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High Blood Cholesterol

Cholesterol is a fat-like, waxy substance that is necessary for normal body functions such as the production of hormones, vitamin D and to digest food. It comes from two sources, where the liver makes most of the cholesterol we need, while the food we consume may also contribute to our cholesterol level.

Though we need it to stay healthy, an elevated cholesterol level can raise our risk of cardiovascular diseases (CVDs), which is the leading cause of death globally and in Singapore.  


Symptoms of high blood cholesterol

Based on the Ministry of Health’s National Health Survey, 1 in 2 Singaporean adults has borderline high to high blood cholesterol.1 Similar to other conditions such as high blood pressure and high blood glucose, you would only know that you have high blood cholesterol upon screening. Hence, as a rule of thumb, it is recommended to go for your health screening at least once every 3 years if you are aged 40 years and above. 2


For a healthy individual, your blood lipid levels should be as follows:


Desirable Level

Total cholesterol

< 5.2 mmol/L

HDL-cholesterol

< 3.4 mmol/L

LDL-cholesterol

1.0 to 1.5 mmol/L

Triglycerides

< 2.3 mmol/L


Generally, there are two types of cholesterol, the good and bad cholesterol.
LDL-cholesterol is the bad cholesterol which sticks around the artery wall forming a fatty build-up, which cause blockages and reduce blood flow to the heart. On the contrary, HDL-cholesterol is the good cholesterol which can help to remove bad cholesterol from the arteries.

Triglycerides is a type of fat made by our body from the food we eat (e.g. high fat, high sugar and alcohol). Overweight individuals tend to have higher level of triglycerides in their blood. 

Excessive triglycerides with elevated LDL-cholesterol can increase your risk of CVDs.


Tips to lower blood cholesterol

Blood cholesterol can be lowered by making some changes to your lifestyle 


Be active

Research has shown that doing more than 150 minutes of moderate-to-vigorous physical activity per week would reduce an individual risk to coronary heart disease by 30 percent. 3 In fact, evidence have indicated that an individual who have existing risk factors for CVDs (e.g. high blood cholesterol) would be at a lower risk to premature death as compared to inactive individual who does not have any risk factors for CVDs.

If you have not been working out, it is definitely beneficial to get moving as every minute that you engage in physical activity would be helpful to reduce your risk to CVDs significantly, even if you have existing disease.


Quit smoking

It is evident that tobacco use (e.g. smoking) is linked to CVDs and cancer. In particular, it increases the risk of death from undiagnosed coronary heart disease by 300 percent. Smoking  promotes CVDs as it damages the blood vessel’s lining, promotes fatty deposits in the arteries, increases clotting by raising bad cholesterol (LDL-cholesterol) & reducing good cholesterol (HDL-cholesterol) and promotes coronary artery spasm. 4



Simple eating habits to lower blood cholesterol


1. Limit saturated fat intake

Excessive consumption of saturated fat increases the level of LDL-cholesterol in your body. To minimise your saturated fat intake, choose lean meat, remove visible fat & poultry skin, choose low-fat/non-fat options and minimise the intake of palm-based “vegetable oil”.


2. Avoid trans fat

Every 4g of trans fat you consume doubles your risk to CVDs. To minimise your trans fat intake, be mindful on your consumption of pastries, cakes, cookies, commercially deep-fried food, products made with vegetable shortening and hydrogenated or partially hydrogenated oils. 


3. Choose unsaturated fats

Replacing saturated fat and trans fat with unsaturated fats will help to lower your blood cholesterol.

Monounsaturated fat: Olive oil, canola oil, peanut oil, most nuts and avocados are great sources of monounsaturated fat, which helps to lower total and LDL-cholesterol in the body.

Polyunsaturated fat: There are two main types of polyunsaturated fat, namely Omega-3 and Omega-6 fats. 


Omega-3 reduces blood clotting in the arteries and protects them from hardening. Oily fishes such as salmon, sardines, Spanish mackerel, tuna and seeds (e.g. chia seeds, sacha seeds) are good sources of Omega-3. Omega-6 helps to lower total cholesterol and LDL-cholesterol. Vegetable oils such as corn oil, soybean oil and seeds such as sunflower seeds and sesame seeds are good sources of Omega-6. 

Our body requires both Omega-3 and Omega-6, where having a diet with higher Omega-3 : Omega-6 ratio is beneficial for our heart health. As we can easily attain Omega-6 from food (e.g. food cooked with vegetable oils such as corn oil, soybean oils, etc), it would be ideal to incorporate more Omega-3 in our diet. 

Tip: Instead of tossing your salad with creamy dressing, toss it lightly with unsaturated oils (e.g. olive oil, chia seeds oil, sacha inchi seed oil) for an additional boost of healthy fats.


5. Choose wholegrains

Research has shown that consuming more wholegrains (e.g. brown rice, quinoa, oats, millet, etc) can reduce the risk of chronic diseases such as CVDs, diabetes and certain cancer. Based on a meta-analysis consisting of 24 studies, it was observed that wholegrain diet lowered total cholesterol levels by an average of 4.6 points. 6


6. Have a variety of colourful fruit and vegetables

Having a variety of colourful fruit and vegetables can help to reduce your risk towards CVDs and colon cancer as it contains high amount of soluble fibre that can help to reduce the absorption of cholesterol and lower LDL-cholesterol (bad cholesterol) in your blood.

Tip: Leave the skins on to maximise your fibre intake


References


  1. Ministry of Health. 2010. National Healthy Survey. [ONLINE] Available at: https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/reports/nhs2010---low-res.pdf . [Accessed 25 March 2021].


  1. Ministry of Health. 2021. The ABCs of Health Screening. [ONLINE] Available at: https://www.healthhub.sg/live-healthy/403/abcs_of_health_screening. [Accessed 25 March 2021].


  1. Mora, S., Cook, N., Buring, J. E., Ridker, P. M. & Lee I. 2007.  Physical Activity and Reduced Risk of Cardiovascular Events. Circulation, 116, 2110-2118


  1. Heart UK. 2010. Smoking [ONLINE] Available at: https://www.heartuk.org.uk/healthy-living/quit-smoking . [Accessed 25 March 2021].


  1. Iqbal MP. 2014. Trans fatty acids - A risk factor for cardiovascular disease. Pak J Med Sci, 30(1), 194-197.


  1. Hollænder PL, Ross AB, Kristensen M. 2015. Whole-grain and blood lipid changes in apparently healthy adults: a systematic review and meta-analysis of randomized controlled studies. Am J Clin Nutr. 102(3), 556-72. 


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