Ways to help your patients with hyperlipidaemia management at home
High cholesterol levels affect just over 6%*1 of Australians however, we know that many are not addressing some of the modifiable risk factors associated with hyperlipidaemia that they can work on at home.
Given the burden of high cholesterol and cardiovascular disease (CVD) in Australia, as part of overall management, it’s important to regularly check that our patients are also engaged with their non-pharmacological management goals, and support them.
What are plant sterols and how do they help manage cholesterol?
Plant sterols (phytosterols) are a group of fat-like substances that occur naturally in plants. They increase the activity of cholesterol synthesis and LDL receptors which result in a decrease of serum LDL cholesterol concentrations. They work by reducing the amount of dietary and biliary cholesterol that is absorbed from the gut into the body, more specifically causing reductions in serum total and LDL cholesterol. 2-4
There are a number of studies which have shown that consuming 2 grams of plant sterols either in free form or as fatty acid esters, can lower cholesterol levels. 2,3 When plant sterols are combined with a healthy lifestyle, they can lower LDL-cholesterol concentrations by up to 10-15%2,4
Plant sterols can be regularly found in small amounts in foods such as fruits, vegetables, wholegrains and nuts. 2-4 However, there are also Australian-approved foods fortified with plant sterols which can help patients to meet the recommended daily dose, such as specialised margarines, milk and breakfast cereals. 2,4
Here is a useful checklist to remind patients about modifiable lifestyle behaviours to help manage their cholesterol and CVD risk:
1. Eat a high fibre, plant-based diet
We know that eating a balanced diet with lots of plant foods is important for managing cholesterol, such as fruits, vegetables, nuts and high fibre wholegrains. 2 Fibre also helps to reduce the absorption of cholesterol from the gut and can help reduce serum cholesterol levels. 5
2. Introduce plant sterols as part of a healthy diet2
The Australian Heart Foundation states that foods enriched with 2–3 grams of plant sterols a day will benefit patients with CVD and higher LDL-cholesterol levels, as well as those with familial hypercholesterolaemia. 2 An example is to start the day with breakfast cereal that is enriched with plant sterols such as Sultana Bran+ with Cholesterol Lowering Plant Sterols,* This can provide patients with the daily recommended intake of plant sterols in one serve.
3. Limit foods high in saturated fats
Check and remind patients to avoid or limit takeaway foods high in saturated fats, 2 such as deep-fried food, hamburgers and pizzas and commercially-baked goods such as cakes and biscuits which contain high levels of saturated and trans fats. Choosing lean meats and low-fat dairy as well as substituting polyunsaturated or monounsaturated oils or margarines can also be helpful. 2
4. Obtain and keep weight within the recommended healthy weight range2
The Australian Government’s Healthy Weight Guide can provide information for your patients as well as supporting them to plan, track and monitor their weight loss.
5. Exercise regularly
Encourage your patients to engage in moderate-intensity physical activity such as walking, jogging, or cycling, for 30 minutes daily or most days. 2
6. Obtain and remain smoke-free2
Tobacco smoke is responsible for 12% of CVD morbidity and mortality in Australia. 6 In addition to your support, patients can contact Quitline for help. 2
7. Limit alcohol intake2
Consumption of alcohol should be limited to 2 standard drinks a day for men and 1 standard drink a day for women.
As GPs, we know that regular monitoring and support is key to helping our patients in their pharmacological and non-pharmacological management of hyperlipidaemia and CVD risk, As well as eating healthily, Heart Foundation recommendations for adding plant sterol-enriched foods may also provide an extra tool for helping patients to manage their cholesterol at home.
* A 50g serve of Sultana Bran® + with Cholesterol Lowering Plant Sterols contains 2g of plant sterols, which can reduce cholesterol as part of a healthy varied diet low in saturated fat. 2g of plant sterols daily is required to help lower cholesterol. Additional consumption does not provide further benefit. May not be suitable for children under 5 years and pregnant or lactating women.
- Australian Bureau of Statistics, National Health Survey: First Results, 2017-18
- Heart Foundation of Australia. Position Statement; Phytolsterol/stanol enriched foods. https://www.heartfoundation.org.au/getmedia/d25f0d73-54b2-4399-a645-e095... Accessed July 2020
- *Ras, et al. Br J Nutr, 2014. 112(2): 214-9
- Dietitians Australia. All about plant sterols and stanols for cholesterol management https://dietitiansaustralia.org.au/smart-eating-for-you/smart-eating-fas...,. Accessed July 2020
- Dietitions Australia, Can I lower my cholesterol through dietary changes? https://dietitiansaustralia.org.au/smart-eating-for-you/smart-eating-fas...
- Heart Foundation. Smoking and Tobacco regulation. https://www.heartfoundation.org.au/programs/advocacy-smoking-and-tobacco.... Accessed July 2020
Dr Sam has been a practicing general practitioner since 2005 and is now a director of one of Sydney’s most successful private general practice networks, where he focuses on a multitude of issues that affect young families aided by his postgraduate training in Sports Medicine and Paediatrics.
As an avid health and fitness ambassador Dr Sam strongly encourages everyone he meets to get out there and start moving. Leading by example Dr Sam keeps himself fit in the gym or in the surf.
Dr Sam is involved in a number of public campaigns and he works closely with various health charities to help look for new ways to educate people in health matters. In 2018 he was proud to be announced as a Life Education Ambassador.
Dr Sam Hay – BMedSci, MBBS(Hons), FRACGP, Graduate Diploma of Sports Medicine, Diploma of Child Health
This blog is sponsored by Kellogg's.