A Family Doctor's Tale - HIGH CHOLESTEROL

DOC I HAVE HIGH CHOLESTERPL

High Cholesterol is the presence of raised amount of total cholesterol in the blood (normal  blood total cholesterol = 200mg/dL).


Cholesterol is a fat molecule in the body which is needed for many normal body functions.


It is produced mostly in the liver and is present in the cell walls and membranes of the brain, nerves, muscles, skin, heart , intestine and of course liver.


Cholesterol is used by the body to make the body's hormones(male and female) and bile acids used to digest fats.


It is important to remember that female and male hormones requires cholesterol to as an ingredient in their production.
Without cholesterol the adolescent will not have adequate hormones for their puberty.


20-30% of the cholesterol comes from the food that is eaten.


1.A diet high in saturated fat mainly animal fat, butter, lard


2.Trans-fatty acids in fast food and processed foods


3.Brains of pigs, sheep, fish are particularly high in lipoproteins and fat


4.Liver, skin fat, etc


5.Egg yolk and products containing egg yolk like fish roe, cakes, ice cream,


6.full cream milk


7.Peanut butter, peanut oils, coconut oil


Genetic factors - Familial hypercholesterolemia has been known for high cholesterol in families.


It does not mean that a thin person will have low or normal cholesterol. Some of them have very high cholesterol.


The family doctor can do a blood test usually on a fasting patient (no food from the night before the test):
A blood test for lipid profile measures :


1.total cholesterol


2.LDL (low-density lipoprotein [the bad cholesterol]),


3.HDL (high-density lipoprotein [the good cholesterol])


4. triglycerides—another fatty substance in the blood.


High lipid readings are when the
1.total cholesterol in your blood is more than 200mg/dL,


2.LDL cholesterol is more than 130 mg/dL (130-159 is borderline high; 160 is high; 190 is very high).


3.HDL, the "good cholesterol," should be around 40 mg/dL or greater.
With HDL, the higher the number, the better, and 60 mg/dL is protective against heart disease.


4.Triglycerides is more than 200 mg/dL


The danger of high blood cholesterol are:
The excess cholesterol will then be deposited in the arterial walls causing narrowing of the arteries and reducing the blood flow to the heart, kidney and the brain.


Therefore any thickening of the arterial wall of blood vessels to the heart, kidney or brain as a result of deposit of cholesterol deposited in the wall of these arteries will reduce the flow of nutrients and oxygen to the heart, kidney or brain resulting in heart attack, kidney failure or stroke.


The family doctor will treat high cholesterol:
1.Dietary  and lifestyle modification


2. Medications:


1. statins (HMG-CoA reductase inhibitors) has been found to reduce high cholesterol fairly fast especially the more potent ones such as Lipitor and Crestor.
However they also have more side effects particularly damage to the liver (hepatitis) and muscles (myopathy)


2.fibrates is preferred especially if the triglycerides is high or if the patient has liver problem.
Lipanthyl (a fibrate) has been found to be as effective if not more effective than statins.
Side effects are myopathy.


3.Combination treatment of statins and fibrates are more effective but have more side effects such as increased myopathy and rhabdomyolysis in addition to hepatitis.


4.ezetimibe, niacin, bile acid sequestrants, plant sterol-containing products have also been used together with statins for better effect.


Treatment Regime:
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1. Total cholesterol is less than 250mg/dL: Diet and weight control is sufficient.


2.Total cholesterol is 250-300mg/dL: Diet and weight control is a must.

If associated risk factors such as high blood pressure, diabetes, heart disease, obesity and smoking is present, drug therapy is necessary.


3:Total cholesterol is more than 300mg/dL:
drug therapy together with diet and weight control is required.


The family docor will advise on prevention of high cholesterol:


Diet Control
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1. Reduce intake of fatty meats
   Eat lean meat and poultry
  
2. Avoid organs of animals especially liver, brain
   Eat more beans, peas or bean curd


3. Avoid seafood especially prawns, crabs, lobsters, squids'
   Take more fish  
  
4. Avoid deep fried food
   Take more steamed food and non-creamy soups
   
5. Avoid lard and butter  
   Take margarine or polyunsaturated vegetable oils
   
6. Avoid creams, coconut milk, cakes
   Eat Fish oils (omega 3) , garlic
  
7. Avoid alcohol, excess rice, jams, sugars, sweets
   Eat more fruits and vegetables
  
Weight control:
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Reduce the calories in food

Exercise:
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Mild to strenous exercise

Stress:
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Avoid stress which can sometimes make you eat more.