Melanie Cole, MS (Host): Do you think you're too young to worry about cholesterol? Well, think again. We're here to discuss when to start paying attention, what your numbers really mean, and how early prevention can help reduce your risk of heart disease.

Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole, and joining me today is Dr. Anirudh Rai. He's a primary care physician at Henry Mayo Newhall Primary Care. Welcome as always, Dr. Rai. You are a fan favorite here on It's Your Health Radio. So today, we're talking cholesterol. Before we get into what our numbers mean and all those things, I want you to tell the listeners what cholesterol is, because a lot of people don't know what it is. There's good cholesterol, bad cholesterol, total cholesterol, one that we make in our own body, external cholesterol. Tell us what it is.

Anirudh Rai, MD: Yeah. So, cholesterol is a big component when it comes to everyone's health. To talk about cholesterol, I'll just kind of simplify it as best I can. I would supply it to at least three components a little bit more. You have your good cholesterol, which is your HDL; your bad cholesterol, your LDL; as well as triglycerides, which are also a type of bad cholesterol.

So, I would kind of simplify it in that sort of regard. But you did mention and allude to a bit, there's two pathways for it. So, there's two ways your body gets cholesterol. It's ingesting it by food and whatever you ingest and eat. And the other way is your liver. It makes these kind of cholesterols. Because in your body, cholesterol is vital and important to make sure each cell, your body is well-maintained. Cholesterols are what keep the cell's integrity intact, which means the cell walls and all its proteins rely on cholesterol. In fact, a lot of your hormones also are a type of cholesterol. So, cholesterols are part of your essential building blocks as well as proteins. So, cholesterols are important. It's just a matter of how much you have certain types of cholesterol, which play a role in your health.

Melanie Cole, MS: Okay. So, we know that it's important. It's not something we want to eliminate from our bodies altogether or from our diet. It's just we'd like to get it in the better forms. What do the numbers mean? We see these numbers anywhere from 150 up to, oh, you don't want to see the three hundreds. We also see it separated out, as you just said, triglycerides, LDLs, HDLs. Tell us about those numbers And what we're really looking for. When we get that blood checked and we get our cholesterol checked, that lipid panel, what are we looking for in those numbers?

Anirudh Rai, MD: Yeah. Numbers are important and sometimes some of my patient's get kind of scared when it goes to red, you're like, "Is this something I should worry about?" When it comes to cholesterol, you have to see the whole lab as a whole and not just take individual parts. So, the labs that you get done for your cholesterol, you check your total cholesterol, you check your HDL, your good cholesterol, you check your bad cholesterol, the LDL, you also check your triglycerides. Sometimes they also will run what they call VLDL, which is another form of bad cholesterol.

So when it comes to we as physicians or anyone kind of interpreting lab work, you have to see it as a whole. Because just because your total cholesterol is high, it doesn't mean that you need to be placed on medications. If your total cholesterol is high and your good cholesterol is at a very good position, above 40 or 45 or even 50, then we could have a conversation saying, "Hey, we may not need to put you on medication. I think you're doing a good job with dieting and exercising, good fiber diet." But if your LDLs, your bad cholesterols are really high, even if your good cholesterols are high, then I would say we would talk to you about, say, "Let's see if we can lower the bad cholesterol. I wish it could be black and white saying if this number reaches that, we could start you on something. Cholesterol is something that has a lot more gray than we want it to be, I'll be honest.

Melanie Cole, MS: It definitely does now, complications if we let cholesterol go sort of unchecked, if we are not able to, you know, fix it with diet, what are some of the complications from unchecked cholesterol in our bodies?

Anirudh Rai, MD: Yeah. So, that's the thing we at physicians always try to avoid. So, the bad cholesterol, the LDL and the triglycerides are what we call atherogenic, meaning they're more prone to form these kind of clots and kind of block your arteries. That's the main reason we want to look at that with a bit more eyes, especially if there's a family history of a heart attack at a early age, a family history of high cholesterol. Because as physicians, especially their primary care doctors, prevention is better than cure, they say. So, it's always good to see if we could prevent a heart attack or a stroke by just maybe even lifestyle changes or even maybe with medications. So, these bad cholesterols or triglycerides as well as the LDLs are what we look at when it comes to the bad side, forming clots and blocking the arties. The good cholesterol honestly helps clean up these arteries. So if your good cholesterol is quite high, you might actually see active cleaning of your arteries. So, it's important to have a look at the cholesterol panel as a whole and not just look at individual parts.

Melanie Cole, MS: The good cholesterol really does shuttle the bad cholesterol out. So, it's such a fascinating system, Dr. Rai, it really is to me. Now, when we think about, when we start checking our cholesterol, we think of it as something that older people deal with. It comes with age. You and I talked a little off the air. Mine came with medication. But it can rise with age and such. But we're seeing younger people with higher cholesterol numbers. Tell us what you're seeing. Is this really the case?

Anirudh Rai, MD: In my experience, yes, we are seeing younger folks who are having a little bit higher cholesterol. But again, it was more of a blanket statement. It's more of a proper history-taking to see, and a lot of these patient's actually have a family history. It doesn't have to be just parents who have high cholesterol, grandparents having high cholesterol could also be a clue saying, "Hey, your body may be all prone to just producing more cholesterol." But at the same time, the western diet does make it easy for cholesterol to be ingested and increased in one system. So, I always try to educate my patient's on the importance of making sure you have a healthy, balanced diet, because that plays a big role when it comes to cholesterol as well.

Melanie Cole, MS: So, what does that mean when we hear the terms low cholesterol? "Oh, don't eat eggs," "Oh, be careful, even things like shrimp have cholesterol." You know, we hear all these different things, but then we hear about foods, fiber, oats, things, you know, our good fats, avocados, salmon, fish, mackerel, all those things that can help to lower that cholesterol. Give us a little balance here, Dr. Rai, what does that mean when we say a healthy diet?

Anirudh Rai, MD: Well, that's a good question. That's a vast subject in itself. But to give you a general idea, when you eat any kinds of foods, even if it's a little bit of glucose, starches, you're going to have some form of cholesterols, fat in it. Your body ingests it. It actually takes care of it in the small intestine, bile enters, and it breaks it apart, and you get cholesterol. Triglycerides actually are the first that form with what we call a chylomicron. So, these are pretty essential when it comes to triglycerides, cholesterol. You have formation of it one way or another when you ingest pretty much most, if not all kinds of foods. It is just a matter of the portions.

If you have foods that have higher cholesterol or higher fat contents in it, you'll be absorbing more of it, such as, let's say, a hamburger versus a salad. That's a pretty stark comparison. Salad itself will have some cholesterols in it. But burgers tend to have way more just because of how they're cooked and the ingredients that are used in them. So, it's more of proportionality. Your body's going to ingest and form cholesterol no matter what. We just got to understand the proportionality. I'm not saying you should go and look at each, you know, catalog and start dieting and looking at what you should and shouldn't eat. It's just a matter of proportionality and timings. No matter what, people will have some form of triglycerides that go up after they eat, as well as LDLs that go up after it. That's just a natural way your body functions. It's just a matter of proportionality.

I always tell my patients, if you could eat healthier foods, you should. But I wouldn't just say, you know, cut off hamburgers completely. We need cholesterols and fats to survive nonetheless. This kind of talk and nutritional talk is more of an individual case. You know, what is the person trying to look for? Is the person wanting to lose more weight? Are we trying to just balance the cholesterol? So, there is a lot of individuality and a tailoring to a diet when we talk about these things from patient to patient.

Melanie Cole, MS: Yeah. That's really important to note. It is very personalized. And me seeing people for 35 years in this field, trying to cut things out of their diets and do all of these things. It doesn't work because they're denying themselves and it's just not sustainable. So when you talk about personalized nutrition, that is really the key, what you said just right there.

So now, cholesterol medication, we hear about them—statins, what are they? What are they doing? They've been around a while now. Tell us about these. Because you know, I told you off the air, I'm going on them.

Anirudh Rai, MD: Yeah. So, statins are the tried and true core when it comes to cholesterol, management. And the way they function actually, they actually target an internal enzyme that actually is part of your natural way of producing cholesterol. I believe it is the HMG co-enzyme, which is an enzyme that helps break apart and it helps produce some of these cholesterols. And we target that enzyme and help lower your internal cholesterol. It doesn't lower your cholesterol that you eat. So anytime you eat, you can theoretically still increase your cholesterol. What this does is it lowers your internal production of these cholesterols.

And it's been very effective. Studies have shown time to time that it helps with many different things. It's helped not only lower your chance of heart attack if you definitely need them, of course. And the key is if you need them. So, we could talk about it later, but there is a slight, I would say, non-beneficial or maybe even harmful benefit if you start cholesterol medications too early or if you start medications, and if you don't need it. But these medications for patient's who do need it is extremely helpful. It helps lower your triglycerides, help lower your bad cholesterol, and it can actually help increase your good cholesterol to a certain degree as well. So, these medications are proven to prevent heart attack, prevent stroke, help clean up the arteries. And it's, again, these patient's are the ones that would need it. And at the same time, if there's certain factors we know are causing your cholesterols to go up and if they go away, let's say medication causing it or if you change your diet significantly, people can get off these medications as well.

Melanie Cole, MS: That's really good to hear. I mean, that is great. And since these podcasts are also my therapy, tell me about side effects. Is there anything I can expect, you know, when I'm going on this coming up in the next few days, things that I should look for, side effects that I'd want to tell my physician about if they happen?

Anirudh Rai, MD: Yeah. The most common side effect to tell you about actually is muscle aches and a little bit of tiredness they say sometimes can occur. I would say these side effects can be tailored to particular types of statins. As, you know, the statin arsenal is wide, and I'm hoping it gets wider as well. And certain statins are more prone to these side effects. We always tell our patients, if you get muscle aches or muscle pains, you know, let your doctor know. Sometimes switching to a different statin can be helpful. But at the same time, it's something we want you to tolerate if you're having side effects with any of these medications, thankfully there are other alternatives and newer medications that are coming out these days that could be a better fit for you.

Melanie Cole, MS: That's good to know. I think I'm going on a pretty low dose, so I guess I'll see, right? What else, Dr. Rai, would you like to tell us about cholesterol and specifically cholesterol that we're seeing in the youth. You know, in the younger population, we know, you and I have talked about it, that the obesity epidemic, that our diet, this western diet can be, you know, just abysmal, and that the foods that we're ingesting, the processed foods, the fake foods, these kind of things, we know we want to stick with those whole foods with the healthier foods. But what would you like to tell people about cholesterol specifically. You know, here's your chance to say anything that you want for people listening about cholesterol and why it's so important to know our numbers.

Anirudh Rai, MD: Absolutely. Cholesterol is one of the few things we actually have some form of control over, because usually cholesterol is silent. You're not going to know you have high cholesterol because you're walking around, you're doing your normal things. So, cholesterol, in a certain way, is a silent killer as well, because you won't know until later on, until you find out when something's gone wrong, that, "Hey, do you have high cholesterol?"

So, I would always say follow with your primary care doctor, because, again, prevention is better than cure. If you could find out you have high cholesterol, treating it sooner is always better. And of course, dietary changes, living a healthy lifestyle, that plays a role in keeping the cholesterol in a healthy way. So, cholesterol is not an enemy entirely. It is also a friend. Your body needs the cholesterol to live and survive as well. So, we want to keep that balance going. So, it is something that everyone should understand.

One thing that I always get a lot with my patient's about, honestly, I don't know if you see this quite often as well, is my patient's tell me about statins causing dementia and whatnot. But that's a whole other subject, because ideally the bottom line is, no, I guess scare came out around 2012 when the FDA released one of these side effects saying maybe memory issues of amnesia. But that was for a subset of patients. So, I could say with confidence that statins do not cause dementia, nor do they worsen it. But that is something I see a lot of my patient's talk about actually, So, it is something that I would say if you're worried about it, talk to your doctor about it. Statins are helpful, but again, if you need it.

Melanie Cole, MS: That's great advice, and I'm glad that you mentioned that. Because those myths are out there and we see all this stuff and it can be really confusing. But as always, Dr. Anirudh Rai, you clear these things up for us and you give us the straight talk that we could trust. And you're such a great guest, such a nice man. Your patient's really are lucky to have you. So, thank you again. And I know you'll join us again. We'll talk about something else really exciting here on It's Your Health Radio. Thanks again for joining us.

You can also visit the free Henry Mayo Newhall Hospital online health information library at library.henrymayo.com. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Please always remember to subscribe, rate, and review. It's your health radio on Apple Podcast, Spotify, iHeart, and Pandora. For more health tips, updates, follow us on all your social channels. I'm Melanie Cole.