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Dear Dietitian – How do I manage my cholesterol levels after being on a low-carb diet for pre-diabetes?

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PICT Leanne McCrate Dear Dietitian
Leanne McCrate, RDN, LD, CNSC

Dear Dietitian,

I have pre-diabetes and was on a low-carb diet for a year. The good news is my A1C is 5.6, but the bad news is my cholesterol went from a healthy 165 to 199! My LDL is 125! I am 5’2” and weigh 105 pounds. I was a healthy 120 pounds a year ago, but I can’t put weight on! I don’t feel well every day, and I want my life back! I would greatly appreciate your advice.


Dear Judy,

First, let’s keep everything in perspective. While your cholesterol level isn’t what you want it to be, it’s still pretty good. It may need some tweaking, but it’s doable. Your A1C is now on the low-end of the pre-diabetes scale, so pat yourself on the back! As far as your weight, it’s possible to gain weight and be healthy! 

Next, let’s review some of the terms for other readers. Low-density lipoprotein (LDL) is often called “bad” cholesterol, while high-density lipoprotein (HDL) is referred to as “good” cholesterol. Hemoglobin A1C is a three-month average of blood sugar levels.

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The best way to achieve weight gain while lowering LDL is to eat more healthy food. You will need to take in at least three hundred extra calories every day. A simple way to increase calories is a bedtime snack. A smoothie may be a good option for you, and there are ways to prepare them without sugar. Use peanut butter or tofu as your base. You may choose nuts or seeds as a snack, as these are high calorie but healthy.

Another helpful avenue to healthy weight gain is increasing your fat intake. Focus on unsaturated fat, found in plant foods rather than the saturated fat in animal products. Monounsaturated fats include olive oil, canola oil, nuts, avocados, and nut butters. Polyunsaturated fats are found in corn oil, safflower oil, and sunflower oil. Heart healthy omega-3 fatty acids are also included in this category, and these are found in walnuts and fatty fish, like salmon, mackerel, trout, and sardines.

Another nutrient that helps lower cholesterol is soluble fiber found in old-fashioned oatmeal. Other sources include beans, apples, citrus fruits, and potatoes. Since soluble fiber makes you feel full, and you need to gain weight, increase fiber prudently.

The next strategy is to raise your HDL level. Increasing HDL will help lower your LDL-cholesterol. Health experts believe that HDL acts as a house cleaner by “sweeping up” some LDL particles and carrying them back to the liver for disposal. The best way to increase good cholesterol is through exercise - just 20 minutes of moderate exercise at least four times a week. 

Finally, consider seeing a Registered Dietitian Nutritionist (RDN) who will work closely with you to reach your goals. Most insurance plans pay for an RDN consult, and your doctor will provide a referral for you.

Until next time, be healthy!

Dear Dietitian

Leanne McCrate, RDN, LD, CNSC, is an award-winning dietitian based in St. Louis, Missouri. Her mission is to educate consumers on sound, scientifically-based nutrition. Do you have a nutrition question? Email her today at Dear Dietitian does not endorse any products, health programs, or diet plans.