Reducing bad cholesterol without medication

WHEN your bad cholesterol (low density lipoprotein cholesterol or LDL-C) crosses into a higher-risk zone, a reduction in your LDL-C is necessary to minimise your risk of heart attack and stroke. Do not be lulled into a sense of complacency by your lack of symptoms, as American Heart Association data shows that about 50 per cent of men and 65 per cent of women who die suddenly of heart attacks do not have prior warning symptoms. 

Prevention is better than cure. Hence, it is best to embark on a quest to navigate into healthy territory by making the right decisions about diet, embarking on lifestyle interventions and weaning off dreadful lifestyle habits.

‘Dangerous’ red flag foods

“Dangerous” foods not only include those with high LDL-C (bad cholesterol), but also those with high saturated fat and trans-fatty acids. Saturated fat is a key ingredient for making bad cholesterol and also a contributor to weight gain. Dietary trans-fatty acid, in particular, is double trouble as it elevates LDL-C and lowers the so-called “good cholesterol”.

The first red flag food is processed meat (synonymous with high cholesterol food). Before you sink your teeth into savoury processed meats like sausages, hot dogs, bacon and our local bak kua (barbequed meat), be aware that they are often made from the juiciest portions of meat (which means highest fat content).

The second red flag food is red meat. Whether it is your succulent beef steak (in particular wagyu beef), your tender lamb shank or your delicious pig trotters (a local favourite), beef, pork and lamb have abundant saturated fat. Those portions of red meats with the highest fat include hamburgers, roasted ribs and pork chops.

The third red flag food is fried food. While you will not be surprised that fried chicken wings have high LDL-C, you may fall off your chair to find that fried onion rings and fried mozzarella sticks are among the worst culprits for elevating LDL-C. Fried foods such as french fries, doughnuts and fried chicken not only contain saturated fat, but trans-fatty acids as well.

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The last red flag category comprises cookies, pastries and cake, which have been made with an abundance of butter. In particular, in addition to saturated fat, these foods often have trans-fatty acids. Not to disappoint you, but the ugly truth is that snacks such as microwave popcorn, frozen pizza, refrigerated dough (such as biscuits and rolls) and stick margarine may also contain trans-fatty acids.

Just remember that fast food consumption comes with a heavy cost to your health. Alas, do not despair, as we will discuss the transition into an enlightened diet later in the article.

The sugar-fat link 

While fruit consumption is one of the pillars of good health, caution must be taken with those containing high triglycerides (TG). Regular consumption of “fruit sugar” fructose in amounts contributing to more than 10 per cent of one’s total daily energy needs will lead to TG elevation. Fructose intake of between 15 and 20 per cent of one’s total energy intake can increase the TG by 30 to 40 per cent.

Not surprisingly, “table sugar” sucrose (a combination of one unit of glucose and one unit of fructose), is the most common source of fructose. Hence, for those with elevated TG, intake of simple sugars (fructose or sucrose) should be limited to less than 10 per cent of total dietary energy intake; individuals with severely elevated TG should consider eliminating added sugars.

Lifestyle evolution

The use of e-cigarettes or vapes has increased, but contrary to popular belief, vaping is not a healthier substitution for traditional cigarettes. Use of tobacco in any form, including smoking and vaping, should stop.

Smoking cessation has clear benefits on overall cardiovascular disease risk. Weight reduction and exercise are also components of this lifestyle evolution. More details can be found in the Singapore Physical Activity Guidelines published by the Health Promotion Board.

A standard drink is defined as 10 g of alcohol, which is the equivalent of two thirds of a 220 ml can of beer, one small 100 ml glass of wine, or 1 nip (30 ml) of spirits. For decades, many have touted the benefits of alcohol consumption on heart disease. Hence, moderate alcohol consumption of less than two standard drinks for men, and less than one standard drink for women has been considered as being acceptable for those who consume alcohol, if TG levels are not elevated.

However, this perceived benefit has not been validated in any randomised controlled trial. The World Heart Federation released a policy brief in 2022, stating that the regular consumption of alcohol raises blood pressure, increases the risk for cardiomyopathy (heart muscle disease), precipitates the onset of atrial fibrillation/flutter (abnormal heart rhythm, which is associated with an increase in the risk of stroke) and elevates stroke risk.

There is a linear association between regular alcohol consumption of at least 100 g per week and an increased risk of stroke, heart failure, fatal hypertensive disease and fatal aortic aneurysm. As such, it is not recommended that alcohol be consumed for the purpose of obtaining purported cardioprotective effects. For those who have not started, do not start.

The enlightened dietary transition

Give your processed foods (bacon, sausages and hot dogs) a miss in your breakfast menu. The hamburger in the fast-food joint should also be struck off your list of breakfast choices. Adding dietary fibre such as barley and oats, which contain the fibre b-glucan, into your breakfast menu can reduce LDL-C. A dietary fibre intake of 20 to 30 g per day is a step in the right direction.

If you still have a craving for red meat, give yourself an occasional treat of a 100 g of leaner cuts like sirloin, pork loin or filet mignon.

For your protein boost, tuck into low-cholesterol skinless lean chicken, fish and beans. However, do not go overboard with fish, because daily fish intake often results in elevated blood-mercury levels. A reasonable frequency will be two to four days of fish alternating with other food choices.

If you miss your fried foods, eating foods prepared with minimal olive oil and cooked in an air fryer will give a reasonably safer option.

If you are a stickler for details and read labels in supermarkets diligently, you should restrict your total fat intake to no more than 25 to 35 per cent of your total calorie intake. Of this, about two-thirds should be mono and polyunsaturated fats and less than one-third saturated fats. Your daily cholesterol dietary intake should be reduced to less than 300 mg per day.

Finally, if you are unable to bring your LDL-C into the low-risk zone, medication may have to be considered.

This article is part of a monthly series on health and wellbeing, produced in collaboration with Royal Healthcare