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Cholesterol: The good, the bad and the ugly

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You tend to hear a lot about cholesterol: HDL, LDL, VLDL. But what actually does all of it mean? Read on…

Cholesterol: A word that gets a lot of bad press, not all of it deserved. As in the typical Indian film, there is a good guy or HDL and the bad guy or LDL. Of course, there is a host of other characters too like VLDL and triglycerides.

High LDL cholesterol and low HDL cholesterol –– described as abnormal cholesterol levels –– are a major risk factor for heart disease and stroke. The bad news is that Indians are genetically vulnerable being born with narrower arteries. Indians have a two-three times higher incidence of coronary disease than North Americans or Western Europeans. Worse, in Indians, heart disease tends to occur a decade earlier and the incidence is also more severe.


Bad cholesterol is harmful on its own and for other reasons too, says Dr. Srikanth Sola, Consultant Cardiologist, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, and formerly Staff Cardiologist, Cleveland Clinic, U.S. “Bad cholesterol is like bad company –– undesirable in itself and leading to other problems.

It causes atherosclerosis or blockages in arteries. When blockages build up gradually, it can cause angina (chest pain on exertion or emotional stress) or improper blood flow to legs and abdominal organs. Sometimes, a piece of these blocks break off suddenly and occlude the entire artery causing a heart attack or stroke.”

A major factor in high bad-cholesterol is genes but others include being overweight, a sedentary lifestyle, stress and foods loaded in saturated fat.

Dr Anil Mishra, Medical Director and Senior Consultant Interventional Cardiologist, B.M. Birla Heart Research Centre, Kolkata, explains: “Despite a low-cholesterol diet, you can have high LDL because the body is genetically programmed to produce more especially if you have a family history. Occasionally, high LDL can be caused by a disease like hypothyroidism.”

If all preventive measures fail, people with high cholesterol counts — especially diabetics and post heart-attack/stroke patients — are prescribed medication.

However, increasing good cholesterol is a tougher job. As Dr. Mishra says: “There is effective medicine to reduce bad cholesterol but the same cannot be said of medicines to increase good cholesterol. I advise regular exercise, no smoking and eating nuts like almonds, walnuts and chestnuts. Walking three-four km a day and good diet are, perhaps, the best measures.”

So, taking medication alone is not enough; it must be accompanied by lifestyle changes.

Begin early

As always, prevention is better than cure. However, while most people get heart-health conscious in their mid-30s or early 40s, doctors warn that could be too late. Childhood is the time to begin. As Dr Mishra reveals: “The foundation for atheromatous plaque that causes blockages in arteries is laid in childhood and early teens.”

A cause for concern, therefore, is that today's children are getting less exercise thanks to TV, computer-games, and study-load. Also, many children and teenagers snack regularly on salted, deep-fried crunchy-munchies and eat fast-food/street-food heavy in salt and oil (often reheated oil, thus additionally dangerous).

Dr. Sola notes that childhood-obesity rates are increasing rapidly. “And obese children are at higher risk of developing heart disease, high cholesterol, diabetes, high BP, obesity-related problems earlier than normal-weight children.”

Children should eat lots of whole grain, fruits and vegetables with salty, deep-fried foods being occasional indulgences.

Work out regularly

And exercise a lot too. Dr. B. Sesikeran, Director, National Institute of Nutrition, Hyderabad, adds: “We don't recommend that children reduce intake of dairy products but definitely a good amount of regular physical activity in the form of outdoor games will be good for their future health.” Parents should serve healthy meals and set an example by indulging in sports/exercise and involve their children in them, says Dr. Mishra.

Ultimately, you decide your health. Our modern, stress-inducing environment and genetic vulnerability might be bad news. But a lot is in our own hands; we hold the key to good health.

Stay healthy

* First exercise. Dr Sola recommends brisk walking for at least 30 min, five times a week.
* Dr. Mishra and Dr. Sola recommend a vegetarian diet high in whole grain like brown rice, whole wheat atta, brown bread, sprouts, fresh fruit, vegetables.
* Avoid frying food; have it steamed, grilled or baked.
* The principal sources of bad cholesterol in a veg diet are ghee, butter, cream, cheese and whole-fat milk. In a non-veg diet the main sources are meat, mutton and eggs.
* For non-vegetarians, the best option is limited portions of fish. Avoid red meat and mutton.
* Egg white in moderation (not yolk) is okay for those whose cholesterol is under control but not for those with high cholesterol.
* Reduce weight especially around the abdomen.

Make a difference

Chennai-based, software professional M. Sujatha, (39)

A check-up after occasional breathless bouts showed her lipid profile counts on the border of abnormal. Additional risks were family history and being anxietyprone.

Immediate lifestyle changes were ordered, though not medication.

Sujatha complied immediately. For lunch and dinner she chose soups of leafy, green vegetables; salads minus dressing; fresh fruits, sprouts, boiled vegetables, dal; dry rotis; brown rice and low-fat curds. Non-vegetarian was grilled fish.

Breakfast was either cereals; veggie-stuffed parathas roasted in minimum oil; idlis/low-oil utthappams with sambar instead of the oil-drenched pickles and gunpowder she loved.

This diet was combined with a daily 40-minute walk (except Sundays), some meditation, and lots of laughing sessions with her kids. "After 10 months,in which I cheated only on eight days,HDL rose and LDL fell, both significantly," she says.

Mumbai-based businessman Deepak Rathod (51) He had cholesterol problems. Given additional risk factors of borderline diabetes, being overweight and heavy-smoking, he was recommended strong medication plus lifestyle changes.

He took only the medicine religiously but did little else. He reduced smoking instead of quitting and exercised just twice a week. Diet changes seemed too much deprivation. Two years later, he suffered a severe heart-attack.

"Now, I am a reformed man. I advise others to learn from my example and take preventive measures," Rathod says.

( Courtesy: The Hindu )


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