Lipids are a collective term meaning the fat component in our blood. They comprise cholesterol and triglycerides.
Lipids are actually made by our own body from carbohydrate even if we do not eat them. They are essential components of cell membranes and are used to make many steroid hormones such as vitamin D, sex hormones and cortisol.
However, excess eating will cause levels to rise such that they get accumulated in blood vessel walls, a process called atherosclerosis. Food items such as animal fats are extremely rich in cholesterol. Many Singaporeans already avoid these and wonder why their cholesterol levels are still high. This is because the body makes excess cholesterol when we eat in excess.
Dietary cholesterol is found only in foods of animal origin. Plant foods may contain oils e.g. avocado, coconut, palm oil, peanuts etc but do not have cholesterol. Oils can also be used by the body to manufacture cholesterol.
Some people are also predisposed with a family history of a tendency to higher cholesterol levels.
Lipid blood tests include total cholesterol which consists of LDL, the ‘bad cholesterol’ that can harm, and HDL or good cholesterol which can limit the bad effect of LDL. There is another item, triglycerides, blood fat which can also cause atherosclerosis and needs to be lowered if it is too high.
While total cholesterol is a good screening test, it is actually a combination of good and bad cholesterol together. The LDL level is what doctors use when ordering treatment. Total cholesterol should not exceed 5mmol/L (200mg/dL) and LDL 4 mmol/L for normal people, about 3 mmol/L for those with conditions such as hypertension and 2.6mmol/L for those already with heart disease.
HDL should be more than 1mmol/L and triglyceride not exceeding 2mmol/L. Lipid tests include the LDL/HDL ratio which indicates total risk balancing good and bad. This should be 3.5 or less.
Although a high result itself will not cause symptoms, over time the cholesterol will cause atherosclerosis and accumulate in lipid plaque formation along vessel wall linings which block up blood vessels.
Blood vessel blockages in the heart will lead to heart attacks, and in the brain to strokes. When a lipid laden plaque bursts or ruptures, this can lead to a sudden, catastrophic and devastating event. Controlling lipid levels is therefore an important strategy to reduce these diseases.
Limit total fat intake, high cholesterol foods and carbohydrate. Keep total fat intake between 20 to 35 percent of calories for adults. Make choices that are lean, low fat or fat-free. Choose fish, skinless poultry and lean meat. Avoid animal fat.
Certain food items, apart from fat, known to contain higher cholesterol, include shellfish, crabs, lobster, egg yolk, squid and prawns. While it is prudent to consume these in moderation, one need not abstain totally. Total dietary moderation is more effective than omitting one or two items but still overeating overall. For example, it is okay and even good for growing children to eat an egg a day.
Other preventive measures:
If your blood lipid levels do not achieve the desirable range despite lifestyle modification, you may need cholesterol-lowering medication. Examples are statins like simvastatin, lovastatin and atorvastatin for cholesterol and fibrates such as gemfibrozil and fenofibrate for triglycerides. These drugs are taken under medical supervision and monitoring as a minority of patients may develop muscle aches, muscle inflammation and liver inflammation, requiring drug regime adjustments.
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