with your GP or diabetes doctors.
If you’re looking for other nutritional support to make life with your type 1 diabetes a bit easier, check out these other blogs!