Health Awareness blog

Nowadays, people are educated enough to worry about their own health. They are more concern about having a good health because they know healthy life will increase their quality of life and people around them. One question that frequently been asked today in the clinic is, “May I check for my cholesterol level doctor?”

What is your cholesterol level? Are you concern enough about your body? 

CHOLESTEROL is a fatty substance which is essential for life. It is needed for a healthy nervous system, good digestion and to produce important hormones in the body. So, we know that cholesterol is not totally a bad thing. However, too much cholesterol in the body will give us trouble.

Research has been done to show the importance and the ugly side of the cholesterol. It shows that a raised of blood cholesterol level is one of the main risk for heart disease. Cholesterol can build up on the blood vessel walls and contributes to a narrowing or hardening of the arteries.

So, where does cholesterol come from? 

Most cholesterol is made in the body by the liver. It is known as ‘blood cholesterol’. This mean that the body can provide all the cholesterol it needs.

But that’s not all, cholesterol also can be found in certain food. It is known as ‘dietary cholesterol’. Foods rich in cholesterol include egg yolks, offal (liver, kidney), shellfish (prawns, shrimp, lobster, mussels) and fish roe. Fats that contained in the food are a mixture of saturated and unsaturated fat. Unsaturated fat can be either monounsaturated and/or polyunsaturated.

The fact that you have to know is most saturated fats are converted to cholesterol in the body. Well, most of the time the body can maintain a healthy level of blood cholesterol however, the balance can goes wrong. This is mainly due to too much consumption of food contained fats (especially saturated fat). This will lead to increase in blood cholesterol.

WHAT IS THE RELATIONSHIP BETWEEN HIGH CHOLESTEROL AND RISK OF HEART DISEASE OR STROKE?

The relationship is very complex. It helps if you understand how cholesterol travels through the body. Cholesterol is insoluble in water travels in the bloodstream. To transport cholesterol to various cells, it is combined with a ‘carrier protein’ to form fat/protein mixtures called lipoproteins.

TYPES OF CHOLESTEROL 

There are 5 principal types of lipoprotein particles are found in the blood. However, to make it less complicated, I will only discuss about 2 main forms of lipoproteins. For those who are interested, I will discuss about the other lipoproteins in another section. The 2 main ones are:

• LDL  cholesterol (low density lipoprotein) – often called “Bad” cholesterol
• HDL cholesterol (high density lipoprotein) – often called “Good” cholesterol

 Low Density Lipoprotein

• LDL transport cholesterol from the liver through the arteries to other part of the body where it can be used.
• It may attach inside the walls of the arteries and cause hardening and narrowing. That is how it gets its name, ‘bad cholesterol’.
• What will happen next if no action taken? Yes, you are right, the arteries will block!
• This can cut off or slow down the blood supply to the heart and other important organs in the body like the brain. This may lead to heart attack and stroke later on.

 High Density lipoprotein

• The main principal for this type of lipoprotein is to collect excess cholesterol and transport it back to the liver where it will be eliminated. Hence it’s get it’s name, the “good cholesterol’.
• A high HDL level will protect against heart disease.

OPTIMAL VALUES FOR CHOLESTEROL  

EFFECTS OF CHOLESTEROL 

• Reduces blood supply to the organs
• Cholesterol gets deposited in the blood vessels in the form of plaques
• This will narrows the blood vessels
• Narrowing of the blood vessels lead to blockage in right coronary artery
• Consequently lead to stroke and heart disease

RISK FACTORS FOR HIGH CHOLESTEROL 

• Smoking
• High blood pressure
• Diabetes
• Hereditary
• Being overweight
• Eating habit of foods rich in saturated fat

MANAGEMENT    

• Fiber-rich diet
• Exercise
• Quit smoking
• Regular medications ( if you have hypertension, diabetes mellitus or other chronic medical illness)
• If you cannot control your cholesterol level by any above, some medications will be prescribed to you by your family doctor to help you reduce the blood cholesterol.

FACTS 

• 1% reduction in body cholesterol reduces the chances of stroke or heart attack by 2%.
• To reduce that risk of stroke or heart attack, it is important to keep LDL cholesterol as low as possible and HDL cholesterol as high as possible.

 References:

1. Clinical Medicine by Kumar and Clark. 4^th edition.
2. Irish Heart Association Fact sheet.
3. Learn and live. American Heart Association. 2004.
4. http://www.cholesterol-count.co.uk
5. http://www.mayoclinic.com
6. The Healthy Heart Kit. Health Can. 1999.
7. Third Report of the National Cholesterol education Program (NCEP). NIH. 2002.
8. Pfizer health fact sheet.

• Reduce stress, learn how to relax
• Control diet and maintain an ideal body weight
• Eat less salt. For suggestion, try to take pepper, herbs and spices for seasoning.
• Reduce sugar in the diet. Add more sugar in your smile.
• Stay away from alcohol! However, if you are an alcoholic, keep within recommended limits. 
• Regular exercise. Be physically active every day. Try walking, cycling, jogging, swimming or any other aerobic exercise. Build up regularly to about 30 minutes, preferably for most days of the week.
• Quit smoking. If it is too hard, try to reduce smoking.
• Occasionally, do self monitoring of blood pressure, blood sugar level and cholesterol level
• Eat more fruits and vegetables.

  Recommended limits for alcohol: 

Men – 21 units per week

Women – 14 units per week

A glass of beer/wine = 1unit

A measure of spirits = 1 ½ unit

It means that no more that 2-3 nits a day with some alcohol free days. (Try to have food with alcohol)

* For muslims, alcohol is ‘haram’ and totally not allowed. We believe that alcohol will cause more harm than good physically and mentally. Alcohol may lead to multi organ damage and will lead to social problems. So, I personally advice all of us to stay away from alcohol. It is always wise to stay sober.

 Body mass index (BMI) classification: 

BMI = weight / (height) ²

Weight in kg and height in meters

Normal range = BMI 20-25

Grade 1 obesity = BMI 25-30

Grade 2 obesity = BMI 30-40

Grade 3 obesity = BMI >40

 Sample menu: Breakfast

High fiber cereal with low fat milk

Whole meal bread or toast

Fruit juice or fresh fruit

Tea or coffee

 Mid morning

Fruit or whole meal bread or scone

Tea, coffee, water or diet drinks

 Lunch

Small serving of cheese, egg, lean meat, poultry or fish

Large serving of raw or cooked vegetables

Whole meal bread or roll

Low fat yoghurt or glass of low fat milk

Fresh fruit

Tea, coffee, water

 Mid afternoon

Fresh fruit

Tea, coffee or diet drinks

 Main meal

Fish, chicken, lean meat or low fat vegetarian alternatives (moderate serving)

Large serving of raw or cooked vegetables

Potato, rice or pasta

A glass of low fat milk

Fresh fruit, cooked fruit, tinned fruit in own juice

Fruit based dessert or low fat milk pudding

Tea or coffee

 Supper

Tea or diet drinks

Whole meal scone/bread

  Reference:

1.      Irish Heart Foundation fact sheet

2.      Malaysian Ministry of Health fact sheet

3.      Oxford Handbook of Clinical Medicine