The silent killer

Cholesterol can be ‘good’ or ‘bad’. But which is which? Dr Ingrid Penzhorn answers our concerns.

‘Darling, your cholesterol…’ So, because of your (well-meaning) partner’s knowing looks, you change your order of sticky ribs to a roast vegetable salad. Sigh. Woody Allen was right: ‘You can live to be 100 if you give up all the things that make you want to live to be 100.’

Every year more than 70 000 South Africans die from heart diseases, and one of the risk factors is hypercholesterolemia.

Cholesterol is produced by the liver and forms a vital part of cell membranes, hormones, bile acids and fat-soluble vitamins. Hypercholesterolemia, though, is a negative condition where a surplus of low-density lipoprotein cholesterol (LDL-C), or ‘bad’ cholesterol, damages your arteries and can eventually cost you your life.

My cholesterol was more than five on a finger-prick test at the chemist. Now what?

A reading greater than five means that you should then have a blood test (known as a fasting lipogram) that determines the levels of your high-density lipoprotein cholesterol (HDL-C) and LDL-C*.

These values, in addition to other risk factors such as smoking, high blood pressure, age and sex, are taken into account to determine your risk for heart disease. If indicated, a doctor will prescribe lifestyle changes (such as diet and exercise), with or without medication.

*HDL-C is seen as ‘good’ cholesterol, as it removes excessive cholesterol from the arterial walls and takes it back to the liver. This way it protects against heart disease. LDL-C is seen as ‘bad’ cholesterol, as it aids the building of the plaque in arteries that causes heart disease.

But doesn’t cholesterol affect only bald men with beer bellies?

In premenopausal women, oestrogen increases the ‘good’ cholesterol, but after menopause this levels out. Being overweight is a risk factor for both sexes. The American Heart Association recommends you start testing your cholesterol from age 20.

Which foods are good for my cholesterol?

The right diet can increase your HDL-C and lower your LDL-C, thereby decreasing your chances of heart disease. Choose mono-unsaturated fats about saturated and trans fats. Use avocado on your toast instead of margarine or butter.

Eat lean red meat, remove chicken skin, buy fat-free dairy products and avoid snacks like crackers and biscuits. Try to limit your cholesterol intake to 200mg/day.

Most types of meat contain 70mg/100g. Soluble fibre (oat bran), omega-3 fatty acids (oily fish) and isoflavones (soya beans) promote good cholesterol levels.

But Professor Tim Noakes says low-fat diets are yesterday’s news?

Cardiologists argue that Prof Tim Noakes’s statements last year could put heart disease patients on the wrong track.

He made headlines when he ascribed his newfound health to a low-carb, high-fat/protein diet. The only thing both parties agree on is that refined carbohydrates increase your risk for these diseases.

(Read the Sports Science Institute of South Africa’s statement about this debate on

Doesn’t cholesterol medication have negative side effects?

Statins are the most generally prescribed medication because they work, are cost-effective and offer additional anti-inflammatory protection.

Side effects such as muscle pains and increased liver enzymes can be decreased by taking coenzyme Q10 supplements, a vitamin-like substance that plays an important role in the production of energy and also functions as an antioxidant.

New research shows statin use does increase the risk of developing diabetes in susceptible individuals, for example, insulin-resistant or overweight people. However, the advantages of statin treatment override the risk of diabetes.

So if I faithfully take my statins, can my exercise bike sit in the corner doubling as a clothing rail?

Unfortunately exercise is an essential part of treatment. About 150 minutes of moderate exercise (fast walking) or 75 minutes of intense exercise (jogging) a week is needed.

Can I rather buy natural cholesterol aids at my health shop?

There is a whole range food supplements that show cholesterol lowering properties: red yeast rice extract, policosanol (an alcohol from sugar cane), artichoke leaf extract and berberine, to name a few.

If your cholesterol is mildly elevated and your doctor recommends ‘lifestyle changes’ to start with, you can try these things as supplements to diet and exercise. But only do it under supervision of an expert, such as your GP or a trained naturopath.

Familial Hypercholesterolemia (FH)

It’s estimated that around one out of every 72 people in coloured and Indian communities have hereditary high cholesterol. This is around seven times higher than the occurence of FH in the general Western population.

Homozygous FH (if the gene mutation is passed on from both parents) is a rare but serious condition where children can die from heart disease in their 20s.

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