Week 2: Heart Disease

Nutrition for Health Promotion & Disease Prevention

Katie Ferraro, MPH, RD, CDE

Disclaimer

This course is designed for educa0onal purposes only. It is not intended as medical advice or medical services. The informa0on provided in this course should not be used for diagnosing or trea0ng a health problem or a disease, nor does it qualify you as a health care provider. It is not a subs0tute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider.

Lowering Cholesterol with TLC: Therapeutic Lifestyle Change

Cholesterol: What & Why

o Two primary ways to lower cholesterol: drugs & lifestyle

o Therapeu0c Lifestyle Change (TLC)

Lipid Goal

Total cholesterol

High Cholesterol Risk Factors

Non-modiable: oHeredity oAge oSex

Modiable: oDiet oOverweight oPhysical inac0vity

The Modifiable Risk Factors

Overweight oExcess weight raises LDL levels oExcess weight raises triglyceride levels oExcess weight lowers HDL levels oLosing weight can help LDL & TG, HDL

The Modifiable Risk Factors

Physical Inac0vity oContributes to overweight oRaises LDL oLowers HDL oRegular physical ac0vity can help you HDL, TG, lose weight and in turn LDL

The Modifiable Risk Factors

Diet oSaturated fat raises LDL levels, animal foods oTrans fat raises LDL, hydrogenated oils & fats oCholesterol found only in animal foods

The TLC Diet

Can calculate your calorie needs here: hTp://www.nhlbi.nih.gov/cgi-bin/chd/step2intro.cgi

Saturated fat

TLC: Does it Work? Change LDL Reduction

Saturated fat

Application: Saturated Fat

oBarry is following an 1,800 calorie/day diet oHow many grams of saturated fat per day max should he have if following TLC?

Solution: Saturated Fat

oTLC says no more than 7% of calories from saturated fat/day

o1,800 calories per day X 0.07 = 126 calories from saturated fat

oQues0on asks about GRAMS of saturated fat, 1 g fat = 9 calories, 126 calories from saturated fat 9 calories/g = 14 grams saturated fat

What does 14g sat fat look like?

o3 tablespoons of lard o2 oz cheddar cheese o6 oz cooked ground beef (70% lean, 30% fat) o2 tablespoons buTer

Application: Eggs & Cholesterol

oRita is following TLC to lower her cholesterol oShe has eliminated most animal products from her diet but she loves eggs!

o1 egg has 186 mg cholesterol oTo keep within TLC guidelines, how many eggs per week can she have if she has almost no other sources of cholesterol in her diet

Solution: Eggs & Cholesterol

Niacin for Cholesterol o Niacin, water soluble B-vitamin (B3) o Nico0nic acid is the form that improves cholesterol levels o Available over the counter, should be taken under physician

supervision o Helps improve all lipoproteins total cholesterol, LDL,

triglycerides and HDL o When taken in high doses can lower LDL 5-15%, up to 25%

in some people o Cau0on: niacin ush from large doses (1-3g doses is about

50-150 0mes amount in MVI, UL is 35 mg, DRI 14-16 mg)

Niacin for Cholesterol

How to avoid ushing? o Take an extended-release product o Take with food preferably aqer dinner or bed0me snack

oAvoid hot drinks and alcohol when you take niacin

o Consider aspirin (or ibuprofen or naproxen) before meal with niacin but consult health prof 1st

For More Information o Your Guide to Lowering Your Cholesterol with TLC:

www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf o Therapeu0c Lifestyle Changes Diet from NHLBI:

hTp://www.nhlbi.nih.gov/cgi-bin/chd/step2intro.cgi o NIH Senior Health TLC for High Blood Cholesterol:

hTp://nihseniorhealth.gov/highbloodcholesterol/therapeu0clifestylechanges/01.html

o UCSF Pa0ent Educa0on Guidelines for Low Cholesterol, Low Saturated Fat Diet: hTp://www.ucsuealth.org/educa0on/guidelines_for_a_low_cholesterol_low_saturated_fat_diet/index.html