February 18, 2025 • 33 mins
Welcome to Season 3 of the Essence of Health Tea Time podcast!
It’s Heart Health Awareness Month! While you may be aware that Cardiovascular Disease is the leading cause of death in the United States, did you know that Cardiovascular Disease takes the life of one woman every 80 seconds?
It's important to be proactive about your health, particularly for women who are disproportionately affected by heart disease and knowing your risks with lipid testing is a good place to start. We’ll tackle this “heavy hearted” subject in today’s episode by looking at our “internal highways” and the “trucks” and “sweepers” that help us to keep cardiovascular balance.
On today’s episode of the Essence of Health Tea Time Podcast, Dr. Shayla Toombs-Withers will be spilling “𝐓𝐡𝐞 𝐓𝐞𝐚 𝐨𝐧 𝐋𝐢𝐩𝐢𝐝 𝐓𝐞𝐬𝐭𝐢𝐧𝐠: 𝐖𝐡𝐚𝐭 𝐘𝐨𝐮𝐫 𝐒𝐭𝐚𝐧𝐝𝐚𝐫𝐝 𝐂𝐡𝐨𝐥𝐞𝐬𝐭𝐞𝐫𝐨𝐥 𝐓𝐞𝐬𝐭 𝐌𝐚𝐲 𝐍𝐨𝐭 𝐁𝐞 𝐓𝐞𝐥𝐥𝐢𝐧𝐠 𝐘𝐨𝐮”.
Synopsis
- Understand the evidence based screening recommendations for Cholesterol Screening by age group
- Discover what exactly is included in cholesterol testing and why
- Explore the impact that your hormones may be having on your Cholesterol and heart health
- Discover available Advanced Lipid Testing that goes beyond traditional testing to determine your cardiovascular risks
- Get Dr. Shayla’s “Fat Free Tea” on Lifestyle Factors and practical strategies to lower your cholesterol levels and cardiovascular risks without medication
Connect with Essence of Health:
– Join the FREE Nourish & Flourish 5 Day Challenge at www.DrShayla.com/NFchallenge
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The Essence of Health is in You!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to the Essence of Health Tea Time Podcast.
(00:12):
I am your host, Dr. Shayla Toons-Whithers.
As a double board certified family and obesity medicine physician with over 12 years of experience
in medicine, I teach motivated individuals how to achieve their desired quality of life
while preventing and reversing chronic diseases.
(00:33):
It's tea time!
What part of your health journey is most challenging?
Is it the actual effort of sticking to a plan?
The cooking and the meal planning?
The exercise routine?
Not enough time for everything you think you need to do?
Or the confusion of it all?
(00:54):
If you said yes to any of these obstacles, then keep listening to learn how you can smash
these problems just by checking your email.
You check your email inbox every day already, but what if checking your inbox brought you
better health instead of the stress it sometimes can bring?
Well, I have news for you.
(01:15):
You can improve your health, get a jump start on improving your health conditions, and start
to feel like a better version of you just by checking your email inbox over the next
5 days when you join the free Nourish and Flourish 5 Day Challenge.
You'll get health tips, actionable videos, a goal and habit tracker, and healthy recipes
(01:38):
every day for 5 days.
Better health is the best investment you'll ever make, and this is only a small investment
of your time.
You have nothing to lose, but everything to gain.
The Nourish and Flourish 5 Day Challenge was designed to set the foundation for healthy
habits for life.
(01:59):
Say yes to yourself today and sign up now at drshayla.com forward slash nfchallenge.
I'll also place these details in the show notes.
The essence of health is in you.
See you in your inbox.
I'm excited to announce that our group metabolic coaching program, the Mind Body Balance Collective,
(02:21):
has started, and we are ready for you to come and join us.
Within this monthly program, we'll work together to not only develop your personalized plan
to improve your condition of insulin resistance, lower your blood sugar, lose weight, re-energize
your body, and keep you feeling your best self, but we'll also get you off of that fat
(02:43):
diet hamster will for good by giving you a sustainable plan that actually works within
your busy schedule to keep you in good health.
And best of all, you'll be amongst a safe, encouraging group of cheerleaders there to
support you along the way.
The Mind Body Balance Collective is where you want to be.
(03:03):
Head on over to drshayla.com forward slash mbbc to enroll now, and let's get started
today.
It's tea time.
A widely known fact that is also the sobering truth is that cardiovascular disease is the
leading cause of death in the United States.
(03:24):
Even more shocking, while we often think of heart disease as a man's problem, it actually
kills more women than all forms of cancer combined.
Did you know that cardiovascular disease claims the life of one woman every 80 seconds in
the United States?
An episode of the Essence of Health Tea Time podcast is typically 15 to 20 minutes long.
(03:46):
Now you do the math on that.
While this information may sound frightening, today's episode is not about doom and gloom.
I'll be spilling the tea on lipid testing, what your standard cholesterol test may not
be telling you.
Here's the crucial point.
The American Heart Association tells us the simple truth that most cardiovascular diseases
(04:09):
can still be prevented with education and healthy lifestyle changes.
And I agree, but prevention starts with you, your understanding of your cardiovascular
risk and your willingness to be in the driver's seat of improving your health.
Now keep listening and get this tea.
How many times have you gone for your yearly checkup, you got your preventative lab work
(04:31):
done and your doctor told you that your cholesterol was high or that your cholesterol was borderline
high or even your cholesterol is too high.
So now here's your statin medication to get started with.
But what does any of this actually mean?
And more importantly, what does it mean to your overall health and your risk of heart
(04:53):
disease?
One thing for you to know is that it's more important than a simple good or bad cholesterol
number.
Risk factors for cardiovascular disease include high blood pressure or hypertension, high
blood cholesterol, smoking, lack of physical activity and obesity.
For women, further risk factors include menopause, use of birth control pills and bilateral urethraectomy,
(05:20):
which is removal of your ovaries and premenopausal women, because this sends those women into
early menopause.
While some of these risks are unavoidable due to a variety of reasons, what you put on your
plate and how you move your body and what you do with your lifestyle are things that
you can certainly decide.
(05:41):
Let's start with the basics of cholesterol testing.
A simple blood test can give you your cholesterol levels.
Cholesterol screening is recommended as early as 9 to 11 years old with the focus on identifying
genetic lipid disorders and early risk factors for childhood health conditions.
For adults age 20 to 39 years old with average risk for heart disease, cholesterol screening
(06:06):
is recommended every four to six years.
However, if you have a condition like diabetes, high blood pressure, obesity, previously had
high cholesterol or other risk factors, you likely should be screened more frequently
as we do know that heart disease often doesn't develop overnight.
And just because you're a young adult doesn't mean that you aren't at risk for being well
(06:29):
on your way to your first heart attack or stroke.
Now once you get to age 40, you should receive cholesterol screening every four to six years
as well.
However, your arthrosclerotic cardiovascular disease score or we'll just call it ASDVD
score should also be calculated and used to determine your chance of having a cardiac
(06:53):
event within the next 10 years.
The ASDVD score is a calculation that takes into account your age, sex assigned at birth,
your race, your cholesterol levels, your blood pressure, your diabetes status and smoking
habits to estimate a person's 10 year risk of developing arthrosclerotic cardiovascular
(07:16):
disease ASDVD, which is caused by plaque buildup in your arterial walls, which includes heart
attacks, strokes, blockage of blood vessels, peripheral vascular disease and aneurysms
of your larger vessels within your body like your aorta.
There are lots of online ASDVD score calculators that you can access yourself as well to gain
(07:41):
a better understanding of your risk.
And with traditional cholesterol testing, you may hear it referred to as a lipid panel.
This is a general term for fatty compounds that include cholesterol, triglycerides and
phospholipids.
Cholesterol is a waxy fat like substance found within your body that is necessary for good
(08:02):
health.
It is made in your liver and a certain amount of cholesterol is essential for bodily functions
within our cells and within our hormones.
Your body makes the necessary amount of cholesterol it needs for proper functioning.
So the remainder of cholesterol that you develop comes from the foods you eat, particularly
from animal based foods and animal products since their bodies also make cholesterol as
(08:28):
did yours.
And oils including coconut oil, palm oil and avocado oil that are high in saturated fat
can increase your risk for making your cholesterol too high as well.
This is why consuming predominantly plant based foods and avoiding oils in your diet
is going to be very important to reduce your risk for heart disease and its complications.
(08:51):
Now, back to the labs.
A cholesterol screening test will typically break down your total cholesterol into other
components including low density lipoprotein or LDL, otherwise known as bad cholesterol,
high density lipoprotein or HDL, otherwise known as good cholesterol and triglycerides.
(09:12):
LDL or bad cholesterol is used by the body to build the walls or membranes of cells in
your body.
I once heard a good description of LDL that I'll share with you.
Think of the LDL particles in your body as tiny delivery trucks that are responsible
for carrying cholesterol through your bloodstream, which is the highway for your body.
(09:34):
These trucks are supposed to deliver cholesterol to yourselves to help your body with those
necessary functions like building cell membranes and producing essential hormones.
But here's the problem.
When there are too many of these LDL particle trucks on your blood vessel highways, they
can start causing traffic jams.
Now, folks, I'm originally from Atlanta, so I've seen my fair share of traffic jams.
(10:00):
And for anyone who has been sitting in traffic, you've witnessed the calamity that can happen.
Well, within your blood vessel highways, when the LDL particle trucks get backed up because
there are simply just too many of them on the road, then some of these trucks crash
into your artery walls, dropping and losing some of their cholesterol cargo along your
(10:21):
blood vessel highway, which can build up over time into what we call plaque formations.
The more buildup in your blood vessels, now the highways block and blood can't flow freely,
leading to those cardiovascular events, depending on which vessel highways are affected, including
heart attacks and strokes.
(10:42):
Here's what HDL or good cholesterol comes into play.
So HDL is your street sweeper crew.
The HDL comes along, cruising through your blood vessel highways, picking up that excess
cholesterol that the LDL particle trucks just littered along the highway and the street
sweeper crew take it back to your liver for processing.
(11:05):
This is why having a high HDL is actually a good thing, because the more cleanup crews
you have along the blood vessel highway, the better maintain your highways will be to allow
that blood to flow freely.
Now for women, get this tea.
It shows that women typically have higher HDL levels than men before menopause, thanks
(11:26):
to estrogen.
Estrogen acts on the liver, stimulating it to produce more good cholesterol or HDL and
lowering bad cholesterol or LDL, giving some protection from cardiovascular disease.
However, as estrogen levels drop for women as we enter menopause, it also affects this
cholesterol balance, which is one reason why cardiovascular disease risk actually increased
(11:52):
during this time.
So it's important to maintain good overall health, because while you can't stop your
natural progression to menopause, being aware of its impact can help guide your health and
wellness decisions.
If you're frustrated with your weight, taking more medications than you'd like to, have
been told that you are at risk for the development of a chronic preventable disease, or just
(12:16):
are not feeling in the best of health, then I'm talking to you.
Why?
Because you're tired of fat dieting, you know it's time for a change, and you want
a sustainable plan to improve your health.
If you have found yourself at this place in life, well I have developed a program that's
just for you.
It's called The Essence of Health, and it's your prescription for transformation.
(12:41):
My goal with this program is to give you the tools needed to create sustainable lifestyle
changes within a group coaching setting, along with one-to-one individualized coaching to
give you a personalized path to help that's just for you.
The benefits are priceless, so join today.
Go on over to eohcoaching.com to learn more.
(13:05):
The Essence of Health is in you.
Let's get back to our lipid panel.
Triglycerides are also a type of fat and are a part of our lipid panel.
However, they have a bit different function in our bodies.
While cholesterol is used to build cells and hormones, triglycerides are more focused on
energy storage.
(13:26):
When you eat, your body will use the calories that it needs for functioning, and it will
convert any excess calories it doesn't need to use right away into triglycerides.
The triglycerides are stored in your fat cells.
The stored triglycerides are later released by your hormones to use for energy between
meals.
But here's the process, T. High triglycerides can be a sign that your lifestyle and your
(13:52):
dietary habits may need some refinement.
If you regularly eat more calories than your body needs, particularly from those processed
high carb foods, you know, the good stuff, the chips, the cookies, the packaged snacks,
crackers, soda, you may develop high triglycerides, also known as hypertriglyceridemia.
(14:15):
Overindulgence in alcohol can also contribute to this as well.
Now, you may be wondering, why does any of this matter?
It matters because remember, triglycerides are still fat, and too high levels of triglycerides
can cause some serious health problems, including hardening of the arteries or thickening of
(14:36):
the artery walls, which increases your risk of stroke, heart attack, and heart disease.
Very high triglyceride levels can also cause acute inflammation of the pancreas, known
as pancreatitis.
Really high triglyceride levels can affect your body's ability to properly break down
fats, leading to a condition called multifactorial chylomicronemia syndrome, which can cause
(15:02):
symptoms like short term memory loss, swelling of your liver and spleen, significant stomach
pain and skin changes.
Well, this is not a game, folks.
This is why triglyceride levels can sometimes be the first sign that your lifestyle really
needs some immediate adjustments.
These four values of knowing your total cholesterol, your LDL, your HDL, and your triglycerides
(15:27):
can be evaluated further by your doctor to help even more with determining your cardiovascular
disease risk by looking at the ratios of how one of these values compares to the other.
For instance, the total cholesterol to HDL ratio.
If we were to compare your total cholesterol number to your HDL number, this would be a
(15:48):
strong predictor of your overall cardiovascular health.
Think of it this way.
The ratio tells us about the balance between all of the cholesterol in your body and your
street sweeper crew, their capacity to clean it up.
If your total cholesterol is a bit higher than normal, but your HDL is also adequately
(16:10):
high, you may have enough street sweepers to keep your highway blood vessels maintained.
But if your HDL is too low, your risk for those traffic buildups on your blood vessel
highways will be higher.
You can calculate your own total cholesterol to HDL ratio by dividing the total cholesterol
number by your HDL number.
(16:33):
Optimally, you want this ratio number to be equal to or less than 3.5 as this level or
below is associated with a lower risk of coronary heart disease.
Your triglyceride to HDL ratio is another important comparison.
This ratio is particularly useful in assessing your risk of cardiovascular disease and insulin
(16:55):
resistance.
Remember that high triglycerides typically are associated with dietary intake of highly
processed carbohydrate foods.
And higher triglycerides to HDL ratios often indicate insulin resistance, which can lead
to inflammation and increased cardiovascular risk.
(17:16):
So this ratio is a pretty powerful indicator of both.
To calculate your triglyceride to HDL ratio, divide your triglyceride number by your HDL
number.
Optimally, you want this ratio number to be equal to or less than 1.5.
(17:36):
Another important comparison that can come from your lipid panel is your LDL to HDL ratio.
This tells us the balance of bad cholesterol to good cholesterol and is a significant predictor
of cardiovascular risk.
Remember that when you have all of those cholesterol filled LDL particle trucks on your blood vessel
(17:57):
highways, you want to make sure that you have enough street sweeper crew members or HDL
to keep your blood vessel highways maintained and functioning for proper blood flow.
Optimally, you want this ratio number to be equal to or less than 2 for reducing your
cardiovascular risk.
Now, as with many things in science and in medicine, research continues to emerge with
(18:23):
more advanced testing that can be done with cholesterol to further determine our cardiovascular
risk.
Think of the previously discussed lipid panel as your open window and these more advanced
tests as more of your telescope lens to give you more detailed information about your cardiovascular
health.
(18:44):
Several advanced lipid tests can be performed, including apolipoprotein B, lipoprotein A,
small dense LDL cholesterol, lipoprotein associated phospholipase A2, and high sensitivity C
reactive protein.
I'm going to break these down a bit for us.
(19:05):
Apolipoprotein B gives us insight into the total number of actual plaque causing particles
you're carrying in your bloodstream.
It gives us a further breakdown of the types of LDL particles circulating in your body,
including very low density lipoprotein or VLDL and intermediate density lipoprotein
(19:28):
or IDL.
Think of it this way.
Apolipoprotein B takes our LDL particle trucks where they're going.
So it's sort of like the wheels on the truck.
The apolipoprotein B wheels, however, only lends itself to helping the LDL trucks, not
the street sweeper crew.
(19:50):
But because the apolipoprotein B wheels are helping the LDL trucks, it can further assess
how heavy or how dense the LDL is that is being carried through our blood vessels, which
in turn can give even more information regarding just how bad your LDL cholesterol actually
is.
(20:11):
Because apolipoprotein B is specifically telling us how many of your trucks are actually dropping
those plaques along your blood vessel highways.
Optimal levels of apolipoprotein B can vary based upon your personal risk factors.
So definitely review these results with your doctor.
(20:31):
Now while we're thinking about the heaviness or density of our LDL particle trucks, let's
discuss our small dense LDL cholesterol marker.
It's another advanced test that shows one's increased risk for cardiovascular disease.
Think of the small dense LDL particles as small compact cars on your blood vessel highways.
(20:54):
Even though your LDL particle trucks are dropping and losing LDL particles along your blood
vessel highway, because they're too full, your small dense LDL particles can still zip
through along the highway, causing even more damage to your blood vessels.
Smaller particles of LDL actually carry more risk for heart disease than its larger counterparts.
(21:17):
Due to its smaller size, these particles can readily slip through the lining of the blood
vessels, getting embedded into the wall of those vessels, where it can then trigger inflammation
and even more plaque formation, blocking the flow of blood.
So you definitely want this number to be low, ideally less than 35 milligrams per deciliter
(21:39):
to optimize your cardiovascular health.
But lipoprotein A levels are also associated with increased cardiovascular risk, but can
be thought of as more of a risk factor of inheritance.
The American College of Cardiology and the American Heart Association include lipoprotein
(21:59):
A as a risk enhancing factor within their guidelines, particularly for individuals with
a family history of premature atherosclerotic cardiovascular disease or plaque forming type
of heart disease causing heart attacks and strokes.
This particular test is usually recommended for people younger than age 65 who have had
(22:20):
a heart attack, those with a family history of premature heart disease, and those with
elevated LDL cholesterol that hasn't improved much, even with the use of statin medications,
since it occurs largely due to genetic risk and doesn't fluctuate much in response to
modifiable lifestyle risks like our other cholesterol factors.
(22:42):
But this is also why optimizing those factors that you do have control over are important
because there will always be other factors that we can't control.
There are other advanced cardio, edit, there are other advanced cardiac markers associated
with inflammation that can be measured to determine your cardiovascular risk, including
(23:06):
lipoprotein associated phospholipase A2 and high sensitivity C reactive protein.
Lipoprotein associated phospholipase A2 is an inflammatory promoting enzyme that binds
to LDL.
It can be thought of as an early alarm system for your cardiovascular risk, as its presence
(23:27):
with elevated levels in your bloodstream are strongly linked to an increased risk of having
a coronary event like a heart attack or stroke.
Now while not strictly a lipid test, high sensitivity C reactive protein is crucial
in advanced cardiovascular testing because it measures inflammation throughout your body.
(23:48):
This inflammation measure is associated with arthrosclerosis or plaque buildup in your
blood vessel highways, increasing your risk for heart attack.
And high sensitivity C reactive protein can also be an indication of increased risk for
diabetes, which is also a risk factor for heart disease.
(24:09):
High sensitivity C reactive protein is stratified into three risk categories.
Low risk is going to be less than one, average risk is going to be one to three, and high
risk is going to be greater than three.
Individuals in the high risk greater than three category have two times the risk for
cardiovascular events compared to those in the lower risk category.
(24:32):
Now you might be wondering when you may benefit from having these advanced tests beyond the
typical lipid screening recommendations.
Based upon current research, you may benefit if you have a family history of early heart
disease, your standard lipid panel results don't quite align with your overall health
picture, and you and your doctor may be weighing the risk and benefits of medication therapy.
(24:59):
You have autoimmune conditions or chronic inflammation, you're approaching or going
through menopause, or if you have unexplained cardiovascular symptoms, despite normal basic
lipid panels.
When it comes to improving your cholesterol levels and reducing your cardiovascular risk,
there are several medication options available, including the popular known statin medications,
(25:23):
but I won't go into medication options on this episode, but stay tuned to a future episode
and I'll dive into the available options.
But now here's the inspirational tea that you should make sure you understand is that
cardiovascular disease is largely preventable, particularly in women.
(25:43):
Only 75% of coronary heart disease cases can be prevented with better lifestyle choices
such as not smoking, exercising regularly and eating a healthful plant-for-it diet.
Now let's dive into what I would consider the most empowering part of our discussion
beyond just that knowledge that you've gotten, because knowledge is power.
(26:06):
But now here's how you can actively improve your cardiovascular health through lifestyle
choices, particularly through a whole food plant-based diet, exercise and stress management.
Let's talk about the whole food plant-based nutrition.
Now research has shown that a properly planned whole food plant-based diet can reduce your
bad cholesterol significantly and even in just a few weeks.
(26:31):
But this is the fascinating part is how it works just on multiple levels.
The one is the fiber intake within plant-based foods.
Plant-based foods are rich in fiber that work together for your heart health.
Plant-based foods also carry insoluble fiber that's helpful for your gut health and gut
bacteria, which we now know is crucial in our cardiovascular health and our brain health
(26:54):
and our mental health and our weight management and so many things.
So to get more fiber within your diet, you want to focus on unprocessed whole grains
because remember we talked about those processed carbohydrates contribute into your higher
triglycerides.
But focusing on those unprocessed carbohydrates like still cut oatmeal, barley, farro, quinoa,
(27:17):
brown rice, those are going to be good options.
Brown flaxseeds and chia seeds as well.
Dark leafy greens and beans.
These are all great options to give you healthful plant-based fiber that's going to be for your
heart health and for lowering your cholesterol and cardiovascular risk.
The other key component to plant-based foods are that they contain phytosterols, which
(27:41):
are actually cholesterol fighting type of nutrients found in plant-based foods.
So it's like having natural cholesterol medicine, if you will.
The best sources for these are once again going to be those dark leafy green vegetables,
nuts and seeds like almonds and walnuts, avocado, which is a healthful source of fat, not avocado
(28:02):
oil because remember what we discussed with the oils in your triglycerides.
Once again, those whole grains are going to give you an excellent source of phytosterols
and legumes or beans.
Another key component in those plant-based foods are going to be the antioxidants that
you're going to get, which is going to be helpful in fighting oxidation from the bad
(28:25):
cholesterol because oxidized LDL or oxidized bad cholesterol can be dangerous for our arteries
and increase that inflammation and those hardening of our blood vessels.
So foods that are high in those protective antioxidants are going to be berries, especially
blueberries and strawberries because those antioxidants are actually in the natural pigment
(28:46):
of those fruits.
Your dark leafy greens, you hear a resounding theme here, eat the dark leafy greens and
then other colorful vegetables because those antioxidants are within the pigment of those
vegetables.
Now, the next key is exercise.
You aren't just exercising just to burn calories, but physical activity when it comes to cholesterol
(29:09):
and cardiovascular health is actually helpful for increasing your HDL, that good cholesterol,
because you want lots of street sweepers out there keeping your blood vessel highways clean.
Regular exercise is also going to be helpful for reducing inflammation, so lowering those
CRP risks like we talked about.
(29:30):
It's going to be helpful for maintaining a healthful blood pressure, which will further
lower your cardiovascular risk.
And here's another key to exercise.
It's helpful for improving your insulin sensitivity and insulin balance, which can help improve
diabetes because remember diabetes is a cardiovascular and cholesterol risk and helpful for the triglycerides
(29:51):
because remember those triglycerides are tied to those processed carbohydrates.
Also by exercising, it actually helps your body to keep your blood sugar and your insulin
levels at a better balance.
Optimally for exercise from the American Heart Association, you should be aiming for about
150 minutes of moderate physical activity per week.
(30:13):
Moderate activity is going to be like brisk walking, swimming, cycling, dancing, something
that really gets your heart rate up.
You should also aim for two to three sessions of strength training.
You can use the stretchy resistance bands, you can use dumbbells, kettlebells, or you
can even do body weight exercises like pushups.
Those are all great for maintaining your cardiovascular health.
(30:36):
The other key to maintaining your cardiovascular health and your cholesterol metabolism and
lowering inflammation is sleep and not just any old sleep, but quality sleep.
Yes, you can listen to previous episodes of the Essence of Health Tea Time podcast where
I specifically talk about sleep, especially as it relates to insulin resistance.
And we know that insulin resistance is a part of cholesterol and heart health.
(31:00):
But just a key reminder that you need to be getting at least seven to nine hours of quality
sleep, dark, cool environment in your bedroom, and keeping a routine schedule so that you
optimize the quality of your sleep.
And now the key component as well that often gets overlooked is stress management.
(31:21):
A lot of times we're on the go, the hustle and bustle of everyday life and things get
stressful but when we are more stressed that actually raises the inflammation within our
body that raises our blood pressure, it impacts negatively our cholesterol and puts us at risk
for cardiovascular disease.
So you want to take a moment to get that proper sleep for stress management, but also meditate
(31:45):
or pray whatever works for you.
Keep breathing, spend time outdoors to boost your happy hormones and help your mental health,
make social connections within community engagement or even yoga or Tai Chi, gentle types of exercises
to reduce your stress and therefore reduce your inflammation and improve your cardiovascular
(32:05):
disease.
Now, if you are looking for a comprehensive, holistic approach to improving your health
and lowering your cardiovascular risk, I invite you to visit the Essence of Health website
and schedule your free consultation with me today.
Within our Lifestyle Medicine membership program, we get to the root cause of your health concerns.
(32:27):
Go into depth with practical and tangible solutions to prevent and reverse your preventable risk
factors and improve your overall health and wellness using evidence-based approaches,
medication management and optimizing holistic therapeutic approaches as well.
Medical services are now offered in many states, so check out our website.
(32:49):
Now that you've gotten another heart healthy dose of the tea with me today, be sure to
share the wealth by liking and subscribing to this podcast and share this episode with
your family, your friends and your colleagues so that they too can reap the benefits.
Remember, the Essence of Health is in you.
Thank you for joining me today on the Essence of Health Tea Time Podcast.
(33:12):
Click the subscribe button on your favorite podcast platform so that you never miss a
moment of the Essence of Health Tea Time Podcast.
Check out the show notes to obtain your free tips for Healthy Living God to get you started
on your health and wellness path.
Follow me on social media at Essence of Health Wellness Clinic on Facebook, Instagram and
(33:37):
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Interested in becoming a member of the Essence of Health coaching program?
Well head on over to www.eohcoaching.com.
The Essence of Health is in you.
Welcome to the Essence of Health Tea Time Podcast.
(00:12):
I am your host, Dr. Shayla Toons-Whithers.
As a double board certified family and obesity medicine physician with over 12 years of experience
in medicine, I teach motivated individuals how to achieve their desired quality of life
while preventing and reversing chronic diseases.
(00:33):
It's tea time!
What part of your health journey is most challenging?
Is it the actual effort of sticking to a plan?
The cooking and the meal planning?
The exercise routine?
Not enough time for everything you think you need to do?
Or the confusion of it all?
(00:54):
If you said yes to any of these obstacles, then keep listening to learn how you can smash
these problems just by checking your email.
You check your email inbox every day already, but what if checking your inbox brought you
better health instead of the stress it sometimes can bring?
Well, I have news for you.
(01:15):
You can improve your health, get a jump start on improving your health conditions, and start
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5 days when you join the free Nourish and Flourish 5 Day Challenge.
You'll get health tips, actionable videos, a goal and habit tracker, and healthy recipes
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every day for 5 days.
Better health is the best investment you'll ever make, and this is only a small investment
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habits for life.
(01:59):
Say yes to yourself today and sign up now at drshayla.com forward slash nfchallenge.
I'll also place these details in the show notes.
The essence of health is in you.
See you in your inbox.
I'm excited to announce that our group metabolic coaching program, the Mind Body Balance Collective,
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has started, and we are ready for you to come and join us.
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Head on over to drshayla.com forward slash mbbc to enroll now, and let's get started
today.
It's tea time.
A widely known fact that is also the sobering truth is that cardiovascular disease is the
leading cause of death in the United States.
(03:24):
Even more shocking, while we often think of heart disease as a man's problem, it actually
kills more women than all forms of cancer combined.
Did you know that cardiovascular disease claims the life of one woman every 80 seconds in
the United States?
An episode of the Essence of Health Tea Time podcast is typically 15 to 20 minutes long.
(03:46):
Now you do the math on that.
While this information may sound frightening, today's episode is not about doom and gloom.
I'll be spilling the tea on lipid testing, what your standard cholesterol test may not
be telling you.
Here's the crucial point.
The American Heart Association tells us the simple truth that most cardiovascular diseases
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can still be prevented with education and healthy lifestyle changes.
And I agree, but prevention starts with you, your understanding of your cardiovascular
risk and your willingness to be in the driver's seat of improving your health.
Now keep listening and get this tea.
How many times have you gone for your yearly checkup, you got your preventative lab work
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done and your doctor told you that your cholesterol was high or that your cholesterol was borderline
high or even your cholesterol is too high.
So now here's your statin medication to get started with.
But what does any of this actually mean?
And more importantly, what does it mean to your overall health and your risk of heart
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disease?
One thing for you to know is that it's more important than a simple good or bad cholesterol
number.
Risk factors for cardiovascular disease include high blood pressure or hypertension, high
blood cholesterol, smoking, lack of physical activity and obesity.
For women, further risk factors include menopause, use of birth control pills and bilateral urethraectomy,
(05:20):
which is removal of your ovaries and premenopausal women, because this sends those women into
early menopause.
While some of these risks are unavoidable due to a variety of reasons, what you put on your
plate and how you move your body and what you do with your lifestyle are things that
you can certainly decide.
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Let's start with the basics of cholesterol testing.
A simple blood test can give you your cholesterol levels.
Cholesterol screening is recommended as early as 9 to 11 years old with the focus on identifying
genetic lipid disorders and early risk factors for childhood health conditions.
For adults age 20 to 39 years old with average risk for heart disease, cholesterol screening
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is recommended every four to six years.
However, if you have a condition like diabetes, high blood pressure, obesity, previously had
high cholesterol or other risk factors, you likely should be screened more frequently
as we do know that heart disease often doesn't develop overnight.
And just because you're a young adult doesn't mean that you aren't at risk for being well
(06:29):
on your way to your first heart attack or stroke.
Now once you get to age 40, you should receive cholesterol screening every four to six years
as well.
However, your arthrosclerotic cardiovascular disease score or we'll just call it ASDVD
score should also be calculated and used to determine your chance of having a cardiac
(06:53):
event within the next 10 years.
The ASDVD score is a calculation that takes into account your age, sex assigned at birth,
your race, your cholesterol levels, your blood pressure, your diabetes status and smoking
habits to estimate a person's 10 year risk of developing arthrosclerotic cardiovascular
(07:16):
disease ASDVD, which is caused by plaque buildup in your arterial walls, which includes heart
attacks, strokes, blockage of blood vessels, peripheral vascular disease and aneurysms
of your larger vessels within your body like your aorta.
There are lots of online ASDVD score calculators that you can access yourself as well to gain
(07:41):
a better understanding of your risk.
And with traditional cholesterol testing, you may hear it referred to as a lipid panel.
This is a general term for fatty compounds that include cholesterol, triglycerides and
phospholipids.
Cholesterol is a waxy fat like substance found within your body that is necessary for good
(08:02):
health.
It is made in your liver and a certain amount of cholesterol is essential for bodily functions
within our cells and within our hormones.
Your body makes the necessary amount of cholesterol it needs for proper functioning.
So the remainder of cholesterol that you develop comes from the foods you eat, particularly
from animal based foods and animal products since their bodies also make cholesterol as
(08:28):
did yours.
And oils including coconut oil, palm oil and avocado oil that are high in saturated fat
can increase your risk for making your cholesterol too high as well.
This is why consuming predominantly plant based foods and avoiding oils in your diet
is going to be very important to reduce your risk for heart disease and its complications.
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Now, back to the labs.
A cholesterol screening test will typically break down your total cholesterol into other
components including low density lipoprotein or LDL, otherwise known as bad cholesterol,
high density lipoprotein or HDL, otherwise known as good cholesterol and triglycerides.
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LDL or bad cholesterol is used by the body to build the walls or membranes of cells in
your body.
I once heard a good description of LDL that I'll share with you.
Think of the LDL particles in your body as tiny delivery trucks that are responsible
for carrying cholesterol through your bloodstream, which is the highway for your body.
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These trucks are supposed to deliver cholesterol to yourselves to help your body with those
necessary functions like building cell membranes and producing essential hormones.
But here's the problem.
When there are too many of these LDL particle trucks on your blood vessel highways, they
can start causing traffic jams.
Now, folks, I'm originally from Atlanta, so I've seen my fair share of traffic jams.
(10:00):
And for anyone who has been sitting in traffic, you've witnessed the calamity that can happen.
Well, within your blood vessel highways, when the LDL particle trucks get backed up because
there are simply just too many of them on the road, then some of these trucks crash
into your artery walls, dropping and losing some of their cholesterol cargo along your
(10:21):
blood vessel highway, which can build up over time into what we call plaque formations.
The more buildup in your blood vessels, now the highways block and blood can't flow freely,
leading to those cardiovascular events, depending on which vessel highways are affected, including
heart attacks and strokes.
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Here's what HDL or good cholesterol comes into play.
So HDL is your street sweeper crew.
The HDL comes along, cruising through your blood vessel highways, picking up that excess
cholesterol that the LDL particle trucks just littered along the highway and the street
sweeper crew take it back to your liver for processing.
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This is why having a high HDL is actually a good thing, because the more cleanup crews
you have along the blood vessel highway, the better maintain your highways will be to allow
that blood to flow freely.
Now for women, get this tea.
It shows that women typically have higher HDL levels than men before menopause, thanks
(11:26):
to estrogen.
Estrogen acts on the liver, stimulating it to produce more good cholesterol or HDL and
lowering bad cholesterol or LDL, giving some protection from cardiovascular disease.
However, as estrogen levels drop for women as we enter menopause, it also affects this
cholesterol balance, which is one reason why cardiovascular disease risk actually increased
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during this time.
So it's important to maintain good overall health, because while you can't stop your
natural progression to menopause, being aware of its impact can help guide your health and
wellness decisions.
If you're frustrated with your weight, taking more medications than you'd like to, have
been told that you are at risk for the development of a chronic preventable disease, or just
(12:16):
are not feeling in the best of health, then I'm talking to you.
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(12:41):
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(13:05):
The Essence of Health is in you.
Let's get back to our lipid panel.
Triglycerides are also a type of fat and are a part of our lipid panel.
However, they have a bit different function in our bodies.
While cholesterol is used to build cells and hormones, triglycerides are more focused on
energy storage.
(13:26):
When you eat, your body will use the calories that it needs for functioning, and it will
convert any excess calories it doesn't need to use right away into triglycerides.
The triglycerides are stored in your fat cells.
The stored triglycerides are later released by your hormones to use for energy between
meals.
But here's the process, T. High triglycerides can be a sign that your lifestyle and your
(13:52):
dietary habits may need some refinement.
If you regularly eat more calories than your body needs, particularly from those processed
high carb foods, you know, the good stuff, the chips, the cookies, the packaged snacks,
crackers, soda, you may develop high triglycerides, also known as hypertriglyceridemia.
(14:15):
Overindulgence in alcohol can also contribute to this as well.
Now, you may be wondering, why does any of this matter?
It matters because remember, triglycerides are still fat, and too high levels of triglycerides
can cause some serious health problems, including hardening of the arteries or thickening of
(14:36):
the artery walls, which increases your risk of stroke, heart attack, and heart disease.
Very high triglyceride levels can also cause acute inflammation of the pancreas, known
as pancreatitis.
Really high triglyceride levels can affect your body's ability to properly break down
fats, leading to a condition called multifactorial chylomicronemia syndrome, which can cause
(15:02):
symptoms like short term memory loss, swelling of your liver and spleen, significant stomach
pain and skin changes.
Well, this is not a game, folks.
This is why triglyceride levels can sometimes be the first sign that your lifestyle really
needs some immediate adjustments.
These four values of knowing your total cholesterol, your LDL, your HDL, and your triglycerides
(15:27):
can be evaluated further by your doctor to help even more with determining your cardiovascular
disease risk by looking at the ratios of how one of these values compares to the other.
For instance, the total cholesterol to HDL ratio.
If we were to compare your total cholesterol number to your HDL number, this would be a
(15:48):
strong predictor of your overall cardiovascular health.
Think of it this way.
The ratio tells us about the balance between all of the cholesterol in your body and your
street sweeper crew, their capacity to clean it up.
If your total cholesterol is a bit higher than normal, but your HDL is also adequately
(16:10):
high, you may have enough street sweepers to keep your highway blood vessels maintained.
But if your HDL is too low, your risk for those traffic buildups on your blood vessel
highways will be higher.
You can calculate your own total cholesterol to HDL ratio by dividing the total cholesterol
number by your HDL number.
(16:33):
Optimally, you want this ratio number to be equal to or less than 3.5 as this level or
below is associated with a lower risk of coronary heart disease.
Your triglyceride to HDL ratio is another important comparison.
This ratio is particularly useful in assessing your risk of cardiovascular disease and insulin
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resistance.
Remember that high triglycerides typically are associated with dietary intake of highly
processed carbohydrate foods.
And higher triglycerides to HDL ratios often indicate insulin resistance, which can lead
to inflammation and increased cardiovascular risk.
(17:16):
So this ratio is a pretty powerful indicator of both.
To calculate your triglyceride to HDL ratio, divide your triglyceride number by your HDL
number.
Optimally, you want this ratio number to be equal to or less than 1.5.
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Another important comparison that can come from your lipid panel is your LDL to HDL ratio.
This tells us the balance of bad cholesterol to good cholesterol and is a significant predictor
of cardiovascular risk.
Remember that when you have all of those cholesterol filled LDL particle trucks on your blood vessel
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highways, you want to make sure that you have enough street sweeper crew members or HDL
to keep your blood vessel highways maintained and functioning for proper blood flow.
Optimally, you want this ratio number to be equal to or less than 2 for reducing your
cardiovascular risk.
Now, as with many things in science and in medicine, research continues to emerge with
(18:23):
more advanced testing that can be done with cholesterol to further determine our cardiovascular
risk.
Think of the previously discussed lipid panel as your open window and these more advanced
tests as more of your telescope lens to give you more detailed information about your cardiovascular
health.
(18:44):
Several advanced lipid tests can be performed, including apolipoprotein B, lipoprotein A,
small dense LDL cholesterol, lipoprotein associated phospholipase A2, and high sensitivity C
reactive protein.
I'm going to break these down a bit for us.
(19:05):
Apolipoprotein B gives us insight into the total number of actual plaque causing particles
you're carrying in your bloodstream.
It gives us a further breakdown of the types of LDL particles circulating in your body,
including very low density lipoprotein or VLDL and intermediate density lipoprotein
(19:28):
or IDL.
Think of it this way.
Apolipoprotein B takes our LDL particle trucks where they're going.
So it's sort of like the wheels on the truck.
The apolipoprotein B wheels, however, only lends itself to helping the LDL trucks, not
the street sweeper crew.
(19:50):
But because the apolipoprotein B wheels are helping the LDL trucks, it can further assess
how heavy or how dense the LDL is that is being carried through our blood vessels, which
in turn can give even more information regarding just how bad your LDL cholesterol actually
is.
(20:11):
Because apolipoprotein B is specifically telling us how many of your trucks are actually dropping
those plaques along your blood vessel highways.
Optimal levels of apolipoprotein B can vary based upon your personal risk factors.
So definitely review these results with your doctor.
(20:31):
Now while we're thinking about the heaviness or density of our LDL particle trucks, let's
discuss our small dense LDL cholesterol marker.
It's another advanced test that shows one's increased risk for cardiovascular disease.
Think of the small dense LDL particles as small compact cars on your blood vessel highways.
(20:54):
Even though your LDL particle trucks are dropping and losing LDL particles along your blood
vessel highway, because they're too full, your small dense LDL particles can still zip
through along the highway, causing even more damage to your blood vessels.
Smaller particles of LDL actually carry more risk for heart disease than its larger counterparts.
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Due to its smaller size, these particles can readily slip through the lining of the blood
vessels, getting embedded into the wall of those vessels, where it can then trigger inflammation
and even more plaque formation, blocking the flow of blood.
So you definitely want this number to be low, ideally less than 35 milligrams per deciliter
(21:39):
to optimize your cardiovascular health.
But lipoprotein A levels are also associated with increased cardiovascular risk, but can
be thought of as more of a risk factor of inheritance.
The American College of Cardiology and the American Heart Association include lipoprotein
(21:59):
A as a risk enhancing factor within their guidelines, particularly for individuals with
a family history of premature atherosclerotic cardiovascular disease or plaque forming type
of heart disease causing heart attacks and strokes.
This particular test is usually recommended for people younger than age 65 who have had
(22:20):
a heart attack, those with a family history of premature heart disease, and those with
elevated LDL cholesterol that hasn't improved much, even with the use of statin medications,
since it occurs largely due to genetic risk and doesn't fluctuate much in response to
modifiable lifestyle risks like our other cholesterol factors.
(22:42):
But this is also why optimizing those factors that you do have control over are important
because there will always be other factors that we can't control.
There are other advanced cardio, edit, there are other advanced cardiac markers associated
with inflammation that can be measured to determine your cardiovascular risk, including
(23:06):
lipoprotein associated phospholipase A2 and high sensitivity C reactive protein.
Lipoprotein associated phospholipase A2 is an inflammatory promoting enzyme that binds
to LDL.
It can be thought of as an early alarm system for your cardiovascular risk, as its presence
(23:27):
with elevated levels in your bloodstream are strongly linked to an increased risk of having
a coronary event like a heart attack or stroke.
Now while not strictly a lipid test, high sensitivity C reactive protein is crucial
in advanced cardiovascular testing because it measures inflammation throughout your body.
(23:48):
This inflammation measure is associated with arthrosclerosis or plaque buildup in your
blood vessel highways, increasing your risk for heart attack.
And high sensitivity C reactive protein can also be an indication of increased risk for
diabetes, which is also a risk factor for heart disease.
(24:09):
High sensitivity C reactive protein is stratified into three risk categories.
Low risk is going to be less than one, average risk is going to be one to three, and high
risk is going to be greater than three.
Individuals in the high risk greater than three category have two times the risk for
cardiovascular events compared to those in the lower risk category.
(24:32):
Now you might be wondering when you may benefit from having these advanced tests beyond the
typical lipid screening recommendations.
Based upon current research, you may benefit if you have a family history of early heart
disease, your standard lipid panel results don't quite align with your overall health
picture, and you and your doctor may be weighing the risk and benefits of medication therapy.
(24:59):
You have autoimmune conditions or chronic inflammation, you're approaching or going
through menopause, or if you have unexplained cardiovascular symptoms, despite normal basic
lipid panels.
When it comes to improving your cholesterol levels and reducing your cardiovascular risk,
there are several medication options available, including the popular known statin medications,
(25:23):
but I won't go into medication options on this episode, but stay tuned to a future episode
and I'll dive into the available options.
But now here's the inspirational tea that you should make sure you understand is that
cardiovascular disease is largely preventable, particularly in women.
(25:43):
Only 75% of coronary heart disease cases can be prevented with better lifestyle choices
such as not smoking, exercising regularly and eating a healthful plant-for-it diet.
Now let's dive into what I would consider the most empowering part of our discussion
beyond just that knowledge that you've gotten, because knowledge is power.
(26:06):
But now here's how you can actively improve your cardiovascular health through lifestyle
choices, particularly through a whole food plant-based diet, exercise and stress management.
Let's talk about the whole food plant-based nutrition.
Now research has shown that a properly planned whole food plant-based diet can reduce your
bad cholesterol significantly and even in just a few weeks.
(26:31):
But this is the fascinating part is how it works just on multiple levels.
The one is the fiber intake within plant-based foods.
Plant-based foods are rich in fiber that work together for your heart health.
Plant-based foods also carry insoluble fiber that's helpful for your gut health and gut
bacteria, which we now know is crucial in our cardiovascular health and our brain health
(26:54):
and our mental health and our weight management and so many things.
So to get more fiber within your diet, you want to focus on unprocessed whole grains
because remember we talked about those processed carbohydrates contribute into your higher
triglycerides.
But focusing on those unprocessed carbohydrates like still cut oatmeal, barley, farro, quinoa,
(27:17):
brown rice, those are going to be good options.
Brown flaxseeds and chia seeds as well.
Dark leafy greens and beans.
These are all great options to give you healthful plant-based fiber that's going to be for your
heart health and for lowering your cholesterol and cardiovascular risk.
The other key component to plant-based foods are that they contain phytosterols, which
(27:41):
are actually cholesterol fighting type of nutrients found in plant-based foods.
So it's like having natural cholesterol medicine, if you will.
The best sources for these are once again going to be those dark leafy green vegetables,
nuts and seeds like almonds and walnuts, avocado, which is a healthful source of fat, not avocado
(28:02):
oil because remember what we discussed with the oils in your triglycerides.
Once again, those whole grains are going to give you an excellent source of phytosterols
and legumes or beans.
Another key component in those plant-based foods are going to be the antioxidants that
you're going to get, which is going to be helpful in fighting oxidation from the bad
(28:25):
cholesterol because oxidized LDL or oxidized bad cholesterol can be dangerous for our arteries
and increase that inflammation and those hardening of our blood vessels.
So foods that are high in those protective antioxidants are going to be berries, especially
blueberries and strawberries because those antioxidants are actually in the natural pigment
(28:46):
of those fruits.
Your dark leafy greens, you hear a resounding theme here, eat the dark leafy greens and
then other colorful vegetables because those antioxidants are within the pigment of those
vegetables.
Now, the next key is exercise.
You aren't just exercising just to burn calories, but physical activity when it comes to cholesterol
(29:09):
and cardiovascular health is actually helpful for increasing your HDL, that good cholesterol,
because you want lots of street sweepers out there keeping your blood vessel highways clean.
Regular exercise is also going to be helpful for reducing inflammation, so lowering those
CRP risks like we talked about.
(29:30):
It's going to be helpful for maintaining a healthful blood pressure, which will further
lower your cardiovascular risk.
And here's another key to exercise.
It's helpful for improving your insulin sensitivity and insulin balance, which can help improve
diabetes because remember diabetes is a cardiovascular and cholesterol risk and helpful for the triglycerides
(29:51):
because remember those triglycerides are tied to those processed carbohydrates.
Also by exercising, it actually helps your body to keep your blood sugar and your insulin
levels at a better balance.
Optimally for exercise from the American Heart Association, you should be aiming for about
150 minutes of moderate physical activity per week.
(30:13):
Moderate activity is going to be like brisk walking, swimming, cycling, dancing, something
that really gets your heart rate up.
You should also aim for two to three sessions of strength training.
You can use the stretchy resistance bands, you can use dumbbells, kettlebells, or you
can even do body weight exercises like pushups.
Those are all great for maintaining your cardiovascular health.
(30:36):
The other key to maintaining your cardiovascular health and your cholesterol metabolism and
lowering inflammation is sleep and not just any old sleep, but quality sleep.
Yes, you can listen to previous episodes of the Essence of Health Tea Time podcast where
I specifically talk about sleep, especially as it relates to insulin resistance.
And we know that insulin resistance is a part of cholesterol and heart health.
(31:00):
But just a key reminder that you need to be getting at least seven to nine hours of quality
sleep, dark, cool environment in your bedroom, and keeping a routine schedule so that you
optimize the quality of your sleep.
And now the key component as well that often gets overlooked is stress management.
(31:21):
A lot of times we're on the go, the hustle and bustle of everyday life and things get
stressful but when we are more stressed that actually raises the inflammation within our
body that raises our blood pressure, it impacts negatively our cholesterol and puts us at risk
for cardiovascular disease.
So you want to take a moment to get that proper sleep for stress management, but also meditate
(31:45):
or pray whatever works for you.
Keep breathing, spend time outdoors to boost your happy hormones and help your mental health,
make social connections within community engagement or even yoga or Tai Chi, gentle types of exercises
to reduce your stress and therefore reduce your inflammation and improve your cardiovascular
(32:05):
disease.
Now, if you are looking for a comprehensive, holistic approach to improving your health
and lowering your cardiovascular risk, I invite you to visit the Essence of Health website
and schedule your free consultation with me today.
Within our Lifestyle Medicine membership program, we get to the root cause of your health concerns.
(32:27):
Go into depth with practical and tangible solutions to prevent and reverse your preventable risk
factors and improve your overall health and wellness using evidence-based approaches,
medication management and optimizing holistic therapeutic approaches as well.
Medical services are now offered in many states, so check out our website.
(32:49):
Now that you've gotten another heart healthy dose of the tea with me today, be sure to
share the wealth by liking and subscribing to this podcast and share this episode with
your family, your friends and your colleagues so that they too can reap the benefits.
Remember, the Essence of Health is in you.
Thank you for joining me today on the Essence of Health Tea Time Podcast.
(33:12):
Click the subscribe button on your favorite podcast platform so that you never miss a
moment of the Essence of Health Tea Time Podcast.
Check out the show notes to obtain your free tips for Healthy Living God to get you started
on your health and wellness path.
Follow me on social media at Essence of Health Wellness Clinic on Facebook, Instagram and
(33:37):
YouTube and at doctor.tw at eohwc on TikTok.
Interested in becoming a member of the Essence of Health coaching program?
Well head on over to www.eohcoaching.com.
The Essence of Health is in you.
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