A Cardiologist's Warning for Women in Their 20s & 30s with Dr. Martha Gulati

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Nobody warned us that heart disease is the #1 killer of women.

Nobody warned us that some of the biggest risk factors can show up in our 20s.

And nobody warned us that there's a blood test almost every woman should have checked.

So we brought on one of the world's leading cardiologists to tell us everything.

This episode covers the heart disease risks hiding in plain sight, the cholesterol myths taking over social media, and the simple things every woman should know to protect her future health.

In this episode:

•  The heart disease test every woman should know about 
•  Why healthy women still have heart attacks 
•  PCOS, fibroids & cardiovascular risk 
•  What your cholesterol numbers actually mean 
•  The truth about statins 
•  Alcohol, saturated fat & heart health 
•  How to protect your heart before problems start 

This is one of those episodes every woman should hear. ❤️

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DISCLAIMER: Nothing mentioned in this episode is medical advice and should not be taken as so. If you have any health concerns, please discuss these with your doctor or a licensed healthcare professional.

Transcript

SPEAKER_00 0:06

If you're doing all the right things, eating clean, taking the supplements, following the skincare routine, and you're still freaking out, bloated, burnt out, or just feeling off, you are not the problem. The problem is that the wellness world wasn't built for real women with real bodies, real stress, and real questions that deserve better than vague advice and viral wellness trends.

SPEAKER_01 0:29

Welcome to Girls on Wellness, the No BS podcast cutting through the noise with science, sass, and zero shape.

SPEAKER_00 0:35

I'm Jeanette, and I'm Victoria, and we're naturopathic medical graduates who didn't just wake up one day and decide we were into wellness. We've spent the last decade learning the science, doing the clinical work, and graduating with the degrees.

SPEAKER_01 0:48

This isn't just another influencer podcast. We're not here to sell you a greens powder or to tell you to balance your hormones with seed cycling and good vibes. We're done with fear-mongering around food, detox teas, clean beauty BS, overpriced supplements that you don't need, and the biggest lie that you are the problem when it doesn't work. No, we're flipping the script.

SPEAKER_00 1:10

This is Girls Come on Wellness. Smart, sexy, science facts, and developed for women like you. Not something that can be influenced by what happens in our 20s and 30s. But what if we've been completely wrong? What if some of the biggest predictors of your future cardiovascular risk have already happened? Things like PCOS, fibroids, pregnancy complications, cholesterol patterns you may have never noticed, or genetics that you didn't even know mattered. Today's guest is one of the world's leading experts in women's cardiovascular health. Dr. Martha Gulabi is a cardiologist, professor of cardiology, director of the Davis Women's Heart Center at Houston Methodist, former president of the American Society for Preventative Cardiology, author of the best-selling book, Saving Women's Hearts, and has even spoken at the White House on the future of women's heart health. In this episode, we're talking about the heart disease tests that every woman should know about, the numbers you actually need to know, why healthy women still have heart attacks, the truth about cholesterol and statins, whether alcohol is ever truly heart healthy, and the biggest misconceptions women have about protecting their hearts, especially in their 20s and 30s. This conversation completely changed the way that we think about prevention. And we have a feeling it's gonna do the same for you. Let's get into it. Oh my God, guys. Wait, before we get into today's episode, if you've somehow been living under a rock, you might have missed that we officially launched our GGW merch this past week. This has been such a passion project for Jeanette and I. We had the best time dreaming these pieces up, designing them, and finally getting them into your hands. Seeing all of your orders come through has honestly been surreal. We are so, so grateful. Make sure you are signed up for our email list to grab a special discount if you haven't already purchased your merch. And then treat yourself to a cozy hoodie or crew neck for summer nights by the fire, maybe a tea for the gym or just to look cute. And of course, a tote bag for absolutely anything and everything. Things are already starting to sell out, so don't wait too long if you've had your eye on something. Okay, promise that's it from me. Let's get into today's episode. Welcome to Girls Gone Wellness, Dr. Galati. Thanks for having me. Thank you so much for coming on today. I don't think in our two years of running this podcast, we've ever had someone with so many credentials beside their name. So we are just so thrilled to talk to you today. I feel like you're like a superhuman when I'm looking at your website. I'm like, how does this girl do it all? Um, so it's very exciting for us. I'd love for you to tell us a little bit about your journey into cardiology. Did you always want to be a cardiologist?

SPEAKER_02 4:30

I don't know if I always wanted to be a cardiologist, but certainly once I started medical school, I definitely wanted to be a cardiologist. I I actually trained or did medical school at University of Toronto, and I had an amazing mentor at Women's College Hospital. Um, back then it was a hospital, not an outpatient center. And there's a very well-known physician named Dr. Len Sternberg, who was my mentor and to this day still remains my very, very good friend. Um and he took me under his wing and told me I needed to be a cardiologist. And I really enjoyed learning from him when I was a student because I thought it was also fascinating and it all made sense. Um, it was very logical. I'm a very come from a very strong math background. I needed something that I don't have to memorize, but could actually work out from first principles, and that's what cardiology was to me. So I feel really lucky because when I was training at Women's College Hospital, I got to learn a lot about what we didn't know about women. And I remember writing my letter for residency why I wanted to do what I wanted to do. And I was very clear that I wanted to be a cardiologist, but that I just wanted to um study women's hearts. And so I I feel very lucky that something that I said in medical school has come true.

SPEAKER_01 5:54

Yeah, that's incredible. Did you always know you wanted to be a doctor when you were younger? Like, did you have that trajectory?

SPEAKER_02 6:00

I I think so. I mean, I I there's stories that when I was three years old that I'd run around and tell people I wanted to be a doctor. And so, um, so uh, but I don't know what a th three-year-old actually knows about being a doctor. I will tell you that when I was uh quite young, I lost my mother. Um, and I realized like I in the moment that when she was lying in the intensive care unit and we knew we were gonna lose her, and you know, it it probably hit home to me, you know, why really I wanted to be a doctor and um the things that we could do to be a good doctor, you you know, I I feel like some parts of why she ended up not being able to be treated was because she didn't have a very good doctor um and who missed a diagnosis and um and took her away from us. So I hope to be the exact opposite.

SPEAKER_01 6:59

Thank you for sharing that. I think it's so special when we have that, you know, personal story and it makes us better practitioners, I think, in the future. So thank you for sharing that. Um I love that you mentioned that you wanted to work with women's hearts because I think when we think of cardiovascular disease, we think of, you know, the stereotypical kind of like male patient, maybe older, maybe you know, looks a certain way, and we don't really think about women having these issues, but women are and do have these issues. So I'm very excited to talk to you about this today. Um, and just to get into it, obviously, wellness culture is taking over the internet. Um, we have people buying all sorts of supplements, powder blends, you know, whatever TikTok is telling them. It's kind of crazy. Um, but I think on a positive side of things, we do have people taking more of an interest in their health. Um, even if their approach maybe doesn't follow the data or the science. Um, but with this interest in wellness, do you think people are actually getting healthier? Like, are we trending in a trajectory to better health or are we going kind of the opposite way? What do you think about that?

SPEAKER_02 8:03

I I don't think it's one or the either. I think it's a kind of a mix. I think that we should be talking about wellness. And I'm glad that conversation is starting. And I'm glad it's starting with young people because I think, you know, people start being more concerned about their health when you're older, maybe my age, like where you start thinking, like, you know, I don't want to get this disease, I got to do that preventive screening. But really, from a as a cardiologist, anyway, I would say like the younger that I can make convince somebody to start being proactive about prevention and cardiovascular disease prevention, particularly, the better. Um, the thing I think with wellness trends though, is like you said, sometimes it's like because I saw it on TikTok, everybody should be taking this injection or they should be um, I don't know, like there's so many so much misinformation out there these days. Um and I think that that's the hard part that we're having uh to be able to counter. So much of the clinic visits I have with women these days is them saying, like, should I take this because some influencer told me I should take it? Um and sometimes it's not even influencers. I will say now that I'm in the US, I mean, sometimes a government official is saying that we should use certain things that aren't in space. So, you know, we I think people in the healthcare field really have a responsibility, honestly, like you know, whether you like social media or not, to be able to know what's coming and to counter it with evidence. Because the most trusted person to the our patients will always be the people that are providing the care to them. As much as they, yes, they are influenced by things, um if they're asking about it, they're asking truly our opinion. I'll just give you an example though. I I have a very dear friend, she's one of my best friends, and she decided, um, I think because of something she heard on social media and then um that she decided she needed uh bioidentical hormones. And um, so she went to some practitioner, but it was not a medical practitioner, and they injected some sort of or implanted, I guess, these hormones into her. She didn't even tell me. She tells me a lot of things when she wants my advice, but I think she knew what my answer would be. The unfortunate thing was that she because after that, she started having excessive bleeding, uterine bleeding, and um went to um her her local physician who told asked her about that and said, Oh my gosh, you shouldn't be on that. She was on estrogen unopposed without progesterone. And we know that that could cause cancer. Thankfully, she doesn't have cancer. Took quite a few months for the bleeding to stop, needless procedures that she had to have to make sure that she didn't have something else going on. And then she told me about it after it was over. And I was like, one of your best friends is a doctor. Like, why wouldn't you talk to me? And she's like, I think I knew the answer of what you were gonna say. But if I could be misled, what it taught me is that almost everyone can be misled, and I think that that's why we just need to be, we don't, we we should not be judgmental. Like I I, you know, we we need to be just partners in their care and understand the things that they would like to do, but not place judgment on what maybe they've done, but really just provide the evidence behind the science, whether that's a supplement, whether that's a procedure, whether it's compounded medications that people are getting these days. Yeah, is it's such a big issue though, right now.

SPEAKER_00 12:23

Well, I feel like the online space has really convinced so many of us that bioidentical hormones are almost like necessary for everyone for like a from a cardiovascular standpoint now. That's what I feel like everywhere I look, people are talking about this. And it's coming across as like every single woman in menopause needs to have these hormones, which I mean, there's no black and white in medicine. So you already know that that's not accurate information, right? And I feel like, I mean, I'm gonna admit here, I watch some reality TV, but I see it on reality TV. I see these real housewives getting pellets, testosterone pellets, and it's everywhere.

SPEAKER_02 13:03

First of all, it was stated by a government official in the US that hormone replacement therapy is cardioprotective, not based on evidence. He said that, but as a result, what has happened, in my opinion, is that women now are thinking because we advised against hormone replacement therapy for them for whatever reason. Yeah, patients are saying this is why I have heart disease now, or this is you you haven't provided me with protection. And that that is a wrong message to be sending out there when there's literally no evidence to date that it's cardioprotective. So I mean, I think that is one big piece of misinformation. And then the other thing is when the testosterone issue has gone out of control for women. Like, I mean, it's already out of control for men, but it's gonna be hard to get them off of it, mostly because it affects their sex drive, and I guess they're happy about that. But you know, I I there's so much out there, and I think it's hard to navigate who's telling the truth. And I think also obviously, even our healthcare community, we have to stay on top of things so that we can really answer things that might not always be in our space. Um, you know, because not everybody's gonna have access necessarily to, I don't know, whether it's a gynecologist who knows everything or an endocrinologist who knows everything about hormones. Yeah. You know, some cardiologists are like, oh, that's just not my space. But I'm like, but if you're taking care of patients who are gonna ask you about that, we should at least have the party line of what we know about the safety and what we know about the potential cardiovascular consequences because some days I feel um like the list of medications that people are taking is smaller than the list of supplements and other things that they're taking.

SPEAKER_00 15:07

For sure. Totally. I think Jeanette sent me the other day, it was like Kim Kardashian's on 35 different supplements every day.

SPEAKER_02 15:15

I saw that too. I saw that article and I was like, why is it like again, people with all the money in the world are being ill-advised, but somebody's making money off of her by charging her, the Kardashians, for her supplements. And yeah, there are supplements that are dangerous, yeah, for sure. That's the problem is that people are sometimes affecting their own health adversely, thinking that they're doing something good for their health.

SPEAKER_00 15:46

Yeah, yeah, absolutely. You have on your website this statement, it says heart disease is the leading cause of death for women in the United States, accounting for about one in every five female deaths. And you said that's why awareness and proactive care are so important. I think at our age, Jeanette and I are in our 20s. I think we have this idea that we don't need to worry about our heart health until we're in our 50s and 60s. And I feel like we haven't really got the message that the outcomes for us, our cardiovascular outcomes, are predicted by our 20s and 30s, are they not? A little bit.

SPEAKER_02 16:25

There's many things that occur in our youth, if you will, that can affect our risk of cardiovascular disease. I think, first of all, if somebody in their early 20s or even late 20s is aware of the things that you know that if they're at risk for heart disease or not, whether they are or not, but thinking about how should I maintain a healthy life, that's better than starting later. The earlier you do it, the better. But for women specifically, there are things that get that happen during our during our entire reproductive life course that can predict your future risk of heart disease. For example, even in our younger ages, in our teenage years, onset of menarchy matters. So when what age you had your period at, the if it's very early or very late, that's actually puts you at higher risk for heart disease. If you have something called, used to be called uh until a few days ago, polycystic ovarian syndrome, but now known as polyendocrine metabolic ovarian syndrome. I hope I got that right. But that is something that can appear at any age, uh, you know, after the onset of people's periods. And that is also greater association, not just with the risk of developing diabetes, but also heart disease. Then there's things that can happen when women are pregnant. And so pregnancy can obviously happen at potentially any age, you know, at any age after a woman has had her period. But um if you have things, adverse pregnancy outcomes like hypertension during pregnancy or or pre-eclampsia, if you have gestational diabetes, if you have a preterm birth, if you have a small for gestational age uh baby, um, those are examples of things that happen during pregnancy, often resolve, and then people think, okay, well, they're gone, I'm okay, baby's okay. But nobody tells them that those are predictors of future cardiovascular risk. For women that uh have early onset of menopause, which you know, for many that could happen in their 40s or you know, but it so you guys are a little young for that, but if you have early menopause or premature ovarian insufficiency, those are things that also can occur in younger ages, but also predictive of future risk of cardiovascular disease. And they're sex specific, right? So only biological women, women who carry XX chromosomes compared with biological men who are XY, they're the only ones that have these reproductive exposures that are specific that are associated with a greater cardiovascular risk. Even things like uterine fibroids or endometriosis, again, can occur at any age, but the these only happen to women, and yet they are predictive of increased future cardiovascular risk. I think a biggest thing is that nobody tells women when they're occurring. Not only is there this acute issue we need to deal with, but hey, by the way, this is associated with cardiovascular disease. And the reason it's important, so say a young woman at the age of 25 has preeclampsia. Okay, and it resolves, baby's fine, mom's fine. And uh we talk about cardiovascular risk at that time. We're not talking when they're 70, 80 that they're gonna get cardiovascular disease. This is the early heart disease. This can happen in the next 10 years, that they are at a heightened risk for a heart attack or stroke. So you tell me a 25-year-old at 35, say that they have an event. To me, that's a very young woman to have a heart attack or stroke. If we can prevent that, we should do that. But if we dismiss it, that it's gone, and that we're not informing a woman to be able to be proactive and preventive, then I think we're failing women because we need to improve our own health literacy beyond our healthcare community. We need women to understand their risks, empower them to be able to make changes so that they are less likely to develop heart disease. It's no different than telling women to go get a mammogram when they're at the right ages. We want to be proactive, we want to be able to prevent disease. And it isn't just breast cancer that we need to worry about because heart disease is the leading killer of women. You're 10 times more likely to die from heart disease than breast cancer. It's not to beat up on breast cancer. We should get screened for breast cancer, but women should also know what they can do to reduce the risk of heart disease.

SPEAKER_00 21:37

Yeah. For women listening, I know, like just even for Jeanette and I right now. Jeanette has been open about having PMOS, I guess we'll call it now, right? PMOS. Um, I have been open about having uterine fibroids. But what about the women who are listening and they're like, okay, I have fibroids, I have PMOS, maybe I had preeclampsia. What do I do now? Like if my risk. Is higher now in the next 10 years, let's say, what do I even do? Where do I begin? How do you answer that question?

SPEAKER_02 22:08

Well, I think what they should do is start talking with their primary care physician. So whether that's their GP, whether that's an internist, whoever they see, some some women actually think their primary care is their gynecologist, but they should talk with them. You know, what is my risk for heart disease? What additional screening do I need to have to know if I'm at risk? I think most women, you know, with whether they want it or not, they'll get the discussion about what age should they get a mammogram at. They don't often have the conversation about heart disease. And even when, you know, probably every woman knows when you go into doctor and often even the dentist, your blood pressure is often checked. But do you know your blood pressure? Like, did they just tell you it's normal, it's good? Or do you know your numbers? Because it's important to know your numbers, because one thing is just even from hypertension standpoint, we've changed what we consider normal these days. Like every day, well, not every day, but in the time I've been a cardiologist, we have moved down the threshold for what we consider normal. And right now we say normal blood pressure is with your systolic, the top number being under 120 and diastolic being under 80. But that was not what people were told, even you know, a decade ago. And so if somebody told you it was normal then, like, is it normal now? And so it's just important to, I think we can be more empowered by knowing our numbers, whether that's your cholesterol, whether that's your hemoglobin A1C, whether it's your blood pressure, whether it's your LP little a. These are things that if you know them, you can have better discussions even with the physician you're talking about, and and kind of challenge them, like is I I notice this is creeping up, or I notice that this, you know, this value is actually not normal. Are we sure it's okay? And get the discussion going. Because there may be a reason why certain lab values were like, oh, it's just a little bit above normal, but there's not anything we would do about it. I know when we get labs, sometimes you see these abnormal values and you're like, ah, and you're like, oh, this is to physicians are like, oh, well, that's just like mildly abnormal. It probably means nothing, and we'll recheck it the next time. But those discussions need to be had because I think it's important for us to not um not just talk about normal and abnormal, but empower our patient to be really informed about why we're doing these tests and what they mean. Definitely.

SPEAKER_00 24:56

Yeah. I had um an experience somewhat recently, and it's actually the first time anybody talked to me in a healthcare setting about my cardiovascular risk. And I thought it was very interesting because before that I had never even had a lipid panel tested, as far as I can remember. Right. And so my mom, who had always had high cholesterol, even though she's one of the healthiest people I know, I decided to ask, hey, do you think I should check mine just in case? And my family doctor ran my LPA and my APOB, which I definitely want to ask you about. And then he ran my lipid panel. And my lipid panel looked great, but my LPA was one of the highest he said he's ever seen. And so now I have that, like, oh my gosh, like I'm 28 years old and I have to start thinking about this, which is scary. But there's probably so many people listening who have never had these numbers tested. So I love your thoughts on what should we be having tested when we're looking at screening for cardiovascular markers?

SPEAKER_02 25:56

Yes, um, you know, one thing I think most people don't even know what LP little a is, and it's called lipoprotein little a, but we call it LP little a um for short. Um, and you know, our we just had new cholesterol guidelines released a few months ago. And finally, thank goodness in the United States, we have recommended that everyone get their LP little a checked as an adult. But to be honest, after the age of two, your LP little a is pretty much what it's going to be, with a few caveats for women that during pregnancy there's changes to LP little A, and during menopause, there's changes in LP little a. But nonetheless, at least getting it checked once should be done. It's genetically determined, so it's not something that um you know necessarily it definitely does not reflect what you're eating or what you're doing. It is genetic. So the only people you can blame is your parents. Um choice on your part, but you don't get to choose your parents. So um, but those are it's genetically determined. And if you somebody in the family is positive, the next thing should be everybody in the family better know who's the carriers and who is not. Meaning anyone who's your first degree relative, brothers, sisters, mom, dad, if you have children, they should be tested because it's important to know because elevated LP little A increases your risk for cardiovascular disease. And it's actually one of the most underdone tests that should be done on everyone. Canada was um sooner to the game. They a couple years ago also recommended everybody in Canada needs to have it. Europeans also said the same thing. We were the latest to the game. The US guidelines were only suggesting it in high-risk individuals until our guidelines came out a few weeks ago. So I I'm just glad we've caught up on that. Um, but I think, you know, for everyone, if you you should have cholesterol after the age of 18 at least, and really children should be checked. Though there is pediatric recommendations that, you know, somewhere in the ages of nine to 12, people should have their cholesterol checked. But I know that very few pediatricians actually check children's cholesterol, and it's it's of course important in people who have a family history of heart disease, but it's really important to have it done once just to screen. Yeah, but lipids should be done, and that's a lipid panel which has your LDL cholesterol, your total cholesterol, your HDL, and your triglycerides. That's one thing that should be done. The LP little A, as we said, should be done once in your lifetime. Um, it APOB can be done. I don't know if it needs to be done in everyone, but it's certainly within our guidelines that you can do it. It can help to look in certain patients where their LDL might be normal, but there's a lot of other risk. Um, so if somebody has a lot of something like um cardiometabolic syndrome, for example, they might be someone where it isn't fully represented just because their cholesterol, their LDL looks normal, but their APOB may still be high. So that's another thing that we can recommend. Um, other labs that should be done is you know, at least a screening glucose, but I sometimes we'll do something called a hemoglobin A1C to screen for diabetes, particularly for people who have had for women who have had either gestational diabetes or um even pre-eclampsia or hypertension during pregnancy, have a higher risk of developing diabetes in the future. And of course, diabetes is a risk factor for cardiovascular disease. So these are some of the routine labs that should be done. High sensitivity C reactive protein, I strongly recommend people get that done. It is considered what we call, in our guidelines, a risk enhancer, but it's a marker of inflammation, and inflammation underlines cardiovascular disease. So I think these are some of the tests that need to be done, at least to begin the story of risk assessment. We have risk calculators that are used that put in traditional risk factors and some of these measures that help us predict people's tenure risk as well as their 30-year or kind of more lifetime risk. But again, these risk scores can change. So you may have it done once, but you may need it again done in the future because of course we're human and we change. We, you know, we our weight can fluctuate, our, you know, how we eat fluctuates based on stress and just sometimes eating habits kind of can be where they are just due to different things. So, you know, there's a lot of things that can change. And then, of course, even with aging alone, cholesterol, blood pressure do change, even if you're doing everything right. And and as an example of your mom, like you said, she's the healthiest person you know, but yet she has high cholesterol. You can't look at somebody and know their cholesterol's high, just like you can't look at somebody and know their healthy little A is high. So the the problem of our our um risk calculator, though, for those of you in your 20s, is that unfortunately that doesn't really assess risk well in people that are young in terms of putting you in the risk calculator. It starts at age 30. So, younger people, we still recommend that they get these tests done, but you won't come necessarily away with your 10-year and 30-year risk because we just don't have that data. And again, the risk is quite low just based on your age, but not impossible. And that's why it's important to get things screened. Some of these genetic abnormalities, like LP little A, but also something called familial hypercholesterolemia, which is genetically very elevated LDL. Though these are usually families of people that have very young people with heart attacks or sudden cardiac death. And yeah, they're not going to fit in the risk score, but you can tell just by looking at their LDL cholesterol that there's something genetic going on. The sooner we know, the sooner we can, if they need treatment, we can treat them. And so it is really important to know. But I think the biggest challenge is both from a patient's side, for young women, they probably aren't thinking that much about heart disease, and physicians aren't thinking about that either.

SPEAKER_01 32:55

Yeah, mm-hmm. Yeah, such an important conversation. I'm really glad that you went through all of that. I want to move, stay in cholesterol, but I want to move to diet a little bit because, you know, with cholesterol and diet, there always comes so many, so many myths online. It's really crazy. You have, you know, doctors actually even on one side saying cholesterol doesn't matter. You have the other side saying that you need a statin no matter what to control it. You know, as a as a patient or even just as a consumer with no health or education or medical education background, it's really hard to know who to trust. And I think statins are, you know, commonly stigmatized, obviously, when it comes online. Where do you kind of stand on statin use for someone with elevations in cholesterol? You know, at what point are you suggesting them? And then I think over overarching, like, can diet and lifestyle be enough on its own without a statin?

SPEAKER_02 33:48

Well, diet and lifestyle will always be an important component of treatment, no matter what. I mean, for anyone, we know that a heart-healthy diet, not a keto diet, but a heart-healthy diet for people, you what we consider probably traditionally people would consider like a Mediterranean diet, is as it's labeled, has been the most studied diet. And it's the the one that we have actual randomized control trial and evidence relating to improvement in cardiovascular outcomes, um, both from a primary prevention and also secondary prevention standpoint. But we also know that the that saturated fat that we consume does matter, it does affect cholesterol. It doesn't, it isn't responsible for everyone. For example, for uh Vic's mom, for example, she's already eating, right? You know, there's there's some people that it isn't related to what they eat. I think diet will always be a part of what we recommend to people, no matter what. I mean, from a primary prevention standpoint and a secondary prevention standpoint. What people eat does matter. Saturated fat consumption does matter and can affect your cholesterol, particularly your LDL cholesterol. So it should always be part of what we consider when we're counseling about cholesterol and elevated LDL. It's also true though that there is people out there who have elevated LDL, have an excellent diet, and it's just determined by genetics. It isn't only your what you eat that causes your elevated LDL if you have that. And certainly with elevated LP little A, that has got nothing to do with what you eat. But knowing, you know, the diet part is one component of it, and it should be recommended. But there's certain levels of LDL that we know are dangerous for people to be exposed to. And it's really what we consider that lifetime exposure. You know, we've always talked about cigarettes and the number of pack years, like how long, how many packs have you smoked for how many years? Well, it's sort of like that with cholesterol. The longer you've been exposed to elevated LDL, the more likely you are to lay down atherosclerosis in your body. So some people are going to need medical treatment. And, you know, I know there's a lot of websites out there and as well as influencers out there that are saying statins are bad for you, doctors are just, you know, part of the pharma, mafia, they're trying to get you on it. I just want to first say, I wish, I wish that I was getting paid by pharma to tell people to take statins. I prescribe them every day and they're so good, like they're so cardioprotective. Yeah, that's why I prescribe them, but they're all generic. We're not getting anything for that. Yeah. And the reason that your healthcare team is strongly recommending statins often is because we have had statins now for over four decades. The reason, or one of the main reasons that we've seen a reduction in um cardiovascular disease mortality that fell from like, you know, in the 80s where there was just so much deaths due to heart disease, it dramatically fell with the introduction of statins. And every lipid lowering therapy that we have had subsequently has always been on maximally tolerated statins. So the reason that we choose statins first and foremost is because even if you're a candidate for other lipid lowering therapies, it's always sort of statins first. If you don't tolerate statins, if you get side effects from statins, I'll never make you take a statin. Like that's not, we're lucky. We're living uh in an era now that we have more lipid lowering therapies than we've ever had. Before, all we really had was statins. And then we've had other now we in the most recent decade, we've had newer therapies that are effective and improve cardiovascular outcomes. But it will almost always start at least with a trial of statin therapies. And statin therapies honestly are effective no matter what people read online. They're they are good drugs, they save lives, and that's why you see your cardiologist prescribing them or advising for them. Now, if you get a side effect or if you have a family member that had a side effect, which is why it scares you to be on them, you know, talk about that with your physician because certainly sometimes our, you know, if someone, I always find if somebody had a side effect in your family, you might have either like it might be something genetic about the tolerance to whether it's a hypertension drug or a cholesterol-lowering agent. And we'll choose accordingly. We try one medication and we'll try another till we find the right regime. And you shouldn't have to live with side effects. None of us want you to live with side effects. You can have a great quality of life and also be cardioprotective with other therapies if we need to. For young women, this is always the biggest challenge though, when they do have elevated cholesterol or they have elevated LP little A. The reason that it's challenging is because if they are not finished or have not even started the reproductive journey, this is always the conversation. I just literally had this the other day in my clinic where I'm like, okay, so are we done having kids? Are we having kids? Like, what's our plan? Because sometimes I will advise just, you know, we don't necessarily want you to get pregnant on these therapies. Although there is certain patients that we advise to keep on the medications, but depending on their family planning issues, you know, if they're on some sort of uh contraception, we can still start them and then, you know, stop when they decide that they want to get pregnant, we'll stop our therapy to reduce again the number of years of exposure. If they know, look, I'm not gonna have kids for another four years, okay, then we can start therapy as long as we're you're not at risk of getting pregnant, and then have a very planned reproductive period. Um, there's other people that you know you can't do that, they're not using contraception and they're kind of like, we'll just play with where if we get pregnant, and that's okay too. But then we talk if that's in their plan, if that's in their hopes, wait till they're done and then um and then start therapy. But if you have things that are like if you have familial hypercholesterolemia with a very high LDL, I really try to push them, whether they're male or female, to get on therapy as soon as possible. Um, and and be more planning about the reproductive period because they're at much higher risk. So, but don't be scared of statins and also know that if you have a side effect, there's other therapies out there that can be very useful.

SPEAKER_00 41:14

Okay, wow, that was fascinating. I know there's so much controversy around statins, and I I still don't know why. I don't know where that came from because I feel like we don't hear the same about like blood pressure drugs, but we just nobody wants to take a statin. Like everybody's like, I'm not taking the statin. Like your LDL is like sky high. Like, okay, sure. Um, I don't know if it's because people believe that it's always diet related. But even if it was, I don't see people changing their diet so drastically to make up for that anyway. So it's always made me wonder why people are so, so concerned about them.

SPEAKER_02 41:51

There's also a new camp of people out there, and I'm sure you some people have seen it on social media, and it's including some researchers that are very pro-keto diet and they're pro-animal like consumption of saturated fat. So they encourage that. And we, this is one of the most dangerous things because the keto diet, what we've seen is a lot of people who are doing this, and not if they're not doing it on a plant-based version of keto diet, the problem is their LDL will go up to such levels that we have seen a number of patients who have had heart attacks as a result of really what they're consuming to such drastic levels of LDL. But because online there is this controversy and some misinformation being pushed by a certain group of researchers who will go nameless, it has actually really created a big issue, um, you know, that I think is inf heavily influencing people. And it's interesting, like whenever you'll post something, as a cardiologist, I probably post too much about, you know, whether it's about statins or lipid lowering and the evidence behind it, and you will get attacked by this small group of people that will like they will come out of the woodwork just to attack you. And I it is a very interesting thing, but I know patients are seeing it and they don't know who to believe because some have, you know, MD after their name and and even PhD after their name. And I think it makes it hard to know, like, you know, who's who's giving the outright evidence.

SPEAKER_00 43:36

Oh, yeah, absolutely. I feel like also, I mean, Jeanette and I have had thousands of hours at this point of nutrition training, and I still run into difficulty with my confidence in talking about certain dietary things like eggs, for example, because you'll have two ends of the spectrum with people who are very like PhDs in in diet, like dietetics or whatever it might be. And And they're like, absolutely, eggs are fine, and foods that contain high cholesterol are not going to affect your cholesterol levels. And then you've got the other camp that's saying, actually, we should be cautious of this. And so it's even hard from our perspective. So I can't imagine what a consumer is feeling. So I'd love your thoughts on the dietary piece. I know Jeanette and I were in Florida last month and we saw a billboard that said, I think it was steak and shake, and it said, our fries are now made in beef tallow. Oh my. Oh my god, I know that's not right. What are your thoughts on all the dietary stuff?

SPEAKER_02 44:37

I think there's a couple things about, I think studies, and this is the one thing that I think our patients or the lay people need to appreciate that dietary studies are really hard to do.

SPEAKER_03 44:50

Yeah.

SPEAKER_02 44:50

You know, in reality, how can you truly you can do it in certain places where you get to control each piece of the food? The NIH does these kind of trials where they basically lock people into a building and they control their food. Yeah. Um, but that is not real life. And so when you do these big trials where people have even, you know, diaries where they write what they eat, like we did with the Women's Health Initiative, for example. Part of it, I I know a lot of people think of it as a hormone trial, but there was actually a part that was dietary as well. And you know, it's the hardest thing because you can eat something, and maybe because you eat lots of eggs, you also eat bacon. Like, I don't know. Like, you know, right. So you it's very hard to really always be precise about these dietary studies. And this is, I think it creates it's hard because every day the headlines will be different. Like it you will see articles, eggs are back, they're good for your heart, or no coffee, yes, coffee. What do you do? I mean, I think the biggest thing for diet is moderation about anything. I got interviewed by the New York Times about eggs, actually, and I basically said, you know, I don't have any opposition to eggs, but too many of them are probably not a good thing, and especially for somebody who's trying to control their cholesterol, particularly the yolk part, if you're eating too many eggs, that could be it, because you'll see these people that are really into protein and like that they're and uh they'll tell me they eat egg, eight eggs every day in the morning before they, you know, like that's part of their thing. And like, I don't know if that's such a good idea, right? Yeah, a lot of eggs in moderation. I think is that there's many good components to eggs. Eggs are a simple choice that does give you good protein, and there's a lot of other minerals that you get from eating eggs, and there's a little bit of saturated fat, but if you're eating it in moderation, it's probably okay. It just depends. Are you making it in solid butter? Are you eating with it with bacon? And are you taking the coffee that you also drop butter in? Because right is not the best idea, but it's probably not just the eggs that's the problem. But I think this is the challenge because I I think journals, papers, magazines, they like sort of clickbait news, like things that like grabby headlines. And I think this makes it hard to navigate yourself when you're hoping you're making smart choices and right choices. Um, and every day it seems like we we come out with a different message.

SPEAKER_01 47:36

Oh, absolutely. I feel like on social media the nuance gets left behind because it's not gonna get you followers and likes and shares and all of those things. I know me and Vec have had trouble with that on our our own Instagram because we're like, oh, like we can't, we're not just gonna say things flat out that are wrong. We want to stick with the science, but you know, obviously that doesn't get engagement in all of these things. So I think people um yeah, maybe go the opposite way.

SPEAKER_02 47:59

The ones that I always laugh about is when there's one magic food, like the fruit you must eat. Or you know, and I'm like, there's obviously no one magic food that anyone should be eating in all the time. We just, you know, eat like the rainbow, eat lots of things with multicolors, add variety, enjoy your food because part of food should be enjoyment. And, you know, eat a little less than you probably think you want to eat.

SPEAKER_01 48:30

Absolutely. I have to ask you about uh on the topic of moderation, I have to ask you about alcohol. Because I think we we are like our generation, mine and Vic's generation, I think we are moving towards like getting away from alcohol or just being more like curious about like being sober or just decreasing our alcohol use. Is there really any safe amount of alcohol when we look at at it from a risk perspective for heart disease? I know there is still that myth around even my parents will still bring it up like red wine is heart healthy. Um yeah, I'd love your thoughts on that.

SPEAKER_02 49:04

We all like the studies that say what we're doing is fine when it comes to alcohol and chocolate. Yes. So you know, there's there's from both a cardiovascular but an all health um, to be honest, there's no level of alcohol that's safe. Yeah. And the myth that somehow, well, the you know, sort of the French paradox that the French people do consume a lot of wine and a lot of rich food, and yet they don't have a lot of heart disease, they have a lot of heart disease. They do, but they eat in moderation, probably a little bit more than than we do. Um and the fruit's so good. But um, but the you know, in terms of alcohol consumption, I actually do enjoy the fact that your generation um compared with mine definitely seems to be consuming less alcohol, although it's you guys seem to be consuming some other substances that might not be might not be so good either. But I I think that alcohol, you know, if you're going to consume, as a woman, we should consume no more than a drink a day. That's what the recommendation would be, but less is better, um, and none is probably the best option. Um, there the evidence is not in your favor in terms of like that you're reducing your risk of heart disease by consuming it. Now, if you're enjoying it, if it's culturally part of what how you consume a meal, I'm not gonna stop you, but I am gonna advise just one drink for a woman. Unfortunately, men get two drinks, we get one, um in terms of other risks that we want to be aware of. If you have high blood pressure, one of the easiest ways I find to lower people's blood pressure is simply if they do drink alcohol, cutting out the alcohol or at least reducing it. Alcohol does raise your blood pressure. So um, as opposed to thinking that it's protecting you, honestly, for hypertension, it's not. So those are things to keep in mind. I I again there may be an interesting transition for your younger generation. Um, you know, I definitely I do actually love wine, is the truth. That's why when you started asking the question, I'm like, oh no, like, are they bad? Um but again, it's like a moderation thing. Like, I think that I think wine is beautiful. It's it, I the just the flavors are are really beautiful if you start liking wine, but you have to really not think that it's protecting you. Yes, that's it. As much as we should worry about our hand, our heart, we should worry about cancer. And again, that's where this data has been saying that there's no level of alcohol that's safe. So you know, maybe it's on special occasions.

SPEAKER_00 52:02

Yeah, it's funny because I've become the girl at the restaurant or the bar who will order a Diet Coke. And it's so funny how many people have opinions about my Diet Coke while they drink their cocktails. I really am amazed.

SPEAKER_02 52:16

Exactly. I think and it is funny because there's so much about Diet Coke out there. If if that's what somebody wants to consume, it's probably safe for sure.

unknown 52:30

Yeah.

SPEAKER_00 52:32

Um, I want to talk a little bit about obesity and heart health. I feel like unfortunately, we are in this part of especially Jeanette and I's generation of like the thin is back kind of mentality where it's like very, very thin. Like almost like I'm worried about osteoporosis level thin is very in on social media. And I think that we have this idea and we know that the impact of obesity on cardiovascular health and more visceral fat on cardiovascular health. But I think we think that thin is really metabolically healthy. And I would love your thoughts on that. Like, are we metabolically healthy automatically if we're not obese? Or does body composition matter here?

SPEAKER_02 53:15

Yeah, it's not about necessarily how we look. Um, but that has become, you're certainly right, it is a big issue between Instagram influencing younger and younger women and girls, that you know, how they appear matters because we have to share everything on social media. But then on top of that, with these new weight loss drugs that are being accessed by people who don't necessarily need them, it is changing. And then, of course, the sort of Hollywood appearance where, again, a lot of people are going excessively thin. I think that that is a problem. And I worry the same thing. I worry about osteoporosis, particularly as they get older. And I also worry about the people getting correct nutritional content for their body in general, for all their organs, not just their bones, but also everything inside to work right. You need to have food and you need to have nutrition. I think that you know, the one thing about um where fat deposits is probably more important than anything else. So I, you know, people who are of South Asian descent like myself, you know, if you we we're called the thin fat, I think. Like we look thin, but where we carry our fat will be definitely more in the center and in our organs as well. Um, so even though our body mass index might never be in the overweight or even obese categories, that's actually why for South Asians there's a different cutoff than there is for white people, for example, of where BMI is. Um so I think it fat matters, but it matters where it is. From a cardiovascular standpoint, though, overall, what I would say if you just look at BMI, elevated BMI in the particularly in the obese but also overweight category independently predicts your future risk for cardiovascular disease. So I do love being in an era where I can finally help my patients more than I could before. Before, I would say to somebody who had excess weight, you know, the guidance usually was eat less, move more, and hopefully, you know, somebody will be motivated enough to be able to get there. But even if they were motivated, it's very hard to lose weight. And there's a lot of genetics playing a role in there as well. But now that we do have medications like these GLP1 receptor agonists, and every day we're now have a triple agonist as potentially that might get approved. But we have these drugs and they are very effective. And I do think for people that have excess weight and they're struggling with getting the weight off, which is so much so much of the population. I think it's good that we have these medications. And I don't want people to feel guilty that they needed medications to get to a healthier weight. But I would advise young women to not be using them if they don't. There's a lot of things we are unknown about these drugs. If they start them at a young age for no particular reason, they might need them forever then to maintain their weight. Who knows? Um, are they getting the right nutritional content as we talked about? That concerns me because these do suppress their appetite. And if they're not eating and their their only goal is to maintain a BMI of 16 or something crazy like that, that's also not healthy. And so I think if if people are truly interested in their health, be smart about your health from every aspect. Don't don't just choose, well, I like to look thin, and thin is the thin is in, as you said. Yeah health, I think, is in. I actually think as as a woman, we should, you know, I like now, maybe because I've finally earned my muscles, um, but I like like strength training, and it's changed my metabolism. And I'm older than you guys, and so I need to worry about those things more. But it has changed my metabolism as a result of doing resistance training. I've always ran. I run since I was a kid, yeah. And I used to poo-poo everybody who told me I need to do resistance training. And then just after during the pandemic, I started doing resistance training, and I noticed that that was what helped me in terms of I needed to lose weight during the pandemic. I ate way too much and got too much, and I did need to lose weight, and it changed my whole metabolism, and it's been the best thing I did for myself. And I do think that having muscles and being strong, and and when we enter our 50s and we start thinking about that, and as I take care of patients that are in their 70s and 80s, the ones that if they have a fall and don't break anything, that's like that's my goal in life. Like I'm gonna, I know I'm gonna fall because I'm clumsy, but I don't want, I want to be able to pick myself up, I want to have enough muscle mass on my body, I want to have strong bones. I know these are things that you don't think about in your younger age, but if you create detriment to your bones and your muscles at this age, that's a big problem. We also don't want people to have eating disorders. You know, the other thing I we didn't talk about this, but in the we're talking about reproductive things, but when people have anorexia, which could, you know, if that's the the way that you're keeping thin, you know, anorexia can also cause functional hypothalamic amenorrhea, where basically you don't have periods. And we know that's an increased risk for heart disease too. So, you know, again, you don't think about the consequence of everything you're doing at a young age, but be very careful and take care of your whole body because I think that is the key to having every organ happy and healthy.

SPEAKER_01 59:15

I love that so much. We actually had uh Dr. Spencer Nodolski on last year, last summer. Um, he's a huge obesity doctor, and he was talking about GLP ones with us, and it was interesting because he was saying, like, not only like, yes, will you lose weight on these medications, but you'll also get more um interested in working out and eating right, and all these things will fall into place. So it's it's so interesting how these medications work, and all of those things are gonna contribute to your cardiovascular health, right? If you're lifting weights and you're you're interested in eating a Mediterranean diet, all these things are gonna contribute. So uh we've talked about these medications a lot, and I think they're they're amazing, and I'm excited to see where they go.

SPEAKER_02 59:54

Yeah. Oh, that's he and his brother are great people and learn a lot from them as well. And I love following him and learning from him as well.

SPEAKER_00 1:00:04

Yeah, he was the best. What is one daily habit that gives the biggest cardiovascular payoff over decades? If you could give us one.

SPEAKER_02 1:00:14

Oh, can I have two? Sure, we could do two. For sleep, I think sleep is highly underrated. I everybody needs seven to eight hours of sleep for their overall health, but also for their cardiovascular health. So don't, you know, I know a lot of us, especially you guys in your younger ages, take pride of, you know, all nighters and things that people do or go out very late and get up the next day. I don't know how anyone does that anymore. But I remember that at that age and during medical school and residency, not getting enough sleep. Seven to eight hours of sleep is really necessary, and you should pride yourself in getting that and you're doing something good for yourself by that's self-care. Um, I think the other thing is exercise. Exercise is your best friend, and if you start it young and do it throughout your life, this is one of the best things you can give yourself is exercise. And that includes, like I said, resistance training as well as aerobic activity. Make it a part of your life so that you, you know, you will live long. All the other could controlling for all other risk factors, people who exercise are more likely to live longer and healthier lives. So it is the prescription. I wish I could write for you, but you have to do it. Mm-hmm.

SPEAKER_01 1:01:35

I love it. You know, me and Vicker, two girls that go to bed at 9 p.m. So maybe we're the outliers here, but thank you so much for coming on today. This was an incredible episode. We could have gone on for hours. Uh, this was so amazing. Um, can you let our listeners know where they can find you and follow you on Instagram and your website and everything like that so they can get correct scientific information?

SPEAKER_02 1:02:01

Yeah, my website is drmarthagalati.com, and all my Instagram pages or social media pages are the same at drmarthagalotti. Um, is the handle on Twitter, Instagram. I don't know my LinkedIn, but anyway, you can find me there.

SPEAKER_01 1:02:20

Awesome. Thank you so much. We'll link everything in the show notes. Thank you again for coming on today. Thank you so much for having me.

unknown 1:02:26

Thank you.

SPEAKER_01 1:02:32

Thanks for listening to Girls on Wellness. If this episode made you feel seen, smarter, or just a little less alone on your wellness journey, send it to a friend or take us on Instagram at Girls Gone Wellness Podcast.

SPEAKER_00 1:02:45

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SPEAKER_01 1:03:09

We'll see you next week. Until then, trust your body, question the noise, and don't let anyone tell you you need fixing. This is wellness on your turn.