Do you know what my HDL (high-density lipoprotein, often called “good cholesterol") levels are? 64 mg/dL," says K.K. Jain, a Delhi-based family physician. Most Indians would count themselves lucky if their HDL levels stay above the prescribed minimum of 40mg/dL. Yet experts now hold that the ratio of low-density lipoprotein (LDL) to HDL is a better indicator of health and cardiac risk than total cholesterol. The more the HDL, the better it is.

High HDL = healthy heart

Madhukar Shahi, interventional cardiologist, Artemis Healthcare, Gurgaon, says: “We don’t usually look at total cholesterol. We look at the ratio of HDL/LDL or ratio of total cholesterol/HDL, and also the level of non-LDL bad cholesterols. Third, we look at trigylcerides." For men, a good total cholesterol/HDL ratio is 4.5 or less; for women, it’s 4 or less.

Your workplace can also be a health aid for your heart. To find out how, also read Taking heart care to work

Decoding your blood test report

Feed the (good) bacteria, please!

The third report of the US National Cholesterol Education Program (NCEP) in 2001 noted: “The ability of HDL to predict the development of coronary atherosclerosis has been estimated to be four times greater than LDL and eight times greater than TC (total cholesterol). Treatment is recommended for those with a HDL level below 40 mg/dL." Today, young people are increasingly falling prey to high triglycerides, high readings of “bad cholesterol", too low HDL.

The gender difference

Illustration: Jayachandran/Mint

This gender bender is why women should have HDL levels at least 10 units higher than men, that is, 50mg/dL or above, says nutritionist Ishi Khosla, who heads the Centre for Dietary Counselling, New Delhi.

Medicines, last recourse

“Medicines should be (a) last recourse," she says. Many of her patients, she adds, have managed to perfect their lipid profile by eating right

Dr Jain attributes his own readings to the handful of almonds, walnuts and watermelon seeds he has every morning, plus a diet high in soluble fibre.

Case studies

Delhi-based clinical and rehabilitation psychologist Divya Parashar, 32, is a case in point. Overweight and suffering from high cholesterol, she was put on statins in December 2005. Weighing 94kg, her cholesterol readings then were: LDL 127 mg/dL; HDL 35.7 mg/dL, triglycerides 199 mg/dL.

Despite regular exercise and a curtailed diet, nothing helped until June 2006, when Dr Parashar met Dr Khosla. A 90-minute cardiovascular exercise regimen, a diet rich in oatmeal, salad, fresh fruit, milk and curd, plus aloe vera, Omega-3 supplements and psyllium husk (isabgol) followed, and by August 2007, she was down to 64kg. Since then, Dr Parashar has maintained her weight, eliminated statins from her life and until June, when checked last, maintained the recommended lipid profile.

Dr Shahi says that if the patient is willing, cholesterol can be altered by diet and lifestyle corrections. “A fair trial of three-six months has to be given. Don’t start medication right away," he says.

No easy way out

Delhi-based journalist S. Kannan, 45, diagnosed with high cholesterol (240 mg/dL) at 37 and prescribed statins, says: “Medicines are the easy way out. You continue living life the way you are and pop a pill every day." Kannan took the diet and lifestyle correction route. It’s been a tough journey, he says, filled with experiments, but he got his total cholesterol down to 165 mg/dL. Nuts, fenugreek seeds soaked overnight and mixed with curd, a lot of salads, less alcohol and 8kg off did the trick. Averse to conventional medicine’s long-term medication plan, he also tried alternative medicine (see below Know | Guggul tree for lipid disorder ).

But it takes very little for the slide to set in again, which may be why doctors often prescribe pills right away.

Maintenance a must

Communications and public relations professional Sanjiv Kataria, 54, another long-time sufferer of dyslipidaemia, sought naturopathy in December 2004 at Jindal’s Naturecure Institute in Bangalore. After the 10-day detox, he had a “perfect" lipid profile, also 5kg (though this was not a stated goal or benefit) and lost his sinusitis problem. He continued a vegetarian diet till January 2005. However, as soon as he returned to his old lifestyle in Delhi, he regained weight, and triglycerides and the total cholesterol shot up, and he fell back on the medical management route.

Most dyslipidemia sufferers (people with an unhealthy lipid profile) don’t give lifestyle changes a fair trial, either due to lack of awareness or will.

Shifting the focus

Dr Khosla is familiar with the drill. She feels most people are unable to meet the challenge because the list of “nos" seems long. If you focus on the “haves", highlighting all the good stuff allowed, and introduce lifestyle changes gradually, the results follow readily, she says.


1O ways to get your HDL level up

1. Take a walk: Any exercise—walking, jogging or bicycling—that raises your heart rate, done for a minimum of 45 minutes a day, is effective. Duration is more important than intensity.

2. Maintain a healthy weight: Reduce weight if overweight. Especially important is abdominal fat (waist line more than 80cm for women, 90cm for men).

3. Stop smoking: Giving up tobacco improves HDL levels.

4. Find better fats: Cut out trans fatty acids totally. Partially hydrogenated vegetable oils (commercially-produced biscuits and bakery products, peanut butter, fried street foods, processed food products) need to go. Replace with mono-unsaturated fats (found in canola oil, mustard oil, avocado oil, olive oil, nut oil, among others). Use a combination of oils (rotate your household cooking medium), with special focus on cold-pressed oils, which retain their essential fatty acid composition better than refined fats and those heated to high temperatures. Also, feed on fatty fish (just two-three servings of salmon, ‘hilsa’ and other fatty fish each week make a difference because of the Omega-3 fats). Nuts are nice too: Almonds, walnuts, pistachio and several types of seeds (pumpkin, watermelon, fenugreek, flax, sesame) are beneficial for their healthy fat proportions.

5.Add soluble fibre: Oats and oat bran or other whole grains, fruits such as apples, grapes and citrus fruits, most vegetables and legumes, fenugreek seeds and psyllium husk are good sources. For the best results, eat at least two servings a day.

6. Consider soy: Though still a matter of debate requiring further research, some studies have shown that 25g (about three servings) of soy protein a day can help increase HDL levels and lower LDL.

7. Reach for red wine: One glass (30-60ml) per day, drunk with a meal (not on an empty stomach) has protective benefits.

8. Defuse the dairy debate: Doctors usually advise Indians to give up dairy items, says Dr Khosla, “due to the high fat content of whole milk products. But new research shows that conjugated linoleic acids (CLAs) found in the rumen of cows and other ruminants, and present in their milk, is helpful in reducing bad cholesterol and triglycerides." Skimmed milk and low-fat dairy foods are a good compromise.

9. Think about probiotics: Recent studies have shown that certain probiotic formulas (especially those that include prebiotic fructooligosaccharides) can help lower LDL levels, as well as reduce levels of triglycerides.

10. Don’t stop: If you don’t make these changes a habit, you will soon be back to square one.

Source: Ishi Khosla, nutritionist, New Delhi; Seema Gulati, chief nutritionist, Diabetes Foundation of India, New Delhi.


Know | Guggul tree for lipid disorder

Gugulipid, an extract from the guggul tree (‘Commiphora wightii’), has long been used in Ayurveda and has received regulatory approval in India for lipid disorder. Yet it isn’t widely endorsed by doctors. Peeyush Jain, head of department, preventive and rehabilitative cardiology, Escorts Heart Institute and Research Centre, New Delhi, says that during controlled trials, guggul was not found effective, and the benefits perceived by patients are probably due to other diet or lifestyle changes. A May 2002 article in ‘Science’ magazine endorsed it, reporting that Texas-based scientists found that gugulipid extract blocks the Farnesoid X Receptor (FXR), which plays a key role in maintaining cholesterol levels. Meanwhile, the guggal tree is highly endangered (it’s on the International Union for the Conservation of Nature and Natural Resources, or IUCN, red list) in India. Chitra Narayanan

Debate | Eggs and cholesterol

Eggs get bad press as cholesterol culprits. In ‘Help your heart with the good cholesterol plan’ (see above), two individuals claimed to have had opposite experiences. Even with high cholesterol levels, Divya Parashar was told it was fine to eat eggs. But Sanjiv Kataria attributed his backslide to whole eggs and has since sworn off the yolk. Delhi-based nutritionist Ishi Khosla says the recommendation for dietary cholesterol is “less than 300mg a day". A large egg has 200mg, all in the yolk. Eggs are fine for most people, but if in doubt, leave out the yolk. Another hypothesis to chew on: Saturated and trans fats are more harmful for blood cholesterol than dietary cholesterol in foods. Chitra Narayanan

Beware | Alcohol and cholesterol

In moderation, alcohol (especially red wine) can increase high-density lipoprotein (HDL, or “good cholesterol") and also offers anticoagulant benefits. However, it may also increase blood pressure, raise triglyceride levels and encourage weight gain. Doctors, therefore, advise teetotallers against taking up drinking. Those who do drink should stop at two small ones on alternate days, sipped along with a meal. “When taken with carbohydrates, the effect on trigycerides is minimal," says Madhukar Shahi, interventional cardiologist, Artemis Healthcare, Gurgaon. Chitra Narayanan

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