Controlling cholesterol

Looking at nutritional alternatives in cholesterol control.

WE already know from the third National Health and Morbidity Survey (NHMS III 2006) that five years ago, about 43% of adult Malaysians (30 years and above) were overweight (29%) or obese (14%); 43% had hypertension; and 15% had diabetes.

Since Malaysians continue to lead unhealthy lifestyles and indulge in high-calorie unhealthy foods, the situation is definitely worse now.

If we concentrate only on those 40 and above, then the figures will be more worrying; and figures for those 50 and above will be really alarming, because the survey figures were somewhat “diluted” by the relatively healthy 30-39 age group.

I hope that in the future, the Government will release figures that will indicate these differences so that we realise that the problem is bigger than what the NHMS seems to show.

However, the survey on younger Malaysians should continue because unhealthy trends begin in childhood and continue through adult life, resulting in early onset of non-communicable diseases (or chronic lifestyle diseases as I prefer to call them) like obesity, hypertension, heart disease, diabetes and cancer.

A survey involving 10,000 students showed that 24% of those aged between six and 12 were either overweight or obese. Another survey showed that about 38% of youngsters between 12 and 18 were overweight.

Most adults have high cholesterol

It is not surprising that we doctors see so many patients who have dyslipidaemia (abnormal lipid/fat levels – particularly high total cholesterol and LDL-cholesterol; high triglycerides; and low HDL-cholesterol). And many of these patients are on cholesterol-lowering drugs, which are mainly statin drugs.

I estimate that over 50% of the patients above 50 years have high total and “bad”/LDL-cholesterol levels, and most of them have been prescribed statins by their doctors.

While diet is a factor in raising our cholesterol levels, it must be remembered that it contributes only 10-15% to the total cholesterol. The bulk of it is what is produced by our liver, and this is influenced by our general health, many hormones (especially the metabolic and sex hormones), exercise, and fitness.

So if you are not healthy, your cholesterol levels may be abnormal even if you are not overweight and do not consume much animal products.

Children with high cholesterol

More worrying is the increasing prevalence of abnormal lipid levels in children and young adults.

Recently, the US National Heart, Lung, and Blood Institute (NHLBI) recommended that all children be screened for high cholesterol at least once between the ages of nine and 11 years, and again between ages 17 and 21 years. This is because 30-60% of children already have high cholesterol levels!

This correlates with the rising incidence of obesity and atherosclerosis (which causes heart attacks and stroke) in children and young adults in the last two decades.

Since Malaysian children are also living similar “Western” lifestyles, eating similar unhealthy junk food and getting fat/obese, we should also consider this so that we can monitor and advice those children and young adults who are at risk much earlier, and help them avoid getting heart disease or stroke later in their lives.

Statin therapy

While there is no doubt that many studies have shown the benefits of normalising lipid levels (to reduce the risk of heart attacks, stroke and peripheral arterial disease), my concern is that most patients are put on the statin drugs without recourse to basic and safer alternatives first.

The statin drugs are known to have side effects, the most common of which are myopathy (many patients complain of muscle cramps) and liver stress (many patients have high levels of liver enzymes).

The first and most important step is always a reversion to a healthy lifestyle and diet, maintaining an ideal weight, and doing sufficient exercise. In addition, I would prescribe nutritional therapies.

To be fair to the doctors, the problem is that most patients are not disciplined and committed to adopt the lifestyle/diet/exercise that would enable them to achieve their ideal weights and normalise their cholesterol levels.

However, it is my observation (especially feedback from the patients who come to me for nutritional therapy advice) that our doctors are too quick in prescribing the statin drugs without considering the alternatives. So I end up “weaning off” these patients who come to me from statin drugs to nutritional alternatives.

Here are some nutritional therapies that have been proven to reduce bad cholesterol. Some may even raise the good HDL-cholesterol.

Soluble fibre

Soluble fibre can reduce the absorption of dietary cholesterol. Animal products are the sources of cholesterol in our diet, but plant products that contain much saturated fat can also cause the blood cholesterol level to rise.

You will need at least 5g of soluble fibre a day to decrease your total and LDL-cholesterol. The more you ingest, the better the results. We all know through the local campaigns that oatmeal is effective in lowering cholesterol. That is because one bowl of oatmeal or oat bran provides more than 5g of soluble fibre, and therefore, daily consumption can reduce and maintain healthy cholesterol levels.

Other sources of soluble fibre include apples, bananas, barley, kidney beans, pears and prunes.

Omega-3 essential fatty acids

Omega-3 fatty acids can reduce total and bad cholesterol, triglycerides, as well as raise good cholesterol. They also reduce inflammation and may help lower the risk of chronic lifestyle diseases (eg hypertension, heart disease, stroke, cancer, and arthritis).

They are important for cognitive functions (eg memory). Deficiency may cause fatigue, poor memory, dry skin, heart problems and mood swings. Developing foetuses, babies and children need enough omega-3 fatty acids for healthy nerve, eye and brain development.

Omega-3 fatty acids can be found in deep-sea fish such as salmon, tuna, mackerel, trout, herring, sardines and halibut; other seafood including algae and krill; some plants; and nut oils.

It is recommended that we eat omega-3 rich fish at least twice a week, but there is also concern that most of the fish are now contaminated by heavy metals, which can cause toxicity problems and increase cancer risk.

So in order to get higher doses of omega-3 fatty acids to lower cholesterol (or for other benefits) without having the risk of contamination, it is better to rely on omega-3 supplements for therapy. I use purified molecular-distilled omega-3, which are guaranteed to be free of contaminants.

Tocotrienols (super vitamin E)

We are the world’s leading producer and exporter of tocotrienols – the family of vitamin E that are far superior in many aspects compared to the more widely available form of vitamin E (tocopherols).

Our palm oil is the richest commercial source of tocotrienols, while the common vitamin E supplements (alpha-tocopherol) is extracted from soy.

Clinical research has shown that tocotrienols can reduce total and LDL-cholesterol, dissolve existing cholesterol plaques while also having brain-protective and skin-protective effects against ageing. Tocotrienols may also be helpful against some forms of cancer.

Combined therapy

There are other nutritional therapies which have been shown to be effective, though not necessarily having as much evidence as the above methods (eg red yeast rice, guggul lipids, berry extracts, mangosteen extracts, etc).

When any of the above nutritional therapies fail, I combine two or more methods until I achieve the desired results. In fact, the patients benefit from the multiple health-enhancing effects of the nutrients.

Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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