Young blood, maybe not

far too many under-40-year-olds are victims Of high cholesterol.

Well, I’d gone for an executive health checkup, and when they gave me the results, I was shocked…” That’s how most of these stories start, with a blithe customer unpleasantly surprised to discover that he or she has unhealthily high levels of cholesterol. It’s something typically associated with middle age, and by these people, with their parents, perhaps — because these customers are all young, still only in their 20s or early 30s.

Cholesterol is one of hundreds of terms, like “triple bypass”, that once only a medical-school graduate would have known but which are now part of our daily vocabulary. As the word has spread, so has what it represents: within the last few decades in the West, and since the 1990s’ liberalisation in India, more and more people have gained too much of it. And, according to several recent studies, young adults are the biggest gainers.

“Yeah, obviously I was shocked,” says Srijeet Das, a 28-year-old advertising executive, who had his revelatory checkup two years ago. “It was way too high. It was around 300.” It should ideally be under 200 mg/dL of blood; if it is above 240 the patient is considered at high risk of heart disease. “They did an angiography and all, fortunately [arterial] blockage was not there.” So “they gave me some medicines. They asked me to exercise and stop eating fatty food.”

“Basically the reason is overeating and obesity — fast food and the lack of exercise, watching TV and playing computer games,” says Dr V K Bahl of AIIMS, and now president-elect of the Cardiological Society of India (CSI). “The food is changed, and [over time] it leads to so-called metabolic syndrome,” a combination of disorders including high blood pressure, blood sugar and cholesterol, and obesity (particularly abdominal obesity), which greatly raises the risk of heart disease and diabetes. Dr Bahl says that heart attacks in 30-somethings are growing common.

Although cholesterol, a soft, waxy substance, occurs throughout the body, it tends to accumulate in blood vessels. Humans do need it in small amounts, because it helps our bodies make certain hormones, vitamin D, and so on. Too much of it impedes blood supply to the brain and makes the heart work too hard, straining it dangerously.

Most of our cholesterol comes from our diet — processed foods, poultry, dairy products and especially meat. It has nothing to do with fat content; for example, organ meat (liver, brain, kidneys) has little fat but lots of cholesterol.

Sonam Mahajan, 23, spent a year working in Chile. “When I got back [earlier this year] I got a regular health checkup done, and the cholesterol levels were accelerated,” she says. She blames “high consumption of red meat” in Chile. “The Indian system is not used to it… Within two-three months once I was eating home food,” her cholesterol dropped to normal.

There are two types of cholesterol. Low-density lipoprotein (LDL) is bad, and high-density lipoprotein (HDL) is good. Along with total cholesterol count, one has to watch the balance between the two. Plant-based foods and oily fish are good at raising HDL, which helps clear out LDL, and they contain little or no LDL.

“I personally think diet and lifestyle changes should be the first line of treatment,” says Dr S Padmavati, chief consultant in cardiology at the National Heart Institute in Delhi. “If after three months there is not sufficient improvement then drugs can be thought of. Drugs have side effects.” Dr Bahl cautions that drugs “are not a cure — they control”.

Yet all those we interviewed said they had immediately been prescribed medication. Priyanka Desai, a 33-year-old who does market research into consumer behaviour, says “The first guy wanted to put me on a whole list of medications.” She was pregnant at the time, and “caught up and cooped up in the office”. Instead she asked around informally and was told to lose weight and watch her diet. A nutritionist she consulted told her to take crushed garlic and methi-pani every day. It seems to have helped. “You can see weight loss, but can’t keep tabs on LDL-HDL like that,” she says. “From time to time I check and I did see the levels drop.”

Diet and lifestyle advice is hard to follow, young patients find. “Somehow I exercised for a month,” says Srijeet Das, “but now I've carried on with medication.” He was told to do cardio and upper-body workouts — running and weights, essentially — but hasn’t stuck to it. “Once in a week” is all he manages. “It’s a sad state, man, it's a sad state.”

Desai, on the other hand, is sticking to her workout regime. “I’ve shed weight, so that makes me feel good,” she says. “I feel much better, my stamina has improved.”

Corporate lawyer Amitava De (name changed), 38 and a former smoker, was told he had cholesterol problems “five-six” years ago. “At the moment I’m doing relatively well,” he says, but he hasn’t been consistent with exercise or medication either. “It’s ultimately in the mind, I guess. It’s about time management and being able to force yourself to do certain things every day despite being tired. A lot of us work 15-hour days on a regular basis. I’ve had to cut down on my sleep time [to exercise], which I don’t think is good. It’s very easy to say cut down on your lifestyle, but it's not easy to do it.”

Upending one’s food habits is also a trial. “I’ve not been able to ignore eating,” says Das. “I’m a big foodie.” Desai too loves her food, but she has been firm with herself. “I don’t binge,” she says, has cut down on carbs, is eating more greens and salads and has virtually given up alcohol. “I can’t cut off on everything,” she qualifies. “One day in a week I don’t control myself too much.”

“I’m a non-vegetarian,” says De, “so I used to eat a lot before. I still do but I try and avoid red meat as far as possible.” At restaurants with friends, colleagues and clients, however, he can’t afford to watch too closely. “I will eat if I have to — not sit in a corner and sulk.”

Dr Padmavati says compliance with doctors’ advice to young patients is “Poor. About 20 per cent follow orders.” But knowledge of the scale of the problem, while still abysmally low, is growing. “I think people are now becoming conscious,” says Dr Bahl. “There is so much media hype, and gym and [fitness] awareness is coming.”

He also points out that as more young people see friends and peers tracking their cholesterol, they too will consider getting themselves tested more regularly. Ideally, given prevailing lifestyles, people should check their cholesterol every five years or so, starting at age 20, and increase frequency depending on the results.

The problem may be graver than any of these individual patients think. Elevated cholesterol in the young, for instance, is gradually being associated with a greater risk of non-heart ailments which occur later in life, including Alzheimer’s disease. Even if one is not overweight, other factors, including family medical history and food and smoking habits, ought to be kept in mind. Studies of individuals of exceptional longevity have found that in many cases their bodies are genetically predisposed to have larger HDL and LDL particles, which get cleaned more easily from the blood. So it is perfectly legitimate to make a connection between healthy cholesterol levels and a longer life.