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5StepstoUnderstandCholesterol©2007,Dr.AnjaliAroraISBN978-81-207-3244-5

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Theauthorwishestothankallacademicians,scientistsandwriterswhohavebeenasourceofinspiration.

Title

Cholesterol isawhite,waxy,chemicalsubstance. It isvery important for thefunctioningofeverycellofyourbody.CholesterolalsohelpsmanufacturevitaminD,hormoneslikecortisolandyoursexhormones.

Whencholesterolinyourbody,goesupbeyonddesirablelevels,itcanputyouattheriskofhavingastroke,developingheartdiseaseorothercardiovasculardiseases.

01.TestYourselfForCholesterol

Yes No Diet

Youofteneatfriedfoodsorfoodshighincholesterol,suchascheese,butteroreggs. Youeatyourfoodwithgravyorsaucesregularly. Youeatrichmeatpreparations.

Yes No Addictions

Youareasmoker. Youareunabletoquitsmoking. Youchewtobacco.

Yes No Lifestyle

Youareoverweightandeatplentyofsaltyfoods. Yourbloodpressureishigherthan120/80mmHg.

Youexerciselessthanthriceaweek.

Yes No FamilyHistory

Youhavediabetesorafamilyhistoryofdiabetes.

Yourparent/siblinghashadaheartattackor strokeorhasdevelopeddiabetesby the ageof50.

Yes No OtherRiskFactors

Youareawomanonbirthcontrolpillsnearingmenopause. Youdrinkmorethantwocupsofcoffeeaday. Youconsumealargeamountofalcoholeveryday.

Themore timesyouanswer “yes” to the above statements, thegreater isyour riskofhavinghighcholesterol,coronaryheartdiseaseorastroke.

02.UnderstandCholesterolCholesterolismanufacturedinthebodyandisalsoingestedthroughfoodlikebutter,eggyolkandmeats.Thelivermakesmostofthebody’scholesterol,whichhelpscarryfattopartsofthebodythatneedfatforenergy,orstorage,suchasthehiporbelly.

TypesofCholesterol

Theliverplacescholesterolintopackagescalledlipoproteinsmadefromlipids(fatandcholesterol)andprotein.Theseareofdifferenttypes.

LDL-C:Low-densitylipoproteinorbadcholesterolHDL-C:High-densitylipoproteinorgoodcholesterolVLDL-C:Verylow-densitylipoproteincholesterolTriglycerides:AtypeofingestedfatLp(a):Theworstkindofcholesterol

LDLCholesterol

Ittransportscholesterolfromthelivertoallthecellsinthebody.Ifthecholesterolavailableismorethanrequired,thenLDLwillendupcirculatinginthebloodstreamandeventuallygetdepositedontheinnerwallsoftheartery.Itiscalledthe‘badcholesterol’becauseitcancauseblockageandresultinlackofbloodsupply.

HDLCholesterol

HDLcholesterol isalsoknownas the ‘goodcholesterol’, as it travels in thebloodstreamfrom theperipheralareasofthebody,bringingcholesteroltotheliverforbreakdown.

VLDLCholesterol

Large fat particles called chylomicrons and fatty acids formVLDL. It is used for energy and fatdeposition.

Triglycerides

Theyareatypeoffatalsoproducedbytheliver.Inhumannutrition,morethan95%oftheingestedfatisintheformoftriglycerides.

Lipoprotein(a)

Overthepastfewyearsresearchershaveidentifiedanotherformoffatcalledlipoprotein(a)orLp(a).Itisknowntobeassociatedwithatherosclerosisandcoronaryarterydisease.

Lp(a)hasmoretodowithgenesthandiet.Itsscreeningisimportanttofindoutanindividual’sgeneticprobability of getting heart disease and to help reduce other risk factorswhichmay lead to heartdisease.

Ahighfatdiethasbeenassociatedwith increased incidenceofatherosclerosisandcoronaryarterydisease(CAD),obesityandcertaincancers.

03.WhatDoesCholesterolDoo?Cholesterol helps carry digested fat from the liverto the whole body. The blood vessels act as ahighway.Afterfulfillingthisfunction,cholesterolreturnstotheliverandrepeatstheprocessalloveragain.

Afterfatorfoodiseaten,itgoesthroughthestomachandisthendigestedandabsorbedinthesmallintestine.Afterthisitissenttothelivertobeprocessedandshippedthroughoutthebody.

The liver loads the fat on to the VLDLs. These travel through the blood vessels, unloading fatthroughoutthebody.TheemptyVLDLsthenbecomeLDLs.

SomeLDLpiecescangetstuckalongthebloodvesselwalls,thusnarrowingthebloodvessels.

TheroleofHDLsistoseparateLDLpieceswhicharestucktothebloodvesselwallsandshipthem

backtotheliver.TheLDLpiecesareeitherrecycledintonewVLDLsorbrokendownandexcreted.ThenewVLDLsrestarttheshipmentprocess.

Whenoneeatsextrafat,moreLDLpiecescangetstuckalongthebloodvesselwalls,iftherearenotenoughHDLstoreleasethem.Bloodvesselscanthusgetblocked,resultinginaheartattack.IdeallyoneshouldhavemoreHDL.

FactsaboutAtherosclerosis

Atherosclerosis sets in over the years. It can lead to disability and even death. The nameatherosclerosisisderivedfromGreek.Itreferstothethickeningofthearteriesoveraperiodoftimeduetotheaccumulationoflipids.

LDLOxidation

LDL-Cisthemajorcholesterolthatmediatesthelinkbetweenserumcholesterolandatherosclerosis.LDL is modified by certain metabolic processes in the body (e.g. oxidation, acetylation,glycosylation)resultingintheformationofamodifiedatherogenicLDL.TheinteractionofthisLDLwithmonocytes(typeofcellsinourblood)transformsthemintofoamcellsresultingintheformationofatheroscleroticplaques.

IgnoredFacts

Highlipidsbythemselvesdonotproduceanysymptoms.Itisthepathologicalinvolvementwiththevesselwallororgan,whichleadstothediseaseprocess.Itisunfortunatethatthesettinginofhyperlipidemia often goes unnoticed. Formation of Atherosclerotic Plaque artery plaqueUntitled-3 18 4/14/2009, 3:13 PM Xanthelasma (deposits on the eyelids) and xanthoma(depositiononelbowsandotherpartsofthebody)arenevertakencareof.Manydiseaseslikenephroticsyndrome,atheroembolioftherenalarteriesandend-stagerenaldiseasearealsotheresultofhighlipids.Pancreatitiscanalsobeaconsequenceofhightriglycerides.Diagnosingatherosclerosisearlybecomesdifficultasthereareusuallynosymptoms,untilitisatafairlyadvancedstage.Atherosclerosiscanbeprevented.Itsprogressioncanalsobeslowedbyeliminatingthefactorscausingit.

04.MeasureYourRisk01.MeasureYourRisk

Asimplebloodtestgivesyourtotalcholesterolandotherlipid(fat)levels.Compareyourtestresultwith theguidelinesbelowtodetermineyourriskfactors.Abloodtest requiringa12-hourfastwillmeasureLDL,HDL,VLDL,triglyceridesandLp(a).

Anybodywith coronary arterydisease, stroke,or twoormore risk factors shouldkeep theirLDLunder70mg/dl.

Lp(a)–AnotherimportantLipoprotein

Highlipoprotein(a)isassociatedwithahigherincidenceofatheroscleroticandheartdisease.IfyourLp(a)isgreaterthan20mg/dl,theriskofatheroscleroticdiseasecandouble.AnincreasedLDL-CalongwithhighLp(a)stepsupyourriskforatheroscleroticdiseasethreetofivefold.Lp(a)denotesageneticproblem.Lp(a)cannotbealteredthroughdietaryhabits.Lp(a)canbereducedwiththehelpofniacin.

LDLReceptors

In1985,MichaelBrownand JosephGoldstein received theNobelprize in1985 for theirworkon

LDLreceptorsandhighcholesterol.

02.FactsRelatedToLDLReceptors

SomepeoplearebornwithadeficiencyofLDLreceptors.Peoplewith LDL receptor deficiency try compensating this defect by producing an excess ofLDLor“badcholesterol”.Inpeoplewithastressed,overindulgentandsedentarylifestyle,highLDL-Cisproduced.Thisself-madelifestyleresultsinthereductionofLDLreceptors.Inbothhereditaryandcasesofself-indulgence,therelationshipisbetweenreducedLDLreceptorsandproductionofhighLDL-Cintheblood.

CholesterolandLifestyle

AWesternlifestyleofhighstress,fattyfoodandsedentarylifestyleleadsto...

Anincreaseininsulinresistance.Moreproductionofinsulin(duetotheconsumptionoffatorsimplesugars).Depositsoffatonyourbellythatleadstoabdominalobesity.MoreLDL,thatstickstoyourarteriesandcausesblockages.

High cholesterol is regarded as one of the most important factors for plaque deposition andhardening of arteries (atherosclerosis). Like theWest,with a high consumption of junk food, thisproblemisnowbecomingprevalentamongtheSouthAsianpopulationalso.

CholesterolandEmotionalStress

Emotionalstressreleasesthehormones–adrenalin,noradrenalinandcortisol,whichcounteractinsulinreaction.Ademandformoreinsulinistheresult.This insulin resistance, lipid disorder of lowHDL, high triglycerides, apple type obesity andprematurecoronaryarterydiseaseisknownastheReavensyndrome.

LipoproteinSubfractionTesting

It is done to help evaluate your risk of developing coronary artery disease (CAD). Lipoproteinsubfraction tests of LDL are done based upon their size, density, and/or electrical charge.Lipoproteins are heterogeneous particles – containing molecules of proteins, cholesterol,triglycerides andphospholipids.As theycirculate in thebody,variousmolecules are removedand

othersareaddedtocreateparticlesofdifferentcompositions.Lipoproteinparticlesareformedthatvaryfromlargeandfluffy(thosewithahighproportionoftriglycerides)tosmallanddense(thosewithahighproportionofprotein).SmalldenseLDLparticlesareseentobemoreatherogenic(morelikelytocauseatherosclerosis)thanlightfluffyLDLparticles.ResearchersthinkthatthepresenceofsmalldenseLDLcouldbeoneofthereasonsthatsomepeoplehaveheartattackseventhoughtheirtotalandLDLcholesterolarenotparticularlyhigh.

Thenumberofsmall,denseLDLandHDLparticlesapersonhasispartiallygeneticallydetermined.Thisispartiallyduetogender(malestendtohavemoresmallLDLandHDLthanfemales).Itisalsorelated to lifestyle and a person’s general state of health. Certain diseases and conditions, such asdiabetesandhypertension,areassociatedwithincreasedlevelsofsmalldenseLDL.

Lipidsubfractiontestisconductedbygivingafastingsampleofbloodfortestinginthelaboratory(thesamewayasyougiveforlipidprofileassay).

Lipoproteinsubfractiontestingisnotroutinelyordered.Itoffersusefulinformationinassessingriskinpatientswhohaveapersonalorfamilyhistoryofearlyheartdisease,especiallyiftheirtotalandLDLcholesterolvaluesarenotsignificantlyelevated.

Subfraction testing isusuallydonealongwith the lipidprofile test.Lipoprotein subfraction testingmayalsobeaskedforaspartofanoverallevaluationofcardiacriskwhensomeonehasapersonalorfamilyhistoryofearlyCoronaryArteryDisease(CAD),especiallywhentheydon’thavetypicalcardiac risk factors, such as high cholesterol, high LDL, high triglyceride, low HDL, smoking,obesity,inactivity,diabetesand/orhypertension.Subfractionscanbeaffectedbylipidtreatmentalong

with lifestyle changes. LDL subfraction testing may also be occasionally ordered to monitor theeffectivenessofthetreatmentindecreasingthenumberofsmalldenseLDLparticles.

Althoughthereisageneticcomponent,lipoproteinsubfractionscanbealteredbyadoptingadietlowinsaturatedfats,losingexcessweightand exercising regularly. The use of lipid-lowering drugs may also help affect the subfractiondistribution.

HDLCholesterol

TherelativeimportanceofHDL-2andHDL-3cholesterolasriskfactorsforischaemicheartdisease

(IHD)isstilluncertain.

HDLParticles

ThenumberofHDLparticlesapersonhasispartiallygeneticallydetermined.StudiesobservethatlargefluffyHDLparticlesmayprovidemorecardiacprotectionthansmallHDLparticles.MaleshavemoresmallHDLandLDLparticlesthanfemales.SubfractionsofHDL:HDL2,HDL3wereseen tobe inverselyassociatedwith the incidenceofischaemicheartdisease.

BloodSugarandLipids

Youcangetyourbloodsugartestedwhenyougiveyourbloodsampleforalipidprofiletest.Ahighlevelofbloodsugar,alongwithhighcholesterol,doublestheriskofCADandatherosclerosis.

FreeRadicalFormation

In the presence of excessive free radicals, LDL (the bad cholesterol) changes its form to oxidisedLDL,whichsticks to thewallsof thearteries, thus increasing thepossibilityof thedevelopmentofatherosclerosis.

03.CholesterolFacts

Forevery1%dropinthetotalcholesterol,thereisa2%decreaseintheriskofhavingaheartattack.Theriskofheartattackdropsbyabout4%whenHDLlevelsareincreasedby2%.Thehumanbodymanufacturestwothirdsofitscholesterol,one-thirdofwhichcomesinthroughfood.Studies state that inmostAsian countries, themean levels of total cholesterol are lower thanthosefoundinwesterncountries.

The incidence of coronary heart disease is also lower, but, incidence of stroke, particularlyhemorrhagicstroke,ishigherinAsians.Aclearevidenceispresentinvolvinghazardsofhighersystolicbloodpressureatall levelsofcholesterolandhazardsofhighercholesteroldiseasesatalllevelsofsystolicpressure.Effectsofmajorriskfactorsforcardiovasculardiseaseareconsideredtobemultiplicative.

If1factordoublestheriskinvolvedandanothertriplesit, thenjointriskfactorsincreaseyourrisksixfoldforcardiovasculardisease.

Factorsthatcanaffectthebloodcholesterolreadingsare:

Seasonal variation: Cholesterol is approximately 5% higher in your body in winter than insummer.

Bodyweight:Onrecentlossinweight,yourcholesterolislikelytobelower.

Blood testandbodyposition:Blood test and thepositionof thebody affect levels of bloodcholesterol.Achangefromlyingdowntosittingupcanraiseyourcholesterollevel.Thisisduetothepresenceofincreasedproteininblood.

BloodDrawingTechnique

While drawing a blood sample, if the tourniquet had been tied very tightly or fingers had beensqueezedhard,yourcholesterolresultswillshowahigherreading.Ascholesterolisbondedtobloodprotein,theextraproteincollectedwillgiveahighfalseresultduetosqueezing.

Ifyourlipidprofilereportishighyoucangetitrepeatedonthreedifferentdaysandcompareit.Ifitremainshigh,dosomethingaboutit.

ObesityandHighLipidLevels

ObesitywasacommonproblemintheWest,butisnowbecomingrampantinIndiaandotherEasterncountries.Overweightandobesepeoplearecommonlyknowntohavehighbloodcholesterol,hightriglyceridesandlowHDL-C(goodcholesterol).LowHDL-Cgivesthemnoprotectionagainstheartdisease.

An increase in LDL-C (bad cholesterol) in obese patients makes them more susceptible to heartproblemswithexcessiveamountofcaloriesbeingtakenthroughsaturatedfats(desighee,friedfoodsand lot of sweets like khoya barfi, coconut sweets, chocolates, cakes, etc). Also lack of exerciseworsensthesituation.

MetabolicSyndromeorSyndromeX

Aclusterof risk factorswhichused todevelopwithprogressiveageandpostmenopausearenowseentodevelopat20and30yearsofage.Allovertheworld(includingIndia)increasingwaistlinesandpotbelliesarepointingtowards“heartbreaking”problemsandnotprosperity.Peopledevelopingthissyndromehave2-3ofthefollowingriskfactorspresent.

HighbloodsugarHighbloodpressureWaist>40inchesinmenand>35inchesinwomen

LowHDL-CHighTriglyceridesPresenceofsmallLDLparticles

Metabolicsyndromeifnotattendedtotimely,canleadtoheartandotherassociateddiseases.Stressandhighlevelsofcholesterolmakeadeadlycombinationfortheearlydevelopmentofheartdisease.

WomenandCholesterol

Cholesterollevelsareseentoincreaseduringpregnancy.Duringthelasttrimester(i.e.lastweeksofpregnancy),anincreaseincholesterolandotherlipidsisespeciallyseen.Thiscanbeattributedtotheneedforthegrowingfoetus.Also,morefatsmayberequiredbythemotherduringbreastfeeding.

04.Menopause

Estrogenissecretedbythefemalereproductivesystemuntilmenopause(i.e.45-50yearsofage).Tillthen,awomanisprotectedfromheartdiseaseasshehasahigherHDLandacomparativelowLDL.HDL helps clear excessive cholesterol of the body and brings it to the liver for breakdown. ThisprocessprovidesthewomenUntitled-3324/14/2009,3:13PMprotectionagainstheartdisease.Astheperimenopausalstagesetsin(atabout40-50yearsofage),thereisadecreaseinestrogenproductionand a reduction in HDL. This makes a woman susceptible to heart disease as much as her malecounterpart.

CholesterolLevelsinChildren

<170mg/dl Acceptable<170–199mg/dl Borderlinehigh<200mg/dl Definitelyhigh

Persistenthighlevelsofcholesteroleveninchildrenresultinthedamageofthebloodvessellining,subsequentlyleadingtobuildupofatheromatousplaques.Todaythiscanbeasaresultofsedentaryhabits(TVandcomputerwatching),consumptionofjunkfoodandobesity.

Due to a heavy academic curriculum a child’s outdoor activities are restricted. Children who areoverweight,havehighbloodpressure,diabetesorthosewithafamilyhistoryofheartdiseasemust

gettheircholesterolorlipidslevelschecked.

Monitoringofthebloodsugarandlipidprofileofschoolgoingchildrenshouldbecomemandatory.If screening is conducted annually, the cardiac disease process can be nipped in the bud. Thepercentage of young people developing syndrome X is alarming. Prevention of coronary arterydisease must be in the minds of all. Parents of all affected children too should be screened by aphysicianoratalipidclinic.

CholesterolLevelsandOlderAdults

Coronarydiseaseandhighcholesterollevelsareseentodevelop,moreinmiddleagedpeopleover50yearsandalsoinolderpeople.

Thismaybeduetolessexerciseandalteringeatinghabits.Chewingproblemswithfallingteethandeatingoutmorecouldalsobe thereasons.Developmentofassociateddiseases likediabetes,bloodpressure,arthritisandstressoftenresultinincreasedcholesterollevels.

HDL-Cisalsoseentodecreasewithlessexercise.Byloweringyourcholesterolandotherlipidswithappropriatemedicationandlifestylechange,youcanaddmorefruitfulyearstoyourlife.

MedicationAssociatedwithHigh

Cholesterol LevelsMany types ofmedicines are known to increase cholesterol through their sideeffects.Someofthemare:

Beta Blockers: (Atenolol, Propanolol, Metapropanolol) Beta blockers are a commonly usedmedication.OneoftheirmainsideeffectsisanincreaseinLDLcholesterollevels,andadecreaseinHDL-Clevel.

Diuretics:(Hydrochlorthiazide)

Theseareoftengiventopatientswithhighbloodpressure.Alongwiththebloodpressuremedication,patients are advised diuretics to help reduce the fluid load in the body.Diuretics unfortunately notonlyincreasetotalcholesterolbutcandecreasethegoodcholesterol(HDL-C).Theyalsoincreasethebadcholesterol(LDL-C)andtriglycerides.

Someothermedicationwhichcanderangeyourcholesterollevels:

ContraceptivepillsCorticosteroids(usedinrheumaticdisease,asthma,etc.)Anabolicsteroids

05.CholesterolAndLifestyle01CholesterolAndLifestyle

Bettereatinghabits,exercising,losingweight,dealingwithstresspositivelyandgivingupsmokingarethequickestwaysofdevelopingahealthierlifestyle.

BetterNutrition

Abalanceddiethelpsfighthighcholesterol,heartdisease,strokeandotherrelateddiseases.Good

foodsarenotmanufacturedfoods.Goodfoodsarenaturalfoodswhicharenutritiousandprotectthebodyagainstdiseases.

FibreFacts

The indigestible fibre in food is a very important part of healthy eating. It helps in normal bowelmovementandlowerscholesterol.

Alow-fat,high-fibredietcanhelpreducetheriskofcertaincancers,particularlycoloncancer.

TypesofFibre

Solublefibre:Itswellsupandholdswater.Insolublefibre:Itdoesnotswellsupandholdswater.Itconsistsofcellulose,themainconstituentofcellwallsinplants.

BestSourcesofFibre

Acombinationoftheabovewillensureahealthybalanceofsolubleandinsolublefibre.

Fibre–theGoodCholesterolLoweringAgent

Highintakeofsolublefibreisknowntodecreasebloodcholesterolby10-25%.Inthewesternworldoatfibreisusedregularly.Oatsareknowntolowerabsorptionofcholesterolinyourdigestivetract.Isabgol,isanexcellentfibrerichproduct,extensivelyusedinIndia.Itisalsoknowntohaveexcellentcholesterolloweringproperties.

Fibretakenthroughtraditionalgrainsandcerealsisgoodforloweringthecholesterolandfatsfromthebody.

02.SomeBeneficialFoods

Garlic: It helps lower cholesterol and prevents hardening of arteries. It also helps in thinning ofbloodandreduceshighbloodpressure.

Soya:Itcontainsnosaturatedfatandcanimprovegoodcholesterollevels.Itisfoundinsoyaoil,tofuandsoyamilk.

Stanols:Theyarefoundinplantsandsoyabeanoil.Theyhelplowercholesterollevels.

Nuts: Almond, walnut and macadamia contain monounsaturated fat, which is good for reducingcholesterol.

OmegaFattyAcids

Omega3andOmega6

Theyareessentialfattyacidswhichcomeunderspecialtypeofpolyunsaturatedfattyacids.

Omega3fattyacidsarefoundinfish,seafood,nutslikewalnut,flaxandpumpkinseeds.Omega6fattyacidsarefoundinsunfloweroil,cornandsoyabeanoils.

Omega 3 Fatty Acids: Are essential fatty acids which are classified under special type ofpolyunsaturatedfattyacids.Thesefattyacidsprotectyouagainstheartdiseasebydecreasing thefatandtriglyceridelevelsinyourbody.Theyarenotmadebythebodybutcanbesuppliedthroughdietorsupplements.

Theabilityofomega3fattyacidstoreduceplateletaggregationisimportant.Adietrichinfishoilsand other omega 3 fatty acids also helps reduce clot formation and sticking of the platelets to thearterialwalls.Thisresultsinlessplaqueformationandslowdevelopmentofatherosclerosis.

Niacin:Itisawater-solublevitamin(vitaminB3)thatcanlowerLDLandincreaseHDLlevels.Thebestnaturalsourcesofniacinarericebran,wheatbran,peanuts,organmeatslikeliverandfishliketrout,salmonandhalibut.

ChooseYourFatsSensibly

Excessiveuseoffatscanincreaseyourcholesterol levels.Fatshavemorecalories(9pergm)thanproteinorcarbohydrates(4pergm).Toloseweightfaster,decreasethefatinyourdiet.

MonounsaturatedFats:Thesearepresent inolive,mustardandrapeseedoils.TheyareknowntoincreasethelevelsofHDL(goodcholesterol)andlowerLDL(badcholesterol).

PolyunsaturatedFats:Theyareobtainedfromsafflower,sunflowerandcornoil.TheycanloweryourLDL(badcholesterol),butcanalsoloweryourHDL(goodcholesterol).

SaturatedFats:Fatsfromanimalsourcessuchasbutter,gheeandpartiallyhydrogenatedoilsshouldbeavoided.Fatsfromvegetablesourceslikecoconutandpalmoilaretobeusedless.Blendtwoormore oils of different groups. They help in the healthy heart diet. Never reuse fried oil as it isunhealthy.

03.ReduceTheIntakeOfCholesterol

Naturalfoodsinbalancedandmoderatequantitieshelpincholesterolreductioninanormalhealthyadult.

Oil:Thequantityofoilandoilproductsusedshouldnotbemorethan3-4teaspoons(inwomen)and4-6teaspoons(inmen)daily.Thetypeofoilusedisalsoveryimportant.

Sugar:Thequantityofsugarandsugarproductsuseddailyshouldbeabout3-4teaspoons,notmore.

Salt:Saltintakeshouldbelessthan1teaspoondaily.Thisamountofsalt(about1teaspoon)canbetakeninahumidandhotweather.

Fruits:Itisagoodsourceofsolublefibreforanormalperson.500gmsoffruitscanbetakenperday.Reducetheintakeofsugarrichfruitslikemangoes,grapesandbananas.

Milk:Theintakeofmilkandmilkproducts(oflow-fatorskimmedmilk)shouldbeabout500gmsperday.

Vegetables: They have negligible calories if not cooked with too much fat. Okra, cucumber,

eggplant,cauliflowerandfrenchbeansaresomeexamples.Somehealthyleafyvegetablesarelettuce,cabbage,mint,celery,spinach,corianderandsoyaleaves.

FishOils

Fishoils are extracted from fish.Someof themcontainpolyunsaturated fatty acids that reduce thetendencyofbloodcellsandplatelets to formbloodclots.Theyalso reduceLDLand triglycerides,andincreaseHDL.

Fishes which help in lowering cholesterol are usually found in cold ocean waters, for example,salmon.

Eatingfish twoto three timesaweekhelps inreducingyourriskofheartdiseases.Takingfishoilcapsulescanbehelpful,buttheydonotcompensatefullyforthebenefitsofactuallyeatingfish.

Labelsoncannedfoodsshouldbereadtoassesstheamountofcaloriesthefoodcontains.Also,avoidfoodswithpreservatives,asexcessivesaltandcolourareharmfultoyourbody.

04.SomeUsefulTips

Dalia(BulgurWheat/Bran):Richinfibre,theybindtocholesterolandfatsinthebodyandhelpinsecretingthem.Daliaorbranaregoodasbreakfastcereals.

Oats:Theycontain“Betaglucan”–asolublefibre.Oatbranhelpslowercholesterollevels.Itcanbemixedinwheatas“atta”ortakenasoatrollsoroatporridge.

Esabgol:Thisrichfibrewhentakennotonlyaidsinrelievingconstipation,buthelpsineliminatingfats and cholesterol from the body. It can be taken before meals or at night after dinner withcurd/milk.

Soya and its products: Soya contains antioxidant compounds. It is also known to help bloodcholesterollevels.Itcanbeconsumedaftercooking,asgranulesornuggets.Tofu(soyapaneer)canbecookedoreatenrawwithsalad.Soyamilkandcurdareoftensubstitutedfordairyproducts.

WhenBuyingDairyProducts

Milk:Buyfatfreemilkratherthanwholemilkormilkwith2%fat.Fatfreemilkormilkwith1%fathasasmuchquantityofcalciumpresentaswholemilk(Calciuminmilkisnotrelatedtothefatpercentagepresent).Cheese:Look for“fat free”, “lowfat”or“partly skimmed”cheese.Pickupcheesecontaininglessthan3gmoffatorlessperounce.Softcheese:Choosethelowfatvariety.FrozenDairyDesserts:Pickupfrozendessertslowinsaturatedfat.Thesecanbeicemilk,lowfatfrozenyoghurtorfruitjuicesandsorbets.

Fatsandoils

WhenBuyingFatsandOils

Chooseliquidvegetableoilslikecanola,mustard,olive,corn,sunflowerandsaffloweroils.Butter,desigheeand,solidshorteningsarerichinsaturatedfatandcholesterol.Theseshouldbeconsumedinlessamount.Ifyouneedtogetmargarine,buyitwithunsaturatedliquidvegetableoils.

WhenBuyingBreakfastFoods

Choosewholegrainbreads.Theycontainmorefibrethanwhitebread.Eatdrycereals–mostofthemcontainalowfatcontent.

Limitthemuesliandbrantypescontainingcoconutandnuts.Avoidsweetbakedgoodies.Lowfatsweetsandsnackscanbeeatenonceinawhile.Remember,thesemaybelowinfat,butnotincalories.

Percentagesrefer topercentof totalcalories.Thereversaldiet isavegetariandietcontaininglessthan10%totalfatandminimalsaturatedfat.

05.HealthyExercise

Itisnevertoolatetogetstrongerandstaystrong.

Exerciseshouldbedonebeforemeals,neverimmediatelyaftermeals.Ifyouhaveaheartproblem,hypertensionoranyother specialcondition,consultyourdoctorbeforeexercising.Listentoyourbody.Whenfatiguedorunwell,donotexercise.

Exerciseshouldcontainthreephases:warm-upphase,briskphaseandcool-downphase.

Exercisingduringextremetemperatureslikeveryhotorcoldweatherputsextraburdenonyourheartandbloodvessels.When exercising during hot and/or humid weather, decrease the duration and intensity of

exercise.Allowyourbodytowarmupandcooldown.Drinkplentyofwaterbefore,duringandafterexercise.Incoldweather,avoidheatloss.Dressinlayersandremoveextraclothingasyouwarmup.

WatchYourWeight

Yourbodystoresmorefatandcholesterolifyouareoverweight.Thefastestwaytoloseweightistoreduceyourintakeoffatandsugar.

ThePinchTest

]Grasptheskinatthesideofyourwaistbetweenthethumbandtheindexfinger.Ifitismorethananinch,thenyouneedtolosefat.

06.De-Stressing

Stressisacontributoryfactortowardshighcholesterollevels.

Stress is responsible for excessive secretions of adrenaline and thyroid hormones. It also causesexcessivesecretionofkidneyhormones.Throughvariousmechanismsanincreaseincholesterolandblood pressure occurs. Roughening, thickening of the arteries andmore fat deposition also takesplace.Thechancesofgettingaheartattackorstrokeareenhanced.

HowtoDealwithStress

Avoidchronicstress.Changeyourattitude.Situationsdonotchange,youcan.De-stressyourself.

De-stressingTechniques

Exercise:Desk jobs often involve longworkinghours at the table or computer.This leads to badposture,alongwithchronicstress.Onecanperformtheseexercisestohelpde-stresswhileworking.

HeadrotationsShouldershrugsLowerbackstretchingAnklesandlegsstretching

MassagingtensemusclesWalkingbetweenthetablesoralongthecorridorasmuchaspossible.

PositiveThinking:Thinkhonestly,positivelyandspecifically.

Laughter:Enjoyagoodlaughbyrecollectingsomehumorousincidentinyourlife.

Self-distraction: During long and heavy working hours, de-stress yourself by standing near awindoworsippingaglassofwater.Youcanalsodoafewstretchingexerciseswhilesitting.Thiswillhelpbreakthemonotony.

MentalImagery:Relaxbythinkingaboutgoodthings(likeafuturevacation).Lowerthenoiselevelaroundyou.

07.Medication

Proper diet, exercise and a change in lifestyle can reduce cholesterol, but your doctormay advisemedicationtoo.

The decision to give you drugs will be based upon the type of hyperlipidaemia you have. Forexample:

HighcholesterolwithlowHDLHighcholesterolwithhighLDLHighcholesterolwithhightriglyceridesHightriglycerideswithlowHDL

Medicationadvisedcouldcontain:

StatinsFibratesGemfibrizoleNiacinEzetimibeAnyotherorcombinationsoftheabove

Statins (Atorvastatin, Simvastatin, Pravastatin, Rosuvastatin) are HMG CoA Reductase Inhibitors.Theyactbyblockingthecholesterolsynthesisthroughcompetitiveinhibitionintheliver.

Doyouknowthatbabiesdonothaveatherosclerosis?

TheirLDL-Cis<50mg/dl

CholesterolAbsorptionInhibitors

Ezetimibe: It inhibits the absorption of cholesterol selectively. It does not interfere with theabsorptionoffattyacidsandfatsolublevitamins.

NicotinicAcidDerivatives:Theyhelplowerbothtriglyceridesandcholesterolplasmalevels.TheyalsoaidinincreasingthelevelsofHDL-C.

Omega3fishoils:Theyhelpreducelevelsofcholesterolandtriglyceridesinplasma.

Fenofibrate:Theyhelplowertriglycerides.15%ofcholesterolisonlydecreasedbythismedication.

Bezafibrate: It helps suppress endogenous cholesterol synthesis, helping increase specific LDLreceptors,whichleadstoincreaseinLDLcatabolism.IthelpsincreaseHDL-C.

Gemfibrizole:Itisseentoreducelevelsoftriglyceride,cholesterolandLDL-C.ItalsohelpsincreaseHDL-C.

Dependingupontheindividualpatient,lipidloweringdrugscanhavesideeffects.Thereshouldbenoself-medication,adoctormustalwaysbeconsulted.

06.MythsAndFactFileMyth

Totalcholesterollevelbelow240mg/dlisacceptable.

Fact

Totalcholesterolshouldbebelow200mg/dl.LDL(badcholesterol)mustbebelow130mg/dl.Ifyousuffer from heart disease or diabetes, LDL should be below 100mg/dl.Also, if yourHDL (goodcholesterol)isbelow40mg/dl,itraisesyourriskofheartdisease.

Myth

Vegetableoilsaregoodfortheheart.

Fact

Allvegetableoilsmaynotbeheart-friendly.Palmandcoconutoilsarehighinsaturatedfatandcanraise cholesterol. ‘Trans-fats’, the partially hydrogenated vegetable oils found in baked foods andmargarine,arealsoknowntoraisecholesterol.Vegetableoilslikeolive,canolaandmustardcontainmainlymonounsaturatedandpolyunsaturatedfatsandaregoodinrecommendedamounts.

Myth

Goodcholesterol(HDL)canonlyberaisedbycertainmedication.

Fact

Goodcholesterol(HDL)canberaisedbyexercising(abouthalfanhourdaily),givingupsmokingand losingweight.Medication is recommended if, evenafterpractising the above, theHDL is stilllow.

High cholesterol need not be a curse. Careful diet management, proper exercise and a regulatedlifestylecanhelplowercholesteroltoacceptablelevelssothatyoucanleadafulfillinglife.