Why Understanding High Cholesterol Matters

When’s the last time you checked your cholesterol levels?

In Singapore, 33.6% of the population suffers from high cholesterol. According to the World Health Organisation (WHO), one-third of all coronary heart diseases stem from high cholesterol levels – making the condition an extremely important one to address. 

High cholesterol is often undetectable during its early stages – the only effective way to test for high cholesterol is through a blood test. Unfortunately, many Singaporeans with high cholesterol are undiagnosed and untreated, which increases their risk of developing severe cardiovascular diseases.

As with all health conditions, prevention is better than cure. In this article, we’ll be learning more about this asymptomatic, yet widely prevalent condition.

What is Cholesterol?

Cholesterol is a fat-like, waxy substance that’s a type of blood fat or lipid, which aids in the creation of cell membranes, hormones and vitamin D. 

The cholesterol in our bodies come from two sources; it’s either produced in the liver or obtained from the food that we consume. While the liver is primarily responsible for producing cholesterol (about 75%), the remaining 25% comes from foods such as meat, poultry and dairy products that contain dietary cholesterol. When foods that are rich in saturated and trans fats are consumed, the liver may also produce more cholesterol than usual and raise blood cholesterol levels to an unhealthy level.

There are also two kinds of cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

Low-density lipoprotein (LDL) is often referred to as “bad” cholesterol  because it can lead to plaque build-up on the walls of blood vessels. This process is known as atherosclerosis and causes the blood vessels to become narrower, less flexible and damaged – thus restricting blood flow to the heart and other vital organs. 

High-density lipoprotein (HDL), a.k.a. “good” cholesterol, is responsible for carrying excessive LDL, triglycerides and other harmful fats to the liver for processing. Once broken down, they’re converted into bile and removed from the body. Unfortunately, only one-third to one-fourth of LDL is carried away by HDL

What is considered High Cholesterol?


According to guidelines set by Singapore’s Health Promotion Board (HPB), the following cholesterol levels are considered as optimal for both men and women:

Total cholesterol: Less than 200 milligrams per deciliter (mg/dL) or 5.2 mmol/L

LDL cholesterol: Less than 130 mg/dL or 3.3 mmol/L

HDL cholesterol: Greater than 40 mg/dL or 1.0 mmol/L

When Total Blood Cholesterol levels exceed ​240 mg/dL or 6.2 mmol/L, patients are experiencing hypercholesterolaemia – also known as high blood cholesterol.

Risk factors that lead to high cholesterol levels

Unfortunately, high cholesterol usually doesn’t manifest any symptoms until later stages when more serious issues start to appear. As such, at-risk individuals need to go for check-ups regularly to test for blood cholesterol levels. 

In addition to regular check-ups, understanding the following risk factors may be beneficial for cholesterol management.

1. Unhealthy diet

Consumption of foods high in saturated fat and trans fat, such as fatty meats, full-fat dairy products (such as cheese, butter and ghee), fried food and tropical oils (such as coconut and palm oil) are high in cholesterol and could drastically raise cholesterol levels.

Alternatively, foods that are high in fibre (such as oatmeal and beans) and unsaturated fats (such as fatty fish, avocado, vegetable oils and nuts) can reduce LDL cholesterol levels.

According to the National Lipid Association, daily consumption of 5 to 10 grams of soluble fibre can help lower total and LDL cholesterol by 5 to 11 points. Soluble fibre can bind to fats and cholesterol in the small intestines, allowing excess cholesterol to be removed from the body. 

2. Obesity

Obesity could be another indicator of developing high cholesterol. With an increased amount of fat tissues, more free fatty acids (fats) are deposited in the liver where it combines with glucose to form triglycerides. This could lead to the overproduction of triglycerides and in turn, higher cholesterol levels.

3. Smoking

An academic article published on PLOS One has shown that acrolein, a highly reactive compound found in cigarettes, impedes the transportation of LDL to the liver for excretion. In addition to raising LDL and lowering HDL levels, smoking can damage blood vessels and result in plaque build-up in the arteries.

4. Heavy consumption of alcohol

Alcohol has a negative impact on cholesterol levels. As alcohol is broken down into triglycerides, excess consumption of alcohol can increase triglyceride levels and lower HDL levels.  

Symptoms of high cholesterol


Without proper management of cholesterol levels, these are some of the effects that more advanced high cholesterol patients may face: 

1. Effects on the cardiovascular and circulatory systems

As plaque build-up in the arteries obstructs the flow of oxygenated blood to the heart muscle, this could result in chest pains (angina), an early warning of a heart attack and a possible indication of high cholesterol levels. If this persists, it could worsen over time, fully blocking blood flow to important organs like the heart and brain, resulting in a heart attack or stroke. 

According to Dr Martyn Thomas, Director of Cardiovascular Services at St Thomas’ Hospital in London, patients who have suffered from severe heart attacks may have irreversible heart muscle damage, resulting in heart failure and corresponding symptoms such as breathlessness, tiredness and swollen ankles.

Survivors of stroke are likely to experience a temporary or permanent loss of vital brain functions such as paralysis, memory and vision loss, speech impairment and personality changes that range from apathy to neglect.

However, if arteries of the intestinal tract, legs, and feet are affected, it can arise in peripheral arterial disease (PAD). Left untreated, individuals may experience leg muscle pains and the loss of mobility and independence

2. Effects on the nervous system

Although 20% of the body’s entire supply of cholesterol is located in the brain, for the development and protection of nerve cells, excess cholesterol could cause brain damage and affect functions such as memory, movement and speech.

Moreover, a study led by researchers with the Atlanta Veterans Affairs Medical Centre and Emory University, have indicated a causal relationship between LDL cholesterol and the early onset of Alzheimer’s disease

3. Effects on the digestive system

As cholesterol helps in the production of bile, having too much cholesterol may result in the formation of gallstones which can cause severe pain. Moreover, this can result in inflammation of the gallbladder and blockage of the pancreatic duct, where individuals could develop fever and intense, constant abdominal pain.

Dietary Supplements for High Cholesterol


If you are looking for ways to complement a healthy lifestyle, dietary supplements like Beta Glucan may be helpful to lower cholesterol levels.

Beta Glucan is a soluble fibre that can be found in the cell walls of certain types of plants and some yeasts, bacteria, fungi, and algae, making it highly suitable for dietary supplementation. 

Several studies have shown that beta glucan is effective in lowering cholesterol levels. By forming a layer of gel in the small intestines, absorption of cholesterol and bile acids into the bloodstream is inhibited. The lack of bile acids signals the small intestines to excrete more bile using cholesterol, thereby reducing cholesterol in the body.

A separate study also found that individuals who consumed 3 grams of beta glucan per day for 8 weeks had their LDL cholesterol and total cholesterol levels reduced by 15% and 8.9% respectively.

Beta glucan is likewise known for its other health-boosting benefits such as the regulation of blood sugar levels and improvement of immune and digestive health. 

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