Cholesterol

cholesterol

What is Cholesterol?

Cholesterol is a fat-like molecule (lipid) that circulates in the blood with the help of a lipoprotein carrier. It has a waxy structure and is present in all the cells of the human system. Similar to protein, cholesterol is essential to build all the cells.

However, too much cholesterol can pose a risk to the heart and various other health conditions. Besides the risk, it is also an essential molecule to synthesize all the hormones in the human body. For instance hormones like progesterone, estrogen, and androgen need cholesterol for proper functioning.

Types of cholesterol

  • Low-density lipoprotein (LDL) :

LDL is known as bad cholesterol. Too much of LDL can block the arteries and causes a heart attack or stroke due to a condition called atherosclerosis. The level of LDL must be as low as possible.

  • High-density lipoprotein (HDL) :

HDL is the good cholesterol which acts as a scavenger molecule by carrying the extra cholesterol molecules to the liver for metabolism. Higher the level of HDL, lower the risk of heart disease.

hdl ldl

  • Triglycerides :

Triglycerides are alternative energy sources released by the hormones. A higher level of Triglycerides contributes to heart disease, hence it is recommended to maintain normal levels.

Cholesterol levels 

Cholesterol level varies with age. Children tend to have a low level of cholesterol while the adults have increased cholesterol level as the age progresses. Following are the total cholesterol levels:

For adults :

  • Desirable level – less than 200 milligrams per deciliter (mg/dL)
  • Borderline high level – 200 to 239 milligrams per deciliter (mg/dL)
  • High-risk level – 240 and above milligrams per deciliter (mg/dL)
  • For children (less than 17 years old),
  • Desirable level – less than 170 milligrams per deciliter (mg/dL)
  • Borderline high level – 170 to 199 milligrams per deciliter (mg/dL)
  • High-risk level – 200 and above milligrams per deciliter (mg/dL)

What is High Cholesterol?

High cholesterol is a condition in which the blood has high levels of a white, waxy, fat-like substance (cholesterol). The human body needs small amounts of cholesterol. The liver makes all the cholesterol that the body needs. Extra (excess) cholesterol comes from the food that we eat.

Cholesterol is carried from the liver by the blood through the blood vessels. If you have high cholesterol, deposits (plaques) may build up on the walls of your blood vessels (arteries).

Plaques make the arteries narrower and stiffer. Cholesterol plaques increase your risk for heart attack and stroke. Work with your health care provider to keep your cholesterol levels in a healthy range.

What increases the risk of High cholesterol?

This condition is more likely to develop in people who:

  • Eat foods that are high in animal fat (saturated fat) or cholesterol.
  • Are overweight.
  • Are not getting enough exercise.
  • Have a family history of high cholesterol.

What are the signs or symptoms of High cholesterol?

There are no symptoms of this condition.

Factors influencing high cholesterol levels:

  • Women undergoing menopause
  • A Family history of early heart diseases
  • Women aged 50 years and Men aged above 40 years old
  • An Unbalanced diet, normally containing a lot of junk foods
  • Obesity
  • Decreased physical activity
  • Diabetes mellitus

Potential health complications of cholesterol

  • Atherosclerosis- clogging of the arteries by LDL followed by hardening of arteries.
  • Angina- chest pain due to the plaque formed by the LDL.
  • Peripheral Arterial Disease- restricted blood flow to body parts due to the plaque.
  • Stroke
  • Heart attack
  • Hormonal imbalance
  • Reduced cognitive skills
  • Formation of gallstones

high cholesterol

Cholesterol and pregnancy:

  • Level of cholesterol during pregnancy is usually high to synthesize hormones that safeguard the gestational period and the time of childbirth.
  • Female hormones such as estrogen and progesterone are very important for the growth of the fetus. These hormones are regulated by cholesterol.
  • During pregnancy, the level of cholesterol increases by 30% to 50% from the normal recommendable level.
  • The growing fetus utilizes two third of the cholesterol from the mother for its brain and bone development.

Diagnosis of High cholesterol levels:

  • Cholesterol circulating in the blood is determined by a blood test called a lipoprotein panel or total lipid profile which shows the level of LDL, HDL, triglycerides and total cholesterol individually.
  • Patients are advised to fast for 9 to 12 hours with an exception of drinking water.
  • Normally the test is conducted in the morning before breakfast on an empty stomach.
  • Drinking alcohol before cholesterol test can disrupt the lipid profile and hence not advisable.
  • High cholesterol may be diagnosed from the results of a blood test.
    • If you are older than age 20, your health care provider may check your cholesterol every 4–6 years.
    • You may be checked more often if you already have high cholesterol or other risk factors for heart disease.

    The blood test for cholesterol measures:

    • “Bad” cholesterol (LDL cholesterol). This is the main type of cholesterol that causes heart disease. The desired level for LDL is less than 100.
    • “Good” cholesterol (HDL cholesterol). This type helps to protect against heart disease by cleaning the arteries and carrying the LDL away. The desired level for HDL is 60 or higher.
    • These are fats that the body can store or burn for energy. The desired number for triglycerides is lower than 150.
    • Total cholesterol. This is a measure of the total amount of cholesterol in your blood, including LDL cholesterol, HDL cholesterol, and triglycerides. A healthy number is less than 200.

Following is a table that guides how to read and understand the lipid profile results

Cholesterol Risk Chart:

Total cholesterol (mg/dL) LDL

(mg/dL)

Triglycerides

(mg/dL)

Desirable level Lower than 200 mg/dL Less than 100 mg/dL 149 mg/dL or lower
Borderline High 200 to 239 mg/dL between 130 to 159 mg/dL 150 to 199 mg/dL
High Risk 240 mg/dL or higher 130 to 159 mg/dL or higher 200 mg/dL or higher

cholesterol

In the case of HDL, the results are predicted differently since they are good cholesterol and are the scavengers of LDL.

  • Desirable level – more than 50 mg/dL for women and more than 40 mg/dL for men
  • Low (risk) – less than 35mg/dL
  • Optimal (best) –  greater than 65 mg/dL

Low cholesterol diet:

A heart foundation at the UK has released a list of foods that can fight and maintain cholesterol level. These are referred to as, ‘cholesterol busters’ as they lower the level of bad cholesterol circulating in the blood.

  • Soya foods like tofu, soya milk etc.
  • Nuts- rich in fiber, protein, and vitamins like potassium.
  • Oats and barley- rich in beta-glucan that binds to the free circulating cholesterols and prevents absorption by the tissues.
  • Foods rich in plant sterols and stanols- these are the mimicking molecules of cholesterol and induce a placebo effect in the body.
  • Vegetables and fruits containing soluble fiber that can break down cholesterol like peas, beans, lentils, sweet potato, okra, and strawberry.

High Cholesterol treatment

This condition is treated with diet changes, lifestyle changes, and medicines.

Diet changes

  • This may include eating more whole grains, fruits, vegetables, nuts, and fish.
  • This may also include cutting back on red meat and foods that have a lot of added sugar.

All of these supplements are available in the market and has proven results in lowering LDL, maintaining optimum HDL and monitoring arteries for unobstructed blood flow.

  • Fish oil which has omega 3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)
  • Garlic pills
  • Ginseng extracts and candies
  • Guggle powder
  • Niacin (Vitamin B) pills
  • Red yeast rice – rice which supports the growth of a fungus that can produce cholesterol-lowering statin.
  • Artichoke leaf extracts/ pills
  • Raw fenugreek

Lifestyle Modifications

  • Modifications may include getting at least 40 minutes of aerobic exercise 3 times a week. Aerobic exercises include walking, biking, and swimming. Aerobic exercise along with a healthy diet can help you maintain a healthy weight.
  • Quitting smoking.

Medicines

  • Medicines are usually given if diet and lifestyle changes have failed to reduce your cholesterol to healthy levels.
  • Your health care provider may prescribe a statin medicine. Statin medicines have been shown to reduce cholesterol, which can reduce the risk of heart disease.

Besides consuming the supplements and nutrients, major modification in lifestyle is necessary to maintain a healthy cholesterol level.

  • Increased physical activity like swimming, jogging, walking, cycling, and other sports
  • Quitting smoking
  • Reducing alcohol consumption
  • Weight loss at a moderate level
  • Cleaner food habits involving abundant saturated fat and total avoidance of trans-fat found in junk food.

A Guide to lower LDL cholesterol:

1.Serving size- a small pack of a food item may have many servings
2.Total fat- 35% of total calories intake per day
3.Saturated fat- less than 7% of total calories intake per day
4.Cholesterol- less than 200mg per day
5.Dietary fiber- 5 to 20gm per day

Follow these instructions at home:

Eating and drinking

If told by your health care provider:

  • Eat chicken (without skin), fish, veal, shellfish, ground turkey breast, and round or loin cuts of red meat.
  • Do not eat fried foods or fatty meats, such as hot dogs and salami.
  • Eat plenty of fruits, such as apples.
  • Eat plenty of vegetables, such as broccoli, potatoes, and carrots.
  • Eat beans, peas, and lentils.
  • Eat grains such as barley, rice, couscous, and bulgur wheat.
  • Eat pasta without cream sauces.
  • Use skim or nonfat milk, and eat low-fat or nonfat yogurt and cheeses.
  • Do not eat or drink whole milk, cream, ice cream, egg yolks, or hard cheeses.
  • Do not eat stick margarine or tub margarines that contain trans fats (also called partially hydrogenated oils).
  • Do not eat saturated tropical oils, such as coconut oil and palm oil.
  • Do not eat cakes, cookies, crackers, or other baked goods that contain trans

General instructions

  • Exercise as directed by your health care provider. Increase your activity level with activities such as gardening, walking, and taking the stairs.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You are struggling to maintain a healthy diet or weight.
  • You need help to start on an exercise program.
  • You need help to stop smoking.

Get help right away if:

  • You have chest pain.
  • You have trouble breathing.
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