September is National Cholesterol Education Month

By Parul Kharod

What is Cholesterol?

Cholesterol is a waxy, fat-like substance that is found in all cells of the body. Our bodies need cholesterol to make hormones, vitamin D, and enzymes that help with digestion. Our bodies make all the cholesterol we need, but we get excess from food.

Cholesterol is transported in the blood in substances called lipoproteins, which have fat on the inside and protein on the outside. There are two types of lipoproteins: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Having healthy levels of both types of lipoproteins is important.

Why? Because the risk of having Coronary Artery Disease (CAD) is four times higher in South Asians!

According to the World Health Organization and multiple other studies conducted worldwide, South Asians have more severe heart disease rates compared to other populations.

Coronary Artery Disease (CAD) Facts:

• #1 cause of death in males and females in South Asia
• 2 times more likely to have a fatal heart attack
• 3 times more likely to have a heart attack
• 4 times higher risk of heart disease
• 50 percent of heart attacks occur before the age of 55

The higher risk factors are linked to the following clinical factors:

• Increased risk of insulin resistance and diabetes
• Impaired reverse cholesterol transport and low HDL
• Higher levels of Lipoprotein (a)
• Central adiposity - the accumulation of fat around the abdominal area
• Elevated blood pressure
• Elevated triglycerides
• Elevated inflammatory markers

There are other lifestyle factors that play an important role:

• Sedentary habits and lack of regular exercise
• Diet high in unhealthy fats – fried foods; snack foods made with vegetable shortening, Vanaspati ghee, palm oil, Dalda, partially hydrogenated oil; excess use of oil in cooking
• Diet high in simple starches and sugars
• Lack of adequate fruits and vegetables
• Lack of healthy fats
• Smoking and alcohol

In 2018, the American College of Cardiology (ACC), the American Heart Association (AHA), and National Lipid Association revised the 2013 guidelines on treatment of cholesterol to reduce cardiovascular disease risk in adults.

Key messages from the revised guidelines:

• In all individuals, emphasize a heart-healthy lifestyle across the life course. A healthy lifestyle reduces atherosclerotic cardiovascular disease (ASCVD) risk at all ages. In younger individuals, healthy lifestyle can reduce development of risk factors
• Atherosclerosis (buildup of fats, cholesterol and other substances in and on your artery walls (plaque), which can restrict blood flow) begins early in life and progresses silently, so it is important to have a heart healthy lifestyle from an early age. Risk assessment should be started as early as age 20.
• For children and adolescents (ages 10-19), promote healthy lifestyle practices to prevent or reduce ASCVD risk.
• While there is no ideal target blood level for LDL-C, the 2018 guideline recognizes, in principle, that “lower is better." Studies suggest that an optimal total cholesterol level is about 150 mg/dL, with LDL-C at or below 100 mg/dL. People with increased risk factors should have a target of LDL-C at or below 70 mg/dL.
• The new guidelines specifically mention that South Asians have increased ASCVD risk. Lifestyle counseling is recommended for a heart healthy diet consistent with racial/ethnic preferences to avoid weight gain, and address blood pressure and cholesterol.

How to lower cholesterol & triglycerides and reduce risk of heart disease:

Limit saturated fats. Saturated fat can increase your levels of LDL cholesterol. They are present in animal foods, such as meat, dairy products (milk, cheese, paneer), and eggs, and also a few vegetable oils, such as palm oil, coconut oil, and cocoa butter.

Avoid Trans fats. Trans fats are used as a preservative to increase shelf life. They have been proven to increase risk of heart disease as they increase LDL cholesterol and triglyceride levels while reducing levels of HDL cholesterol. Limit packaged processed foods, fast food, and frozen ready to eat foods. Avoid foods that have “partially hydrogenated oil" or “vegetable shortening" in the ingredient list.

Limit simple starches and sugars. High intake of simple starches can raise triglycerides and cause fatty liver. Limit all sugars in foods and beverages, including honey and jaggery. Limit all simple starches such as maida (all-purpose flour), white rice, and processed snacks. Limit atta.

Limit total amount of fat. Limit fried foods. Use very limited amount of oil in cooking.

Eat heart healthy fats. Eat nuts and seeds in small quantities (preferably raw, unsalted). Walnuts and flax seeds are especially beneficial in lowering cholesterol and triglycerides, they are a good source of omega-3 fats.

Increase foods with soluble fiber. Eat a variety of intact whole grains, beans and legumes, and plenty of colorful non-starchy vegetables.

• Other recommendations:

Limit sodium intake
Do not eat excess amounts of protein, especially animal proteins
Drink adequate amounts of water
Practice mindfulness and reduce stress
Regular exercise

Parul Kharod, MS, RD, LDN is a registered dietitian and licensed nutritionist and works as a Clinical Dietitian with Outpatient Nutrition Services at WakeMed Hospital in Cary and Raleigh. She can be reached at