Take control of your cholesterol levels with sensible lifestyle choices

The Straits Times (19 May 2015) - You are neither fat nor anywhere near middle-aged, which makes it all the more perplexing when your doctor tells you that you have high cholesterol. High cholesterol puts you at greater risk of heart disease. It is a more misconception to think high cholesterol is the domain of the overweight or older set.

Unhealthy lifestyle options such as excessive alcohol consumption, stress, a diet high in saturated fats and a sedentary lifestyle may increase the risk of high cholesterol levels. Genetic makeup and existing medical conditions such as diabetes and hypothyroidism may also increase this risk.

Dr Ching Min Er, an associate consultant with the Department of Cardiology at Tan Tock Seng Hospital, said: “Having a high cholesterol level is not limited to those of a certain age or body weight. Genetics leading to conditions such as familial hypercholesterolemia – a genetic disorder which results in unusually high cholesterol, childhood obesity, a diet high in saturated fats and a sedentary lifestyle are some reasons for high cholesterol levels in children, young adults and those who are slim.”

What is cholesterol and should you worry?

Cholesterol is a waxy “fat-like” substance that is present in cell membranes and is a precursor of bile acid and steroid hormones. It is essential for normal body function such as cell synthesis and steroid hormone production. But at high levels it becomes a cardiovascular risk factor as it get deposited in the arterial wall, causing narrowing and hardening of the arteries leading to atherosclerosis.

Generally cholesterol can be categorised as good cholesterol – high-density lipoprotein (HDL) and bad cholesterol – low-density lipoprotein (LDL). Dr Tan Hong Chang, a consultant with the Department of Endocrinology at Singapore General Hospital explained: “As cholesterol is insoluble, it has to be carried through blood attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. Cholesterol carried by different lipoproteins is reported on most standard lipid test. Cholesterol carried by LDL is considered ‘bad’ cholesterol as this cholesterol is involved with atherosclerosis. Conversely, cholesterol carried by HDL are considered as ‘good’ cholesterol and are protective against cardiovascular diseases by HDL carries cholesterol deposited in arteries back to the liver for disposition.”

Early detection to combat the silent killer

High cholesterol is known as the silent killer because it does not usually cause obvious symptoms.

Doctors advise regular health screenings to check on your cholesterol levels.

Dr Ching said: “According to the local Clinical Practice Guidelines, every man and woman above the age of 40 should have their lipid profile checked. But, if your baseline risk is higher than average due to family history and genetic predisposition, you may need to be screened earlier or more regularly.”

There are various components that make up a full lipid profile, including LDL levels, HDL levels and triglycerides levels (TG).

A healthy cholesterol range varies from person to person. She said: “The healthy cholesterol range is tailored to each individual’s cardiovascular risk profile. Someone at a higher risk for strokes and heart attacks needs to keep his or her cholesterol level lower than someone with no other medical problems.”

On average, a target LDL level for someone at a high cardiovascular risk profile is 1.8mmol/L or less. If you are someone with no other medical problems, medications only need to be started when your LDL levels are above 4.9mmol/L.

Treatment Options Available

For those with a high cholesterol level, initial treatment usually consist of a therapeutic lifestyle changes and if needed, medication.

Statins are a class of drugs most widely used to lower cholesterol levels. Statins work by blocking a substance your body needs to make cholesterol. Statins help your body to reabsorb existing cholesterol build-up on your artery walls, reducing further blockage to your blood vessels. Other drugs include Ezetimibe, bile acid sequestrants, fibrates and nicotinic acids.

Dr Ching’s advice is: “Start changing your lifestyle and eating habits to ensure that your cholesterol level gets to an acceptable level. Those who are prescribed cholesterol-lowering medication should also embark on changes for a healthy lifestyle and diet.”

Healthier Lifestyle Choices

Ms Joyce Tan Sze Chia, a dietitian with the Department of Nutrition and Dietetics at Tan Tock Seng Hospital, said: “A healthy and well-balanced diet along with regular exercise goes hand in hand to keep your blood cholesterol under control. Include wholegrain products such as brown rice, oats or whole meal bread in your diet as they are rich in soluble fibre. Soluble fibre have been shown in studies to reduce cholesterol absorption in the gut, which help to reduce your overall blood cholesterol level.”

She recommends two servings of fruits and vegetables daily as they are rich sources of fibre, vitamins and minerals.

Limit food intake that are high in saturated and trans fat such as fatty meat, poultry skin, full fat dairy products, palm oil, coconut milk, butter and deep fried food. These foods have been shown to increase the LDL cholesterol (bad cholesterol) and total cholesterol level. Replace saturated fat with unsaturated fats such as olive oil, canola oil, nuts and seeds to help decrease cholesterol level.

Include Omega 3-rich fish such as salmon, tuna and sardine at least two to three times a week in your diet as it helps in reducing blood triglycerides level. Ms Tan said: “It takes between three to six months after embarking on a heart-healthy diet and regular physical activity to achieve significant improvements in blood lipid profile. Maintaining a healthy diet can be challenging and a lifelong commitment, but it can be done.”