Cholesterol management: Facts and myths 

Dr G Vijayaraghavan of the Kerala Institute of Medical Sciences gives an understanding of the sterol needed to build healthy cells in your body.
Representational image. (Express Illustrations)
Representational image. (Express Illustrations)

THIRUVANANTHAPURAM: There is a dangerous misinformation related to health issues going viral in social media since the last few years. Patients are taking more time for consultation, friends are asking more questions and even doctors become confused following the barrage of statements in social media. 

'Cholesterol – read about facts and myths' and 'High cholesterol does not cause heart disease' are some of the sensational messages many of us have started subscribing to. The misinformation leading to disinformation has flooded the internet sites and subsequently, it is the common man who is being misled.

When we learn medicine from standard education programmes, we do refer to important internet sites and always probe for the evidence base. Its guidelines are formulated after detailed deliberations of expert committees of highly reputed international organisations. 

Interstingly, many of these messages cite from websites like 'mercola.com' which is generally called as the 'world’s No.1 health website'. They based their conclusions on the 2010 dietary advice to the Americans by the US Department of Agriculture, Health and Human Services.

As per Journal of American College of Cardiology, there are four treatment groups who required cholesterol-reducing drugs are individuals with heart disease or stroke. Secondly, patients with LDL-cholesterol levels at 190. Thirdly, persons with diabetes aged between 40 and 75 years with LDL-cholesterol levels between 70 and 189 mg/dL. And, individuals without evidence of cardiovascular disease or diabetes but who have LDL-cholesterol levels between 70 and 189 mg/dL. 

Persons with documented heart disease and strokes, diabetes mellitus, very high levels of individual risk factors, chronic kidney disease (CKD), are automatically at a high cardiovascular risk. 

They all need active management of all risk factors. Establishing at least a 50 per cent reduction of LDL Cholesterol is the target of treatment. No target cholesterol levels are to be aimed at. Many clinicians continued to estimate lipids periodically and checked whether the LDL Cholesterol has come down below 100 mg/dl or 70 mg/dl as the case demands.

Mercola.com in their internet sites and through social media continued to spread the rumour that 2015 new guidelines may lift the limits on dietary cholesterol. These guidelines were published promptly by the departments of Agriculture, Health and Human Services. It stated that the diet should contain less than 10 per cent each from added sugars and saturated fats and also limited the sodium intake to less than 2.3 grams per day. Healthy eating patterns include fat-free dairy products such as milk, yoghurt, cheese etc.Other products sold as “milk” but made from plants may contain calcium and be consumed as a source of calcium, but they are not included as part of the dairy group because their overall nutritional content is not similar to dairy milk.

What we should be eating?

We should continue to avoid all fried foods and stick on to grilled or steamed foods. Cooking oil has to be mostly polyunsaturated vegetable oils and a maximum of 3 to 4 teaspoonful per day. 

Better to avoid butter, ghee, vanaspati, coconut and palm oil, as well as coconut milk and coconuts in the diet. Hydrogenated oils are harmful to us and should be avoided. Plenty of green vegetables and fruits should be encouraged. People should be encouraged to take papaya, watermelon, apple, pear, guava and avoid sugar-rich grapes, mangoes and dates. Milk should be reduced to about three ounces per day.

Starchy food should be reduced to form only 30 per cent of the diet and sugary drinks should not be used. It is better to avoid all tubers as they supply only carbohydrates. People should be encouraged to eat more fish and skinned chicken. Whereas beef, mutton and pork to be reserved for special occasions. 
We have to educate the public that weight gain is often not from breakfast, lunch or dinner, but from what you eat in between. Munching and snacking should be stopped if you want to control your weight. This kind of practical guidelines has to be popularised among the community to spread the message of cardiovascular disease prevention. 

The message for the medical community as well as the public is that essentially, the cholesterol guidelines have not significantly changed since the Adult Treatment Panel III guidelines were published by the National Cholesterol Education Programme (NCEP) in 2002. 

In 2017, the guidelines of the American College of Cardiology, the American Heart Association and the European Society of Cardiology have reiterated the same. These are the guidelines followed by the entire world for planning prevention of cardiovascular diseases in the community. 
For our survival; let us stick on to this scientific ‘evidence-based medicine’ for serum lipid control as it has proven to reduce cardiovascular diseases. 

Dr G Vijayaraghavan is the Vice- Chairman and Founder Director of the Kerala Institute of Medical Sciences, Advisor Emeritus, Royal College of Physicians of Edinburgh. 

(The views expressed by the author are his own)

Related Stories

No stories found.
The New Indian Express
www.newindianexpress.com