Choles­terol: friend or foe?

De­spite the hype about choles­terol lev­els, 50% of heart attacks have nor­mal read­ings prior to the cat­a­strophic event.

The Star Malaysia - Star2 - - HEALTH - By Dr C.S. FOO

CHOLES­TEROL has such no­to­ri­ety that when­ever some­one has a heart at­tack, it is al­ways the first sus­pect. My friends come in all shapes and sizes, but two bud­dies come to mind.

The first is quite well en­dowed in the mid­dle, eats what he sees, finds it hard to spare time for ex­er­cises, but is com­forted by nor­mal choles­terol lev­els. The other is mean and lean with­out an ex­tra ounce of fat, watches his diet, runs marathons “part time”, and yet “suf­fers” from high choles­terol.

If I had to trade places, the choice would be the lat­ter. De­spite the hype about choles­terol lev­els, 50% of heart attacks have nor­mal read­ings prior to the cat­a­strophic event.

More than two decades ago, we clas­si­fied risks of heart at­tack into ma­jor and mi­nor. The three ac­cepted ma­jor risk fac­tors were, and still are, hy­per­ten­sion, high choles­terol, and smok­ing. Heart dis­ease was the num­ber one killer then. To­day, medicine is mak­ing

Ath­er­o­scle­ro­sis is un­avoid­able but it is alarm­ing when it hap­pens pre­ma­turely as this ac­cel­er­ates the risk of dy­ing un­ex­pect­edly and pre­ma­turely. amaz­ing ad­vances with new drugs, di­ag­nos­tic tools, and ther­a­peu­tic tech­niques that have made old timers like my­self ob­so­lete. Yet, heart dis­ease is still the chart top­per in cur­rent-day mor­tal­ity statis­tics.

At the risk of ruf­fling some feath­ers, di­ag­no­sis and treat­ment is like treat­ing a sick tree with nox­ious chem­i­cal sprays on the leaves. Per­haps it may make good sense to nur­ture the roots be­fore the tree be­comes sick.

Quot­ing an ar­ti­cle ti­tled Are You Court­ing A Heart At­tack by yours truly ( Sun­day Star, July 21, 1991), it was stated that “Death due to heart attacks will con­tinue to rise for at least an­other decade be­fore we can see the re­sults of health ed­u­ca­tion ef­forts. Aware­ness to­wards the im­por­tance of pre­ven­tive health is rather limited, even among the ‘ welle­d­u­cated’ seg­ment of our pop­u­la­tion. The pre­vail­ing at­ti­tude of ‘I don’t feel it, I don’t care’ should be dis­carded be­cause, by the time you feel it, it will be too late.”

Twenty years later, the in­ci­dence of heart dis­ease has in fact es­ca­lated and here we are still bark­ing up the same tree, but missing the for­est. How­ever, the song that I am go­ing to sing to­day bears the same ti­tle as the one 20 years ago, but the lyrics have cer­tainly been rewrit­ten. There is much bet­ter un­der­stand­ing of the ge­n­e­sis of heart dis­ease to­day. Choles­terol is only one of the char­ac­ters in this in­tri­cate play.

The ori­gin of the story be­gins with the ar­chi­tect’s de­sign of the hu­man body. In the blue­prints are the des­ig­nated role of choles­terol. In an ideal state of har­mo­nious equi­lib­rium, choles­terol is not the bad guy it is por­trayed to be. It is meant to carry out var­i­ous cru­cial func­tions.

The mem­brane of ev­ery liv­ing cell in any tis­sue and or­gan is com­posed of choles­terol as its build­ing block. There would be no sex and reproduction with­out choles­terol as both male and fe­male hor­mones are de­pen­dent on its con­stant sup­ply to keep the juices flow­ing.

Fat-sol­u­ble vi­ta­mins, A, D, E, and K have choles­terol in­cor­po­rated within. Bile salts are made up of choles­terol and aids in the di­ges­tion of fat it­self. Choles­terol also has a good heart in the op­pos­ing sense that it tries to heal heart dis­ease but it­self be­comes em­broiled in a bit­ter bat­tle and gets in the cross-fire. Like the un­for­tu­nate scape­goat, it is os­tracised as the scoundrel of heart dis­ease.

On the av­er­age, the adult hu­man body has in its re­serve 35g of choles­terol. Di­etary in­take hov­ers around 200mg per day. The bulk of choles­terol is man­u­fac­tured by our liver, es­ti­mated to be around 1g daily. We are there­fore “ab­sorbers” and “pro­duc­ers”. Here is some bad news. When choles­terol in­take is re­duced, the in­ter­nal pro­duc­tion steps up a notch as com­pen­sa­tion.

Pro­gres­sive dam­age:

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