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Well, hello, and welcome to Fearless Fabulous You. I am your host, Melanie Young, and welcome to what's starting to be my tenth season. Ten years that I have been hosting this show. Wow, amazing, how far I've come. This shows started as a way to empower women to take charge of their health because I had recovered from breast cancer and was rethinking my health and how I took care of myself as well as what I wanted to
do with my life. And from that I wrote a book called Fearless Fabulous You, Lessons on Living Life on your Terms and thought, how am I going to promote this book? And I said, oh, I'm going to show our show called Fearless, Fabulous You and find amazing women to interview about how we all can live life on our terms in good health. So if you do follow me,
you know that heart health is a recurring theme. I always do at least two shows on heart health and other health topics at least in one season, and today we're going to address it again. I have hit the ripe old age of over sixty. I'm north of sixty, and I have learned, as many of my friends and funds and followers also north of sixty, that your metabulism just changes. It stactually starts chase in your fifties, but
it keeps changing. And a recent visit to my primary care physician, because I am very good at going to all my scheduled Dutch's appointments, revealed that my cholesterol was a bit high and my weight was definitely too high for my small frame. And granted, I live a life of incredible travel and eating and drinking good food and writing about wine, reporting on all that on my other show, That Connected Table, but it was kind of a wake up call, particularly after knowing that I have heart disease
in my family. My grandmother died of of cardiac arrest very suddenly, and my father had ongoing heart issues which resulted in a quintuple bypass surgery and a stent. It's not what ultimately did him in he died of metastasized prostate cancer. But knowing that I have a family history of heart condition, and knowing that my cholesterol was high, and knowing that my weight was even higher, I gave myself a six week turnaround plan. Obviously, nothing really can happen.
Everything can't be achieved in six weeks, but you can make headway. And I'm a believer that you do this by diet and exercise. In Changing habits doesn't mean giving up everything you love, particularly if it's what pays your bills, like wine and wine writing. But it means moderation and making smarter decisions. So I am going to be addressing
this today with an expert on my show. We're going to be speaking with doctor Elizabeth Klotus, who is a BORED certified practicing cardiologist, founder of the Preventative Cardiology Clinic near Minneapolis, Minnesota, and she trained at Mayo Clinic and John Hopkins. She's got a off of information She's also founder and chief medical officer of Step one Foods, which we will discuss at the end of the show is foods that are to help with managing lowering your cholesterol.
Which we're going to talk about what you know you should be eating, and I always hate talking about what you should not be eating, but we're going to talk about adding in more because it's about crowding out bad stuff and adding in good stuff. Before we get into the conversation, I did, like I always do, I popped on over to the Center of Disease Control CDC website to get some facts to set this up. Cholesterol high. Total cholesterol in the United States is pretty big topic.
Between twenty seventeen and twenty twenty recent stats, ten percent of adults age twenty year older had total cholesterol levels above two forty milligrams, and about seventeen percent had high debts to high density lipoprotein HDO or good cholesterol levels below forty milligrams. It's a a lot of technical talk for some of you, so I'll let the doctor weigh in. But here's the thing. In summary, high cholesterol has no symptoms, so many people don't even know that their cholesterol is
too high. We're going to talk about how you can check it. We're also going to talk about why it matters because, according to the CDC, having high cholesterol raises the risk for heart disease, the leading cause of death and stroke the fifth leading cause of death stroke and for women, heart disease and cardiac arrests is like number one as from per the American Heart Association. So women have a high risk for heart disease and often, as I have explained on this show, symptoms are not like
men and they're different. So we're going to dive into all this, and most importantly the takeaway is what can you do starting now to maintain a healthy cholesterol for you through lifestyle changes. So, doctor Elizabeth Klotis, Liz, as you said before we went on, welcome to Fearless, Fabulous.
You, Oh Melanie, thank you so much for having me. I'm excited to be here with you. And honestly, as I was listening to the intro, we you know we could sit down and have coffee and talk about this for hours because our I think approach to heart disease prevention and interest in this area obviously is very much on the same page. So I really look forward to our conversation today.
Absolutely. You know, I always like to start with a little backstory because I like to explain who my guests are, which I semi did. But I am curious why you decided to become a cardiologist. Was there something in your own life that said I want to You know, there's always a reason you become a doctor, and it is a long road, and becoming a specialist is that even longer road? So what inspired you?
Well, yeah, the long road is for sure true. I mean from the time I graduated high school, they to the time I hung up my cardiology shingle was fourteen years of uninterrupted education. So it's a it's a very long road to get here. And actually it's interesting because I didn't get here kind of the way a lot you know, I didn't pick the specialty the way a
lot of people pick their specialties. Right, they had you know, they broke their leg when they were young, so they became an orthopedic surgeon, or you know, their mom had cancer so they became an oncologist. Actually, my just like in your family have a history of cancer, you're a personal history of cancer. My my family is cancer everywhere and yet that's not that's not why it's and I didn't become an oncologist. I chose cardiology honestly because of
a mentor that I had during medical training. It's you know, I did a rotation on cardiology when I entered internal medicine. Because it's a it's a layered uh, it's a layered education process. First, you you know, do your medical school, then you do an intro interro medicine residency, and then you specialize and go on to cardiology, which then you can further sub specialize into things like electrophysiology or congestive
heart failure, you know, transplant management, things like that. Anyway, but it was literally on the first day of my cardiology rotation that uh, that my mentor inspired me. He he just his peers batter. He's he's retired, but this was a male clinic, and he just made every single patient and every single cardiology problem seemed fascinating and and it's an amazing thing, feeled. I mean, the heart is
a miracle if you think about it. I mean, it beats, it pumps blood, you know, just all on its little like, all on its little alone, sixty times a minute. Sixty minutes an hour, twenty four hours a day, seven days a week, fifty two weeks a year, for you know, a hundred years. It just keeps going. It's amazing. There's there's no engine that does that.
So right, quite an engine. And it is, you know, what keeps us living because technically, if your heart isn't beating, you're dead. You know, you could be brain dead, but your heart can keep beating, right.
Yeah, it's a it's an obviously it's an incredibly important organ. And you know, and I think the other thing honestly that attracted me to cardiology is because you can do so much, you know there, you know you can, and it's and it's such a wide breadth of almost subspecialties within cardiology. You can almost be a you know, a radiologist in some sense and read heart ultrasounds and heart
sets and heart MRIs. Or you can be almost a surgeon and an insert stance and you know, or you know, pacemakers. You can you know, be like what I what I do, which is be on the prevention end. And actually my hope is to put myself out of work is so people don't don't need us anymore.
So I always said that when I wrote my book to help women diagnose with breast cancer, I hope no one ever has to buy my book. You know, you know, it's amazing, doctor clot Is, that we take our hearts for granted. You know, we talk about women talk about love. They're always looking for love, They're always looking for their soulmate. They're always you know, expressing themselves and you know, I love you and emoging their heart. But we mistreat it by not taking care of it. And it is really
the beating heart is what defines you as living. And if you've ever held someone like I have, who watch their the heartbeat die, which I did with my mother, I watched her heartbeat die, it is a very powerful thing to watch someone who is dying and the last thing you see is a beating heart. It is the last thing to go. And we take it for granted, don't you agree? I, you know, very much so.
And I think it's because it just kind of keeps doing its job right and and it can take an awful lot of abuse, which is you know, which is which is amazing. And again, our bodies are so incredibly resilient, but at some point we you know, we exceed the capacity of our bodies to make up for what we're doing.
And that's why it's so important to start early in terms of your prevention efforts, because both the building of disease or the prevention of disease are cumulative of you know, those those efforts or those habits, you know, multiply over time. And you're right in terms of women, this is our disease. You know, we we think about and you've had breast cancer. So I don't in any way want to diminish breast cancer as a you know, as a as a health threat.
It's a terrible disease. It takes, it takes a lot of women's lives. But you know, one out of thirty women will die from breast cancer, one out of three will die from heart disease. So so heart disease is our disease, and it is almost entirely preventable. Eighty percent of it need not exist. And you know, a family history is a risk factor for sure, but family history genetics are not destiny. Genetics are a you know, a
risk factor. They add about twenty percent. They account for about twenty percent of your risk, which means eighty percent is something you have some control over if you have family history. Right, you're starting a little bit behind an eight ball, but it doesn't mean you're fated to this. And this is an avoidable.
Disease, absolutely, and with all risk predenttion. I like to start with I have a little quadrant, but the two big ones nutrition and movement. I never say exercise, I say movement, but it's exercise, and those are the two that can help reverse a lot of damage. But you
do have to start early. And what's interesting is so many parents should be aware that it starts with, you know, teaching good habits as children to their children, so that you know they're not sedentary, they're not eating the wrong foods, they're eating balanced diets, and they're leading an active life. I want to this show is about cholesterol because a lot of people don't even understand what cholesterol is. And
it is a big term, and there's different terms. So I want you to define the different types of cholesterol because people here there's good cholesterol, people here there's bad cholesterol. They hear of diet here. There's a lot of terms.
Yeah, so first of all, just in general, what is cholesterol, Well, cholesterol is a waxy fat like substance that can be found in all sorts of places inside our body. Every cell wall of every cell within our bodies has some cholesterol. We use cholesterol to make hormones, bile acids, vitamin D, and other substances, so cholesterol is actually important for our
body structure and function. The problem is, if there's too much cholesterol circulating in the blood stream, some of the excess it can become trapped in artery walls, and this build up is called plaque. And if enough of it accumulates, that plaque can narrow blood vessels and make them less flexible, causing what's you know, typically referred to as hardening of
the arteries. And it is this process, that accumulation of plaque in our arteries that leads to these potentially devastating health events like heart attacks and strokes or the need for procedures such as you know, bypass surgery and stents. So it's a you know, this is a progressive disease. And to your point, it starts early. You know, autopsy data, this this build up of gunk inside our arteries, it starts very early. You know, in autopsy studies performed on
soldiers killed in the Korean and Vietnam War. So these are young men in their twenties and thirties. They were already seeing significant plaque build up when autopsies done are on children. What a tragic thing to do an autopsy on a child. But we're starting to find the earliest precursors of plaque in children as young as ten. So
the earlier we start with preventive measures, the better. Okay, Now, cholesterol, so we talked about kind of what it is generally the way to You can't, for the most part, feel that you have high cholesterol. By the time you feel things like a heart attack stroke bypester, you've had cholesterol
for an high cholesterol pH an offully long time. Really, the only way to know if you have an abnormal cholesterol profile is to get checked with a blood test, and when you do that, you will get four numbers. One is the total cholesterol, and then you'll get HDL cholesterol, LDL cholesterol, and triglyceterides. Okay, total cholesterol. The total cholesterol is the sum of all the cholesterol in your body, so it's kind of everything that's below the line. Those
three other numbers. Those three other numbers make up the total cholesterol. The total cholesterol should typically be under two hundred. It's malograms per deest leader or the units, but we'll stop talking about the units because they're all the same anyway.
It should be under two hundred. But the total cholesterol is actually less important than what it's made up out of, right, because I just said there's good cholesterol, bad cholesterol, trigolystrides, and you can have various combinations of those three things and end up with the same total but with very different health implications. Okay, let's start with good cholesterol HDL. HDL is the good cholesterol. It's the happy cholesterol. You want to keep it high if it helps you remember
which is which. HDL is the cholesterol that is not depositing in our arteries. It's on its way out. So you actually want this number as high as possible. In women, we're happy to see it should be over fifty, so you know that's where you should be. If you have an HDL cholesterol under fifty, that's its own risk factor for earlier atherospherosis, so it should be over fifty. LDL is the bad stuff. This is the cholesterol that's potentially
depositing in our arteries. It's the lousy cholesterol. You want to keep it low. This is the cholesterol that you know, all physicians obsess over because LDL cholesterol is most tightly linked to heart disease risk. It's almost you know, a linear line between LDL and heart disease risks. So the
higher it is, the higher your risk. Most cardiologists, actually all cardiologists would say, you know, everyone should be under one thirty for LDL as you accumulate risk factors, and that could be a family history of heart disease, or you have high blood pressure, you're a smoker. At some point, under one hundred would be better. Once you have documented heart or vascular disease, so you've had a heart attack or stroke or bypasser to your stent, your LDL should
fall under seventy. Now the vast majority of us will require medications to get there, and there's even data to show that under fifty is additionally protective. So the main message around LDL is the lower, the better. The last component of a cholesterol profile are the triglycerides. Triglycerides are not much of a cholesterol particle. They're actually mostly fat, So if you try to add up the three numbers, you won't get to the total. It doesn't add up right.
So the formula is actually good cholesterol plus bad cholesterol plus one fifth of the triglycerides gets you to the total. Triglyceride levels should be under one fifty in everyone, But the range of triglycerides is very broad, so it's just a different animal. It lives on a different scale. The lowest triglycerides I've ever seen and someone on no medications is twenty seven. But the highest I've ever seen is in the thousands. So it's a ginormous range. But everyone
should be under one fifty. Triglycerides on their own are not much of a risk factor for heart disease per se. They tend to be more of an indicator of metabolic health. You know, the higher your triglycerides are, the more likely things are out of whack. You know your weight's not right, you're eating poorly, you're not exercising, you're drinking too much. You know that triglycerides will give you up, like they'll be the first ones to rise and say like something's not quite right here.
That makes a lot of sense, So just to recap LDL. You want your LDLs low, right, Yes, you want your HDLs high mm and you want your triglycerides low yep. Right, And you should go to the doctor like I do with a shopping list. I go with a checklist. Now't ever go to your doctor unless you have a checklist. And I have a checklist. If everything I want check because I swear if they if I don't have that,
then won't do it. So you got to go in there and demand that you get all the necessary tests so that you can have them as a benchmark and read the results because you get them in your portal. It's it's your benchmark to see what you need to do if you need to do any adjusting. Now, the logical way that these get adjusted from a physician standpoint is to prescribe medication.
Right yep, high cholesterol. Here's a pill.
And that would normally be what.
That would normally be a statin. So this these are you know, medications that most people are familiar with because they've heard them, because they're because they're so frequently prescribed. The original ones were you know, called lipatour and crust store. Now they're all basically all generic, so that for maybe a torvas dat YEP or suba STAT and SIMBA STAT and so that. So that's the category of girls. It's actually the most widely one of the most widely prescribed drug categories on the.
Planet, exactly besides annadepressants and most of the relaxers. I could go on, because I do have and I do like my primary care physician, but he loves to prescribe things, and I hate taking pills. So my husband's taking satins. I'm not because I I don't. So there's a big reason I don't like taking drugs, prescription medication unless absolutely necessary. And the biggest reason is that I write about wine. It is a job, and I know that there are interactions,
and I read interactions carefully. I also know that you can't operate a car, and there are certain things that affect your decision making. And I am one of those people who does not do well on prescription medication. I get foggy. I have had reactions from itching to brain fog to whatever. I also know that you have to be very careful if you drink wine, you've got to watch that, and if you're oper aning machinery. So for me, very few work and my mother was the same way.
She would have reactions. You've got to be very careful. It's not that they're bad. You have to do what's right for you. My husband is taking a stat However, I'm a big believer that you you know, change a start with you and not what you pop. And it's not the pill you pop in your mouth, but the food you pop in your mouth. And if you want to get rid of the gunk, get rid of the junk.
Could not have said it better myself. I'm going to use that line. Okay, pray.
I do like to speak, but that is something I say quite a bit, and you know, I'm a big believer in it. It's hard, it's not easy to follow. But you go into the doctor and you find out you're twenty five pounds overweight in your cholesterol sigh, you go, I think I'm going to do something about it because I don't want to get sick. So again, this is
a blood test. Anyone can have it. Is there a certain age that people should be starting to get their cholesterol check or should just be part of your Yeah.
So actually, you know, it's it's recommended that the first cholesterol check happened in childhood and and you know a
good rule of thumb. And this isn't exactly you know, like the you know, US Preventive Services Task Force would say, but it's close enough and it's really easy to remember once you know, before you turn ten, you know, twice in your or sorry, once in your teens, twice in your twenties, you know, three times in your thirties, four times in your forties, at least every other year in your fifties, and then yearly sixty onwards. So it's you know,
it's it's something that should increase in prextent. It assumes your your your numbers are normal, right, you may need more free checks if they're abnormal or you're being started on a therapy or you're using diet to modify this, so then then you're going to need more frequent assessment. But but if otherwise everything looks good, that's that's a pretty good way to think about it, and it's easy to remember.
Also if you're having life changes. I am going to safely assume that if you're pregnant, or you're going through menopause, or you're in some kind of treatment, that you have to watch things because there are certain types of things that will increase your cholesterol based on that.
Yeah. Yeah, so so with pregnancy we can see changes in cholesterol, but honestly, we don't really measure cholesterol during this time. We don't do anything about it because there are no safe treatments for cholesterol during pregnancy, not because they're they're intrinsically unsafe, it's just they've not been tested and so, you know, and this is actually a big problem in general for women who are are pregnant or
of child bearing age. They're typically excluded from all trials, right because no one, no one wants to you know, do anything that could in any way potentially you know, hurt the fetus. So so we have a big gap in knowledge as to what to do, you know, in
in that patient population. But you know, once you're once you're you know, you're not going to have any more children, you're using contraception, or you're you know, past past reproductive age, you know that obviously we can use all sorts of medications. There's there's all sorts of options for that, which is where diet becomes really important, you know, for for women during their reproductive years, and lifestyle becomes really important. In terms of menopause. Boy, that is a big time where
cholesterol profiles can change. So remember at the beginning, I said, you know, we use cholesterol for all sorts of things, right to make cell walls, to make hormones, to make file well in order to use that. The truth is we can actually make most of the cholesterol we need for those functions inside our cells. We actually don't need a lot of circulating LDL cholesterol to be around to use.
But if we're if we're going to use, but if it's out there and in the bloodstream, it's kind of like sound money, like one of both making it inside. When you just grab it, you know, take it inside the cell and use it for what you need. But in order to grab it, you need a receptor and that receptor has to be primed and active to pick up an LDL particle, so bad cholesterol particle from you know, from the storage time, from from the bloodstream and bring
it inside the cell. Okay, Estrogen up regulates LDL receptors. It makes them way more active. So when we have estrogen around, our LDL levels are lower. Our cholesterol, especially that the bad cholesterol levels are lower because we're very efficient at grabbing it from our bloodstream and bringing it
inside ourselves. When we lose estrogen during menopause, you know, when we go through menopause, that that protective sort of booster for those LDL receptors goes away, and all of a sudden, we're left with kind of lazy LDL receptors. And so what a lot of women experience is like, wait, my weight's the same, I'm exercising the same, I'm eating the same stuff, and my ld all just went through the roof your It's that estrogen loss is what happened.
Wow, that's interesting. I have no ESG because I went through menopause and I had estrogen receptor positive cancer, so they blasted me with romats inhibitors. So I have no estrogen, although I feel very president and fabulous. But you know, that's probably another reason why my cholesterol went a little off. But like I said, it's under control. But it was off. But a lot of it was lifestyle. So let's talk about diet. First of all, exercise is critical. It goes
hand in hand with diet. You really can't do one without the other. They are the Handsle and Gretel. They are the tweetlede and tweedled dumb. They work together. You can't just exercise and keep eating what you want, and you can't just you know, stop eating in that exercise. They are essential. There are other things as well, right, sleep, stress management, your mental health. Those are all the not
the milking exactly, but it's really critical. So let's talk about diet because there are foods that can help lower cholesterol. It's not they're not magic pills, but they are easy to add into a diet and to replace other things. Right, So give us some examples.
Okay, so I'll talk a little bit more in generality for more categories of foods. So the things that influence and I'm just going to focus on LDL because that's the particle where really, you know, laser, you know, laser focused on in cardiology. So the things that are going to impact your LDL level from a dietary perspective are going to be the types of fats you eat and the types of carbs you eat. It has very little
to do with how much cholesterol you consume. It has very little to do with how much protein you consume. So you can kind of leave those those two things to the side. So let's do the fats first. The fats that you should be avoiding are saturated fats. Those are fats that are solid at room temperature. They come primarily from animal sources butter, cheese, the marbling, and beef, the fat and chicken. Saturated fats at best are going to be neutral, meaning they're not going to help you.
In many people, they raise LDL cholesterol, and they do that through kind of the same way as losing estrogen. They downregulate LVL receptors, and in some people that can be a really profound effect. Like you know, some people go on a keto diet and their LDL goes through the roof. So saturated fats are going if anything, they're
going to raise LDL. They're also pro inflammatory, and all of these things that we're actively trying to avoid, cancer, dementia, heart disease, these are all driven in part by inflammation. So you don't want to be throwing you know, you want to be tamping that down. You're not throwing gasoline on a fire. Right now, that doesn't mean you should.
You need to eat a low fat diet. Unsaturated fat, So those fats that are liquid at room temperature, so fats like olive oil, the oils and nuts and seeds, oils and fish, avocados. Those fats are perfectly fine to eat. They're at worse neutral, so they're not going to hurt you. In most people. They upregulate LDL receptors so your LDL levels fall. They also help raise HDL cholesterol and lower triglystride, so they give you an overall better cholesterol profile, and
they're anti inflammatory. The only caveat I'm going to put around unsaturated fats is that you should eat them as close to their original form as possible. So when I'm talking when I say fish, I mean like you know, boiled or you know, or poach salmon, I'm not talking you know fish sticks. And I'm talking raw nuts right, not roasted, salted, you know, barbecue flavored almonds, right like that.
That's not it, because those those unsaturated fats are pretty delicate, and the more we mess with with the food, the more we potentially the nature the benefits those fats and the benefits that they carry, and we add things that we don't need. Okay, that's the fat story.
Well, I also want to just interject one thing. It's also about using measuring spoons because Marion Nessel, who's the heads the NYU Center for Food Studies and is a is a righteter dietitian. You know, they all have calories. So it's not like you can just drizzle your olive oil all over the place lavishly, a tablespoon of oil, no matter what is about one hundred and twenty calories.
Yes, no, absolutely, so thanks for pointing that out, because it's it's you know, there is a calorie. You know, there is a calorie you know price here. So so it's not about drinking a gallon of you know, olive oil every day. But but but if you're if you're going to have some fat in your diet, it's it should be unsaturated. All quick note about coconut because it comes from plant, these sources, but it's but it's solid at room temperature. From a cholesterol perspective, it's much more
like beef fat than it is like olive oil. So you know, coconut oil is wonderful on your body less so inside your body exactly.
And I'm a big believer in putting it on your body. To me, it's lotion, but it's not what you want to ingest and I think just that whole visual of if it's solid room temperature, that kind of gives it away. Maybe that's not your best fat.
Yes, yes, okay, moving on to the carbs. So carbs, you know, it's not about a low carb diet. It is about a very choosy carb diet. So what you want to avoid are simple processed carbohydrates. You want to just like for the unsaturated fats, you want to eat your carbs as close to their original form as possible. So brown rice, not rice krispies, and apple not apple sauce or apple juice, right, go upstream as far as
you possibly can. And the reason for that is because whether carbs are super processed or whole and unprocessed, all carb hydrates are ultimately digested and absorbed as sugar. And it's just kind of how quickly does that digestion happen and how high does the sugar go? If you eat a bowl of rice Christie's, your body looks at that and says like child's play, Like I can digest it like that. I mean, it's just the inner most part of a rice grain. It's been mild, it's been puffed,
it's been extruded. You know, I'm you know, this is going to take me nothing to digest. It's predigested for me. And that's what happens. It gets broken down quickly, absorbed quickly, and your blood sugar spiral upwards. And what happens next Insulin spikes and insulin is there to put you know, all the sugar away. But insulin is a storage hormone. It shifts our body into storage mode. What's the storage from of cholesterol? LDL? LDL levels go up when insulin
levels are high. What's the non storage from of cholesterol hdl?
HDL levels can be.
Depressed when in some levels are high. What's the storage form of sugar? It's actually triglystrides. You can think of our body as having kind of covered space to put sugar, you know, away, because we need it in reserve, you know, if you're we needed for instant energy. So it's good to have some sugar like ready to go. But that covered space is finite. And and if you just ate a big bowl of rice crispies and your and your body just got flooded with sugar, the bie says, well, okay,
I've filled my I filled my cupboards. But I still have all this sugar floating around. What am I going to do with it? Oh? I know, I'll concentrate it. I'll turn it into fat and triglystride levels go up. So some of the worst cholesterol profiles I've seen have been in people who eat a no cholesterol, no fat diet, and they will say, like, look, zero zero zero on the package. It's like this is great for me, and I go like, no, you're eating rice cakes and fat
free cookies. You know, stop that. You're you're inadvertently triggering a biochemical response that is comple completely counterproductive to what you're trying to achieve. Okay, now, if you eat the brown rice, right, the brown rice hits your digestive system, and the bodybook send says like, oh, well thanks a lot, it's gonna take me a while. I've got brand, I've got germ. I got to break this down. It's gonna
you know, it's gonna take me a while. So instead of blood sugar is you know, just zipping up like crazy, you know, they kind of go low and slow, so your your insulin levels are much lower and you're not triggering this counterproductive response. The other thing that whole carbohydrates bring to the party are fiber and plant steriles. Fiber works. So let me go back. So there's a natural elimination process for LDL. We didn't talk about that, and that's
related to making bile. So you can think of a big funnel of LDL coming back to the liver where it gets taken up and turned to bile, and then that bile gets dumped in digestive system when we eat, gets used up in the digestive process, and out it goes. So that's kind of an exit strategy for LDL. Now, most of us are pretty efficient and so instead of just letting all that bile run out, we will reabsorb any bile that doesn't get used up in the digestive process.
We put it back so it's ready for the next meal. Okay, well what does that mean. Well, it means that funnel of LVL doesn't have to be nearly as big, right, and so we can keep more LVL floating around in the bloodstream. This is actually the mechanism that the original cholesterol lowering drugs used. We don't prescribe them anymore, but they were called bile acid resins and they literally bound bil and digestive system and you eliminate through the stool
and it worked. LDL levels dropped. The problem was they were messy powders. You had to take eight pills a day. People got digestive upset. It was really very unpleasant. So when Stanton's came along, like wait, one little pill versus all this than that, So we don't use them much anymore. But the process they were leveraging is continuing to happen in our body. So back to food and back to
whole unprocessed carbs because they help leverage this mechanism. So whole unprocessed carbohydrates bring fiber and plant sterols to the party. Fiber works because we can't digest it. So you get a fiber molecule, bile acid molecule, tries digestive, try suggest it, you know, can't do it, and before it figures out like I'm not getting anywhere, it's past the point of no return. So in many ways fiber acts like those medications.
It traps bile in the digestive system, so you know, escort it out of your system, so your LBL levels drop. Plant sterols are natural plant components found in whole unprocessed foods, and they're actually the plant version of cholesterol. Remember how I said everything cell and our cell wall and our body has you know, has some cholesterol on it. Well, same thing goes in plants. Plants have their own cells and cell walls, and they contain their their version of cholesterol.
And that sounds crazy, like why would you eat cholesterol the lower cholesterol. But the reason why this works is because plant sterols are similar but different. They're similar enough that when they're in our digestive system, the body looks at them and says like, oh, hey, you're like one of those file guys. I'm supposed to be absorbed. Oh
you're really important. Here's your absorption site, welcome back. Well, the plant sterol shows up and it's just slightly different enough that it can't get through, and so it blocks an absorption site, meaning while behind it has one less strawway to get back in and we waste more bile. So this is why you know, whole food vegans and vegetarians tend to have significantly lower cholesterol than most of us.
They're you know, they're eating a lot of fiber and plant sterols naturally, so they're really leveraging this you know this you know elimination pathway. They're also not triggering that counterproductive insul response because all the carbs they're eating are complex. Oh and by the way, all their fats are plant based, right, so there, so they're not eating saturated fat that's causing
the their you know, receptors to downregulate. So anyway, there you go, watch your fats, watch your carbs exactly.
And you know, when you eat healthy carbs, you're your fuller longer also, which is important to unders so you don't tend to overrate. I mean, you know, I'm going to zero in on one oat you know, oat meal.
Oh my god, that keeps you full four hours.
Yeah, well you know, and I know I had Step one company that you founded that focuses on foods at lower cholesterol. I was sent some samples. I'm not an energy bar girl, but I do. I make myself heat oatmeal. Here's my tip. If you don't like oatmeal, I don't like hot oatmeal. So what I do is I make overnight oats. For some reason, I like it with its chilled and small, not a big bowl, because you are so full from it versus hot, which just feels like it's not for me. But so if you don't like
something one way, chill it or sprinkle it. So you have some that you sprinkle on top of other things, so you can sprinkle and it still provides you fiber and you do feel fuller, because I think that's the one thing. If I have it oatmeal in the morning, i am. And I've been doing a lot of weightlifting because I'm also really ramping up the way I exercise because I plateaued, So that's been helping in terms of that. Another one, you know, there are fruits and vegetables high
in fiber. An apple, you know, there's a reason they say an apple a day, right, Yes, eats.
The doctor away. Yeah.
So other than oat meal, and whether you sprinkle it or overnight it or anybody just don't happen in a cookie, sugar and everything.
Yeah, yeah, yeah.
What are some other foods that you would recommend that are.
High in that are hid fiber? You know, boy beans, legoons, you know, super high in fiber. Actually, avocados are high fiber. People don't think about that, but they are, and they're they also have all those good chats. So it's another reason why when you eat some GUACAMOLEA you're like, I'm full, Like, so.
Just don't eat it with tons of chips, you know, to do guacamole, is I buy carrot strips? Yeah, those are my crunch or you can cut up a cucumber crunch or something that has crunch basically, and then my husband's eating the chips. I hit for the strips.
Yep, excellent, excellent. Yeah. So you know, I mean really almost any whole fruit or vegetable is going to have to have fiber. You know, leafy greens, you know, high in fiber. It's it's all. Any you know, any plant based food, so long as it's whole, is going to is going to give you fiber. And you know, and and it's only when we mess with things that we start to strip those you know, some of those beneficial
that beneficial ruffage out. So if you you know, if you crave orange juice, have the orange instead eat the orange because you know, the orange juice when you when you squeeze it, you leave the pulp and tiff and and that's that's where the magic is.
And if you must buy orange juice to get it with the pulp of the Beth. I'm not a big juicer. I do like juice, but I watch sugar like hawk, So I stay with vegetables. But you know, again, you lose the fiber aspect of it. So why did you decide to create Step one Foods, which is your product? Just to be clear, I have no affiliation, but it is. It is for people who can't figure it out themselves.
Yeah, you know, I mean along the way, you know, I mean literally, you know, we started talking about, you know, high cholesterol, here's a pill. Well that's what physicians are taught to do. And you know, and and and as I look back on my education, I was educated some pretty you know, some wonderful institutions. I got the wrong advice.
You know.
It's the all the things that I'm treating with drugs. High cholesterol, high blood pressure, you know, high blood sugar. You know, these are conditions that are caused in part or in whole by food. And if something is caused in part or in whole by food, step one should be change the food. The problem is that if you're trying to actually influence a you know, a cholesterol number or a blood pressure number, you know, you really have
to know what you're doing. Like you know, it's it's not just a matter of eating better, although that'll help, but it's really about being strategic and making sure that you get enough fiber, enough you know, plant steriles, enough healthy fats, those omega three fatty acids, enough antioxidant to actually you know, get a benefit. And and this is where it gets really hard for people because you know, they try, but they just don't can't do it quite
right because it's hard. You know, you're measuring your thing and you're buying all sorts of ingredients. Things go bad in your fridge. So so the whole idea behind Step one foods was Okay, let's just make this easy. You know this this is we know what people need, we can deliver it in just two small servings of food a day. We don't have to own your stomach from
from morning tonight. We can just you know, we can just supplement what you're doing with this and then you know, let's see what happens and lo and behold, you know, people can see just with this tiny, tiny, little intervention. And the foods, by the way, you know, for for listeners, are snack bars. They're you know, the things that people are eating already, so snack bars, instant oatmeal, pancake mix, smoothie mix. You know, there's there's a you were talking
about a sprinkle. There's like a sprinkle product which you can just you know, add to like yogurt or something else that you're eating to really boost the nutritional content of that and kind of get you to the nutrient levels you need to affect cholesterol levels. And sorry, go ahead.
Yeah, No, Sprinkles are easy for people that can't deal with other things. Sprinkling is good, you know, and other things to sprinkler nuts, you know, unsolved with nuts or seeds. You know, we sprinkle a lot on our salads. We sprinkle a lot on our Sprinkling is good if you're sprinkling right things. Just don't sprinkle sugar, you know, think about what you sprinkle and it does work, and you know at something with oats is good. But again look for stuff that's low and sugar. We only have about
a minute left. I do need to ask you, is there anything on the front of reducing cholesterol managing and that you're excited about that has in your crystal ball.
Well, you know, my hope is that while we develop new drugs. And you know, and I'm not anti drug I prescribe medications all the time. Some patients need them there they're important, they can be life saving. But I hope that in my lifetime we see a change in the food environment. Look, we we live in a dysfunctional food environment. We are surrounded by hyperpalatable, calorie dense, nutrient poor foods that are delicious, made to be addictive, inexpensive,
and advertised NonStop. What could go wrong? Well, what can go wrong is the health of our country. And you know, and we need a different path. And I'm hoping that Step one foods can be you know, the little standard bearer of how we can do things differently and how we can yield measurable health improvements in as little as
thirty days. I mean, our clinical trial showed that some people had medication level statin level cholesterol reductions with our too little, you know, too little servings a day intervention in thirty days. I mean, if you're someone who can't tolerate statins, you don't want to take them. You've tried them and you know they didn't you know, they didn't work out for you, Like this could be a game changer.
And you don't need to commit to it forever. It's just thirty days and you can see whether or not it works for you.
Well, I know I'm doing thirty days right now of working with and I just want to in order to you wrap this uppropriately. If you are considering making changes, particularly in your diet, make sure you do it with the advice and the consent of your primary care physician, and don't do anything dramatic. I mean, I've consulted with my doctors, my gastro entrologists because I had some GI issues and my PCP before I even started adjusting things
in my diet. And I have a pretty healthy diet as is, but we're testing a few things to take out to see if it will help the GI track. And I also ramped up my exercise. So the bottom line is you have the power within you, as I say at the individual, you have the power within you lend of the good Witch to make the changes you
want to stay healthy for the long term. But you have to do it today, and you have to commit to it, and you have to do it in cooperation with the people that are your board of advisors, which are your physicians, and you have to make the change. I want to thank you again, doctor Elizabeth Clotis, who is a Board certified cardiologist, for sharing your expertise today on Fearless Fabulous You. I think it was very helpful. I thought you opened a lot of answered a lot
of questions about cholesterol. You know, listen to the doctor, not doctor Google. Get your information from credible sources, and that's what I ask everybody to do, and don't share things that you are not expert in. Listen to experts. You've been listening to Fearless Fabulous You. I hope you enjoy this. You can listen to all my shows on iHeart, Spotify, Apple, and about thirty five other podcasts on demand anytime, so check it out and check me out at melaniehung dot
com and Melanie Fabulous. I thank you again for joining me, doctor Clotus, and to all my listeners. You got this day fearless and fabulous