Dietary management of hypercholesterolemia


Hypercholesterolemia refers to the presence of high levels of cholesterol in the blood. Hypercholesterolemia is as a result of increased cholesterol; so cholesterol is a sterol lipid synthesized by the liver and transported in the bloodstream to the membrane of an animal that play a function in the body (Noqvist, 2009).

The cholesterol becomes hyper when the body is occupied with much lipid-like material in the blood and tissues especially nervous tissues (Net Medical Dictionary, 2014).

When the normal level of cholesterol (3.6, 6.4, 6.5 to 7.8 mmol/l) exceeds the various range, it will lead to damage of several blood vessels as well as causing other diseases such as antherosclerosis and stroke (Noqvist, 2009).

Eating of various diets that contain fatty acids such as meat, butter, whole milk and fried food do increase the level of liproprotein, saturated, unsaturated, monosaturated and polyunsaturated fatty acid (Oraye, 2013).

Hypercholesterolemia occurs in continents with a population that consumes the above mentioned types in excess resulting  to high low density liproprotein (LDL) and illness classified into primary and secondary causes affecting all parts of the world’s population ingesting a lot of cholesterol (Azonet, 2013).

Definition of hypercholesterolemia

Carmena, Deriuz and Fruchart (2004) defined hypercholesterolemia as the presence of high levels of cholesterol in the blood.

Hypercholesterolemia (literally mean high cholesterol) is defined as the presence of high levels of cholesterol in the blood (Nodqvist, 2009). It is a form of hyperlidemia (elevated level of lipids in the blood and elevated level of liproprotein in the blood). This shows that hypercholesterolemia is not a disease on its own but metabolic derangement that can be secondary to many diseases and can contribute to several forms of diseases.

Most notably diseases that can result to this condition are;

  1. Hyperlipidemia (elevated level of lipids)
  2. Hyperliproproteinemia (elevated level of lipid and protein combination)
  3. Cardiovascular disease (heart disease)
  4. Dyslipidaemia (Dyslogia – mental retardness)

These disease caused by hypercholesterolemia, is as a result of absence of cholesterol that all animals cell utilize to construct their membrane. On the average, hypercholesterolemia have succeeded in drawing a number of disease such as diabetes mellitus and obesity (Azonet, 2013).

Types of hypercholesterolemia

Health Grade (2013) listed the types of hypercholesterolemia as follows;

  1. Type I familial hyperchylomicronemia
  2. Type II A familial hypercholesterolemia
  3. Type II B familial combined hyperlipidemia
  4. Type III familial dysbeta lipoprotenemia
  5. Type IV familial hyper triglyceridemia
  6. Type V familial mixed hyper triglyceridemia


Classification of hypercholesterolemia

Azonet (2013) classified hypercholesterolemia in two ways according to its causes. That is;

  1. Hereditary (primary cause)
  2. Secondary cause


  1. Hereditary (Familial Hypercholesterolemia): these have to do with family history which often has a premature onset of atherosclerosis occurrence and signs.
  2. Secondary Cause: These include some factors which are;
  • Sleep deprivation
  • Diet
  • Body weight
  • Physical activities
  • Zieve syndrome
  • Anorexia nervosa
  • Antiretroviral drugs


Causes of hypercholesterolemia

JAMA (2001) highlighted two main causes of hypercholesterolemia which are;

  1. Environmental factors
  2. Genetic factors


Others include;

  1. Sedentary lifestyle
  2. Early menopause
  3. Certain ethnic group
  4. Alcohol
  5. Smoking
  6. Gene I
  7. Gene II
  8. Sex
  9. High intake of saturated fats
  10. Physical activities
  11. Sleep deprivation
  12. Age
  13. Hypothyroid
  14. Zieve syndrome
  15. Body weight
  16. Kidney disease
  17. Family history
  18. Antiretroviral drugs
  19. Diet
  20. Lifestyle
  21. Anorexia nervosa
  22. Physical activities


For proper understanding of the causes of hypercholesterolemia, the causative factors are hereby explained as follows;

JAMA (2001) identified the causes as;

  1. Environmental factors includes
  2. Obesity
  3. Dietary choices
  4. Obesity: this varies with age, sex and height as a result of taking more calories that they use in which the excess is stored as fats in the adipose tissue.
  5. Dietary choices: It is obvious that some people like eating foods high in fat than others which cause athrogenic lipoprotein particles.
  6. Genetic factors: The genetic contributions are usually due to the additive effects of multiple genes which occasionally may be due to single gene defect such as in the case of familial hypercholesterolemia.


Bigger and Wooten (2004) pointed out some causes of hypercholesterolemia to include;

  1. Sedentary Lifestyle: People who do not exercise and spend most of their time sitting or lying down have significant higher level of LDL and lower HDL.
  2. Early Menopause: A woman whose menopause arrives early is more susceptible to higher cholesterol.
  3. Certain Ethnic Group: People from Indian subcontinent are more liable to have higher cholesterol.


While Van and Kris-Etherton (2008) traced its causes to;

  1. Alcohol: Consumers of alcohol in excess, regularly and generally have much higher level of LDL and much lower level of HDL compared to people who abstain or drink in moderation.
  2. Gene I: This is found in family members if under 55 (male), under 65 (female) with coronary heart disease or stroke
  3. Gene II: Gene II is mostly found in young and old with dyslipidaemia or hyperlipidaemia (high blood lipids).


Nodqvist (2009) in his work stated that its causes are associated with;

  1. Sex: Men have a greater chance of having high blood cholesterol level than women.
  2. Physical Activity: Lack of exercise increases the level of cholesterol and triglyceride.


Awake (2014) also related it to;

  1. Sleep deprivation: Failing to have a good rest for at least eight hours can cause hypercholesterolemia.


Carmena, Duriez and Fruchart (2004) included its causes to;

  1. Age: As one advance in age, the chance of developing atherosclerosis increases.
  2. Hypothyroid: This is caused by insufficient production of thyroid hormone by the thyroid gland.


Odudu (2013) also traced its cause to;

  1. High Intake of Saturated Fat: Most high cholesterol is caused as a result of eating food containing high saturated fat and not getting enough exercise.


Azonet (2013) relates its causes to;

  1. Zieve syndrome: It is caused by a combination of several hyperlipidaemia.
  2. Body weight: People who are overweight/obese are much more likely to have high LDL level and low HDL level compared to those who are of normal weight.
  3. Family history: In this case, it is as a result of premature onset of atherosclerosis in a family.
  4. Antiretroviral drugs: This causes hypercholesterolemia as a result of taking drugs such as protease inhibitors and nucleoside reverse transcriptase inhibitors.

Maxwell (2013) mentioned some causes as follows;

  1. Diet: Diet causes hypercholesterolemia through the mixture of foods containing high fats such as use of fat oil and snacks.
  2. Lifestyle: The life style of a worker can lead to increase in his or her weight to some extent.
  3. Smoking: This can have quite a considerable effect on LDL weight.
  4. Anorexia Nervosa: This is caused by loss of appetite.
  5. Kidney Disease: This is caused by the interruption of blood supply to the kidney as a result of fats blockage of the vessel.


Signs and symptoms of hypercholesterolemia

Note: The signs of hypercholesterolemia do not exist alone in a way that a patient or doctor can identify it by sight, but are revealed when an individual has one of the symptoms below;

  1. Temporary loss of vision
  2. Ephasia
  3. Dizziness and impairment balance
  4. Paresis
  5. Chest pain
  6. Calf pain
  7. Abdominal pain
  8. Atherosclerosis


For  more understanding of these signs and symptoms, they are hereby explained as clinically as follows;

  1. Temporary loss of vision: This is a situation in which the eyes cannot identify colours and objects for a particular time.
  2. Dizziness and impairment balance: Having a form of tiredness, filling like sleeping when not the time for it and not the time for it and not being able to carry out any social activity.
  3. Ephasia: This is found when there is difficulty in speaking.
  4. Paresis: It is due to weakness, numbness or tangling (paresthia) usually on one side of the body.
  5. Chest pain: This is said to be insufficient supply of blood to the heart which causes pain.
  6. Calf pain: This is painful sensation during movement.
  7. Abdominal pain: During eating a meal, as a result of infection in the intestine, it elevates the pain in the abdomen to other part of the body.
  8. Atherosclerosis: It is a common consequence of having hypercholesterolemia level. The symptoms below is found when hypercholesterolemia is present in the arteries which leads to;
  9. Narrow coronary arteries
  10. Leg pain
  11. Blood clots
  12. Ruptured plagues.
  13. Xanthomas


To know these atherosclerosis symptoms, they are therefore explained below.

  • Narrow coronary arteries: This is a blockage found in the vessels which are connected to the heart.
  • Leg pain: During walking or when exercising, the blood vessels supplying blood especially to the leg, as a result of the narrowness of the arteries pains results as blood flows through the arteries.
  • Blood clotting: As a process of the blockage in the arteries, blood will not be able to flow as normal which causes stroke.
  • Ruptured plagues: This leads to coronary thrombosis (a clot forming in one of the arteries that deliver blood to the heart).
  • Xanthomas: This is commonly found in people who have inherited hypercholesterolemia, having thick yellow patches on their skin, especially around their eyes. Nodqvist (2009).


Hypercholesterolemia can lead to;

  1. Atherosclerosis
  2. High coronary heart disease
  3. Heart attack
  4. Agina
  5. Stroke and mini stroke
  6. Hypertension
  7. Death.


The above-mentioned terms are thus explained below;

  1. Atherosclerosis: This is caused by the narrowing of the arteries when there is high fat content surrounding the arteries vessels.
  2. High coronary heart disease: It is caused by high cholesterol blockage of the arteries as a result leading to abnormality of the arteries that supply blood and oxygen to the heart.
  3. Heart attack: It occurs when the supply of blood and oxygen to the areas of the heart muscle is blocked, usually by  clotting the coronary artery.
  4. Agina: This is due to chest pain or discomfort that occurs when the heart muscles do not receive enough blood.
  5. Stroke and mini-stroke: Is mostly said to occur when a blood clot an artery or vein, interrupting the flow to an area of the brain. This can also occur when there is blockage in the vessel which leads to vessel breaks and brain cell begin to die (Azonet, 2013).


Diagnosis of hypercholesterolemia

The main method is through the use of simple blood test. Before it can be done, do not eat anything for at least 12 hours before the blood sample will be obtained with a syringe or by just prickling of the patient’s finger.

The blood sample will be tested for low density lipoprotein and high density lipoprotein level as well as triglyceride level. (Nodqvist, 2009).


Note: According to Azonet (2013), there is no specific level at which cholesterol level is abnormal. So it is advisable that people who have risk or having any sign and symptoms of any kind should visit his/her doctor and the laboratory to consider having their cholesterol level checked always.


Clinical assessment of hypercholesterolemia

A dietitian needs to know the kind of food such a patient has been consuming by using the method called anthropometry assessment. Anthropometric assessment is the assessment used in knowing the nutritional value of a patient. (Maxwell, 2013). This requires you knowing what the patient like eating. For example, consider a case of a patient having hypercholesterolemia, at first you start clinical assessment by knowing what such patient eat most.

It might be;

  1. Soup like;
  2. Ogbolor soup
  3. Banga soup
  4. Fried stew
  5. Fried melon
  6. Fried beans
  7. Fried rice, yam, plantain, etc.

Snacks such as;

  1. Bounce
  2. Fish pie, meat pie
  3. Egg roll
  4. Gala
  5. Baked bread
  6. Biscuits (containing cream)

Solid food such as;

  1. Eba
  2. Yam
  3. Ripe plantain
  4. Rice, beans
  5. Akpu (derived from Nigerian staple food cassava)

Meat product such as

  1. Liver
  2. Intestines
  3. Fleshy part (red meat)
  4. Chicken (both skin)
  5. Pork meat
  6. Fats and oil
  7. Meat fat
  8. Butter
  9. Milk
  10. Groundnut oil
  11. Salad cream
  12. Pig fat
  13. Coconut oil (has large amount of saturated fatty acid)

Alcohol such as;

  1. Beer
  2. Star
  3. Cock
  4. Palm wine
  5. Wine

Spices such as;

  1. Potash
  2. Big crayfish
  3. Maggi
  4. Salt (brine)
  5. Margarine

Fruits such as;

  1. Pineapple
  2. Apple
  3. Over ripe pawpaw
  4. Banana


Lifestyle such as;

  1. Sedentary
  2. Smoking (in some persons)
  3. Moderate active
  4. Over-eating

Counselling of a hypercholesterolemia patient

Men and women should make conscious efforts in trying as much as possible to cut down the consumption of food and items already mentioned above. When there is a severe case of the problem, proper dietary management will help in the reduction, prevention and fighting of high cholesterol.


Dietary management of hypercholesterolemia

What to avoid and cut down;

The basic fact is, though, that we eat less fat but make sure that are free from saturated fats such as;

  1. Fat in animal products;
  2. Red meat
  3. Sausage
  4. Hot dog and beacon
  5. Butter
  6. Cream
  7. Eggs yolks
  8. Cakes
  9. Chocolates
  10. Fried food
  11. Whole milk
  12. Organ meats

(Tambe, 2010).

What to ingest and cut down;

  1. Always go for soft diet, because its nutritional requirement contains low fat (Odudu, 2013).
  2. Cooking ones meals helps to remove some of the fats which may be indigestible if too much is eaten (Agidi, 2013).

Fat and oil to ingest

  1. Increase intake of polyunsaturated and monounsaturated fats (good quality fats e.g. olive oil, fatty fish, e.g. salmon, herring) each week for at least 2. (Recommended by American Heart Associate), vegetable oil, palm oil (not fried).

Grains to ingest

  • Whole grain
  • Buy whole grain bread and roll
  • Whole wheat bread
  • Brown rice
  • Try whole grain flours to enhance flavours when eating foods with less fats.

Soup to ingest

  • Pepper soup
  • Melon soup (unfried)
  • Vegetable soup
  • Unfried stew
  • Okro pepper soup
  • Melon pepper soup
  • Ogbolor pepper soup

Fish to ingest

  • River fish (dry)
  • Crayfish (cut down big crayfish and ingest small types)
  • Fatty marine fish which contains omega 3 fatty acid.
  • Kpomon (cut down or a slice) (from animal skin e.g. cow only)
  • Sea fresh fish (in small quantity)

Spices to use;

  • Salt (cut down or less)
  • Maggi/knorr (cut down or less or alternate with sweetener)
  • Onion (cloves) (less)
  • Nutmeg (less)
  • Ginger (less)
  • Pepper (less)
  • Mustard seed (less)
  • Curry (less)
  • Urie-rich (less)
  • Urioma (alligator pepper) (less)
  • Uiziza (less)
  • Ogili-isi (less)
  • Ogili-ogba (less)

(Ifejika, 2013)

Herbs to use;

  • Thyme (less)
  • Rosemary (less)
  • Parsley (cut down or less)
  • Bayleaf (less)
  • Akwukwo curry (less)
  • Effirin (less)
  • Aluiuisi (less)
  • Erauksi (less)
  • Ebe otiebo (less)
  • Erah (less)

Vegetables to ingest;

  • Pumpkin leaves (ingest always)
  • Water leaves (ingest always)
  • Bitter leaves (ingest always)
  • Cabbage (ingest as you can – a day at least twice or more)
  • Cucumber (as you can, depend on the quantity)
  • Carrot (two is enough)
  • Tomatoes (as you can)
  • Onion (cloves)
  • garden egg (as you can, for at least three times daily)
  • Okra (as you can)

(Agidi, 2013)

Fruits to ingest

  • Lemon grape (two)
  • Apple (a slice)
  • Pawpaw (show ripe, two slice)
  • Cherries (two or three)
  • Pineapples (a slice)
  • Orange (one or two)
  • Carrot (two or three)
  • Garden egg (more of it)
  • Water melon (a slice or two depending on the size)
  • Cucumber ( as you can depending on the quantity

Fibres to ingest;

  • Orange (inner layer)
  • Water melon (outer layer and seeds)
  • Pineapple (middle stick)
  • Lemon grape (inner layer)
  • Tapioka (derived from Nigerian staple food, cassava)

Juice to absorb

  • Lemon juice (two or three times a week, depending on the situation)
  • Orange juice (two or three, or once daily, it depends on the situation)
  • Yogurt
  • Salad dressing
  • Zobo juice (without mixture of flower and brine)

They contain phytosterol and sterols found in nuts seeds, vegetable oils because studies show that eating 2-3 grain of phytosterols daily reduce total cholesterol (Bigger and Wooten, 2004)

Solid food to ingest

  • Wheat flour
  • Garri or eba
  • Yam (two to three slice, depends on the patient)
  • Plantain (one scoop or three depends on the patient and prescription)
  • Rice (a cup or two after cooking)
  • Beans (size of kitchen spoon at least two and a half or less, depends on the prescription).

Lifestyle to work on

  1. Sedentary to active (always go on exercise at least twice daily)
  2. Eating a balanced diet
  3. Getting regular exercise for at least 30 minutes (recommended on is 120 minutes)
  4. Having a good rest for at least eight hours each night.
  5. Bring your body weight to normal
  6. Always consider having the cholesterol level checked
  7. Always eat not for satisfaction (less quantity)
  8. Patient’s meal should be regularized, breakfast, six thirty almost seven o’clock, lunch at least 12 noon.

Carry out this;

  • Steam boiled or bakes vegetables separately then adds it to any food you are eating.
  • Season vegetables with herbs and spices rather than with sauce, butter or margarine.
  • Try lemon juice or salad dressing.
  • Cut down whole milk and replace with skin or low fat in pudding soups and baked product and use of beverages

(Tambe, 2010)


Cholesterol is good on its own because it helps the body to function properly however, when the intake is too much and excess, it can cause hypercholesterolemia.

The more cholesterol is high, the greater it cause diseases such as cardiovascular disease, hyperlipidemia because it is not a disease of its own.

A major cause for hypercholesterolemia is diets, others include sleep deprivation, lifestyle, sex, gene, high intake of saturated fats and hereditary.

No sign and symptom are known with a mere look of the eyes, they might be seen from sharp pains in the chest, dizziness, calf pain, abdominal pain, and atherosclerosis. Early detection and seeking medical attention is highly encouraged as this can help to manage the situation effectively.

My advice to you as a cholesterol patient is to visit the diagnosis department always to see that your cholesterol level is checked before it is too late.

To help yourself, always cut down the intake of foods mentioned by the dietitian after his assessment and counselling.

A good nutrition is the key to healthy living. So eat good diet during the management of your cholesterol by taking low fat diet and non fats when necessary which also implies avoiding the consumption of large potion size of food (eating not to your satisfaction).

Note of caution: You are what you eat. Good nutrition key to healthy living.


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