By Nkiru Odinkemelu
It was a Saturday morning and a firm was having a walk as a part of activities to commemorate its 5th anniversary. Everyone, big, small, slim and fat, gathered at the venue, ready to commence the walk.
Shortly before the lectures began, the slim people among them began teasing the fat, telling them they were the ones who needed the exercise to burn down their supposedly high cholesterol. Most slim people there claimed they had no cholesterol to burn so would not have partaken in the exercise if it were not mandatory on all staff. But they were wrong. Cholesterol is not about body mass.
Cholesterol is waxy fat-like substance found in all cells of the body. It is essential to many life-sustaining functions. Produced by the liver, the body needs it to make hormones, like estrogen and progesterone and Vitamin D. It is also found in compounds, such as bile that the body creates to help digest food. The body makes all the cholesterol it needs. However, cholesterol is also found in some of the foods we eat.
Experts have stressed that cholesterol is both good and bad. It is good when the level is normal, but bad when the concentrations in the blood get too high and can eventually raise the risk of stroke and heart attack or other possible health problem.
Explaining the concept of good and bad cholesterol, Dr. Chika Ndiokwelu, retired Deputy Director, Nutrition and Dietetics, University of Nigeria Teaching Hospital, Enugu and currently a senior lecturer, Department of Biochemistry, Human Nutrition and Dietetics Unit, University of Calabar, noted that cholesterol travels in our blood stream in small packages called lipoproteins and these packages are made up of fat on the inside and proteins on the outside.
“There are two types of lipoproteins: low density lipoprotein (LDL). This is the one that is referred to as the bad cholesterol and the high density lipoprotein (HDL), known as the good cholesterol. The good HDL carries cholesterol from other part of the body to the liver, where the liver removes it from our body so we say it is good but when one now carries it from the body to the arteries where it will cause problems, it becomes bad cholesterol.

High cholesterol
High blood cholesterol is a condition in which you have too much cholesterol in the blood. A lot of factors influence the flow of LDL (bad) cholesterol in the blood. The body produces the cholesterol it needs. However, it may sometimes produce more than necessary. There will also be other cholesterol that are in the body from intake of high fat foods. The excess produced by the body and the ones gotten from food together can increase the total cholesterol and LDL levels.
High cholesterol is not a respecter of persons; it could be found in adult and children alike, slim and fat, and even rich and poor.
According to the American Hearts Association (AHA), overweight people are likely to have high cholesterol, but thin people can have it too. People who do not easily gain weight are more often less aware of how much saturated fat they eat. Nobody eat anything they want and stay heart-healthy. Children can also have it and it can cause health problems, especially heart disease when the child gets older. Just like adults, high cholesterol in children could be due to diet and obesity, but most often can be inherited.
This is why AHA recommends that cholesterol checks must be considered for children and adolescents who are at higher-than-normal risk; they at higher than normal risk when a parent or grandparent had a heart disease, a high total cholesterol level of 240mg/dL or higher.

Risk factors
For adults, Dr. Ndiokwelu affirmed that many factors, like age, gender, lack of exercise, obesity, smoking, unhealthy diet, diabetes, genetics and Familial Hypercholesterolemia can influence the cholesterol levels in the blood and lead to high levels of LDL cholesterol.
Age: A person’s high cholesterol level tends to increase as the person’s age increases. “At the age of 20, about 22 per cent of the population start having increase in cholesterol; by the age of 30, about 38 per cent; at 40 about 50 per cent and age 50 is about 62 per cent; so that means from the age of 20, people should start checking their cholesterol level, especially, people from families with a history of stroke or heart attack,” said the expert.

Gender: According to John Hopkins hospital, younger women have higher levels of HDL cholesterol than men because the female sex hormone estrogen seems to boost this good cholesterol. But, like much else, everything changes at menopause. At this point, many women experience a change in their cholesterol levels where by the total and LDL cholesterol rise and HDL cholesterol falls.

Lack of exercise: Some research suggests that exercise helps boost levels of HDL cholesterol in the blood, while making LDL less harmful.

Obesity: Being overweight is unhealthy in general, but having a body mass index (BMI) of 30 or greater puts an individual at increased risk for high cholesterol. In addition, a person is at increased risk for high cholesterol if he is a man with a waist circumference of at least 40 inches or a woman with a waist circumference of at least 35 inches.

Diabetes: Elevated blood sugar level has been reported to increase levels of LDL cholesterol and lower levels of HDL cholesterol.

Cigarette Smoking: High cholesterol is also among the many dangers associated with smoking. Smoking also damages the walls of your blood vessels, which causes them to accumulate fatty deposits and may also lower HDL levels, experts have warned.

Cholesterol measurement
High cholesterol does not cause any symptoms, thus, only a blood test can reveal one’s cholesterol numbers, it is thus recommended you talk to your doctor about when cholesterol test is good for you. This is even as some health organisations recommend that everyone ages 20 to 79 be checked every four to six years for the risk of heart attack and stroke.
Cholesterol on the other hand is measured in milligrams (mg) of cholesterol per deciliter (dL) of blood (mg/dL). A total cholesterol level of 240 mg/dL or higher, is considered high. It is considered borderline when it is between 200 and 239 mg/dL. While total cholesterol levels below 200 mg/dL are considered ideal.
However, individual target cholesterol level may be different, as determined by a doctor and depending on a person’s risk factors for heart disease.

How HBC increase risk of other diseases
High Blood cholesterol (HBC) has been found to increase the risk of other conditions, depending on which blood vessels are narrowed or blocked. Some of these diseases include:

Coronary heart disease
Blood cholesterol level has a lot to do with chances of getting heart disease and the main risk associated with it is coronary heart disease (CHD). “If your cholesterol is too high, it builds up on the walls of your arteries. This build up is known as atherosclerosis. This condition causes arteries to become narrowed, and the narrowed blood vessels reduce blood flow to the heart. This can result in angina (chest pain) from not enough blood flow getting to the heart, or a heart attack in cases when a blood vessel is blocked completely and the heart muscle begins to die,” warned Dr. Ndiokwelu.

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain becomes blocked or bursts as a result of plaque formed by buildup of cholesterol. A stroke can result if the blood supply to the brain is reduced. When stroke occurs, part of the brain cannot get the blood and oxygen it needs, so it starts to die.

Peripheral arterial disease
High cholesterol also has been linked to peripheral arterial disease (PAD), which refers to diseases of blood vessels that are outside the heart and brain. In PAD, fatty deposits build up along artery walls and affect blood circulation, mainly in arteries leading to the legs and feet. The arteries of the kidney can also be affected.

Type 2 diabetes is another disease linked to high cholesterol because diabetes can affect the different cholesterol levels. Even if blood sugar control is good, people with diabetes tend to have increased triglycerides, decreased high-density lipoprotein (HDL), and sometimes increased low-density lipoprotein (LDL). This increases the likelihood of developing atherosclerosis.

High blood pressure
High blood pressure (hypertension) and high cholesterol also are linked. When the arteries become hardened and narrowed with cholesterol plaque and calcium (atherosclerosis), the heart has to strain much harder to pump blood through them. As a result, blood pressure becomes abnormally high.

Common foods that increase your cholesterol level
Like earlier said, aside from excess of cholesterol, which the liver may produce, another thing that increases cholesterol level in human body is food intake. According to medical experts, reducing intake of fat in the diet helps manage cholesterol levels. In particular, it is helpful to limit foods that contain cholesterol from animal foods, meat, and cheese; saturated fat – found in some meats, dairy products, chocolate, baked goods, deep-fried, and processed foods; and Trans fats – found in some fried and processed foods or continue and eat your way to heart diseases and stroke.
Giving detailed explanation of the above, Ndiokwelu said: “Cholesterol is found in animal food sources like organ meat, the heart and the liver have the highest cholesterol. It is also found in other things like egg yolk, squid, shrimp and dairy products but that is not the most important thing; you have saturated fat. This is so important because it also helps in increasing cholesterol. It is found in meat, dairy products like full cream milk, deep fried or processed food and ice cream.”
Saturated fat, the expert warned, contributes to clogged arteries and cardiovascular diseases. While monounsaturated and polyunsaturated fats, found in plants and healthful oils, actually protect your health by improving your cholesterol profile.
Talking about oil, Ndiokwelu decried the kind of palm oil majority of Nigerians consume, advising a switch to healthy oil like soybeans oil, canola oil, olive oil, depending on the one an individual can afford.
He said: “When we buy our palm oil and it tends to settle when the temperature is cold and becomes lumpy, that shows the amount of saturation and we are worried about saturated fats because it raises the LDL (bad cholesterol) the more than any other thing in the diet. If you must use palm oil, look for the liquid on top, it is less saturated than the one that is hardened.
“It is not just palm oil, the trans fats are worse fat for health. Trans-fatty acid raises the bad cholesterol and lowers the good cholesterol. These trans-fatty acids are found in oil that is hard like margarine, where hydrogen is added to vegetable oil to harden it. They are also found in fried and processed food.”

How to lower cholesterol
To reduce cholesterol, you must eat healthily, exercise, limit your intake of salt and limit saturated fat found in meat, dairy, milk and milk products, chocolate, baked foods, some processed foods; added sugar and alcohol. Limit animal food sources, like egg yolk, meat, milk, cheese, food that have fat which raise cholesterol, cautioned Ndiokwelu.
Said he: “Healthy eating means increasing our intake of vegetables, such as our greens, pumpkin leaves cabbage, carrot, all green vegetables and coloured vegetables too. Increase your intake of fruits like bananas, oranges, pears, apples, avocados, depending on what you can afford. Eat whole grains like brown rice, beans; and then fat free or low fat diary for those who can afford milk.
“Then protein rich foods, not those high in fat, like if it is meat, trimming off the visible fat in it, some people will like to buy Toso. Eating fish, like mackerel that contain omega 3 which is good for the heart two to three times a week, egg is okay but not eating too much, nuts, legumes like kidney beans, then healthy oil like soybeans oil, canola oil, and olive oil, depending on the one you can afford.
“Then if you want something as a spread on children’s bread or something on yours as an adult, why don’t you go for nuts and seeds butter, like the peanut butter which people use to take their garden egg, that could be used as a spread than the vegetable oil that has been hydrogenated and now rich in trans fatty acid.
“Limit intake of alcohol; being overweight raises the bad cholesterol, and lowers the good cholesterol so that means whoever is overweight should limit the things that make him to add weight.
“Then exercise even if it is brisk walk, 30 to 45 minutes even if it is three times a week or shorter periods on daily basis is better, then don’t forget your salt intake. Most processed foods are salty and that means you are eating so much salt daily and a lot of the processed foods contain added sugar in them, and see your dietician and physician. When we do all these things, am sure we will be able to control our cholesterol. Remember, prevention is better and cheaper than cure.”