“I have been fasting for nearly a month but my cholesterol wouldn’t budge!” complained forty year old Naseem who was diagnosed with high cholesterol a month ago. “What have you been eating?” I asked him. “Honest to God nothing – just nothing. Only two boiled eggs in the morning, butter and two toasts with nothing else in the evening and a glass of milk with a little piece of cheese at night!” confessed Naseem. “With your dietary regimen you are bound to push cholesterol up than bring it down. You have to alter the quality of diet and not the quantity of diet,” I said in a matter of fact way.
How can one reduce cholesterol? There are three cardinal features around which this philosophy revolves. Dieting, exercise and drugs. All of the are equally important. One always starts with diet and exercise. It has to be emphasized in crisis or recovery, before and after an intervention, with drugs and without drugs.
1) DIET: Diet involves:
a) reduction of calories essentially to reduce weight
b) reduction of total fat intake
c) reduction of saturated fat and cholesterol
Obese people are more at risk for atherosclerosis that those at desirable weight. Obese people are more likely to have other risk factors like sugar (diabetes) and high blood pressure (hypertension) etc. First step towards reduction of cholesterol is to reduce intake of food rich in calories. All foods items containing sugar like cold drinks, hot drinks, ice creams, bakery items and desserts etc. should either be avoided or have to be reduced drastically. Fats are a very rich source of calories. Oil has an equal content of calories as compared to ghee, so for reduction of weight both have to be avoided. Many people change over to oil from ghee and think that this should suffice. In the fight against obesity ghee and oil both have to be discarded from diet.
More stress should be laid on fresh fruits and vegetables. Boiled vegetables and pulses (without the tarka) are good sources of nutrition without a high caloric count. An ideal will be to have a couple of glasses of water before attacking the food, take a bowl full of fresh salad followed by a bowl full of boiled pulses like beans, gram (with adequate spice to make it tasty) followed by another two glasses of cold water. Fresh fruit may be eaten after it. The beauty of this is no ghee or oil, no sugar or high caloric stuff and enough variety to choose from.
Fat is present in four main forms in the food we eat, saturated fatty acid, mono saturated fatty acids, poly unsaturated fatty acid and cholesterol. It is advisable to restrict intake of fat to less than 30% of total calories for a day with less than 10% from saturated fatty acid and the rest from unsaturated acids.
1) Saturated fatty acids are mainly responsible for increase in cholesterol. Main animal sources are butter, cream, cheese, fat in beef, lamb and poultry. Coconut oil, palm oil and kernel oil are the main sources of saturated fat from plants. Every effort should be made to avoid this class of food as it is the main source of cholesterol.
2) Mono unsaturated fatty acids are found in olive oil, canola oil, rapeseed oil, peanut oil and sunflower oil. These oils do not contribute towards increase in cholesterol. In fact these help to lower cholesterol. These oils may be used rather liberally but with care because increase in content may increase caloric intake, which may in turn increase weight.
3) Poly unsaturated fatty acids are derived from animal and plant source. These fatty acids reduce total and LDL cholesterol in body. Vegetable oils like sunflower, soybean and corn contain omega-6 fatty acids. Certain fish like trout, sardine, coho and ping salmon and atlantics halibut are rich sources of omega-3 fatty acids. These fatty acids offer protection against atherosclerosis by retarding the process. Intake of omega oils is encouraged to the extent of taking fish two to three times a week (not cooked in ghee). Fish oil capsules containing large quantity of omega oils have not been shown to have any definitive effect on hear problems.
4) Cholesterol is only derived from animal sources like egg yolk, internal organs, milk, butter, cheese etc. Total cholesterol intake should be less than 300 mg per day. It should be reduced further in people with high cholesterol. Every one should be wary of high cholesterol contents of certain food stuff and should make a determined effort to avoid it.
What to avoid:
a) Whole milk: A cup of whole milk contains 5.1 mg saturated fatty acids, 33 gms of cholesterol and 150 calories. Where as skimmed milk contains 0.3 mg saturated fat, 4 mg of cholesterol and 86 calories. Skimmed milk should be substituted for whole milk to reduce cholesterol and caloric intake.
b) Butter and creams: One teaspoon of butter contains 36 calories, 11 mg of cholesterol and 2.5 mg of saturated fat. Avoid butter and cream specially used in bakery items, desserts and ice cream.
c) Eggs: One egg yolk contains 213 mg of cholesterol. Egg while is a rich source of protein and does not contain cholesterol. Egg yolk must be avoided with high cholesterol and the use should be reduced in those with borderline or normal cholesterol.
d) Cheese: Cheddar cheese has high cholesterol and should be avoided. Cottage cheese has 5 mg cholesterol in half a cup so it can be taken.
e) Meats and fish: Contrary to widely held belief, beef and lamb have equal amount of cholesterol that is 22 mg per three ounces. All visible fat should be removed. Poultry should be cooked without skin which is a rich source of cholesterol. Internal organs like brain, liver and kidney etc. are very rich in cholesterol and MUST be avoided. Fish has low cholesterol but shrimps and lobster have high cholesterol.
f) Horrible Combinations: We know ghee has large amount of saturated fatty acids so it has to be avoided. This follows a simple dictum that everything cooked in ghee is high in cholesterol and should be avoided. If an egg is fried in ghee or butter, the cholesterol content goes up – it simply multiplies. Internal organs are the richest source of cholesterol, if cooked in ghee or butter the content increases, add some eggs to it and make it worse and top it up with some bone marrow and make it the ‘deadliest’ of recipe. ‘Kat-a-Kat’ is perhaps what you should be offering to your enemies. ‘Karahi Ghosht’ is lamb cooked in its own fat, special attempts are made to use the fatty portions and extra fat is added to make it really high in cholesterol. Nehari savoured by a lot us is very high in cholesterol; meat with internal organs cooked in ghee with added bone marrow with plenty of spices – ‘finger licking’ but sticking stuff for arteries. What is ‘Chappali Kabab’? Minced meat with lots of unwanted fat cooked in highly saturated fat and topped with eggs and at times bone marrow. It may be tasty but very high in cholesterol. Unfortunately most of our exotic food is very rich in cholesterol.
We know full cream milk has high cholesterol, so does full cream ‘lassi’. What do you think of full cream ‘Khoya’ dissolved in Lassi or milk – is it fit for human consumption? Desset made with full cream milk, eggs and cream tastes sweet but has exorbitantly high cholesterol. So beware of ‘Kheer’, custards and trifles. Though cheese is not used liberally in our foods but pizzas have cheese which has a very high cholesterol content. Cottage cheese, however, is nutritious and does not have high cholesterol content.
‘Halwa’ is not bad except when it is cooked in ghee and has the wrong additives. It is rich in calories because of sugar, ghee/oil and ‘maida’ though cholesterol content varies according to the additives and oil used. Most of bakery items are made in ghee, have eggs in it and are topped by cream. So beware of those attractive colourful ‘snares of cholesterol’ called cakes and pastries. Finger licking ‘mithais’ with tall claims of being cooked in ‘desi ghee’ are rich source of calories rather bursting with calories. Most of ‘mithais’ use eggs and are cooked in ghee hence increasing cholesterol content. I am sure you will agree that the best desset is either fresh fruit or after dinner jokes!
It is quite obvious that to reduce cholesterol one has to use low fat, low cholesterol diet while avoiding dairy products – whole milk, cheese, bakery items, eggs and meat containing fat. Fruits, vegetables and whole grain should be encouraged.
When dieting is not enough – Exercise:
Exercise is a vital companion to any dieting program. It serves the threefold purpose of burning calories, fighting flab and improving efficiency of cardiovascular system. Studies show that individuals who exercise have a high amount of HDL ‘good’ cholesterol which protects against cardiac problems.
Domestic work burns 180 calories (cal), walking 2.5 miles per hour (mph) burns 210 cal, gold burns 250 cal. Walking 3.5 mph burns 300 cal and running 10 mph burns 900 cal per hour. The most accessible, easiest and least expensive means of aerobic exercise is fast walking. Start exercising after consultation with doctor if you have crossed forty. Start with fifteen minutes thrice a week and slowly build it up to 30 minutes four to five times a week.
Drugs – When dieting and exercise are not sufficient:
If dieting and exercise fail to deliver the goods the next step is drugs. Besides fibrates available for a long time a new group of drugs called statins have captured the market. These statins – simvastatin, fluvastatin, lovastatin, atorvastatin and pravastatin are very effective agents to lower cholesterol with quite a safe profit. These have been used in many trials and have been shown to be effective in reducing cholesterol, deaths associated with heart, investigational procedures needed in cardiology and the need for angioplasty and bypass surgery. These drugs should be taken according to the advice of doctors. The drug therapy needs regular monitoring and reduction (and not cessation!) of dosage when targets and achieved.
With sound knowledge and enough zeal, the problem of cholesterol can be conquered. In this war, we need patience and persistence as it is a life long war. The dosage may decrease though careful life long monitoring is required.
_____________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah
How can one reduce cholesterol? There are three cardinal features around which this philosophy revolves. Dieting, exercise and drugs. All of the are equally important. One always starts with diet and exercise. It has to be emphasized in crisis or recovery, before and after an intervention, with drugs and without drugs.
1) DIET: Diet involves:
a) reduction of calories essentially to reduce weight
b) reduction of total fat intake
c) reduction of saturated fat and cholesterol
Obese people are more at risk for atherosclerosis that those at desirable weight. Obese people are more likely to have other risk factors like sugar (diabetes) and high blood pressure (hypertension) etc. First step towards reduction of cholesterol is to reduce intake of food rich in calories. All foods items containing sugar like cold drinks, hot drinks, ice creams, bakery items and desserts etc. should either be avoided or have to be reduced drastically. Fats are a very rich source of calories. Oil has an equal content of calories as compared to ghee, so for reduction of weight both have to be avoided. Many people change over to oil from ghee and think that this should suffice. In the fight against obesity ghee and oil both have to be discarded from diet.
More stress should be laid on fresh fruits and vegetables. Boiled vegetables and pulses (without the tarka) are good sources of nutrition without a high caloric count. An ideal will be to have a couple of glasses of water before attacking the food, take a bowl full of fresh salad followed by a bowl full of boiled pulses like beans, gram (with adequate spice to make it tasty) followed by another two glasses of cold water. Fresh fruit may be eaten after it. The beauty of this is no ghee or oil, no sugar or high caloric stuff and enough variety to choose from.
Fat is present in four main forms in the food we eat, saturated fatty acid, mono saturated fatty acids, poly unsaturated fatty acid and cholesterol. It is advisable to restrict intake of fat to less than 30% of total calories for a day with less than 10% from saturated fatty acid and the rest from unsaturated acids.
1) Saturated fatty acids are mainly responsible for increase in cholesterol. Main animal sources are butter, cream, cheese, fat in beef, lamb and poultry. Coconut oil, palm oil and kernel oil are the main sources of saturated fat from plants. Every effort should be made to avoid this class of food as it is the main source of cholesterol.
2) Mono unsaturated fatty acids are found in olive oil, canola oil, rapeseed oil, peanut oil and sunflower oil. These oils do not contribute towards increase in cholesterol. In fact these help to lower cholesterol. These oils may be used rather liberally but with care because increase in content may increase caloric intake, which may in turn increase weight.
3) Poly unsaturated fatty acids are derived from animal and plant source. These fatty acids reduce total and LDL cholesterol in body. Vegetable oils like sunflower, soybean and corn contain omega-6 fatty acids. Certain fish like trout, sardine, coho and ping salmon and atlantics halibut are rich sources of omega-3 fatty acids. These fatty acids offer protection against atherosclerosis by retarding the process. Intake of omega oils is encouraged to the extent of taking fish two to three times a week (not cooked in ghee). Fish oil capsules containing large quantity of omega oils have not been shown to have any definitive effect on hear problems.
4) Cholesterol is only derived from animal sources like egg yolk, internal organs, milk, butter, cheese etc. Total cholesterol intake should be less than 300 mg per day. It should be reduced further in people with high cholesterol. Every one should be wary of high cholesterol contents of certain food stuff and should make a determined effort to avoid it.
What to avoid:
a) Whole milk: A cup of whole milk contains 5.1 mg saturated fatty acids, 33 gms of cholesterol and 150 calories. Where as skimmed milk contains 0.3 mg saturated fat, 4 mg of cholesterol and 86 calories. Skimmed milk should be substituted for whole milk to reduce cholesterol and caloric intake.
b) Butter and creams: One teaspoon of butter contains 36 calories, 11 mg of cholesterol and 2.5 mg of saturated fat. Avoid butter and cream specially used in bakery items, desserts and ice cream.
c) Eggs: One egg yolk contains 213 mg of cholesterol. Egg while is a rich source of protein and does not contain cholesterol. Egg yolk must be avoided with high cholesterol and the use should be reduced in those with borderline or normal cholesterol.
d) Cheese: Cheddar cheese has high cholesterol and should be avoided. Cottage cheese has 5 mg cholesterol in half a cup so it can be taken.
e) Meats and fish: Contrary to widely held belief, beef and lamb have equal amount of cholesterol that is 22 mg per three ounces. All visible fat should be removed. Poultry should be cooked without skin which is a rich source of cholesterol. Internal organs like brain, liver and kidney etc. are very rich in cholesterol and MUST be avoided. Fish has low cholesterol but shrimps and lobster have high cholesterol.
f) Horrible Combinations: We know ghee has large amount of saturated fatty acids so it has to be avoided. This follows a simple dictum that everything cooked in ghee is high in cholesterol and should be avoided. If an egg is fried in ghee or butter, the cholesterol content goes up – it simply multiplies. Internal organs are the richest source of cholesterol, if cooked in ghee or butter the content increases, add some eggs to it and make it worse and top it up with some bone marrow and make it the ‘deadliest’ of recipe. ‘Kat-a-Kat’ is perhaps what you should be offering to your enemies. ‘Karahi Ghosht’ is lamb cooked in its own fat, special attempts are made to use the fatty portions and extra fat is added to make it really high in cholesterol. Nehari savoured by a lot us is very high in cholesterol; meat with internal organs cooked in ghee with added bone marrow with plenty of spices – ‘finger licking’ but sticking stuff for arteries. What is ‘Chappali Kabab’? Minced meat with lots of unwanted fat cooked in highly saturated fat and topped with eggs and at times bone marrow. It may be tasty but very high in cholesterol. Unfortunately most of our exotic food is very rich in cholesterol.
We know full cream milk has high cholesterol, so does full cream ‘lassi’. What do you think of full cream ‘Khoya’ dissolved in Lassi or milk – is it fit for human consumption? Desset made with full cream milk, eggs and cream tastes sweet but has exorbitantly high cholesterol. So beware of ‘Kheer’, custards and trifles. Though cheese is not used liberally in our foods but pizzas have cheese which has a very high cholesterol content. Cottage cheese, however, is nutritious and does not have high cholesterol content.
‘Halwa’ is not bad except when it is cooked in ghee and has the wrong additives. It is rich in calories because of sugar, ghee/oil and ‘maida’ though cholesterol content varies according to the additives and oil used. Most of bakery items are made in ghee, have eggs in it and are topped by cream. So beware of those attractive colourful ‘snares of cholesterol’ called cakes and pastries. Finger licking ‘mithais’ with tall claims of being cooked in ‘desi ghee’ are rich source of calories rather bursting with calories. Most of ‘mithais’ use eggs and are cooked in ghee hence increasing cholesterol content. I am sure you will agree that the best desset is either fresh fruit or after dinner jokes!
It is quite obvious that to reduce cholesterol one has to use low fat, low cholesterol diet while avoiding dairy products – whole milk, cheese, bakery items, eggs and meat containing fat. Fruits, vegetables and whole grain should be encouraged.
When dieting is not enough – Exercise:
Exercise is a vital companion to any dieting program. It serves the threefold purpose of burning calories, fighting flab and improving efficiency of cardiovascular system. Studies show that individuals who exercise have a high amount of HDL ‘good’ cholesterol which protects against cardiac problems.
Domestic work burns 180 calories (cal), walking 2.5 miles per hour (mph) burns 210 cal, gold burns 250 cal. Walking 3.5 mph burns 300 cal and running 10 mph burns 900 cal per hour. The most accessible, easiest and least expensive means of aerobic exercise is fast walking. Start exercising after consultation with doctor if you have crossed forty. Start with fifteen minutes thrice a week and slowly build it up to 30 minutes four to five times a week.
Drugs – When dieting and exercise are not sufficient:
If dieting and exercise fail to deliver the goods the next step is drugs. Besides fibrates available for a long time a new group of drugs called statins have captured the market. These statins – simvastatin, fluvastatin, lovastatin, atorvastatin and pravastatin are very effective agents to lower cholesterol with quite a safe profit. These have been used in many trials and have been shown to be effective in reducing cholesterol, deaths associated with heart, investigational procedures needed in cardiology and the need for angioplasty and bypass surgery. These drugs should be taken according to the advice of doctors. The drug therapy needs regular monitoring and reduction (and not cessation!) of dosage when targets and achieved.
With sound knowledge and enough zeal, the problem of cholesterol can be conquered. In this war, we need patience and persistence as it is a life long war. The dosage may decrease though careful life long monitoring is required.
_____________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah
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