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General InterestLifestyle Modification as Therapy

Lifestyle Modification as Therapy

Coronary artery disease and stroke are among the leading causes of death in Thailand and globally. One of the major risk factors is metabolic syndrome, which are metabolic abnormalities that cause a subcutaneous fat build-up, especially that of visceral fat or abdominal obesity. The accumulated fat causes inflammation, induces insulin resistance, and increases the risk of type 2 diabetes. It also leads to dyslipidemia, hypertension (high blood pressure), and ultimately various non-communicable diseases (NCDs).


Luckily, you can also examine yourself whether you have the metabolic syndrome.

  • If have 3 or more risk factors, you may be at risk of NCDs, even when the LDL-cholesterol levels from your blood test are normal.
  • Abdominal obesity –90 cm waistline or bigger (≥ 36 inches) for men and 80 cm or bigger (≥ 32 inches) for women
  • Triglyceride levels over 150 mg/dL, or being hyperlipidemic and on cholesterol-lowering mediation
  • HDL-cholesterol levels under 40 mg/dL for men and under 50 mg/dL for women, or being hyperlipidemic and on cholesterol-lowering medication
  • Blood pressure of 130/85 mmHg or above, or being on medication for hypertension
  • Blood sugar level higher than 100 mg/dL or having been diagnosed with type 2 diabetes


According to surveys, whether you are still healthy or already diagnosed with metabolic syndrome, lifestyle changes are crucial as it improves your health without the need for medication. The main goal is to reduce LDL levels. Research indicates that reduction of blood LDL can prevent death from heart disease by slowing or stopping the build-up of plaque on the artery wall.

There are 3 main principles for blood LDL level reduction: dietary adjustment, increase in physical activity, and body weight management.


1. Dietary adjustments

Eat less cholesterol and saturated fat, avoid trans-fat: Saturated fat is found in animal products such as fatty meats, milk, butter, cheese, sausage, bacon, palm oil, and coconut oil. This type of fat increases LDL level. A person should not consume more saturated fats than 7% of daily energy requirement, or about 11-15 grams (2 – 3 teaspoons) per 2,000 kcal energy requirements. Avoid trans-fats found in pastries, croissants, and cakes. This is not only increases harmful fat like LDL, trans fat also decreases the level of good fats like HDL, as well as increasing inflammation, causing insulin resistance, related to type 2 diabetes and heart disease.

Increase fiber in your diet: Even though the body cannot digest or absorb it, regular consumption of dietary fiber can reduce the risk of heart disease. Not only is fiber beneficial for our gastrointestinal system, but it also keeps you satiated with less energy intake as well, which is ideal for people who try to lose weight.

  • More plant stanols and sterols – Natural substances found in various plants such as fiber. Plant stanols and sterols hinder intestinal cholesterol absorption, decrease blood LDL levels without affecting those of HDL and triglycerides. Eating at least 2 ladles of different vegetables per meal on a regular basis helps you get the beneficial phytonutrients from plants.
  • Omega-3 Fatty Acids – Found in fish, beans, canola oil, and flax seeds. Although consuming omega-3 may not lower your LDL levels, it helps prevent thrombosis and reduce inflammation.
  • Sodium – Condiments such as fermented foods, soups, and processed foods have high sodium content. Reduction of sodium intake can help lower blood pressure.
  • Alcohol – Men should have no more than 2 drinks per day and for women no more than 1 drink. Excessive alcohol consumption is extremely damaging for your health, harming liver and heart, raising blood pressure, and increases triglycerides in the blood.


2. Increase physical activities

A lack of physical activity is a risk factor for heart disease. Regular exercise helps control your body weight, decrease LDL and triglycerides levels, increase HDL levels, improve performance of the lungs and heart, as well as lower blood pressure. It also helps reduce the risk of diabetes.

You do not need marathon running to get enough physical activity. It is important to move your body regularly, for example, try to get up and walk during breaks, quicken your pace, or by doing your housework. It is advisable at least 30 minutes a day of exercises such as jogging, tennis, dancing, etc. for 5 days each week, or simply walk 10,000 steps per day as an easiest alternative.


3. Maintain appropriate body weight 

Gaining weight makes your blood triglycerides increase, lowers HDL and raises LDL levels, as well as heightens the risk of noncommunicable chronic diseases.

However, weight is not the only indicator of obesity. What is important is the body fat mass. Body fat percentage in men should not be higher than 28% of body mass, and in women not higher than 32%. For those without the means to measure fat mass, a simple method like waist circumference measurement is enough. Men’s waistlines should not exceed 90 cm and women’s 80 cm. Be mindful of the amount of food you are eating and try to stay active to maintain a healthy weight.


4. Sleep

Sleep deprivation and irregular sleep patterns increase the risk of noncommunicable diseases. People who work at night shifts are prone to weight gain with their disturbed sleep cycles.

It is recommended to keep a regular sleep-wake schedule even on weekends and go to bed before 22:00 to allow the growth hormone to function optimally, and for increased secretion of leptin, the satiety hormone. On average, sleep-deprived people tend to eat 300 Calories more per day. Importantly, avoid using electronic devices such as mobile phones or tablets for at least 2 hours before bedtime, because blue light suppresses melatonin release and makes it difficult to fall asleep.

Although dietary changes, exercise, and weight management are great for minimizing the risk of cardiovascular diseases, make sure to get sufficient sleep, reduce stress, and avoid smoking as well to stay healthy from the inside out.


  1. National Heart L, Institute B. Your guide to lowering your cholesterol with TLC. Bethesda, MD: US Department of Health and Human Service. 2005.
  2. Zimmet P, Alberti KGMM, Stern N, Bilu C, El-Osta A, Einat H & Kronfeld-Schor N. The circadian syndrome: Is the metabolic syndrome and much more!. J Intern Med  2019; 286: 181–191.
  3. St-Onge M-P, Roberts AL, Chen J, Kelleman M, O’Keeffe M, RoyChoudhury A, et al. Short sleep duration increases energy intakes but does not change energy expenditure in normal-weight individuals. The American journal of clinical nutrition. 2011;94(2):410-6.

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