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Cholesterol Made Simple: What to Know and How to Take Control · Flourish- A Prisma Health Podcast

• 0:00
  Joey Wahler (Host): The CD.
• 0:00
  C says it's too high for about one in 10 Americans.
• 0:04
  So we're discussing controlling cholesterol.
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  Our guest is Eric Schapp.
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  He's a physician, assistant and clinical lipid specialist.
• 0:16
  This is Flourish, a podcast from Prisma Health.
• 0:20
  Thanks so much for joining us.
• 0:21
  I'm Joey Wahler.
• 0:23
  Hi there Eric.
• 0:23
  Welcome.
• 0:24
  Eric Shoup: Thank you, Joey.
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  Appreciate it.
• 0:27
  Glad to be here with you.
• 0:28
  Joey Wahler (Host): Yeah, appreciate the time.
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  Great to have you board.
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  So first, we hear about it a lot, of course, but for those that don't know
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  specifically, what exactly is cholesterol?
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  Eric Shoup: Yeah, so cholesterol is something that we all need, right?
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  We need it to make the cell membrane formation.
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  we need it for, hormone production for both men and women.
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  So it's a necessity and our body creates enough of it, for the most
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  part, to take care of those things.
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  So when people say, oh, well, cholesterol's bad for you.
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  Well, too much cholesterol is bad for us, but we need some in order
• 1:03
  for the daily function of our bodies.
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  Joey Wahler (Host): Interesting because I think you hit on it there.
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  I get the feeling many people are under the misconception
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  that all cholesterol is bad.
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  So that being said, why is high?
• 1:15
  High cholesterol a problem for us.
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  Eric Shoup: Yeah, so high cholesterol, when we have too much of it, the
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  body is looking for places to put it.
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  A very tempting place for That is to be out in our arteries.
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  So our arteries in our neck, in our heart, in our limbs, like our legs and
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  So, it slowly deposits it there, because there's no other place for it to go.
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  And over time, right.
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  Unfortunately, the atherosclerotic process, the process of laying
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  down plaque in our arteries, it's not harmful until the end.
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  Until the end where we have symptoms like.
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  A stroke or a heart attack or a cold limb, right?
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  So This is a process that's slowly ongoing in many of us, and a lot of
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  us don't even know that it's getting to a point where it's a problem.
• 2:01
  Joey Wahler (Host): Right So, it just kind of sneaks up on many people.
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  So what causes high cholesterol and can it be hereditary?
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  Eric Shoup: So to keep it simple, I mean, the lifestyle And the heredity
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  are probably equally important.
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  there's certain percentages and some studies that are out there,
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  but there are some people, it's frustrating for them because they
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  are very strict with their diet.
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  I.
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  Joke with some of my patient's and I say, you, you know, you unfortunately
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  could eat grass and drink water and run a marathon every other weekend, and
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  unfortunately your predisposition to have high cholesterol just overcomes
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  your lifestyle ability to modify it.
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  But other people, they respond fairly well.
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  especially people who are overweight or they're diabetic, they have
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  a lot more room to make changes.
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  They can make some significant changes, with their numbers, in comparison to
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  the other group that I just mentioned.
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  So it's all trial and error.
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  So, I usually have people come in and they'll.
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  Choose lifestyle modification for about three to six months
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  and work very diligently.
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  We will see where they're at and decide where we need to go from there, but the
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  first step is usually always lifestyle.
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  Unless they have a significant family history or they already have
• 3:17
  cardiovascular disease of some sort.
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  Joey Wahler (Host): Gotcha.
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  So that being said, what's a quote unquote normal cholesterol range for
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  most people, and there's also such a thing as good and bad cholesterol, right?
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  So what's the difference between those two?
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  Eric Shoup: so your basic lipid panel, you'll get a fair amount of information.
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  You'll get a total cholesterol, you'll get it broken down into good and bad.
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  And you'll get a triglyceride level too, 'cause that's part of the process as well.
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  so typically for most people, if it's what we call primary prevention,
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  so you go to your, provider and you don't have any history of any.
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  Cardiovascular issue.
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  total cholesterol roughly about 180 or less is a good place to be.
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  Your bad cholesterol somewhere around one 30, maybe below a hundred.
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  there are risk calculators that are out there that you can see online.
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  There's a Framingham risk calculator.
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  There's a Reynolds risk calculator, but one that's probably used more
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  than the rest is a called a pooled.
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  Cohort risk calculator.
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  So This is something you can pull up online.
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  it's got your age, your sex, your race, what your total cholesterol
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  is, what your HDL cholesterol is, and are you treated for hypertension?
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  Do you smoke and are you diabetic?
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  So you put all that information in and it'll calculate a risk score, And that
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  will help you decide what in particular your cholesterol value should be.
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  Are you low risk?
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  Are you borderline risk?
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  Are you intermediate risk or are you high-risk?
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  And as you figure those out, then that will specify kind of what your
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  LDL cholesterol value should be.
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  Joey Wahler (Host): Can good cholesterol balance out the bad?
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  Eric Shoup: Yeah, so we hear that all the time, right?
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  I, have a lot of patient's who come in and they say, my HDL is so high
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  that people tell me that I don't have to worry about my bad cholesterol.
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  And I go, well, I have lots of people who come to me with pretty good HDL values in
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  the sixties and seventies, yet they still have trouble and they have to go to the
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  cath lab and have some procedures done.
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  So having a high good cholesterol is helpful, but it doesn't completely
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  negate having a high bad cholesterol.
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  So the bottom line is, is you would like a good mix of both.
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  Make sure you try to do things to help raise your good cholesterol,
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  like, good weight management, good lifestyle, exercise on a regular basis.
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  Those are very helpful.
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  And then with the other side of the coin is, you know.
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  Good.
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  low saturated fat intake, low cholesterol intake, things of that nature.
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  So if you balance both, then you'll get the best of both worlds.
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  Joey Wahler (Host): And so at what point should we get our cholesterol
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  check that, of course, presuming it's not been checked in a while, which
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  of course it should be regularly.
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  Eric Shoup: Yeah, so initially what'll happen is, you know,
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  your pediatrician usually is gonna check it at around age 10.
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  Now, sometimes they'll check it a little bit earlier, especially if.
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  There's a strong family history of cardiovascular issues, they'll maybe check
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  it at age two to kind of get a jump on it.
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  but age 10 And then at age 20, And then typically every five years after
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  that, unless you need to be treated.
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  And then once you go down that treatment paradigm, it all depends, you know,
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  is it lifestyle check in three to six months if you're starting to have to.
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  Consider medications, then you might want to have those follow-up
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  between one and three months after change in medical therapy.
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  Joey Wahler (Host): Okay.
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  Now, in order to lower that bad cholesterol and raise the good, what
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  are some of the foods that are best for lowering high cholesterol, and
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  which ones should we stay away from?
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  Eric Shoup: the best thing to do is to eliminate processed foods, right?
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  So if you look at the label and you see anything that reads hydrogenated, just
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  kind of keep on walking past that you want Whole Foods is the best thing to do.
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  I mean, back when my parents were, uh.
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  Kids, you know, everything was pulled out of the garden.
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  it wasn't, freeze dried or frozen or warmed up in a microwave or
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  boiled away in a pot of hot water.
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  so Whole Foods, Mediterranean Diet, that works very well.
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  So Those are the things to kind of go for.
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  So, good balance of fruits, vegetables.
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  Lean meats, stay away from fried foods.
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  Anything that's fatty, those tend to be problematic.
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  Joey Wahler (Host): Eggs, as you well know, are always a big focal
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  point when talking about cholesterol.
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  Some are probably under the impression they should be avoiding eggs altogether.
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  Is it that or is it just a matter of moderation?
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  Eric Shoup: Yeah, I would agree with the moderation part.
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  With that, Joey, the protein component, right?
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  The egg white.
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  That's very good.
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  And the cholesterol content of it, it's not like you wanna be bringing
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  in eggs on a daily basis, but it is a good, nutritional source.
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  And so it's just moderation with that, your typical egg has, anywhere between 150
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  to 250 milligrams of cholesterol in it.
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  so just.
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  Careful, right?
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  You don't want to be having an omelet every day.
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  But really, the culprit, above and beyond cholesterol is saturated fat.
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  That is really the culprit that leads to a lot of problems.
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  so refined white carbohydrate.
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  Saturated fat.
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  Those are things that we need to be really careful of, right?
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  You know, white bread, white pasta, all of those things, they tend
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  to turn into, sugar very readily.
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  And sugar causes, blood sugar to go up that causes your
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  triglyceride levels to go up.
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  That causes changes with your particle distribution.
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  how we carry our cholesterol in our bloodstream makes it more harmful.
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  And if you really have a lot of blood sugar issues, your cholesterol can
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  become a fancy term as glycosylated.
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  That means your cholesterol can be associated with sugar and it makes it
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  more harmful to your arterial wall.
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  Joey Wahler (Host): And of course, it's always the things that taste best,
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  that have the most cholesterol, right?
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  Eric Shoup: Well, well, that's what we're brought up with.
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  But if we grow up on whole and healthy food, that tastes pretty good as well.
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  but I agree.
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  You know, I, grew up in the 1970s as I'm dating myself as a child, the big
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  thing was little Debbie cakes, right?
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  Oh man.
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  That's.
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  that's nothing but carbohydrate.
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  And so, yeah,
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  Joey Wahler (Host): Absolutely.
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  The oatmeal ones with the vanilla cream inside.
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  Eric Shoup: that too.
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  Joey Wahler (Host): I hear you.
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  Couple of other things, when we talk about lifestyle changes, for the sake of ideal
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  cholesterol levels in terms of exercise.
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  For those that are daunted by the mere thought of exercising, being
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  active, either because they've never been or they haven't been in a while,
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  what are a couple of very basic, simple things that most anyone is
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  capable of doing as a starting point?
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  Eric Shoup: the first thing is move.
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  Do something and do something that you like, right?
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  People go and they say, well, I have to join a gym, And then
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  they make me do stair climbing.
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  They make me, do, the treadmill Pick something that you enjoy.
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  Now, I tell my patient's that if you depend on Mother Nature for
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  your exercise program, it will be a hundred percent failure.
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  Okay?
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  It's gonna get too cold, too wet, too hot, too humid, too whatever,
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  So just make sure you have.
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  Options.
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  so exercise, just a regular walking program is good.
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  It's also good to add something that has some resistance activity
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  And that doesn't mean you have to go to the gym and pump iron, You
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  can get a set of dumbbells at home.
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  You can get bands, that they use a lot of times for physical therapy 'cause
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  you wanna make sure, 'cause a good healthy exercise program is, aerobic.
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  Is, for flexibility And for strength.
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  Those are all things.
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  It's great if you can run like a gazelle, but if you can't do
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  a pull up, that's a problem.
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  And if you can't reach down and touch your toes, that's a problem too.
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  So it's a balance of everything.
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  Joey Wahler (Host): You know that well-rounded point you
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  make is a very good one.
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  'cause many people that kind of escapes them also in terms of medication.
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  At what point should one.
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  Be thinking about taking medication for cholesterol and is it safe to say that
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  it's better to rely on the lifestyle changes first if those can be achieved?
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  Eric Shoup: when I have patient's who come to me for primary prevention, so before
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  they have any issues, like unfortunately like a heart attack or a bypass surgery
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  or a stent placed, I always try to get them to work diligently with their
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  lifestyle for a good three to six months.
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  So you have time And then see where they land.
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  Then you kind of put them into, okay, what's your family history?
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  Okay, What's that pooled cohort?
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  Risk calculator?
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  do you have like a predisposition for awful cholesterol?
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  There's something called.
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  Familial hyperlipidemia, that's a fancy term saying if you have that,
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  the likelihood that lifestyle alone is probably not going to get you to goal.
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  An easy way to calculate That is if your bad cholesterol, your
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  LDL is 190 or greater, you have it And then move from there.
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  The other class of patient is the diabetic, so diabetics, they're
• 13:00
  treated almost like they have.
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  Cardiovascular disease because of what we had talked about with the glycosylation
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  of the cholesterol and more harmful.
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  So that patient population, you tend to move to treatment earlier,
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  but other than those FH patient's, diabetics and people who already have
• 13:21
  established disease, otherwise it's okay.
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  Let's see how you can do lifestyle wise And then we'll reassess.
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  Joey Wahler (Host): And in summary here, Eric, you've done such a great
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  job covering some of these details.
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  Overall, for those struggling with high cholesterol that are joining us
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  and they want to know what's the main takeaway here, what would you say?
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  Eric Shoup: I would say don't despair.
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  when I first started in medicine, we had.
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  Over-the-counter niacin and questran, which is what you mixed in a glass of
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  water like Metamucil and you drank it.
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  If we could get your LDL cholesterol down by about 20 to 25, that
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  was a major accomplishment.
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  We have medicines now across the board that I can take people and I have taken
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  people's bad cholesterol values of six or 700 and be able to normalize them.
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  So no matter how bad you think your cholesterol is, and some people have
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  some pretty bad cholesterol out there, there's lots of options, for treatment.
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  And just talk with your, family provider.
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  If you need, a cardiologist or an endocrinologist or a lipid
• 14:31
  specialist, were all available in the community to help you.
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  Joey Wahler (Host): Well, folks we trust you are now more familiar with.
• 14:39
  Controlling cholesterol.
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  Eric shout, keep up all your great work.
• 14:43
  Thanks so much again,
• 14:44
  Eric Shoup: Enjoyed being here.
• 14:45
  Thanks so much for the opportunity.
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  Joey Wahler (Host): same here.
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  Great to have you on for this very popular topic with people these days,
• 14:54
  and really for as far back as I can remember And for more information,
• 14:58
  please visit prisma health.org/flourish.
• 15:02
  If you found this podcast helpful, please do share it on your social media.
• 15:06
  I'm Joey Wahler and thanks again for being part of Flourish.
• 15:09
  A podcast from Prisma Health.