You may have heard that high cholesterol levels are bad for health. But do you know why? And, more important, how does one bring it down? Read on...

One of the often encountered culprits in the rising incidence of heart disease is cholesterol. High levels of cholesterol are common. You can have high cholesterol levels and not realise it because there are no symptoms. Frequently, clinicians advise us to reduce our blood cholesterol levels.

What is cholesterol?

Cholesterol is a waxy lipid, a fatty substance present in the blood stream. Moderate amounts are essential to your health as it is required for the synthesis of some hormones, vitamin D and other important compounds. But too much cholesterol is bad. It collects in the artery walls and, over time, causes hardening and narrowing of the artery. This will slow down and restrict the blood flow to your heart. Such changes can eventually cause heart attacks.

That's not all. More recently, research identifies an association between abnormal lipid levels (dyslipidemia) during midlife and increased cognitive decline in later life. Therefore, maintaining optimal cholesterol levels is a must for everyone; young and old, men and women.

Cholesterol travels in the blood along with LDL (low density lipoproteins or bad cholesterol) and HDL (high density lipoproteins or good cholesterol). LDL causes a build-up of plaque in the blood vessels and increases risk of heart attacks. HDL protects you from heart attacks. So, when doctors advise you to lower cholesterol numbers, they want you to reduce the total and LDL values and not HDL. In fact, the higher the HDL value, the greater the protection to the heart.

Why do some people have elevated and unhealthy cholesterol levels??

The reasons are multiple. Among the causes you cannot change are your genes, age and sex. Some people have high total cholesterol levels because of heredity. Cholesterol levels also increase from age 20 till about 60-65 years. With menopause, LDL levels increase in women and thereby total cholesterol as well. Unhealthy cholesterol levels are also a consequence of being overweight or obese. Lose those extra kilos and you will decrease both total and LDL cholesterol levels. HDL-C levels tend to increase with sustained weight loss.

Among the factors you can control are diet and lifestyle changes, though there is no doubt that pharmacological interventions are important. So, what is the recipe for a healthy cholesterol profile?

Different kinds of fats

High fat intake can increase cholesterol levels beyond normal. Ensure that fats contribute to less than 30 per cent of your energy intake. This translates to an intake of about 50g of both visible fat (added during food preparation) and invisible fat (found in foods) in a 1500kcal diet. Limit cholesterol intakes to less than 300mg a day. If your cholesterol levels are high, then lower to less than 200mg. Minimising your cholesterol intake makes sense but it is unwise to completely eliminate nutrient dense foods such as eggs.

Polyunsaturated fatty acids (PUFA) present in sunflower and safflower oils and monounsaturated fatty acids (MUFA) present abundantly in olive and rice bran oils will establish a desirable cholesterol level. The effects of MUFA are less pronounced than PUFA. Omega 3 fatty acids in fatty fish, walnuts and flax seeds can lower the LDL cholesterol.

Many other compounds in foods can help lower cholesterol levels.

Dietary fibre, especially soluble or gel forming fibres found in oats, whole grains, pulses like Bengal gram, Black gram (urad), Rajma, kidney beans, black beans and fruits like figs, papaya, pomegranate and guava induce beneficial effects on blood total cholesterol and LDL cholesterol levels. The effectiveness of oats in reducing plasma LDL cholesterol levels has been clearly demonstrated, but it may not alter HDL profile favourably.

Ensure a total fibre intake of at least 30 gm a day from a variety of foods. This is simple with a well balanced diet.

Regular physical activity helps lower LDL cholesterol and raises HDL cholesterol levels, lowers your blood pressure and helps you lose weight. The greatest impact of regular aerobic physical activity like walking, jogging, swimming and cycling is on elevating HDL cholesterol levels. Monitor your weight regularly.

A good diet

According to the International Conference on the Diet of the Mediterranean, the key elements of a diet that would effectively control blood cholesterol are as follows:

The major portion of your diet should consist of plant foods like whole grains, legumes and plenty of fruits and vegetables as sources of fibre.

Choose foods that are minimally processed and in season.

Opt for oils such as olive, rice bran and seed oils (til, peanut, soya).

Go for moderate amounts of low fat dairy products.

If you have to eat meat, take less than four eggs a week, minimal amount of red meat and fish and poultry in moderate amounts.

Quick tips

Opt for foods known to beneficially modify your lipid levels

Replace idli/dosa with oats porridge or upma a few times in a week

Have a fruit and/or vegetable salad daily

Include nuts in your diet daily, especially walnuts that are high in omega 3 fatty acids

If you like the aroma of garlic, use it regularly

Get moving. Be physically active for at least 30 minutes on most days

Maintain a healthy weight and a normal BMI. Carrying those extra pounds can elevate your cholesterol in the blood

Smoking is a major risk factor for dyslipidemia or impaired lipid levels

Drink only in moderation; go for red wine

If these changes are inadequate, consult your cardiologist immediately

What's a good level?

Total cholesterol: below 200mg /dl. (For Indians, because of their higher predisposition to cardiac diseases, less than 170mg/dl is recommended)

LDL: less than 100mg/dl

HDL: greater than 40mg/d

Stay away from

High cholesterol foods like egg yolk, meat, poultry and high fat dairy products.

Saturated fatty acids present in ghee, butter and animal foods such as red meat and vegetable oils such as palm oil.

Transfatty acids found in hydrogenated fats such as margarine and vanaspati can elevate cholesterol values and lower HDL numbers.

Hydrogenated shortenings high in transfatty acids are used in baked products such as cookies and to fry samosas and French fries.

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