Jun 11, 2009

Divvy Kant Upadhyay, Medical Intern, Kasturba Medical College, Manipal University, Manipal.
Contributor / Correspondent for Daijiworld since April 2007.

Part I: Get free cholesterol with lip smacking delicacies!

Few days ago a circulating SMS popped up in my inbox. It was about a shopkeeper who is tired of trying to satisfy a customer. Shopkeeper : “Sir, I have told you many times already, there is no-free gift with that item”. Unrelenting Customer “ Oh. Ho, but look here… on the packet it says Cholestrol – free !”

Almost all of us have come across the word Cholesterol several times. More often than not it makes us worry about our health and prevents us from reaching out for lip smacking delicacies. But it is a fact that high levels of cholesterol in the blood are believed to cause cardiovascular diseases, heart attacks and strokes. For those already suffering from Hypertension and Diabetes, Cholesterol may not be good news.

Cholesterol is not wholly a villain of the story. In fact the body itself produces some amount of Cholesterol as it is needed to form cell membranes and perform few vital metabolic functions. It is the excess of Cholesterol that’s bad.

Blood cholesterol levels may shoot up if somebody is frequently having a lot of Fast food or ‘junk’ food like pizzas, burgers, fries and mouth watering delicacies like puris, jalebis and samosas deep fried in oil to name a few. It is the saturated fat in these food items that maybe bad.

In the normal course, the fat we consume gets absorbed in the intestines. Since fat or lipid is not soluble in blood, it changes into Triglycerides and also gets attached to proteins to form ‘Lipoproteins’. The forms of lipoproteins that are important for us to know are ‘Chylomicrons’, VLDL (Very Low Density Lipoproteins), LDL (Low Density Lipoprotiens), HDL (High Density Lipoproteins). These fat-rich lipoproteins sit on ‘chylomicrons’ and travel to the liver and then across the body to give our organs, muscles and tissues the energy needed. They are metabolized or processed in the liver and the extra cholesterol is turned to bile which finds its way out of our body through faeces.

Cells and tissues in the body have a system to take in the amount of energy they need. ‘LDL-receptors’ on cells attract LDL molecules into the cell where the fat is transformed into energy. When the blood cholesterol levels become high, this system goes haywire. There are only few receptors and several LDL molecules. Almost like ostracized orphans, these LDL molecules travel in the blood stream aimlessly till they reach narrow blood vessels (like in the heart & brain), where the body’s defence mechanism in the form of macrophages identifies them and holds onto them. These macrophages ‘interact’ with the LDL to form plaques that get attached to vessel walls. Over a long period of time, a continuous supply of LDL (mouth watering cholesterol rich foods!) in the blood makes sure that these plaques grow in size. This is almost like small food particles and dirt blocking your wash basin pipe. One fine day, the plaque becomes big enough to restrict or block the flow of blood in that narrow vessel.

It is this that is generally referred to as artery-blockages. Blood gets blocked in the coronary arteries due to plaque. Blood and thus oxygen and energy fail to reach the muscle that helps the heart ‘pump’ itself – an event that generally results in ‘heart attacks’.

In the continuing part – read about Good Cholesterol, Bad Cholesterol, Trans Fats and Lipid Profile Tests.

Part II: Cholesterol – the good, the bad and the ugly

Last week you must have read in these columns about the different forms of the cholesterol found in the blood like VLDL, LDL, HDL and trigylcerides. Cholesterol is much akin to a Bollywood thriller flick with a twist in the tale. In it, LDL (Low Density lipoprotein) is the villain and HDL (High Density Lipoprotien)is its sibling that plays the positive character.

Scientific research over the years has resulted in the opinion that very high levels of LDL are directly related to bad health. LDL is responsible for deposition of cholesterol in walls of arteries which could lead to blocking of arteries resulting in fatal heart attacks and strokes. HDL on the other hand is believed to remove excess cholesterol from arteries and tissues. It then takes them to the liver where they are processed and excreted out of the body. LDL levels in the blood are pushed up the easy way as we gulp down ‘tasty’ egg yolks and oily, deep-fried foods rich in saturated fat. Whereas HDL levels in the blood are pushed up the hard way – by exercising and burning calories, avoiding oily and fatty foods and increasing intake of fruits, nuts and green leafy vegetables. Doctors feel that even if one were to have low or normal LDL levels, it is crucial to have high HDL levels to maintain good health. Thus the medical fraternity generally, refers to HDL as the ‘Good Cholesterol’ and LDL as the ‘Bad cholesterol’.

To complete the trilogy of the good, the bad and the ugly, let’s bring in the ‘Ugly’. In 2006, ‘Trans Fats’ created some buzz as the city of New York in USA brought in legislation to restrict the use of Trans Fats in their restaurants. Consumption of Trans Fats, say researchers, has a directly adverse impact on public health. While its use has shown no benefits, it has proved to cause ill health. Lipases-the enzymes in our blood that help in digesting or transporting the fats that we take in, are believed to be unable to breakdown or dissolve Trans Fats, thus leading to a higher concentration of bad cholesterol that can quickly form plaques to clog our arteries. Present in the disguise of Vanaspati (partially hydrogenated oils; one of the largest selling products in the country) it is what actually makes outside food ‘tasty’ and lip smacking. A study done by Delhi based Centre for Science and Environment (CSE)on Indian Vanaspatis found them to have 5 to 12 times more Trans Fats compared to the world’s only standard for trans fats in oil, set in Denmark, at 2 per cent of the total oil. Chemically, the Trans Fat structure has a high melting point, thus it is excessively used in oils, processed foods, ‘ready-to-eat’ meals and baked items to increase their shelf life.

To keep a check on cholesterol levels in the blood, doctors generally suggest taking a Lipid Profile test. It measures the total cholesterol, the triglycerides and the all important high density and low density lipoproteins – HDL and LDL. It is desirable to have your LDL values between 60 and 130 to 150 mg/dl and HDL values upwards of 45 to 60 mg/dl. You need to fast for 12 hours before you take the blood test that would give your Lipid Profile and incase the tests come in the higher range, don’t worry yourself as dietary changes and lifestyle modifications can bring normal results in most cases. Only in uncontrolled or complicated cases, your doctor would like to prescribe you a class of drugs called Statins in order to bring down your LDL Levels to prevent complications.

The take home message about cholesterol is to be aware of your blood cholesterol levels to be on the safer side and then enjoy all kinds of delicacies, but only in moderation. The age old mantra of Exercise, fruits and green leafy vegetables while avoiding excess of fried food or bakery items should see a healthy and thus wealthy you !