Everything You Need to Know About Cholesterol

We hear it all the time: high cholesterol causes health problems. According to the CDC, 78 million U.S. adults (nearly 37%) have cholesterol levels where experts recommend cholesterol medicine or had other health conditions putting them at high risk for heart disease and stroke. We know that too much cholesterol is bad, but what exactly is cholesterol and how can we keep it under control?

We sat down with Dr. Shelley Roque of SIMEDHealth Gainesville Primary Care to learn more.


What is cholesterol?

A substance found in the blood that your body uses to build cells. The liver makes all the cholesterol for your body, the rest comes from animal products, such as meat, poultry, butter, cheese, and milk.  Some oils, such as palm oil, palm kernel oil, and coconut oil, can also trigger your liver to make more cholesterol. Foods high in saturated and trans fats cause your liver to make more cholesterol than normal, potentially bringing a person’s cholesterol level from a normal one to an unhealthy one.

How does it affect our health?

Since cholesterol circulates in the blood, if you have too much of the bad kind or not enough of the good kind, the cholesterol can slowly build up in the inner walls of arteries. This cholesterol build-up in the arteries can join with other substances to form a thick, hard deposit, potentially blocking arteries.  The narrowing  and decreased flexibility of arteries from the cholesterol build up is called "atherosclerosis". Atherosclerosis causes decreased blood flow to the organs that the arteries feed, putting people with atherosclerosis at a higher risk of heart attacks, strokes, and other health problems .

Is there good cholesterol and bad cholesterol?

Some call LDL cholesterol the “bad” cholesterol because having high levels can lead to atherosclerosis, and  increases your risk of heart attacks, strokes, and peripheral vascular disease (disorder of the circulatory system outside of the brain and heart) .

Some call HDL the “good” cholesterol because people with high HDL levels tend to have a decreased risk of heart attacks, strokes, and peripheral vascular disease. It is believed that HDL helps  carry excess LDL cholesterol away from arteries and back to the liver, where LDL is broken down and removed from the body. But only 1/3-1/4 of blood cholesterol is carried by HDL so it does not completely remove LDL.

What are symptoms of high cholesterol?

Sometimes people do not have any symptoms of high cholesterol since it can take time for cholesterol to build up enough in the arteries to become those hard atherosclerotic plaques, and start to cause significant blockages in the circulatory system. Overtime, however, as the blood flow to certain organs starts to decrease, organs will receive less and less oxygen. Your body needs oxygen, so when parts of your body do not get the oxygen it needs, it will not work as well.

So, for instance, if there is decreased blood flow to the heart, a person may start to feel chest pain. If there is decreased blood to the brain, depending on which part of the brain is affected, a person may start to feel numbness, tingling, weakness, slurred speech. If there is decreased blood flow to the legs, a person may start to notice skin changes, such as darker skin, less hair, pain. There is a wide array of symptoms a person can feel from high cholesterol. It all just depends on the extent of build up in the arteries, and which organs are being affected by the blockages.

What are common myths (if any) associated with cholesterol?

LDL is not really a bad cholesterol. We actually need that cholesterol  to help make protective walls around cells and certain hormones, so it is necessary for our body to have. However, having too much of it is what makes it “bad” since its build up in the arteries is what can set off the cascade of events that cause atherosclerosis  (i.e. plaque build up in arteries, see above ).

Are their any foods that might help to lower cholesterol?

There are foods you can avoid, and those are the ones that have a lot of saturated fat, such as red meat, butter, fried foods, cheese. Foods that can help lower your cholesterol are those that have more soluble fiber, such as fruits, oats, barley, beans, peas.

Technically, a vegan diet doesn’t have any animal products, so that could help lower your cholesterol if you really wanted to avoid dietary cholesterol. However, being vegan is not for everyone,  so generally a healthy diet includes a lot of fruits, vegetables, whole grains, beans, peas, lentils, chickpeas, nuts, some fish, and some milk and milk products.

I often recommend a Mediterranean-style diet for my patients with high cholesterol because it is the closest to the American Heart Association’s dietary recommendations.


What tips can you provide to help patients keep their cholesterol in check?

Stay active, try to exercise regularly. Work on losing weight if you are overweight. Avoid foods high in saturated fats. Avoid other risk factors that can make cholesterol build up in arteries worse, such as cigarette smoking and high blood pressure. Finally, follow up with your primary care physician regularly to see if you need to have your cholesterol checked.


If you need help keep your cholesterol in check, be sure to request an appointment with your SIMEDHealth physician.


10 Ways to Stay Healthy

10 Ways to Stay Healthy

Staying fit and active can have a very positive impact on your overall health. According to, “Less than 5% of American adults participate in 30 minutes of physical activity each day, and only one in three adults receive the recommended amount of physical activity each week.” On top of that “typical American diets exceed the recommended intake levels or limits in four categories: calories from solid fats and added sugars; refined grains; sodium; and saturated fat. Americans eat less than the recommended amounts of vegetables, fruits, whole-grains, dairy products, and oils.Dr. Shelley Roque from SIMED’s Primary Care wants you to stay healthy. She put together this list of 10 ways to help you stay fit, healthy and improve your quality of living.

1) Vegetables, fruits, and whole grains are your friends!

Try to get at least five servings of fruits and vegetables every day, and make at least half of all grains whole grains (100% whole wheat bread, brown rice, whole grain cereal) instead of refined grains (white bread, white rice, refined or sweetened cereals).

2) Avoid overeating.

Try to eat slowly with smaller portions. Drinking a glass of water before meals helps to fill the stomach and decrease the time it takes when eating to no longer feel hungry.

3) Avoid sugary drinks and excessive alcohol intake.

Sugar-sweetened beverages are associated with increased weight gain. Drink water instead! If you do drink alcohol, try to drink in moderation. No more than one drink per day for women, and no more than two drinks per day for men.

4) Stop smoking!

If you need help, reach out to your doctor, or you can visit Tobacco Free Florida.

5) Cut down on unhealthy fats

Consume more healthy fats (polyunsaturated and monounsaturated fat) and minimize the unhealthy fats (Trans-and saturated fats). How can you do this?

  • If you eat meat, choose lean proteins, such as chicken and fish, instead of red meats. Legumes (alfalfa, clover, peas, beans, lentils, lupins, mesquite, carob, soybeans, peanuts, and tamarind) are another source of lean proteins.
  • Cook with corn, olive, or peanut oil.
  • If you do decide to eat prepared or processed foods, choose those labeled “zero trans-fat”, which may still have some trans-fat but likely less than similar choices not labeled “zero.”

6) Keep calorie intake balanced with your needs and activity level.

If you are exercising you will need more calorie intake to fuel that energy. However, if you are not very active, you should try to decrease your calorie intake. You can visit National Institute of Diabetes and Digestive and Kidney Diseases for more information on personalized calorie intake goals.

7) Get moving!

Exercise can help improve blood sugar control, decrease blood pressure, improve cholesterol, reduce stress, improve circulation, quit smoking, and decrease the risk of death. Some evidence even suggests that exercise may protect against breast and prostate cancer, delay or prevent dementia, and decrease the risk of gallstone disease.

  • If you normally don’t exercise much, start exercising for a few minutes at a low intensity, such as taking a long walk. Set reasonable goals! So if you think you will really only walk, for instance, 10 minutes once or twice a week, just walk those 10 minutes. Exercising one or two days a week is better than not exercising at all.
  • Then as your physical fitness improves, slowly begin to exercise harder, more frequently, or for a longer time. Exercise does not have to be continuous, since you can still get health benefits if exercise is broken up into three or four 10-minute sessions a day.
  • A good goal is trying to get at least 30 minutes of exercise five days a week. The American Heart Association recommends 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week for those that would benefit from lowering blood pressure or cholesterol.

Most people do not need any special testing before starting to exercise, but you should check your doctor if you are not sure. People with diabetes or multiple risk factors for heart disease may need an exercise test before starting an exercise program.

8) Zzzzzzzzzz!

Sleep plays an important role in your health. While you are asleep your brain is forming new pathways to help you learn and remember information. Studies show sleep deficiency alters activity in some parts of the brain, and you may have trouble making decisions, solving problems, controlling emotions and behavior, and coping with change. So ensuring proper sleep hygiene is important. If you have trouble sleeping, here are some things that may help:

  • Sleep only long enough to feel rested and then get out of bed
  • Try to go to bed and get up at the same time every day
  • Consume caffeinated foods/drinks only in the morning
  • Avoid alcohol in the late afternoon, evening, and bedtime
  • Avoid smoking, especially in the evening
  • Keep your bedroom dark, cool, quiet, and free of reminders of work or other things that may cause stress If possible, solve problems you have before you go to bed
  • Exercise several days a week, but not right before bed
  • Avoid looking at phones or reading devices that give off light before bed

If you still have problems despite good sleep hygiene, you should talk to your doctor to see if there may be other causes of your sleep deprivation. We have a sleep clinic at SIMED for patients that require further evaluation of sleep issues.

9) Mental health is important too!

The stress of everyday life can definitely affect our mood and motivation to live a healthier lifestyle. So it is important to make sure you take care of your mental health as well. Take some time for yourself to relax, whether it’s through meditation, relaxation techniques, counseling, exercise, yoga, laughing with a friend, reading, spiritual outlets, playing with a pet, listening to music, gardening, dancing or drawing. Basically find out what works for you, but make sure you avoid any negative coping skills (such as avoiding problems, drugs, alcohol, etc). Just like with any other medical condition, if you have a mental health disorder (depression, anxiety, etc), make sure to follow up routinely with your physician as well.

10) Develop a relationship with your healthcare team!

We work to try to keep our patients as healthy as possible. Of course there are medical illnesses that are unavoidable, but we will try our best to prevent or detect early health issues through routine check-ups, screening, and immunizations. We are here for you!

If you are interested in scheduling an appointment with Dr. Shelley Roque or any of our Primary Care physicians to discuss healthy living at any of our locations including Gainesville, Ocala, Chiefland, and Lady Lake (The Villages); you can visit our SIMED Primary Care page or click here to request an appointment online.

June is Scoliosis Awareness Month

June is Scoliosis Awareness Month

Remember getting checked for scoliosis in elementary school? Did you ever realize how important it was getting that exam? June is scoliosis awareness month and we asked Dr. Shelly Roque a SIMED Primary Care Family medicine and sports medicine physician questions that were never answered in elementary school. For example:

What is scoliosis?

Scoliosis is a sideways curve in the spine where the spine sometimes looks like the letter “S” or “C”. It is commonly seen in children and adolescents. Most cases are idiopathic, meaning we don’t know why it occurred. Some cases are congenital, which means you are born with a predisposition for the condition, and other cases can be due to conditions that affect the nerves and muscles, such as, cerebral palsy, muscular dystrophy, spinal cord injury. About 30% of adolescents with idiopathic scoliosis have other family members that have scoliosis as well.

What are some common symptoms and/or signs?

Most cases don’t have any symptoms and it is very rare that is causes serious problems. However, if the curve gets very large, it could possibly lead to back, pelvis, or leg pain. Heart and lung problems can also develop due to the curvations effect on the internal organs In very rare, severe cases, scoliosis can lead to compression of the nerves or the spinal cord causing paralysis.

How do you test for scoliosis?

Scoliosis is usually screened for during regular check-ups with the family physician or pediatrician, before the pubertal growth spurt (at about 10-15 years of age).

Tests to check for scoliosis include:

  • Forward bend test - an examiner checks to see if one side of the back is higher than the other
  • X-ray - Is indicated if the physical exam demonstrates significant curvature;or , if there is a need to monitor the degree of curvature in a person previously diagnosed. The images show the curvature and measurements more precisely.

How is scoliosis treated?

Mild scoliosis needs regular observation, but does not need treatment; however, moderate to severe scoliosis may need treatment. In general, the following treatment options are considered:

  • No treatment is needed if the child has mild scoliosis and is finished growing.
  • When the scoliosis is not severe and the child is not finished growing, expectant management is done, which means you can watch over time for changes,
  • Bracing may be needed if the child has a moderate sized curve, and still has a lot of growing to do.
  • Since severe scoliosis usually gets worse with time, surgery can be considered.

Depending on the situation, the patient and doctor may decide to do surgery to help the vertebrae of the spine line up correctly. Surgery is considered for severe scoliosis. The goal of surgery is to help the vertebrae align in more appropriate position.

Is there currently research being done for scoliosis?

Almost all aspects of scoliosis are being researchers there is research investigating how genetics play a roll on who develops scoliosis. Research on bracing devices, techniques, durations; and research on surgical devices and techniques to better align the spine.

For more information you can visit the following websites:

Or request an appointment with Dr. Roque through SIMED’s online appointment request.