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High cholesterol means that you have too much of a fatty substance known as cholesterol in your body. High cholesterol or hyperlipidaemia affects people of all ages, including those who feel healthy and are active. High cholesterol usually has no symptoms, but left untreated leads to complications.

Cholesterol is deposited in the inner walls of your arteries over time, leading to the formation of plaques. These plaques increase in size, causing narrowing and hardening of your arteries. These plaques reduce blood flow through your arteries and increase your risk of developing harmful blood clots. This plaque formation is known as atherosclerosis. Atherosclerosis leads to life-threatening complications such as:

Angina or chest pain
Stroke
Heart attack
High blood pressure
Transient ischaemic attack (TIA)
Peripheral vascular disease
Chronic kidney disease

Not everyone with high cholesterol needs to take medication. Some people only need lifestyle changes. Others need lifestyle changes with medication. People with underlying medical conditions that affect their cholesterol levels need a more complex approach. Your healthcare professional would consider your family history, medical history and lifestyle factors in helping you to reduce your cholesterol levels.

The following lifestyle changes can help lower your cholesterol levels.

Avoid foods high in saturated fats.

Reduce your intake of saturated fats and trans fats. Excessive intake of these fats increases LDL or “bad” cholesterol over time and increases your risk of severe health problems. The American Heart Association recommends limiting saturated fat to less than 6% of daily calories and avoiding trans fats.

Foods rich in saturated and trans fats include fatty cuts of meat, red, processed meats such as sausages, egg yolk, fried foods, fast foods, cakes and pastries. Full-fat dairy products such as whole milk, butter, cheese, sour cream and cream, ice cream, chocolates, and coconut cream contain saturated and trans fats. Opt for fat-free or low-fat dairy products and skimmed milk. Limit your intake of palm oil and coconut oil that contain saturated fats.

Eat more unsaturated fats.

Foods rich in unsaturated fats boost HDL or good cholesterol and consequently reduce bad cholesterol. HDL cholesterol carries LDL or bad cholesterol from the blood to the liver to be removed from the body.

Oily fish such as mackerel, salmon and trout are high in omega-3 fatty acids that boost good cholesterol levels and reduce bad cholesterol levels. Foods that contain monounsaturated fats and polyunsaturated fats, such as olive oil, avocado, nuts and seeds, actively work to decrease bad cholesterol.

Increase your fibre intake.

Foods high in fibre, such as whole grains, fruits and vegetables, contain a type of fibre called beta-glucans that bind to bad cholesterol and help excrete it from your body. Fibre also reduces high blood sugar. When blood sugar is high, more triglycerides are present, thus increasing cholesterol production. Good sources of fibre are oats, wheat, beans, chickpeas, broccoli, avocados, spinach, apples and dried fruits.

Reduce your sugar intake.

Limiting sugar from your diet can lower your cholesterol levels. Excessive sugar intake causes your liver to produce more LDL cholesterol while reducing HDL cholesterol. High sugar levels in the blood also increase triglycerides, which increase cholesterol production. Also, limit your intake of salt.

Exercise

Exercise boosts HDL or good cholesterol levels, lowers blood pressure, reduces the risk of atherosclerosis, and helps you lose weight. At least 150 minutes of moderate-intensity aerobic exercise during the week can lower cholesterol levels. Physical activity such as brisk walking, jogging, swimming, cycling or vigorous outdoor work for 30 minutes on most days of the week will help reduce your cholesterol levels. Losing weight and maintaining a healthy weight will also lower cholesterol.

Reduce your alcohol intake.

Excessive alcohol consumption can raise your triglyceride levels – a type of blood fat that increases cholesterol production.

Stop Smoking

Smoking lowers your HDL cholesterol and raises LDL cholesterol.

Stress

Managing stress will help lower high cholesterol levels. Stress triggers hormonal changes that cause your body to produce cholesterol. Stress also promotes inflammatory markers associated with cardiovascular disease.

References

American Heart Association. Prevention and treatment of high cholesterol. (https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia)

Mayo Clinic. High Cholesterol. (https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/syc-20350800)

Healthline. Everything you need to know about high cholesterol. (https://www.healthline.com/health/high-cholesterol)

Erectile dysfunction or impotence is the persistent inability to achieve or maintain a penile erection firm enough for satisfactory sexual performance. A man has to have good nerve function, hormone (testosterone) levels, adequate blood flow, and a willing mind to have normal erections. Problems with any of these factors can result in erectile dysfunction. It is, however, normal to occasionally fail to get or maintain an erection when you are tired, stressed, anxious, feeling nervous or drinking too much alcohol.

Risk factors of erectile dysfunction

You have an increased risk of getting erectile dysfunction if you are:

40 years and older
Overweight or obese
Physically inactive
Smoke
Drink alcohol
Have medical conditions such as diabetes and hypertension and have psychological conditions such as depression and anxiety
Taking certain medications, including antihypertensives, antidepressants and antihistamines.

Types and causes of erectile dysfunction

Vascular erectile dysfunction

The penis needs sufficient blood flow to become erect and maintain an erection. There are also valves in the penis that close when the penis is filled with blood. Abnormalities of the penile arteries, veins or valves can lead to erectile dysfunction. This is the most common cause of erectile dysfunction, especially in older men. The common vascular causes of erectile dysfunction include:

Atherosclerosis
Hypertension
High Cholesterol
Diabetes Mellitus
Trauma e.g. Penile fracture
Radiation and surgery for prostate cancer
Peyronie’s disease
Smoking

Neurogenic erectile dysfunction

The brain plays a key role in triggering the processes that cause an erection. The brain sends signals that travel along nerves to the penis to cause an erection. Damage or disease to those nerves can cause erectile dysfunction. Some common causes of neurogenic erectile dysfunction include:

Stroke
Spinal cord injury
Diabetic neuropathy
Alzheimer’s disease
Multiple sclerosis
Parkinson’s disease
Radical pelvic surgery
Pelvic injury
Chronic alcoholism

Hormonal-induced erectile dysfunction

Hormones are chemical messengers in the body that inform the body to perform specific functions. Hormonal disorders such as testosterone deficiency, decreased or increased levels of thyroid hormones, increased prolactin, steroid abuse by bodybuilders and hormones to treat prostate cancer can cause erectile dysfunction.

Drug-induced erectile dysfunction

Erectile dysfunction is a common side effect of many prescription drugs. Drugs associated with erectile dysfunction include:

Antihypertensives
Antidepressants
Anticonvulsants
Antihistamines
Antipsychotic agents
Antiparkinson agents
Antiseizure medications
Diuretics
Chemotherapy drugs
Lipid regulators
Prostate cancer drugs
Gastrointestinal reflux disease and ulcer-healing drugs

Psychogenic erectile dysfunction

Psychological conditions that affect your mental health contribute to erectile dysfunction. Some causes of psychogenic erectile dysfunction include:

Depression
Anxiety
Stress
Inadequate interpersonal relationships
Fear of intimacy
Relationship problems
Low self-esteem

Symptoms of erectile dysfunction

Symptoms of erectile dysfunction are:

Persistent difficulty in getting an erection.
Persistent difficulty in maintaining an erection.
Complete inability to get an erection.
Reduced sexual desire.
Requiring a lot of stimulation to maintain an erection.

Diagnosis of erectile dysfunction

To diagnose erectile dysfunction, your doctor will take a medical and sexual history and perform a physical and psychosocial examination. Your healthcare provider would ask about your drug history, whether you have any chronic medical conditions and ask questions about your mental health as part of your medical history. The doctor may also ask to talk to your sexual partner. A physical examination would include an examination of your nervous system, secondary sex characteristics such as male hair distribution pattern to rule out hormonal problems and an examination of your penis and testicles. Your healthcare provider may order blood tests, urine tests and a penile Doppler ultrasound to confirm the diagnosis.

Treatment

There are different treatment options for erectile dysfunction depending on the cause and severity.

Lifestyle modifications

Some lifestyle changes can help in the treatment and prevention of erectile dysfunction. These include:

Eat a diet rich in fruits, vegetables, whole grains and fish and reduce highly processed foods such as red, processed, meats and refined grains.
Quit smoking.
Avoid substance abuse.
Reduce or stop drinking alcohol.
Reduce your cholesterol.
Engage in aerobic exercise such as brisk walking, jogging and running. Research shows that moderate exercise can help restore sexual performance in obese middle-aged men with erectile dysfunction.
Lose weight. A man with a waistline of 42 inches is 50% more likely to have erectile dysfunction than a man with a 32-inch waistline.
Get quality sleep.
Reduce stress and anxiety.

Oral Medications

Drugs known as phosphodiesterase-5 (PDE-5) inhibitors are used to treat erectile dysfunction. These medications are taken orally before sex. They start to work within an hour and help you get an erection with sexual stimulation. They work by increasing the blood flow to your penis. Some of these drugs are sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra). You can buy Viagra online, but you need a prescription for the other drugs.

Vacuum device

A vacuum device or penis pump is a hollow tube placed over your penis to aid blood flow to the penis. It has a pump which is used to suck out air from the tube. This creates a vacuum that pulls blood into your penis, causing an erection. Once you get an erection, you place an elastic ring around the base of your penis to maintain the erection and remove the vacuum tube. After sexual intercourse, you remove the ring.

Surgery

Surgery is not common in the treatment of erectile dysfunction, but sometimes it may be indicated. An example of a surgical technique in the treatment of erectile dysfunction is the use of penile implants. In this procedure, a malleable or inflatable device is inserted into the penis to help you have an erection.

Treating the cause of erectile dysfunction

There are also treatments for the underlying cause of erectile dysfunction. Some of these are:

Medication change. If you are on long-term medication associated with erectile dysfunction, your doctor will change to an alternative drug with a lower risk of erectile dysfunction.
Hormonal therapy for hormonal problems.
Treating high blood pressure, high cholesterol and diabetes with medication.
Psychological counselling and therapy for mental health conditions such as stress, anxiety and depression.

References:

John Hopkins Medicine. Erectile dysfunction. (https://www.hopkinsmedicine.org/health/conditions-and-diseases/erectile-dysfunction).

Harvard Health Publishing. Harvard Medical School. 5 natural ways to overcome erectile dysfunction. (https://www.health.harvard.edu/mens-health/5-natural-ways-to-overcome-erectile-dysfunction).

WebMD. Erectile Dysfunction. (https://www.webmd.com/erectile-dysfunction/understanding-erectile-dysfunction-basics).

Mayo Clinic. Erectile dysfunction. (https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776).

MyClevelandClinic. Erectile Dysfunction. (https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction#symptoms-and-causes).

Cholesterol is a type of fat (lipid) found in the body. The liver produces all the cholesterol your body needs. Other sources of cholesterol are from foods from animal sources such as meat, poultry and dairy products. As dietary fat intake increases, the liver adjusts by decreasing its production of cholesterol.

Cholesterol is needed in the body to build cells and make vitamins and other hormones. However, too much cholesterol cannot be used by the body. The excess cholesterol or lipids is deposited in your blood vessels. These deposits increase in size over time, forming plaques and making your arteries hard and narrow, leading to a medical condition known as atherosclerosis. These plaques block your arteries, thus reducing the blood flowing through your arteries. This can result in high blood pressure. The cholesterol deposits can suddenly break off and form clots that cause a heart attack or stroke.

Good Cholesterol and Bad Cholesterol

Cholesterol circulates through the blood attached to proteins. This combination is known as a lipoprotein. There are different types of cholesterol based on what the lipoprotein carries. The main ones are:

High-density lipoprotein or good cholesterol (HDL) – Good cholesterol or HDL transports excess cholesterol to your liver to be removed from your body. Your liver produces enough cholesterol for your body’s needs and disposes of the rest. If your HDL is too low, there will be too much cholesterol circulating in your blood.
Low-density lipoprotein or bad cholesterol (LDL) – LDL or “bad” cholesterol transports cholesterol throughout your body. LDL cholesterol builds up in the inner walls of your arteries, making plaques form in your arteries. Too much LDL cholesterol increases your risk of cardiovascular disease.

The most common type of fat in the body is triglycerides. They store excess energy from your diet. High triglyceride levels with high LDL cholesterol or low HDL cholesterol also increase your risk of heart disease.

Causes of High Cholesterol

High cholesterol, also known as hypercholesterolemia or hyperlipidaemia can be inherited, but the most common cause of high cholesterol is poor lifestyle choices such as physical inactivity, eating a diet high in saturated fats and drinking too much alcohol.

Unhealthy diet

Eating too many foods that are high in cholesterol, saturated fats, and trans fats may increase your risk of developing high cholesterol. Fatty meat, poultry, and full-fat dairy products like butter, cheese and cream contain dietary cholesterol and saturated fats and can increase cholesterol levels. Palm oil, palm kernel oil and coconut oil contain saturated fat that can increase bad cholesterol. Snacks and desserts such as cakes, meat pies, sausages and biscuits are high in saturated and trans fats.

Physical Inactivity

Exercise helps to reduce LDL cholesterol or bad cholesterol and helps improve HDL cholesterol levels.

Obesity

Being overweight or obese predisposes you to having high cholesterol levels.

Stress

Being under a lot of stress causes your body to produce cholesterol by triggering hormonal changes.

Alcohol

Drinking too much alcohol can raise your total cholesterol level.

Smoking

Smoking increases bad cholesterol (LDL) and decreases good cholesterol (HDL).

Age

The liver removes LDL cholesterol from your bloodstream. As you age, this process decreases. Even though young people can have high cholesterol, it is more common in people over 40 years.

Medications

Some medications used to treat other health conditions can increase your cholesterol levels. These include medications for the following conditions:

High Blood Pressure
Irregular heart rhythms
Acne
Cancer
HIV/AIDS
Organ Transplants

Medical Conditions

Some medical conditions can increase your risk of developing high cholesterol. These include:

Chronic Kidney disease
Diabetes mellitus
Thyroid disease
HIV/Aids
Polycystic Ovarian Syndrome
Lupus

Symptoms of High Cholesterol

High cholesterol usually has no symptoms. A blood test is the only way to detect it.

Prevention

Healthy lifestyle changes can help lower your cholesterol levels. Eat a healthy diet rich in fruits, vegetables, whole grains, poultry and fish. Limit your intake of fatty, red meat and full-fat dairy products. Limit fried foods, salty and sugary foods and unhealthy oils.

Engage in at least 150 minutes of moderate-intensity aerobic exercise a week. Lose excess weight and maintain a healthy weight. Manage your stress levels. Stop smoking and reduce your alcohol intake.

References

American Heart Association. What is Cholesterol? (https://www.heart.org/en/health-topics/cholesterol/about-cholesterol)

American Heart Association. Causes of High Cholesterol. (https://www.heart.org/en/health-topics/cholesterol/causes-of-high-cholesterol)

Cleveland Clinic. High Cholesterol diseases. (https://my.clevelandclinic.org/health/articles/11918-cholesterol-high-cholesterol-diseases)

Mayo Clinic. High Cholesterol. (https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/syc-20350800)

Breast Cancer Awareness Month, which is marked in October annually, aims to promote screening and prevention of breast cancer, which is the most common cancer worldwide and the most common cancer in women, accounting for 25% of cancers in women globally. Breast Cancer is also the most common cancer among women in Ghana.

Early detection is the key to reducing mortality from breast cancer. Screening methods to detect breast cancer include breast self-examination, clinical breast examination by your doctor and mammography. In this article, we discuss how to perform breast self-examination to help you detect breast cancer for early treatment and to reduce the risk of dying from the disease.

Monthly Breast Self-Exam

Inspect both breasts with your arms at your sides. Look for any changes in symmetry, size, shape and colour. Look for changes in breast swelling, redness, soreness, any visible rash and dimpling or bulging of the skin. Check for changes in the position of the nipples and whether they are retracted inwards.
Raise your arms slowly high over your head and check for changes in your breasts and nipples as above.
Place your hands on your hips, flex your chest muscles and compare both breasts, looking for the same changes again. Look for signs of any discharge from your nipples.

Manual Breast Exam while standing

Feel your breasts for lumps while standing. This step can be done in the shower.
Extend your right arm upward and examine your right breast with your left hand.
Extend your left arm upward and examine your left breast with your right hand.
With the pads of your fingertips and keeping the fingers flat and together, examine both breasts by pressing down with your fingers and moving them in a circular motion over the entire breast and armpit.
Examine your entire breast from your collarbone to just above your abdomen and sideways from your armpit to your cleavage. Feel for lumps, swellings and any abnormalities. Squeeze your nipple to check for discharge.
Use light pressure to feel the skin and tissue just underneath, medium pressure to feel the tissue in the middle of your breast and firm pressure for the deep tissue in the back close to your ribcage.

Manual Breast exam while lying down

Next, lie down on a bed or the floor on your back. Place a pillow under your right shoulder to flatten your right breast. Place your right arm under your head.
Examine your right breast with your left hand. Check for lumps and any abnormalities in your breast and armpit following the same process as described above. Feel your entire breast and armpit.
Finally, place the pillow under your left shoulder to flatten your left breast. Place your left arm under your head.
Examine your left breast and armpit with your right hand.

A breast self-exam helps you become aware of the natural look and feel of your breasts so that you can detect any changes in your breasts. A self-breast examination is not a diagnostic tool for breast cancer. It should, therefore, not replace a clinical breast exam and mammogram, which is the best screening tool to detect breast cancer.

Examining your breasts should be done once a month, 2 – 5 days after your menstrual period. See your healthcare provider if you notice any lumps or abnormalities such as skin changes, changes in the position of your nipples or any watery, milky, yellowish or bloody nipple discharge. Bear in mind that menstruation can make your breasts feel lumpier.

References

Breastcancer.org. How to do a breast self-exam: Five steps for checking for breast cancer at home. (https://www.breastcancer.org/screening-testing/breast-self-exam-bse).

MedlinePlus. Breast Self-Exam. (https://medlineplus.gov/ency/artic

High Cholesterol – What Causes it ?

Haemorrhoids (Piles)

Erectile Dysfunction

Type 2 Diabetes Risk Factors

What is Tuberculosis?

Lifestyle Factors to Lower Cholesterol

Erectile Dysfunction

High Cholesterol – What Causes it ?

Breast Self-Examination

Heart Failure – Symptoms, Causes and Treatment

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