Lifestyle and Lipids

Liz Freitick, RD, MA, CD

Nutritional Factors affecting Cardiac Risk Weight LDL-C TGs HDL-C BP Glucose

Calories Exercise Saturated Fat Cholesterol Fiber Carbohydrates Plant Stanols Alcohol Sodium Fish oil supplements

Reduces BP, improves glucose control, improves serum lipids (cholesterol, HDL-C and triglycerides levels) Diabetes Prevention Program 3234 overweight & obese with hyperinsulinemia - 1/3 given intensive lifestyle intervention, 1/3 metformin, 1/3 usual careLifestyle intervention reduced incidence of type 2 DM by 58%, metformin by 31% compared to usual care groupLifestyle group achieved 5.6 kg weight loss and exercised 5 times a week for 30 minutesCalories Modest weight loss of 10-15%

More than 4,500 people who have lost at least 30 lbs. with 3,000 losing an average of 60 pounds (32.4 kg); keeping this weight off for over 6 years with 30-40% of people are able to maintain a loss of 10% of their body weight.

60 to 90 minutes of exercise dailyLower intakes of dietary fatLack of exceptions to diet planSocial support meetings, family/friends of like mindWeighing weeklyAlternating strategies watching weight and losing weight

Calories National Weight Control Registry

Calories Current popular weight loss approaches

Paleo Diet Includes fruit, vegetables, generous amounts of meat, seafood. Avoids grains and dairy. Moderate to high fatZone, South BeachLow, carb, moderate fat, high proteinAtkinsVery low carb, high fat, high proteinGlycemic IndexEat only foods with a low glycemic indexEat Clean Detox2 liquid meals per day, one clean meal-nuts, legumes, fruits, vegetables

Health clubs with weight loss programs Commercial weight loss chains Weight loss websites Diet food home delivery services Retail Meal replacementsSpent annually Estimated $70 billion in 2010-Market includes registered dietitians and nutritionists, surgical/bariatric programs, prescription medications, and the VLCD/LCD fasting supplement programs

More than one way (researched programs)Ornish, Zone, Atkins, Weight Watchers all workNo single answer for everyoneDiverse needs and preferencesPick a safe approach and stick with it

Calories Weight loss approaches

Losing weight:Weigh weeklyLimit sugarPlanning and preparationHealthy snacks availableWeight loss programsExercise variety

Calories Approaches to encourageMaintaining weight:Consistent lean proteinConsistent exerciseRenew as priorityReward yourselfWeigh regularly

Successful weight loss can contain plateaus and fluctuations Prevent further weight gain Maintenance of weight loss that is sustainedsuccessful weight loss is maintained weight loss

Calories Degrees of weight loss

Prevention, attention to weight changeMultidisciplinary programs that are 3 to 12 months longEvidence of commercial weight loss programs leading to success is small but there is weight loss for someFollow-up importantOne-to-oneSocial mediaOnline, AppLong-term success-realistic expectation is 5 to 10 % loss and maintenance (what most can achieve)

Calories What works

Approach Potential changeSaturated fat < 7%8-10 %Dietary cholesterol

Main influence on serum cholesterolFor every 1% increase in consumption of saturated fat calories there is an increase in serum cholesterol of 1.8 mg/dLSome variation expected given genetic predispositionRecommendations7% of calories15-20 grams per day based on 2000 to 2500 kcal respectivelyCulvers 1 scoop Turtle Sundae980 calories27 grams saturated fat

Saturated Fats

Saturated FatsMeat, poultry, fish are 3 ounce portions

Food-amtsat fatFood- amtsat fatFood- amtsat fatButter- 1T7.6Ground beef 6Salmon0.5Margarine, tub- 1T1.5Brat 16Chcheese-1oz6Olive oil- 1T1.8Turkey0.5Ice cream-1c9Mayo- 1T1.5Pork chop2.5Skim milk-1c0.3Cream cheese-1oz6.2Salmon0.5Peanut butter-1T1.7Prime rib12Dark chicken2.3Almonds-1oz1.8Ground round4Tuna in water0.7Avocado- 1/40.9

Claims:Reduce heart diseaseAnti-viralAnti-bacterialWeight lossReduce cancerBetter for cookingNormalize thyroidGood for skin and hairImprove immune functionNew trend is coconut oil

Types of Saturated Fats Less LDL-C increaseIncreases LDL-C No LDL-C effect

Butterfat Lauric 3Myristic 18Palmitic 26Stearic 12Coconut oil 49 18 8 3Beef fat 0 3 26 22Cocoa butter 0 0 26 35

Trans fat recommendations

Soft tub margarine, 1 T.0-2 gramsStick margarine, 1 T.2-3.5 gramsVegetable shortening, 1 T.0-3 gramsKFC Chicken Pot Pie14 gramsBurger King hash browns13 gramsMcDonalds medium fries5 grams

Limit to

Margarine/Butter

TotalSaturatedTransSat + TransButter10.8 grams7.2 grams0.3 grams7.5 gramsMargarineRegularstick11.42.32.44.7

Regulartub11.21.901.9Lite stick9.51.61.83.4Lite tub5.61.101.1

Cholesterol in FoodsOnly found in animal productsInfluence on LDL-C more variable than saturated fatControl intake Low-fat dairyLess lean meat2-4 egg yolks per weekShrimp- no more than once a weekLiver?Goal is < 200 mg daily

FiberSoluble (gummy or viscous)Slows glucose absorption,decreases blood cholesterolIncreases fecal excretion of bile acidsDelays gastric emptying

Psyllium supplements10.2 g (3 doses per day) see decreased in LDL- C from 5% to 10% depending, more if from typical American diet

Stanols/Sterols5 chews per day for 2 grams plant stanols6 capsules for 2 grams plant stanols4 Tbsp Benecol margarine provide 2 grams

CarbohydratesRaise TG, lower HDL-CProcessed CHO, especially fructose, can increase TG dramaticallyVery low fat diets likely too high in CHO for patients with elevated TG50-60% CHO as goal (starches, fruit, sugars)

Fish Oil SupplementsHigh doses can reduce TG, raise HDLLow doses can reduce stickiness of blood, reduce inflammation, and irregular heart beats? prophylactic 1 gram level, 3- 4 gram for lipid loweringDHA and EPA are protective componentsCod liver oil and flaxseed oil-not recommendedCheck supplement label to assess potency, serving sizemany varieties and not regulated or standard

AlcoholIncreases TG production, VLDLsEffects more pronounced in those who drink large amounts of ETOHAre overweight/obeseHave diabetesHave TG disorderWhat is a serving?12 ounce beer5 ounce wine1.5 ounces of 80 proof liquor

Sodium RecommendationAHA and US Dietary Guidelines2300 mg per day or less, 1500 mg eventual goalDASH Diet benefits

Restaurant Menu Itemmg of sodiumJimmy Johns Turkey #41075 Panera-Bacon, Egg, Cheese on Ciabatta Roll1170Applebees Spicy Cheese Nachos4270Auntie Annes Original Pretzel1060Buffalo Wild Wings Boneless Wings 50 pieces19,590Papa Johns Favorite Original Crust Pizza1110Taco Bell Supreme Beef Burrito1110

Plan mealsFruit

Read food labels

SummaryBe activeHealthy weightMainly plant foodsUnsaturated fatsSmaller amounts of poultry, lean meat and cheeseLess processed foods to reduce salt, sugar and add more fiberAlcohol moderationHealthDecision.org is a site that provides data analysis and decision support for health care providers and their patients as they assess and manage the risk of cardiovascular events.https://www.healthdecision.org/index/tool#

Mediterranean Diet Pyramid

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