Hyperlipidemia: You are what you eat!

Hyperlipidemia: You are what you eat!


Assoc. Prof. Dr. Supakorn Rojananin, M.D.

Deputy Dean of Public Relations and Special Affairs

Faculty of Medicine Siriraj Hospital, Mahidol University


            Recently, Siriraj has just admitted a young male (26) who weighs over 300 kilos for treatment. He was once an overweight person and tried to control the weight by himself. However, over the last 2 months, his weight rose rapidly and found himself difficulty to mobilize without exertion. Initially, no underlying disease was found and the patient was diagnosed to have morbid obesity from his improper diet intake.


The above example reflexes lifestyle of overeating which is an increasing problem in our community in contrast to the malnutrition that is rarely seen today.

To keep your body fit and healthy, one should control your weight appropriately with your height. This simple indicator called “body mass index” or BMI. It equals a person’s weight in kilograms divided by height in meters squared. (BMI=kg/m2). Normal range of BMI is 18.5-24.9. BMI over 25 is overweight and over 30 or 40 are obese or extremely obese respectively.


Besides from the BMI, the level of fat (lipid) in the blood stream is also important for your health. Even though the amount of fat level seems to be mostly correlated with your weight but it does not always do. If you do not control your diet, sooner or later, ones will get hyperlipidemia.


     Hyperlidemia refers to elevated blood levels of lipids or fat, including cholesterol and triglycerides. People usually do not know their fat levels without regular blood test since it has no symptoms. As a consequence, in a long period of time, hyperlidemia is associated with an increase risk of coronary heart disease (CHD), which in turn, can result in chest pain (angina pectoris), a heart attack or both as well as stroke, and limb ischemia or claudication (leg pain on walking). Atherosclerosis or plaque deposition in the lumen of arteries is the major cause of these diseases. Plaque is made of lipids and other materials circulating in the blood. To prevent or slow the progression of plaque formation, high fat level should be reduced.


The good news is that lipid levels can almost always be lowered with a combination of diet, weight loss, exercise, and medications. As lipid levels fall, so does the risk of developing heart attack or stroke. And it is also not too late even in those who already had coronary heart disease (CHD); lipid lowering treatment can be lifesaving! 


According to Associate Professor, Dr. Preyanuj Yamwong, from Research Center for Nutrition Support, there are many different types of lipid particles in the blood, some are good and some are bad. Most commonly measured include, total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglycerides.


A desirable level of total cholesterol is usually less than 200mg/dL. LDL cholesterol or a “bad fat” is more accurate predictor of CHD than total cholesterol. Higher LDL cholesterol concentration (over 100mg/dL) has been associated with an increased incidence of CHD in a large number of studies.


On the contrary, HDL cholesterol is a “good fat”, higher level actually lowers the risk of CHD. However, if HDL level is less than 35mg/dL, one should be treated.


Elevated triglyceride levels are also associated with an increased risk of CHD; normally it should be lower than 150mg/dL.


Most hyperlipidemia is caused by lifestyle habits or treatable conditions. These include too much fat intake, obesity, not exercising, stress, and smoking. Others less common causes include diabetes, kidney disease, hypothyroid and familial factor.


Since the condition is asymptomatic, every one should have a blood test for lipid levels every 5 years after age 20. Shorter interval screening is recommended in older age over 45 or who has a familial history of heart disease in a younger age.


How aggressive treatment needed in hyperlipidemia, as Dr. Preyanuj points out, depending on the lipid level, your heart disease risk factors and your general health.


 As a first step in younger ages, only lifestyle changes are recommended. Changing both quantity and quality of diets are needed by reducing the saturated fat and total fat intake. The new guidelines recommend less than 7% of daily calories should come from saturated fat and 25% to 35% from total fat or restrict dietary cholesterol intake to less than 200mg/day.


Most red meats, viscera, shell animals (crabs, squids, oyster, etc.), coconut milk, coconut oil, contain more cholesterol than fish. Vegetables and most fruits have no cholesterol. Some cold water fish such as sardines, salmon contain omega-3 fatty acid that may lower triglycerides as well as beans, nuts, soybeans and vegetable oils.


Stop smoking, reducing alcohol intake, weight control and regular aerobic exercise is a must. If you take more calories you should burn more.


The benefits of lifestyle modifications may be evident within 6-12 months but the efficiency is individually varies. If it does not work or in men over 35, post menopausal women and persons who are at risk of heart disease, lipid lowering medications should be considered.


There are many lipid lowering drugs in the markets. Each has its own mechanism of action, side effects, cost and effectiveness. Therefore it should be prescribed by your physicians only. In 2005, only at Siriraj Hospital, these drugs were prescribed to the public more than 155 millions baht cost!


Dr. Preyanut concludes that the treatment of hyperlipidemia is usually a lifelong process. Although mediations can rapidly lower lipid levels, it still takes time to achieve the results. Discontinuation of treatment and practice usually mean that lipid levels will rise again.