Managing Lipid Problems & Metabolic Syndrome

Dr Daniel Chun Hang WAI, Consultant, Department of Endocrinology,
Singapore General Hospital

Lipid problem

Lipid consists of triglyceride, or fat in our body, and cholesterol. Cholesterol is divided into good cholesterol (HDL-cholesterol) and bad cholesterol (LDL-cholesterol). A high LDL-cholesterol level increases the chance of heart attacks and strokes, but a high HDL-cholesterol level reduces it.

18% of all Singaporeans have high cholesterol. Together, heart attacks and strokes cause more than a quarter of all deaths in Singapore. Fortunately, they can be prevented. Research has shown that besides medication, a proper diet and regular exercise can improve our lipid profile and prevent heart attacks and strokes.

However, some patients develop problems from medications, or cannot control their cholesterol despite conventional treatment. On the other hand, many people are confused by the many contradictory dietary recommendations we come across every day, and many of those come from the West and are difficult to apply to our local context. In addition, very few Singaporeans do regular exercise, because of the demand of work, family and many leisurely pursuits. Some of us have medical conditions like high blood pressure, diabetes, arthritis, back pain among others, which make it difficult, painful or even potentially dangerous to embark on exercise. Others worry about possible injury with exercise as they have not tried it for many years.

Metabolic Syndromes

The metabolic syndrome affects another 18% of patients. It comprises of several related conditions such as central obesity, low HDL-cholesterol, high triglyceride, high blood pressure and high fasting blood sugar (table 1).

Patients with the metabolic syndrome are predisposed to diabetes, heart attacks and strokes. Contrary to common belief, they need not be very obese to develop the metabolic syndrome. They also commonly suffer from fatty liver, obstructive sleep apnea and polycystic ovarian disease. These conditions, together with the metabolic syndrome, need to be treated with aggressive dietary and exercise programs that tackle the underlying problem of insulin resistance.

Metabolic Syndrome Definition (American Heart Association) 3 out of the following 5: • Central Obesity (Waist circumference >90 cm in males and >80 cm in females) • Raised Triglyceride level: = 1.7 mmol/L, or on specific treatment for this • Reduced HDL cholesterol: < 1.03 mmol/L in males and 1.29 mmol/L in females, or on specific treatment for this • Raised blood pressure: systolic BP = 130 or diastolic BP = 85 mm Hg, or on antihypertensive treatment • Raised fasting plasma glucose (FPG) = 5.6 mmol/L or  diagnosed type 2 diabetes Table 1

Studies have shown that a structured program is much more effective in helping patients achieving weight loss and better health than standard advice to eat less and exercise more. In fact, a structured dietary and exercise program can reduce blood pressure, blood sugar, waist line, triglyceride and increase HDLcholesterol thus tackle all the aspects of the metabolic syndrome. It can also reduce liver damage in fatty liver, reduce the severity of obstructive sleep apnea, and normalise menses in polycystic ovary disease.

At the LIFE Centre, we take care of people with all these difficulties and concerns. Our team of doctors, dieticians and physiotherapists are highly qualified to provide holistic care for patients with lipid conditions in a safe manner. Patients can enroll in our dietary lipid program where besides one-to-one counseling and group therapy sessions, they also go for a guided supermarket tour with our dietician to learn healthy grocery shopping, as well as attend our cooking class to learn healthy and tasty cooking. Patients can also enroll in our exercise lipid program where their fitness is first assessed by a treadmill stress electrocardiogram test conducted by our physiotherapist, and an individualized exercise program is then prescribed. Patients are closely supervised during their exercise by the physiotherapists through wearable heart rate monitors. Very high risk patients can exercise while being monitored with an electrocardiogram. Our physiotherapists are well versed in guiding patients with different medical conditions to exercise. Signs on the electrocardiogram suggestive of blockages of the blood vessels in the heart are picked up and medical care arranged. Patients with high blood pressure have their blood pressure monitored before, during and after exercise. Patients with diabetes have their blood sugar monitored likewise. Patients with knee arthritis have a modified program which does not put further strain on their knees; rather, the muscles around their knee are strengthened to alleviate the pain.

Programs
1. Dietary Lipid/Metabolic Syndrome Program
    Dietary management lowers LDL-cholesterol, triglycerides,
    waistline and weight.
    This 6 month program includes:
    - 2 individual consultations with dietician
    - 2 group sessions on healthy eating
    - 1 supermarket tour for real-life learning
    - 1 healthy cooking demonstration to cook healthy
       and delicious food

2. Exercise Lipid/Metabolic Syndrome Program
    Exercise decreases triglycerides, waistline and weight, but
    increases HDL-cholesterol.
    This exercise program allows patients to adopt an active
    lifestyle safely. It includes:
    - 18 exercise sessions (3 times a week)
    - Free fitness testing with exercise treadmill ECG
    - Individualized exercise program starting slow and build up
    - Modified program for those with joint pain or medical conditions

For appointments or programme details, contact :  Tel : 6326 6697

Those who need specialist medical care can consult Dr Daniel Wai, our consultant lipid specialist and accredited endocrinologist who has a research interest in cholesterol metabolism.