High cholesterol:Why it’s bad for you and how to lower it

Dear doctor,

I have been told that I have high cholesterol levels. How do I manage this without taking medication? Do I also need to lose weight and yet I see as though I am okay? Should I avoid taking any fats completely?

Derrick

Dear Derrick,

You can have high blood cholesterol levels even with normal weight. While obesity is one of the risk factors for having high cholesterol levels, it is not the only risk factors. Other risk factors include having a dirt that has a lot of “bad” fats (trans fats and saturated fats such as the ones in processed foods and in fried foods), excess sugar intake, lack of exercise, smoking, excessive alcohol intake, diabetes, hypothyroidism, chronic kidney disease, some inflammatory disorders and some medications. High cholesterol levels may also be due to a genetic disorder which affects how the body processes fats. Cholesterol levels may also rise during pregnancy, especially during the third trimester.

The risk with having high cholesterol levels is that they can contribute to formation of deposits called plaques on the walls of blood vessels. This can cause narrowing of the blood vessels and reduced blood supply to the organs, which can lead to organ damage such as of the eyes, the kidney, the heart, the brain or the limbs. Cholesterol levels should be assessed together with other risk factors for cardiovascular disease so as to determine your overall risk profile.

Fats have an important function in the body and they are necessary in your diet. However, there are different kinds of cholesterol that will be indicated on the blood test and the doctor will assist you in understanding the result. The main distinction is between the “good” HDL cholesterol and the “bad” LDL cholesterol and triglycerides. The aim is to have more of the good type and less of the bad type.

To manage the cholesterol, use more of the unsaturated fats like olive oil, sunflower oil and corn oil and avoid trans fats and saturated fats; take complex starches and whole grains; eat more vegetables and fruits, and other high fibre foods; and reduce processed starches, whole milk and red meat. Also, exercise regularly, stop smoking and reduce alcohol consumption. There are also medication that can help to lower the cholesterol levels.

Dear Doctor,

My ears keep getting blocked and they have to be cleaned in hospital, yet I have never heard of this happening to others. What could be wrong with me?

Leila

Dear Leila,

The ears normally produce wax that helps with cleaning and protecting them by trapping dust, foreign objects and infectious organisms. The wax is then cleaned out naturally by moving towards the opening of the ear, assisted by movement of the jaw, where it falls off or is cleaned off during normal body cleaning.

In some people, the wax can build up to the point of causing blockage, also known as impaction. This may cause hearing loss, itchiness of the ear, pain, feeling of fullness, ringing in the ears, ear discharge and/or smell from the ears.

The wax build-up may be because there is excess production or the wax is excessively dry or hard. It may also be because the ear canal is narrow or the shape makes it a challenge for wax to exit easily. Other risk factors of developing wax impaction include frequent use of ear swabs to clean the ears, use of hearing aids, frequent wearing of ear plugs, or if you have a lot of ear hair.

The impaction is diagnosed by the doctor when they look into the ear canal with an otoscope. The wax can be removed through ear irrigation with warm water or using medications that soften/dissolve the wax; or manual removal through suctioning or curettage. The build-up of wax may recur because the ear canal is constantly producing wax.

To reduce the frequency of impaction, clean and dry the outer part of the ears daily. Do not insert or use anything inside your ear, even cotton swabs, as this actually stimulates more wax production. The ear swabs should only be used to clean the outer ear.

Dear doctor,

I am a 22-year-old female who has never given birth or ever been pregnant. For the past year, I have noticed that every time I press my breasts, some milk comes out. What could be the problem?

Nancy

Dear Nancy,

When there is milk production in someone who is not breastfeeding, this is called galactorrhea. It can happen in women who are not pregnant or breastfeeding, or in men or babies.

Milk production usually results from having high levels of the hormone prolactin in the body. Prolactin is produced by a part of the brain called the pituitary gland. This can be initiated by excessive stimulation through self-stimulation or examination, stimulation during sexual activity or even having a baby sucking on the breasts for long enough. There are medical conditions that cause high prolactin levels such as pituitary tumours, chronic kidney disease, having an underactive thyroid and other hormonal disorders.

There are also medications that can affect the prolactin levels including hormonal medications, some blood pressure medications, some antipsychotic medications among others. In men, reduced levels of circulating testosterone may trigger galactorrhea, and in babies, it can happen as a result of having hormones from the mother still circulating in their blood.

In some people, the cause of the galactorrhea may never be found.

It is advisable for you to visit a doctor for physical evaluation, and necessary tests, including analysis of the discharge, prolactin levels and other tests. Treatment will depend on the exact diagnosis. There are also medications to reduce prolactin levels, therefore stopping milk production. Meanwhile, avoid breast stimulation and pressing of the nipple, and also avoid clothes that have a lot of friction with the nipple.

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