Lipid disorders are a group of medical conditions which refer to excessive levels of fatty substances in the bloodstream. These fatty substances include cholesterol and triglycerides. An excess of bad cholesterol increases your risk of heart disease and stroke .

Types of Lipids

Lipoproteins carry cholesterol in the blood.

• High Density Lipoprotein (HDL) Cholesterol - HDL cholesterol is commonly known as good cholesterol. It removes excess cholesterol and may prevent cholesterol build up in the blood vessels and lower your risk of heart disease.
  
• Low Density Lipoprotein (LDL) Cholesterol - LDL cholesterol is often called bad cholesterol. It can build up slowly in the inner walls of the arteries contributing to the formation of cholesterol plaques. Cholesterol plaques can block up arteries resulting in the hardening and narrowing of arteries (atherosclerosis).
  

If your total and LDL cholesterol levels get too high and HDL cholesterol too low, you will be at an increased risk of getting your arteries choked from deposits of cholesterol called plaque. 

The narrowing of the arteries over time, if left unchecked, reduces blood flow, slowly starving the heart muscle. In critical cases, the blood flow may be completely impeded, leading to the death of the heart muscle, which then leads to a heart attack. With a stroke, blood can't flow to the brain.

Triglycerides

Triglycerides are a form of fat from food; they are also made in the body from other sources of energy like carbohydrates. High levels can increase your risk of heart disease.

Causes & risk factors

Apart from genetic causes of lipid disorders, a diet high in saturated and trans fat will also increase cholesterol. All fats and oil contain a mixture of saturated, monounsaturated and polyunsaturated fats in different proportions. Some foods contain more saturated fat than others. It is important to limit your intake of saturated and trans fat.

There are 4 types of fat in your diet.

Saturated fats (SFA)

These are found mainly in animal foods, like butter, ghee, lard, cream, fat on meat, milk fat and cheese. Vegetable fats like palm kernel oil, palm oil and cocoa butter are rich sources. Too much SFA raises total and LDL cholesterol.

Trans fats

These are formed during the hydrogenation of unsaturated oil a commercial process to harden oil for production of fats like shortening and hard margarine. Hydrogenation causes the oil to be more saturated. Too much trans fats raises blood cholesterol.

Polyunsaturated fats (PUFA)

These are found mainly in nuts, grains and seeds such as sunflower, soya bean, corn and sesame. Some oily fish such as sardine, salmon, mackerel and herring also contain high amounts of polyunsaturated fat called omega-3 fatty acids, which makes blood clot less easily and reduces the risk of stroke. PUFA helps to lower blood cholesterol.

Monounsaturated fats (MUFA)

These are present in olive, canola, peanut and sesame oils, almonds and avocados. Studies have shown that MUFA can lower LDL-cholesterol and increase HDL-cholesterol.

Signs & symptoms

Lipid disorders are usually silent. They are usually picked up during screening or during routine blood tests for other medical conditions. Otherwise, they may only be diagnosed when the complications arise e.g. angina, heart attacks, stroke.

Complications

When there is too much bad cholesterol in your blood, the excess cholesterol gets deposited in the walls of your blood vessels. These deposits cause narrowing and hardening of the blood vessels or atherosclerosis. This can lead to slowing down or blockage of the flow of blood, resulting in

• angina (chest pain) and heart attacks
  
• stroke
  
• peripheral artery disease (narrowing of the blood vessels of the limbs).
  

Lowering of abnormal LDL cholesterol level is most important in the prevention of the above diseases.

Screening & diagnosis

If you have no risk factors (e.g. a family history, diabetes ) for lipid disorders, you should start going for a fasting lipid blood test at 40 years of age. If the blood test is normal, you should continue to screen once every 3 years.

If you have risk factors, you should check with your doctor and start screening for lipid disorders earlier.

Treatment

Know your targets

Your doctor will help you work out your personal target for your lipid disorder. Your LDL cholesterol target will vary according to your risk for developing coronary heart disease. Please discuss with your doctor.

Go for regular check-ups

Follow your doctors advice and lead a healthy lifestyle

Be diligent with your medication

If your cholesterol cannot be controlled by diet and physical activity, your doctor may prescribe cholesterol - lowering medication(s).

Remember medication is not meant to replace a healthy lifestyle

So take your medication in addition to making changes in your lifestyle.

Self-care

• Control your weight to keep your BMI less than 23kg/m2 but not below 18.5kg/m2. Reducing your excess weight will help to lower your total and LDL-cholesterol and triglyceride level.

  • Research has highlighted that being overweight or obese and increasing abdominal girth triggers several biochemical changes in the body, increasing the risk of high blood cholesterol, hypertension and diabetes. All these medical conditions increase the chances of damaging arteries, clogging them up and precipitate a heart attack.

    So, keep a check on your body weight. If you are overweight, eat a little less and exercise a little more, to drop off a few pounds. So, while you may not get to the ideal weight for your height very fast, even a little weight loss is helpful.

• Exercise for 30 minutes for 5 or more days per week. Lack of exercise is associated with a low HDL-cholesterol level. 
  

• Limit alcohol intake to no more than 2 standard drinks per day.
  

  • 2/3 small can of beer (220 ml)
    

  • 1 glass of wine (100ml)
    

  • 1 nip of spirit (30ml)
    

• Don't smoke.
  

• Limit intake of saturated fat

  • A diet high in saturated fat increases the level of LDL cholesterol in the body.

    Animal fat is one of the main sources of saturated fat. So, when you do eat meat or poultry, get the leanest portion. Remove visible fat and poultry skin as well.

    Select dairy products that are lower in fat – low fat or non-fat (skimmed) milk, yogurt and cheese are also healthier choices compared to whole or full cream varieties.

    Palm-based "vegetable oil" can contain a lot of saturated fat. When eating out, go for dishes prepared with healthier oil and cut down on deep-fried food too.

• Minimise trans fats

  • Trans fat is formed when vegetable oils undergo hydrogenation, which is a commercial process to harden oil for production of fats like shortening and hard margarine. Trans fat raises LDL-cholesterol and reduces HDL-cholesterol in the body.

    Food containing trans fat include pastries, cakes, cookies and products made with vegetable shortening and hydrogenated or partially hydrogenated oils. So, watch out for trans fat in your food. Read food labels and look out for the ingredients used.

• Use healthier unsaturated oils

  • Replacing saturated fats and trans fats with unsaturated fats helps lower blood cholesterol, especially LDL-cholesterol. Here are two families of healthy unsaturated fats you should include in your diet:

  • The Monounsaturates: Some vegetable oils (e.g. olive oil, canola oil and peanut oil), most nuts (e.g. almonds, cashew nuts and hazelnuts) and avocados are great sources of monounsaturated fats. These oils tend to lower total and LDL cholesterol levels in the body. Use small amounts in cooking or to add variety to your diet.

  • The Polyunsaturates: This group of fats also provide essential fats that bring unique benefits to heart health. There are two main types of polyunsaturated fat, namely omega-3 and omega-6 fats.

    • Omega-3 fat reduces blood clotting in the arteries and protects them from hardening. Fish such as salmon, sardine, longtail shad (terubok)and Spanish mackerel (tenggiri papan) are examples of good sources of omega-3 fat.

    • Omega-6 fats lowers total and LDL cholesterol levels in the blood. Good sources of omega-6 fat include vegetable oils (e.g. corn oil, soybean oil and sunflower oil) and seeds (e.g. sunflower seeds and sesame seeds).

• Reduce cholesterol intake

  • In the diet, cholesterol is only found in food or beverages of animal origin and not plant food. Fruit, vegetables, grains and nuts do not contain any cholesterol

    Our body also makes cholesterol because it is needed for health. So, eating a lot of food naturally rich in cholesterol will challenge your body to moderate the amount of cholesterol in your blood. 

    Some lucky individuals have livers that can cut back the amount of cholesterol produced when challenged with a high cholesterol diet. However, others are not so genetically blessed and the liver continues to churn out cholesterol, adding to all the cholesterol absorbed from the diet, flooding the blood vessels with more of the plaque-building material.

    Food high in cholesterol include organ meats (e.g. liver, kidney and brain) egg yolks, and shellfish. Moderate your intake of organ meats and shellfish, and have no more than 4 egg yolks per week.

• Include whole grains, fruit and vegetables

  • Including wholegrain food (e.g. brown rice, wholemeal bread and oats) vegetables, fruit and beans in your diet will help to lower blood cholesterol levels. Many of these food are good sources of soluble fibre, which have the ability to bind cholesterol in the gut, reducing absorption and increasing excretion. Such food are also rich in vitamins, minerals and phytochemicals which all work together to reduce the risk of heart disease.