Dyslipidemia - what is it and how to revert it?

Dyslipidemia - what is it and how to revert it?

What is dyslipidemia?
Dyslipidemia is a dysregulation of the fats in the blood. It is one of the factors in the onset of cardiovascular diseases, one of the biggest causes of death worldwide. It may have hereditary origin or it may be related to lifestyle.

Dyslipidemia is clinically characterized by:

• Hypercholesterolemia > Increased total cholesterol (TC) (TC >190 mg/dL) and/or LDL cholesterol (c-LDL) (c-LDL ≥ 115 mg/dL);
• ​Hypertriglyceridemia > Increased triglycerides (TG) (TG ≥ 150 mg/dL);
• Mixed dyslipidemia > Combination of two factors (high TC and/or high c-LDL and TG);
• Hypolipidemia > Decrease in HDL cholesterol (c-HDL) (men < 40 mg/dL and women < 45 mg/dL)

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​Dyslipidemia - risk factors

• Body Mass Index (BMI) - A BMI greater than 25 kg/m2, i.e overweight and obesity
• Excessive fat accumulation in the abdominal area
• Alcohol consumption
• Smoking
• Excessive saturated fat intake
• Sedentary lifestyle
• Genetics

Fats in the blood

• Cholesterol - is a fatty substance present in our body, important for the production of hormones, vitamin D and bile acids, substances that help in the digestion and absorption of fat.
• LDL - They are low-density lipoproteins, and transport cholesterol from the liver to the blood. Better known as "bad cholesterol" as it increases blood cholesterol levels.
• HDL - High density lipoproteins are responsible for “collecting” cholesterol from the blood and bringing it back to the liver to be metabolized, the excess is eliminated. HDL is known as “good cholesterol” because it removes excess cholesterol from the blood.

What are the health consequences of excess fats in the blood?

• Cardiovascular disease, or heart disease, can appear due to accumulation of excessive fat in the bloodstream (atherosclerosis), and form a plaque composed of fat and fibrous tissue that deposits on the walls of arteries. This causes the blood flow that passes through the arteries to be reduced, and over time, this plaque can increase in size, completely blocking the artery, slowing or obstructing the blood flow to the brain and heart. This type of situation can lead to a stroke or an acute myocardial infarction.
• Fatty liver disease (steatosis) - is defined by the accumulation of excess fat in the liver. Dyslipidemia, obesity, and high waist circumference are risk factors for steatosis.
• Insulin resistance, mainly associated with high levels of triglycerides. As a result, insulin resistance causes blood sugar levels to remain high, which can lead to diabetes.

Fats in foods
Saturated fat - solid fats at room temperature; too much consumption can cause an increase in LDL cholesterol.

Saturated fat - food sources

Monounsaturated fat - liquid fat at room temperature; its consumption can help lower LDL cholesterol.

Monounsaturated fat - food sources

Polyunsaturated fat - liquid fat at room temperature; it comes in two forms:

• Omega-3 - associated with a decrease in LDL cholesterol and an increase in HDL cholesterol;
• Omega-6 - associated with lower cholesterol and LDL cholesterol.

Polyunsaturated fat - food sources

Trans fat - obtained from the hydrogenation process of unsaturated fatty acids; associated with increased triglycerides, LDL cholesterol and decreased HDL cholesterol.

Trans fats - food sources

Cholesterol - exists in two types: HDL cholesterol and LDL cholesterol (as noted above); the imbalance between these two types of cholesterol is an important risk factor for cardiovascular disease. Cholesterol can be produced by our body (liver) or come from animal food sources.

Cholesterol - food sources

What is the treatment for dyslipidemia?
Dyslipidemia can be reversed through lifestyle changes, specifically diet and physical activity. This is the first line of treatment.
Medication should be the second line of treatment when lifestyle changes have not been effective.

What are the dietary recommendations to treat dyslipidemia?
The European Society of Cardiology and European Atherosclerosis Society, established as healthy cholesterol parameters for individuals at low risk of developing cardiovascular disease, the following:
Total cholesterol < 190 mg/dL
LDL cholesterol < 115 mg/dL
HDL cholesterol > 40 mg/dL (men) and > 45 mg/dL (women)
Hypercholesterolemia - dietary recommendations based on the principles of Mediterranean food

1. Reduce the intake of foods rich in saturated fat (cakes, biscuits, chocolates, fatty dairy products, sausages, red meat) and substitute the consumption of polyunsaturated fats (mainly Omega - 3, present in fatty fish such as salmon, sardines , fresh tuna, etc).
2. Avoid foods rich in trans fats, present in processed foods; coconut, butter and oil;
3. Choose lean meats such as chicken and rabbit, removing visible skins before cooking;
4. Avoid fried foods and the addition of butter in the food preparation process. Prefer to steam the food, and use olive oil as the preferred fat;
5. Prefer whole grains (bread, rice, pasta, oats) and reduce the consumption of foods rich in simple sugars (sweets, chocolate, cakes, biscuits, juices and soft drinks);
6. Increase consumption of fiber-rich foods: vegetables, seeds, whole grains and pulses; particularly foods rich in soluble fiber, such as: oats, wheat, nuts (almonds, cashews, peanuts, etc), eggplant, orange, apple, banana, kale, carrot, avocado and dry fruit (figs, apricots, etc.);
7. Reduce alcohol consumption: women 1 glass of wine 150ml per day at main meals and men 2 glasses of wine 150ml per day, also at main meals.
8. Increase the consumption of vegetable proteins, such as soy, beans, lentils and grains;
9. Reduce salt intake and use herbs and spices to season;
10. Increase the consumption of foods rich in phytosterols (sterols and stanols): rice bran, corn, wheat germ, flaxseeds, soybeans, olive oil, cashews, almonds, peas, red beans, and fortified foods (margarines, vegetable creams, yoghurts, etc).

Hypercholesterolemia - dietary recommendations

Hypertriglyceridemia - dietary recommendations based on the principles of Mediterranean food
The same recommendations as above, with the addition of the following:

• Fruit consumption should be regulated;
• Restrict consumption of foods rich in simple sugar;
• Exclude consumption of alcohol, soft drinks and sugary drinks.

Hypolipidemia (low HDL cholesterol) - dietary recommendations based on the principles of Mediterranean food

• The same recommendations mentioned above for hypercholesterolemia
• Practice 30 minutes of daily aerobic exercise (eg swimming, walking, light jogging, cycling).

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Myths in dyslipidemia

Egg
The consumption of eggs was once inadvisable for people with high cholesterol levels.
However, the most recent recommendations indicate that consumption of up to one egg a day does not increase blood cholesterol levels and the risk of cardiovascular disease, as long as this is done within a healthy lifestyle pattern.
Studies have shown that excessive consumption of saturated fat and trans fats has a greater effect on raising blood cholesterol than consumption of foods high in cholesterol.

Egg - vitamins and minerals

Prawns
Prawns, despite being high in cholesterol, like eggs, have very low levels of saturated fat. As mentioned above, cholesterol from food does not influence the increase in blood cholesterol, but excessive consumption of saturated fat does. Therefore, its consumption is allowed, within a healthy lifestyle pattern.

Coconut oil
Coconut oil has received particular attention recently as a very beneficial food for health.
However, from a nutritional point of view, it is rich in saturated fat (approx. 82%), which means that its consumption should be limited for people with high levels of blood cholesterol. This can and should be replaced by olive oil, in moderation.

Conclusion
Dyslipidemia is a dysregulation in blood cholesterol levels, which increases the risk of cardiovascular disease, the leading cause of death worldwide. Dyslipidemia can be reversed through lifestyle changes: adopting the principles of Mediterranean diet and physical activity.
Consult a dietitian if you are concerned about your cholesterol levels.

Joana Jardim
UK Registered Dietitian
MSc Clinical Nutrition
Founder of Your Diet Advice

Bibliography
DISLIPIDEMIAS: CARACTERIZAÇÃO E TRATAMENTO NUTRICIONAL, Associação Portuguesa de Nutrição, disponível em
https://www.apn.org.pt/documentos/125048-Dislipidemias_07_28.9.2018.pdf, acedido em 28/09/2021

Cholesterol: Food Fact Sheet, British Dietetic Association, disponivel em https://www.bda.uk.com/resource/cholesterol.html, acedido em 28/09/2021
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Oxford Handbook of Nutrition and Dietetics (Oxford Medical Handbooks), 2nd Edition