Cholesterol is a waxy substance that is found in the bloodstream. The body uses cholesterol to produce cell membranes, hormones, vitamin D and bile acids that help us to digest fat.
Basically, the body produces all the cholesterol it needs. However, cholesterol could also come from our diet.
The cholesterol that our body needs is manufactured in the liver and circulated in the bloodstream.
Your doctor can check your cholesterol level by taking a blood sample and having it tested.
High blood cholesterol can affect anyone. Based on the latest 2015 National Health and Morbidity Survey, it is estimated that 47.7% of Malaysian adults 18 years and above have hypercholesterolaemia, or high blood cholesterol.
This is a serious matter as high blood cholesterol increases your risk for cardiovascular diseases.
Some of the excess cholesterol in the blood can become trapped in the artery wall. Over time, this build-up of excess cholesterol (known as a plaque) can narrow the blood vessels and make them less flexible.
As the blood vessels narrow or become blocked, oxygen and nutrients may not be able to be carried to the heart muscle, leading to chest pain and heart attack, or even a stroke.
Overweight or obesity is also a risk factor for high choleste-rol, i.e. having a body mass index (BMI) of 30 or greater.
Similarly, having a large waist circumference (or too much belly fat) means an increased risk of high choleste-rol levels.
That means a waist circumference of more than 90cm for men or more than 80cm for women, will increase your risk.
Physical inactivity and smoking are two other risk factors for high cholesterol.
In order to find out what your cholesterol levels are, it is important to have your blood checked. The recommended cholesterol test is the lipid profile.
Make it a point to check your cholesterol levels at least once a year.
Your lipid profile will include information on your total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.
Cholesterol circulates in the bloodstream, but it cannot travel on its own because cholesterol and blood do not mix. Therefore, it needs special transport molecules known as lipoproteins to circulate in the bloodstream.
Your blood cholesterol levels are made up of two main components, namely:
• Low Density Lipoprotein (LDL) Cholesterol: Also known as “bad” cholesterol because LDL carries cholesterol to tissues. LDL cholesterol is responsible for obstructing blood vessels and a high count means that you have an increased risk of heart disease.
• High Density Lipoprotein (HDL) Cholesterol: Also known as “good” cholesterol because HDL takes cholesterol from tissues to the liver to be excreted out from the body. Therefore, HDL can help lower your risk of heart disease.
Another component of your lipid profile are triglycerides. These are another form of fat that are found in the blood. The higher the triglyceride count, the higher your risk of heart disease.
The following figures are what you should aim for if you want to reduce your risk of developing heart disease:
• Total cholesterol – less than 5.2 mmol/L
• LDL cholesterol – less than 2.6 mmol/L
• HDL cholesterol – more than 1.6 mmol/L
• Triglyceride – less than 1.7 mmol/L
Reducing high cholesterol
If you have done your screening and your cholesterol is above the recommended normal levels, your doctor will recommend some lifestyle modifications as the first line of intervention.
However, if it is very high, lifestyle modifications must be supplemented with cholesterol-lowering medications, which your physician will prescribe.
These are the main lifestyle improvements you will need to look into when you have cholesterol levels above the normal range:
1. Eat less foods with high fat and saturated fats – choose lean meats (e.g. skinless chicken, beef or mutton with the fat remo-ved). Eat less foods with high saturated fat content such as lard, ghee, butter, poultry skin, fatty part of meats, coconut oil, coconut milk and butter.
2. Increase daily fibre intake – Numerous scientific studies have demonstrated that dietary fibre helps to reduce the risk of non-communicable diseases such as heart disease.
Legumes like peas, lentils and beans are the best sources of dietary fibre.
The Malaysian Dietary Guideline (MDG) recommends consuming half of your grains (which translates to at least two servings a day) from whole grain products such as brown rice, oats, whole grain breads, whole wheat cereals or whole grain crackers.
There is a fibre called beta glucan found in oats, which plays a role in lowering total blood cholesterol and LDL cholesterol.
Fruits and vegetables are also rich sources of fibre; they also contain vitamins, minerals and phytochemicals that have antioxidant properties to fight certain diseases.
3. Regular exercise – The MDG also recommends daily physical activity of at least 30 minutes a day, five to six times a week.
Beginners may split this into shorter sessions (e.g. 10 or 15 minutes each) that adds up to 30 minutes a day.
Physical activity helps in weight control and increases the level of good HDL- cholesterol. Exercise also helps to work your heart muscles to pump more blood to your body.
4. Maintain a healthy body weight – It is important to make it a point to check that you have a healthy body mass index (BMI).
A score of 18.5 or less means you’re underweight; 18.5 – 24.9 is normal; 25 – 29.9 is overweight; and anything more than 30 is obese.
Being overweight or obese has serious health consequences, which include dyslipidaemia and cardiovascular disease.
If you find that your BMI falls into the overweight/obese range, you should start changing your dietary and lifestyle habits.
Focus on shedding some of that extra weight – even a 10% weight reduction helps improve your blood cholesterol levels.
No shortcuts to health
There’s no secret to better health, and certainly no shortcuts either.
The only option is to lead a healthy lifestyle that incorporates a healthy diet, regular exercise, maintaining a healthy weight and abstinence from smoking.
Although lifestyle changes are not a quick fix, you have to make it as a new way of living.
In order to succeed in making the switch to a healthy lifestyle, be sure to plan ahead.
Get the support of your family and friends to keep you on the path to a healthy lifestyle, learn how to read and understand food labels, and if necessary, work with your doctor or a dietitian/nutritionist to come up with a plan on how to lower your cholesterol based on dietary changes.
You may also want to talk to your doctor before you embark on an exercise programme.
Dr Zulfitri Azuan is a council member of the Malaysian Dietitians’ Association (MDA). This article is contributed by Nutrition Month Malaysia (NMM) 2017, an annual community nutrition education initiative jointly organised by the Nutrition Society of Malaysia, Malaysian Dietitians’ Association and Malaysian Association for the Study of Obesity. The programme is supported by educational grant from Pepsico (Quaker Malaysia). To obtain more information, visit NMM’s Food-Fit-Fun Fair at Lower Ground, Centre Court Concourse, IOI City Mall Putrajaya today. Health screening and nutrition counselling is available for free and lots of other goodies are up for grabs. Visit www.nutritionmonthmalaysia.org.my or the Nutrition Month Malaysia Facebook page for more information.