Evo Terra (Host): This is Jamaica Hospital MedTalk. I'm Evo Terra. And with me is Dr. Leah Petrucelli, a family medicine physician from Jamaica Hospital Medical Center. Our topic, hyperlipidemia, better known to most of us as high cholesterol, what it really means, why it matters to your heart, and to your overall health. Thanks for joining me, Dr. Petrucelli.

Leah Petrucelli: Thank you for having me. Very excited to be here today.

Host: Let's start with an explanation of these cholesterol levels. Everyone wants to check your cholesterol level and how it might affect one's health.

Leah Petrucelli: Well, I think that to understand this to its fullest ability, we should start off with why we have cholesterol and where it comes from. So, we have cholesterol, it's not all bad. It's for the critical parts of our body, hormone production, our cell membranes, a lot of really key things that help us function. And we get it from 70% of the time our body's synthesizing this without us knowing. Thirty percent of the time it's coming from dietary cholesterol, so thinking animal products. And so, the problem isn't the fact that we have it, it's the problem when we have it in excess. So when it's in excess over decades of time, it is detrimental. It can result in just about everything from heart attacks and strokes to issues with memory down the line.

Host: Got it. Okay. So, our bodies naturally make and require cholesterol, right?

Leah Petrucelli: Yeah. Correct.

Host: Yeah. Okay, good. I want to make sure I say that loud and clear, because a lot of people I've talked to have a just, "Oh, cholesterol's coming from the bad world." And I like how you mentioned that 70% of it comes from the human body, and only 30% comes from the diet that we eat. It makes sense. Makes sense. Okay. Cholesterol levels, what are those?

Leah Petrucelli: So, I think there's a lot of talk on the good and bad cholesterol, right? So, it's easier to understand it that way, but it's a bit of a misnomer because LDL and HDL aren't actually cholesterol by themselves. Instead, I think of them as little taxis in our body bringing cholesterol to and from our liver where it's processed. They can, however, be a good surrogate to measure if our cholesterol is wildly out of control.

So, let's start with LDL. So, this one's responsible for transport of cholesterol molecules to everywhere around the body from the needed required production to the detrimental accumulation of plaque in our arteries. So, the problem is kind of like a traffic problem. A normal road with cars moving, getting places they need to get to, that's wonderful. But when it's crammed, there's accidents, there's road rage, then we have a lot of issues. And HDL is kind of like the hero of the story. So, I like to think of a cartoon taxi wearing a cape, bringing all that excess cholesterol back to the liver where it can be cleared so it doesn't accumulate in places it shouldn't.

Host: Okay. Got it. And you said a moment ago that while these are not cholesterol molecules in and of themselves, they're good indicators, and that's why we're measuring the LDL and the HDL level in systems.

Leah Petrucelli: Exactly.

Host: Okay. Okay. Understood. You brought up good cholesterol and bad cholesterol. Which one of those two things—well, actually, it can't be either because they're not good and bad, I guess. So, help me understand that. Good cholesterol, bad cholesterol, what's too much, all of that.

Leah Petrucelli: Always easier to understand it in good and bad, black and white, but it's way grayer as we're learning. And I'm trying to clear that up for you today as well as a lot of our patients. So, LDL is the one that we want to control and get down around 70 or below. HDL is the one that we want it fairly high, above 40 if possible. And that's because, again, the LDL brings it out and the HDL brings it back. So, the LDL is bringing it potentially to our arteries where it's bad, whereas the HDL is bringing it back to our liver to be processed and cleared.

Host: Okay. So, we want our LDL to be low and our HDL to be higher. Why is that so hard for me to remember in my head, LDL versus HDL? That seems like easy. L for low, H for high. It's what you want to do.

Leah Petrucelli: Exactly. Exactly.

Host: What is too high? Can you have too much HDL, I guess? But also, when your LDL levels, we know that's high. Tell me what a high level means in the LDL and possibly HDL speak.

Leah Petrucelli: Yeah. So for LDL, if it's above 70, we can start to see some plaque formation. Doctors probably won't get too worked up about it unless it's above like 120, but that is shifting as we move from less of a reactive healthcare system to a more proactive preventative healthcare system. And then, HDL is a little still unclear if there's too high of a number of HDL, but probably less than 100 is good. And then, we want it to be above 40 if possible. There's some differences among genders. But just for simplification sake, we want HDL above 40 and LDL below 70 if possible.

Host: Okay. Those are good numbers to shoot for. So, cholesterol, I mean, if our body makes it, can our body make too much or is it just because we're eating too much? I guess my question is what are the reasons why someone might have elevated cholesterol levels?

Leah Petrucelli: So, I like to think of these as less fixed and more fixed factors. So, the less fixed factors are the things that we have a little bit more agency and control over. So, what we put in our mouth, what we drink, what we eat, how much we move, our sleep habits. And then, the things that are more fixed are like our ZIP code, our socioeconomic status, our genetics. All of these things can be modifiable, but they have degrees to which we can modify them.

Host: I need help understanding how somebody might know they have high cholesterol, right? Because I mean, I don't just go in for routine blood work just for funsies, right? I mean, are there symptoms? Are there signs that I might have high cholesterol when I've not yet been seen by or diagnosed by a doctor?

Leah Petrucelli: Yes, there are. So, the signs would be a family history of heart disease. If your weight is overweight, if you have other risk factors for heart disease like high blood pressure and you smoke, you probably want to get your cholesterol checked. The unfortunate part is that there's not really symptoms until we have disaster.

So unfortunately, until you have a heart attack or a stroke or until you're diagnosed with diabetes or organ issues, we really don't go searching for it. There are some guidelines of when to check, and that's based on those risk factors. But for the average person trying to know, "Is my cholesterol high?" It's really hard to tell. And that's why it's so hard to motivate all of us to do things about it because we can't see it as well.

Host: Yeah. And I think what you're saying there is don't wait for the signs and symptoms because you will have bigger problems. Get checked early on that. Okay. All right. Let's talk about now managing high cholesterol. I know there are a few different ways, and one of those is exercise, right? Move more, I have been told. Any tips beyond just get exercise?

Leah Petrucelli: So as a former personal trainer, I can think of a number of workouts that would address high cholesterol super efficiently and what I would tell most people to do. But I like to actually prioritize consistency because any movement that we can stick with is the best movement for that specific person, and pain, time, energy often limit what we can do. So, whatever someone can do five times a week or daily is the best thing.

So if we go more into nitty-gritty, cardio workouts like walking, biking, swimming, dancing, that's great for flattening those sugar spikes that can lead to the synthesis of cholesterol by our bodies from those products. But building muscle helps boost our metabolic health or how quickly we're able to burn those excess cholesterol molecules in our blood. So, both are good, so both should be added. But you don't need to be lifting heavy weights, and you shouldn't if you never have. So, I like to start with what is the baseline? How can we augment the baseline to even include 10 minutes of movement a day? And then, how can we build from there to include some body weight movements, some cardio movements? Does that make sense?

Host: Yeah. No, that totally makes sense. And I love what you're saying there. Just start moving is good health, right? And then, build on what you have to do. Yeah, you don't have to go lift heavy plates in the gym or crazy things like that. You can just move. And I like that we're going to have an impact on people. But, he says, sometimes that's not enough. Another big key thing is diet. So, talk to us about some components of a nutritional plan that's designed to really reduce the bad cholesterol and maybe even boost the good cholesterol.

Leah Petrucelli: So, this is my bread and butter, what I love most to talk about. And I think we should get back to thinking about, like, that 70% of created cholesterol in our body, where does that come from? What triggers that? So, that's what I address when I talk about diet.

So, there's a lot of myths to bust here. So, my first biggest point is that no one food group is evil. It would be so much easier, again, to say black and white, "Don't eat this, eat this." But we know now from the rise of obesity, heart disease, diabetes, after all of those low-fat and no-fat products on the shelves, that this is not the case. So, I'd recommend disregarding fads and advice that say to avoid one food group because this is not only unpractical and culturally insensitive. But most importantly, not necessary.

So, the problem is overconsumption, which is worsened by food addiction. And so, when we eat excess carbs, let's say, so, like, let's say I eat a pasta dish, then my blood sugar spikes, and then my body so smartly releases insulin from my pancreas so that the blood sugar level doesn't reach a toxic level. So then, the insulin brings the sugar into the cells and creates a cascade of steps where we're creating that cholesterol. That 70% of cholesterol synthesis comes from this type of process. And then, you also get inflammatory markers. So, this isn't an issue once in a while. But when this is every day, let's say we're having high-carb breakfast, lunch, and dinner, and we're eating more than we need, eating excess, and we're not moving, that's when we get a problem where we're hitting that insulin button way too frequently. We can get some insulin resistance, high levels of blood sugar, a ton of cholesterol, and then we can get that issue where it ends up in our arteries. So, it's not just carbs, but carbs lead to that process a little more easily. So, that's why I focus on that. But again, I would never tell someone, "Don't eat rice."

But I think when we're thinking about our carbs, we want to have our carbs match our movement. So if we're pretty sedentary, I want to keep those carbs to a quarter cup per serving of our meal. But if you're moving a ton, feel free to increase that. And the most interesting thing is that dietary fat doesn't cause this synthesis. So, we don't actually get that 70% of our cholesterol coming from dietary fat. It is animal protein and animal fat that creates the 30% of our cholesterol plus or minus, but that's where a lot of the misunderstandings come from, is not understanding how it's actually happening.

And then, we can't talk about any of this without talking about food addiction and food insecurity. So, all of our processed foods are created and specifically designed to suppress our hormones that tell us we're full, so that way we keep eating them, we keep buying them, and it's a business. It's about making money. So, that works against us. So, I like to also bring up a lot with my patients that this isn't your fault, but this is your responsibility

Host: Understood. And, I want to just highlight the point that you said, it's the overconsumption that is the problem, and those processed foods are designed to be overconsumed, really that's the word.

Leah Petrucelli: Exactly. Yes.

Host: Right. Right. So, okay. And I think what's fascinating what you said is that the cholesterol that we do make comes from primarily—I know it's not exclusively this—but primarily from carbs. That's what you're going to make when you have the carbs, right? And then, the bad stuff, the animal product fats and whatnot, everything else that contributes to 30%. So really, 70% way more effort. If you spend more time eating a healthy diet that has less carbs in it or just simply a healthy diet with them, and I'm assuming we're talking about things like whole grains and the things that we've been taught for forever that work much better, yeah? Those have the right kind of attitude. But stay focused there, as much if not more so than you are your animal proteins and dietary fat intake.

Leah Petrucelli: Yeah. We all know that changing our diet is super hard, right? So, why not do it the most efficiently.

Host: Exactly. So, are you advocating for like a plant-based diet then?

Leah Petrucelli: Yeah. So, I think plant-based is a phenomenal way to focus your diet where you're not restricting, but you're just adding. So, a lot of times it's easier to think about dietary changing if we're adding things than if we're just cutting things out.

So, I read this one saying, and it really stuck with me, that we are what our food eats, and that's why animal proteins can be so nebulous and confusing, and you can see studies where you see animal proteins linked to heart disease. And then, you see conflicting studies that don't say that. And that's because a lot of our meat sources are from animals that aren't treated well, they aren't fed well, and they're surrounded by pesticides and pumped with hormones. And all that stuff is super inflammatory for our bodies. So for the carnivore that eats really well-sourced meat and can afford that, like I don't target them to reduce their meat consumption. But if we don't have the means to get good quality meat, then reducing it would actually have some really good benefits to decreasing inflammation in our body and decreasing that dietary cholesterol.

Host: Makes sense. What about food prep? Should we do anything different with the way that we're preparing food if we are cooking food for ourselves at home?

Leah Petrucelli: Absolutely. So when I'm thinking about changes, I want to think about how can we affect the excess of cholesterol, and then how can we decrease our inflammation. And food prep's one of those ways we can address the inflammation. So, a lot of seed oils like canola oil, corn oil, the really cheap oils in the store, those are super inflammatory, because they have omega-6 fatty acids in them, which are really high in a lot of our processed foods. So, we find that when we eat out a ton. That's why just making the switch of eating home more and not eating out can dramatically decrease your inflammation, because you're controlling how you're prepping your food.

So, what I like to advise for is people to cook with avocado oil or good sources of butter or ghee, anything where you have less of those omega-6 fatty acids. And also, a higher smoke point so we're not putting more carcinogens into our food. Olive oil is wonderful to consume, but I usually try to just drizzle that on my food rather than cook at a high heat.

Host: it smokes on me quite a lot. I know that when I get it too hot, I don't want to do that. All right. We've talked a lot about changes that we can make, that an individual person can make for some level of success or the other, right, to help lower this. But sometimes that's not enough. Get the right diet, get the right exercise. Either they can't or together that's not successful by itself to lower cholesterol. What are the treatment options? When we see a doc like you, what are you going to do?

Leah Petrucelli: This is where integrated medicine comes into play. We use medicine, we use lifestyle, and that's so important because we have a lot of circumstances where we can't do it all, whether it's our genetics, our social status, whatever is restricting us. So, it's a beautiful thing that we have medicines, and they're coming out with better and better medicines for cholesterol specifically.

So with regard to medicines, you could be started on a statin, which is very common, very well-known, one of the oldest medicines, very effective in reducing cholesterol. But there's a ton other medicines that can interrupt cholesterol synthesis, and I think that our doctors are really, really well-versed with. So, go to your doctor and find out about those medicines. But what I like to talk about, if someone can't change their diet and they can't change their movement because they have pain and they live in a food desert, they don't have access to good food, there's still a lot of things you can do. So, there's a lot of hacks we can do to our body where if we eat food in a certain order, let's say you have a rice dish and you have some vegetables before you have the rice and your meat, your blood sugar won't spike as high. And if we can flatten those blood sugar spikes, then we get less cholesterol synthesis, less of that 70% of cholesterol synthesis that's happening to our body. So, I love bringing up my mom in this because she's like, "I'm never not going to eat pasta. I'm an Italian mother. You're not going to change me. I love my bread." And I'm like, "Never change, Mom. I love you. But you can change your food order and that would make a big difference."

And also, another quick tip was if you have a tablespoon of vinegar, white vinegar, apple cider vinegar, any vinegar that doesn't have sugar in water before your meal, you can also drop that sugar spike about 30%. So, those are things that anyone can do regardless of income or motivation.

And then, supplements like fiber before those meals can also flatten those sugar curves. And things that can address inflammation are more like improving gut health, improving your sleep. So, there is a lot you can do.

Host: Is there anything else we didn't cover in this that you would like to say?

Leah Petrucelli: I think it could be helpful to just know, like, what are some simple changes to make to my diet? So, I think about what we can add and what we could reduce. So, reducing sugary beverages, processed foods. And doing something to reduce our stress is really good to think about reducing. And then in terms of adding, adding more whole foods, adding more fiber-rich foods, and having more of that plant-leaning diet.

Host: Thank you very much for all this information, Dr. Petrucelli.

Leah Petrucelli: Oh, of course. Thank you for having me. I truly love talking about this, and I would love to come back to chat some more

Host: That we shall do. If you would like to make an appointment with a member of the family med team at Jamaica Hospital Medical Center, please visit jamaicahospital.org. And that wraps up this episode of Jamaica Hospital MedTalk. I have been your host, Evo Terra. While you're on that website at jamaicahospital.org, I invite you to check out all the other episodes of our podcasts that might be of interest to you. And please share this episode with your friends and family. Thanks for listening

disclaimer: All content of this podcast is intended for general information purposes only, and is not intended or implied to be a substitute for professional medical advice, diagnoses, or treatment.