(Presentation adapted from Holly Nickels, Summit Medical Fitness

Center)

Why the concern about cholesterol?

Narrowing of arteries– Major risk factor in heart disease

and heart attacks

Cholesterol Basics Low-density lipoprotein (LDL):

“bad” cholesterol– Too much causes a build up of

plaque in the arteries High-density lipoprotein (HDL):

“good” cholesterol– Lowers risk for heart attack and

stroke

Optimal Cholesterol Levels Total Cholesterol: <200 mg/dl LDL:

< 160 mg/dl if no heart disease or diabetes

<130 mg/dl if 2 risk factors for HD < 100 mg/dl if HD or diabetes

HDL: > 40 mg/dl Triglycerides: < 150 mg/dl

Nutrition Goals to Lower Cholesterol

Change TYPE of fat eatenReduce HOW MUCH fat is consumedIncrease intake of SOLUBLE FIBER Reduce simple SUGAR and

ALCOHOL intake if high triglycerides

Types of Dietary FatMonounsaturated fat

Polyunsaturated fat

Saturated fat

Trans fat

All fats are a combination of mono, poly & saturated fats

Types of Fat Monounsaturated fat

lowers total & LDL cholesterol Sources:

olive/canola/peanut oilcashews, peanuts, pecan, almonds,

sesame seedsavocado

Types of FatPolyunsaturated fat (PUFA)

lowers total & LDL cholsources:

Corn/safflower/soybean oilmayonnaise, Miracle WhipTM

walnut, pumpkin seeds, sunflower seeds

Types of FatSaturated fat

solid at room temperature, raises total & LDL chol

converts to cholesterol in bodysources:

butter, lard, bacon greasecream, sour cream, cream cheese, most

cheeseshigh-fat meats, poultry skintropical oils: palm oil, coconut oil, coconut,

cocoa butter

Types of FatTrans fat

solid at room temperatureraises total & LDL, lowers HDLconverts to cholesterol in bodyLook for “partially hydrogenated” on food label

Trans Fat SourcesMargarine w/ hydrogenated oil

Fast foods - fried chicken/fish, biscuits, fries

Donuts, muffins, crackers

Packaged cookies, Cake mixes, icing,

pie Microwave popcorn

Dietary CholesterolRaises blood cholesterol levels but

not as much as saturated and trans fats

Recommendation: < 300 mg/day dietary chol if LDL normal

Sources:eggs, shrimp

Quantity of Fat …How much?About 20-35% of your total

recommended calories limit saturated fat to 10% of calories

Where do you find fat information?

Read food labels

Why does the fat free product have more calories?

Portion DistortionMost Americans would lose weight by

simply monitoring portion sizesWe tend to underestimate how much we

have on our plate

Slides marked by are adapted from “Portion Distortion” by the National Heart, Lung and Blood Institute at http://hin.nhlbi.nih.gov/portion

COFFEE 20 Years Ago

Coffee(with whole milk and sugar)

Today

Mocha Coffee(with steamed whole milk

and mocha syrup)

45 calories 8 ounces

350 calories16 ounces

Calorie difference: 305 calories

20 Years Ago Today

Calorie difference: 290 calories

500 calories 4 ounces

MUFFIN

210 calories 1.5 ounces

Portion sizesTypical items to visualize your portions

Meats: 3 oz portion = size of deck of cards

Cheese: 1 oz = 4 dice1 cup = size of baseball¼ cup = golf ball1 teaspoon = a quarter

Meat, Fish, PoultryBeef/Pork: choose lean cuts like loin &

round Poultry: choose white meat without skinWild Game: venison, elkFish: aim for 2 servings/week

Omega 3sOmega-3 fatty acids benefit the heart of

healthy people, and those at high risk of — or who have — cardiovascular disease

Reduces inflammationMay improve HDL, reduce LDL, lower

triglyceridesEssential to health but must be obtained

from food

Omega 3 Fatty AcidsSources:

EPA & DHA sources: Fatty fish such as salmon, mackerel, lake trout, tuna, halibut

ALA sources (Plant): Flax seed, canola oil, walnuts, tofu, soybeans Recommendation: daily

Omega 3s-How Much?Because of potential

side effects and medication interaction, only take supplements under MD supervision

Maximum 3,000 mg (3 gm) total Omega 3 without MD supervision

Dosage based on amount of Omega 3, not total amount of fish oil – check label for Omega 3 amount per capsule

Add Flavor in PreparationLow fat cooking methods:

Bake, broil, grill, roastPoach, steam, wrap (in parchment or

foil)Stir fry in low-sodium broth, wine or veg

oil

Add Flavor Without FatSpices & herbs

Rubs Marinades Salsas, chutneys

Fruit puree

DairyChoose:1% or nonfat milkLow fat or nonfat yogurt/cream

cheese/sour creamLow fat cheese, < 3 gm fat per oz. Sherbet, ices

Added FatsUse oils sparingly or nonfat sprays in

cookingSalad dressings: choose nonfat or light

versionsSpreads (tub margarines) have less trans

fats, such as: PromiseTM

I Can’t Believe It’s Not ButterTM

Smart BalanceTM

Brummel & BrownTM

Soluble FiberHelps lower total

cholesterol and LDL

Slows rate of digestion, helps control blood sugar levels

Provides satietyGI function

Beans & LegumesBeans: inexpensive

alternative to meat1/4 c = 1 oz meat

Cook after soaking dried beans

Canned beans OK but rinse to lower sodium

Aim for 2 cups of beans weekly

Fruits and VegetablesSoluble fiber

comes from pectinFresh, frozen or

canned produce are all OK

If canned, choose packed in juice or water

Aim for 5-9 servings per day (1/2-cup serving)

Soluble Fiber Sources & AmountsSources Soluble

Fiber, gmTotal Fiber,

gmWhite Bread Trace 1

Oatmeal, ½ c cooked 1 2

Barley, ½ c cooked 1 4

Cheerios, 1 c 1 3

Whole Wheat Bread .5 2

Pear, medium 2 4

Prunes, ½ c 3 6

Brussels Sprouts 3 4.5

Kidney Beans 3 6

Whole Grains

Check label for word “whole”

Ways to add to dietTry different kinds of

grains

Make half your grains WHOLE, minimum of 3 servings per day

Simple Sugars and AlcoholSugar and alcohol can

raise triglycerides Calorie dense but

nutrient lightExtra calories over

time can lead to weight gain

Limit “added sugar” and alcohol for special occasions

Phytosterols (plant sterols)

Plant equivalent to animal cholesterol - blocks chol absorption in intestines, lowers amount in blood

Sources: vegetable oil (like corn/soybean), nuts and legumes

Fortified foods like Promise ActivTM or Benecol ChewsTM

May lower LDL cholesterol up to 15%option in addition to diet and other lifestyle changesSafe to use with statin medication

Must consume dailyMaximum effect – 2 gms per day

Cocoa FlavanolsType of

antioxidant in cocoa & cocoa products

Higher cocoa concentration has more flavanols

LDL and blood pressure effect?

Other Lifestyle Changes for Cholesterol ControlBe active at least 30 minutes per day

or 150 min/week (for weight loss: 60-90 minutes)

Lose weight, if needed

Quit smoking