Ethnicity is now strongly recognized as an important modifier in the treatment of major risk factors such as hypertension, diabetes and cholesterol problems.
In a recent convention on cholesterol and atherosclerosis—the progressive narrowing of the body’s arteries due to the buildup of fat plaque inside them—this was stressed again, highlighting the need for each country to have its own guide to assessing cardiovascular risk.
The current practice is to rely on guidelines from American and European experts. While these are reliable, there are instances when Asian patients behave differently from Caucasians.
Countries such as Japan, Korea, Singapore, China, India and Taiwan drafted their own guidelines based on their experience and research. Unfortunately, data in the Philippines is not robust enough for country-specific guidelines.
We have guidelines, but the recommendations are based heavily on research and clinical trials done abroad.
My research colleagues lament the stringent challenges to securing local funding for worthwhile studies here.
Doctors Rody Sy and Elmer Llanes and others from the University of the Philippines-Philippine General Hospital are conducting a long-term research project to evaluate the risk-factor profile of Filipinos. But the fate of the project, which is nearing its 10th year, remains uncertain because of lack of funding.
It is hoped that government agencies such as the Department of Science and Technology and its research arm, the Philippine Council for Health Research Development, will infuse some funds into the project.
Dr. Llanes’ presentation of available data highlights the different profile of cholesterol problems in the Philippines. We are avoiding to call it hypercholesterolemia like we used to—and just label it as dyslipidemia.
This is because we now know we have different types of cholesterol in the body—we have bad types (low-density lipoprotein or LDL) but we also have good types (high-density lipoprotein or HDL).
In Caucasians, dyslipidemia is generally due to high LDL. Dr. Llanes presented local data from research surveys showing that, among Filipinos, it’s predominantly low HDL. Up to 70 percent or seven out of 10 in some regions in the country have low HDL. This is the predominant cholesterol problem.
We want a low level of LDL, and a high level of HDL. LDL promotes atherosclerosis and has been linked to heart attacks, strokes and premature deaths. You get LDL from animal fats and other sources of saturated fats such as lard, butter, cheese and dairy products.
HDL helps remove LDL from the body through the liver, and is believed to protect a person against cardiovascular complications. You get HDL from nuts, beans, legumes, high-fiber fruits and vegetables, olive oil, especially the virgin olive oils, rather than the processed olive oils.
How about virgin coconut oil or VCO? I remember the late professor Conrado Dayrit showing us his convincing data that VCO boosts HDL, as well as the body’s immune system.
We can also increase our HDL by exercising regularly and being more physically active, stopping smoking including vaping or e-cigarettes, losing weight if overweight and eating deep-sea fatty fish.
A small amount of alcohol is also good in raising HDL. The problem is, as I see in many of my patients, it’s difficult to limit one’s alcohol intake after the first drink. So, I’d rather not advise it.
A ketogenic diet has been shown in some studies to raise HDL, but this has to be closely supervised by a physician or medical nutritionist, particularly among diabetics who may run the risk of developing ketoacidosis or too much acid in the body due to ketone bodies produced by a ketogenic diet.