When Usha Agarwal, 47, came for advice on “how to get rid of" the whitish-yellow skin tags she had developed under her eyes, she was surprised when I asked her to get her cholesterol levels checked. She had thought I would refer her to a “laser centre". Her skin tags were xanthelasma, which is a build-up of cholesterol under the skin near the eyes, elbows or knees. When I quizzed her about her family’s medical history, I learnt that her mother had died of a heart attack at age 63. Her brother had hypertension and she herself was a few kilos overweight, predominantly around the waist, which is an added risk factor for heart disease. To add to all this, Agarwal loved her food and exercise was limited to opening and shutting the refrigerator, and going for walks only when she travelled abroad.

It was clear to me that a blood lipid profile was needed to check cholesterol levels. Despite Agarwal’s family history, which cannot be changed, there were enough variables in her life that could be changed to prevent a heart attack or stroke.

Bad fats: Cut out saturated fats found in meat, cheese and deep-fried foods.

Cholesterol is needed to make a lot of hormones and bile salts, which are necessary for the digestion of fats. It also helps the body make vitamin D. But an excess of cholesterol causes atherosclerosis, a dangerous condition where excess cholesterol accumulates in the walls of the arteries, forming hard structures. These deposits are called plaques, which can reduce blood flow through the arteries, causing chest pain and complications like heart attacks.

There are two sources of cholesterol, one that the body produces naturally, which accounts for around 75% of the cholesterol content in a body. The rest comes from food. There are broadly three types of cholesterol—LDL (low-density lipoprotein), VLDL (very-low-density lipoprotein), which are bad for the body, and HDL (high-density lipoprotein), which protects the heart. A simple blood test on an empty stomach can estimate the cholesterol fractions, which should ideally look like this: Total cholesterol intake should be less than 200 mg/dl, with the following ratios—LDL less than 100 mg/dl, HDL greater than 60mg/dl, VLDL less than 40mg/dl, and triglycerides (another kind of fat) less than 150mg/dl.

Certain factors and habits of ours affect these numbers. Cigarette smoking, high blood pressure (more than 140/90 mm/Hg), low HDL levels, a family history of early heart disease (before the age of 55 for father or brother, and before 65 for mother or sister) and the natural ageing process of the body are all responsible for an increase in the deadly LDL.

The first three points, of course, are completely reversible lifestyle changes.

To reduce LDL through diet, reduce the intake of saturated fats to less than 7% of the total number of calories. Saturated fats are found in animal products such as butter, meat, eggs, whole-milk dairy, cheese, and in processed foods and bakery products.

Here’s a simple cholesterol-management programme based on lifestyle choices:

Fats: sorting the good from the bad

The good fats are the monounsaturated fatty acids (mufa) and the polyunsaturated fatty acids (pufa). Pufa includes Omega-3 and Omega-6 essential fatty acids. The Australian Heart Foundation recommends consumption of 500mg of marine-based Omega-3 every day. Oily fish such as salmon and mackerel are the best source of these. For vegetarians, flaxseeds, walnuts and soyabeans are excellent sources of pufa.

In Indian diets, we get more pufa from cereals, so in order to get more of mufa opt for rice bran, canola, and olive oil for cooking. The bad fats are the saturated fats and trans fats, like those found in full-fat dairy, red meats, and vanaspati ghee, which should be avoided as much as possible.

Fibre: how to include more

The National Heart, Lung and Blood Institute, (NHLBI) US, recommends fibre intake of 20-25g per day to lower LDL. To get this, include whole grains, fruits and veggies in your daily menu. You should aim to get eight servings of fresh fruits and veggies per day. A very easy way to start the day on a healthy note is to have a bowl of oats and an apple. Oats are a very good source of soluble fibre, called beta glucan. Soluble fibre is an established nutritional supplement to lower cholesterol. It can be found in barley and psyllium (Isabgol). I would recommend 1tbsp of psyllium daily for those who want to lower cholesterol.

Trim belly fat

Exercise! Even if it is just a brisk, 20-minute walk every day. Maintain a healthy weight and body mass index (a measure of body fat obtained from the weight and height of a person). Did you know that losing 4.5kg body weight can lower LDL cholesterol by up to 8%? That’s a lot.

Supplement with plant sterols

Plant sterols, found in all vegetables, fruits, whole grains and nuts, lower cholesterol. The NHLBI-recommended dose is 2-3g per day, which is difficult to get through food alone, so speak to your doctor about adding supplements in your diet.

Reduce stress

Do whatever it takes—exercise, meditation, music, and even that occasional glass of red wine that is considered good for the heart—to boost HDL (good cholesterol), thereby lowering your stress levels.

Vishakha Shivdasani is a Mumbai-based medical doctor with a fellowship in nutrition. She specializes in controlling diabetes, cholesterol and obesity.

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