After a cousin died of cardiac arrest in his 40s, Shreyas N Murthy, a Bengaluru-based theatre artist, went for a health check-up. When the report came back, it showed elevated levels of LDL cholesterol and triglycerides. Subsequent tests only returned higher numbers.
“I had no idea about this problem,” he says. “I was worried about this for several days until a relative [also a doctor] gave me a wake-up call, advising me to make small changes every day and improve my lifestyle.”
Cholesterol is a type of fat which exists in the blood. It helps the body build cells, make vitamins and form tissue and hormones. Cholesterol is either formed in the liver or is obtained from foods from animals such as meat and dairy products. If acquired from the latter source, it is known as dietary cholesterol.
Although cholesterol has several uses and functions, too much of it is not good for the body. Among its types, low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL) cholesterol are considered to be more harmful than high-density lipoprotein (HDL) cholesterol, otherwise known as ‘good’ cholesterol.
“High levels of good cholesterol or HDL protects the body from cardiac events,” says Dr Prasanna Kumar, endocrinologist and diabetologist, Centre for Diabetes & Endocrine Care, Bengaluru. “High cholesterol is a risk factor for cardiac diseases and cerebrovascular diseases. It is also bad for the liver.”
Cholesterol travels across the body in the blood. When the cholesterol level in the blood is high, cholesterol can enter the artery walls, leading to plaque formation – atherosclerosis. This in turn can lead to several heart diseases such as coronary artery disease and peripheral artery disease.
Speaking about identifying signs of cholesterol, Dr Kumar says, “Unfortunately, high cholesterol doesn’t have any symptoms. You can never say when someone develops high cholesterol. At birth, cholesterol levels are normal except in the case of familial hypercholesterolemia (an inherited disorder that leads to significantly high levels of LDL and total cholesterol). Those who are prone may take months or years. Sometimes, the numbers are normal for years — until suddenly, in just a few months, they may reach a dangerous level.”
Cholesterol from food is deposited in the liver; so, high cholesterol can also worsen non-alcoholic fatty liver disease to non-alcoholic steatohepatitis, which can eventually turn into cirrhosis. Other than the heart, high cholesterol is also associated with diabetes, obesity and other metabolic disorders.
Managing cholesterol with exercise
“The body synthesises enough good cholesterol according to its need, so we must give importance to reducing bad cholesterol. With improper lifestyle and food intake, the cholesterol content in the blood increases,” says HS Prema, consultant dietitian and nutritionist. “If the person is obese, weight must be reduced first. And to reduce weight, reduce the caloric intake.”
The definition of appropriate weight varies from person to person. According to clinical standards, body mass index (BMI) is the indicator for appropriate weight. BMI is a measure of body fat based on height and weight. Prema also mentions central obesity, which is more important than just total body weight. This involves measuring the circumference of the waist at the greatest protrusion and calculating the waist-to-hip ratio.
Any exercise regime should be within an individual’s cardiac limits, advises Dr Kumar. “Exercise isn’t uniform; it is different across adolescence, middle and old age, for those with heart disease and without, those with comorbidities and without.”
He continues with an example of prescribed exercise. In the case of people with diabetes, for instance, the American Diabetes Association recommends 150 minutes of moderate exercise every week, with 30 minutes for five days a week.
With or without obesity, physical activity is a must for reducing cholesterol levels. “Walking, yoga or swimming, every day of the week will definitely go a long way in managing cholesterol,” Prema says.
Tackling high cholesterol with diet
Acting on his doctor’s advice, Murthy followed a diet (no rice, ragi, boiled vegetables, etc), an exercise regime (one hour of cardio every day — walking, jogging, cycling, badminton, etc) and lifestyle changes (early dinners, 30-minute walks after dinner).
Talking about how he deals with food cravings, Murthy says, “When I develop a sudden craving for a food item, I go out and have just a piece of it outside. I don’t restrict myself too much, but I don’t store anything at home because it makes me want to reach for them often. I cook my own food.”
A 2019 science advisory by the American Heart Association recommends healthy dietary patterns such as Mediterranean-style and Dietary Approaches to Stop Hypertension (DASH) which are inherently low in cholesterol. These diets are characterised by:
- emphasis on fruits, vegetables and whole grains
- low-fat or fat-free dairy products
- lean protein sources, nuts, seeds and liquid vegetable oils
“Among non-vegetarian food, egg and meat, especially red meat, should be avoided. Marine food is not bad, as it contains N3 and N6 fatty acids [dietary fatty acids regulating LDL and good for heart health],” Prema says.
According to a 2013-14 report by the National Health and Nutrition Examination Survey, meat contributed to 42 per cent while eggs contributed to 25 per cent of the total cholesterol intake.
Vegetable oils like groundnut oil, mustard oil and sesame oil are good sources of polyunsaturated fats. Along with these, soluble fibres, detoxing substances and flavonoids (fruits, vegetables, grains, bark, roots, stems, flowers, tea and wine known for their beneficial health effects) are some additions to the diet which can help contain cholesterol.
An often-ignored factor which influences blood cholesterol is stress. “Stress influences hormone secretion, and hormonal imbalance affects cholesterol synthesis,” Prema says. “Moreover, some people tend to eat unhealthy food when they are stressed. They seek solace in it.” Managing daily stress may also help control cholesterol levels.
Changing the mindset
“I followed the routine for three months, in a disciplined manner. The numbers quickly came under control. But once those three months were over, I realised that this isn’t a sprint but a marathon. It’s a lifelong change,” Murthy says. “I became more conscious of the way I lived and ate. That was the biggest change.”
He has now learned to not go after perfection but make gradual and steady changes and make them a part of his everyday life. Today, Murthy continues to be physically active by playing badminton, walking 13km to 14km a day or working out at home by doing yoga.
Although high levels of cholesterol come without warning, affecting various organ systems of the body, regular health check-ups can help identify it early and make the necessary changes in time. Up to a point, natural methods such as diet and exercise can help bring the numbers under control, but it is best to consult a physician before following a treatment plan.