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Lifestyle and Lipids Liz Freitick, RD, MA, CD

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Lifestyle and Lipids

Liz Freitick, RD, MA, CD

Nutritional Factors affecting Cardiac Risk

Weight LDL-C TGs HDL-C BP GlucoseCalories ✔ ✔ ✔ ✔ ✔ ✔

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 care

Lifestyle intervention reduced incidence of type 2 DM by 58%, metformin by 31% compared to usual care group

Lifestyle group achieved 5.6 kg weight loss and exercised 5 times a week for 30 minutes

Calories

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 daily

• Lower intakes of dietary fat

• Lack of exceptions to diet plan

• Social support – meetings, family/friends of like mind

• Weighing weekly

• Alternating 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 fat

Zone, South Beach Low, carb, moderate fat, high protein

Atkins Very low carb, high fat, high protein

Glycemic Index Eat only foods with a low glycemic index

Eat Clean Detox 2 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 replacements

Spent 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 work

No single answer for everyone

Diverse needs and preferences

Pick a safe approach and stick with it

Calories

Weight loss approaches

Losing weight:

Weigh weekly

Limit sugar

Planning and preparation

Healthy snacks available

Weight loss programs

Exercise variety

Calories

Approaches to encourage

Maintaining weight:

Consistent lean protein

Consistent exercise

Renew as priority

Reward yourself

Weigh regularly

Successful weight loss can contain plateaus and

fluctuations

Prevent further weight gain

Maintenance of weight loss that is sustained–successful

weight loss is maintained weight loss

Calories

Degrees of weight loss

Prevention, attention to weight change

Multidisciplinary programs that are 3 to 12 months long

Evidence of commercial weight loss programs leading to success is

small but there is weight loss for some

Follow-up important

One-to-one

Social media

Online, App

Long-term success-realistic expectation is 5 to 10 % loss and

maintenance (what most can achieve)

Calories

What works

Approach Potential change

Saturated fat >7% 8-10 %

Dietary cholesterol <200 mg 3-5 %

10 # weight loss 5-8 %

Addition of 5 to 10 grams soluble fiber daily 3-5 %

Addition of 2-3 grams plant stanols or sterols6-15 %

Addition of 25 grams soy protein daily 3-5 %

Total LDL-C lowering 25-35 %

LDL-C lowering estimates with diet

Main influence on serum cholesterol

For every 1% increase in consumption of saturated fat calories there is an increase in serum cholesterol of 1.8 mg/dL

Some variation expected given genetic predisposition

Recommendations

7% of calories

15-20 grams per day based on 2000 to 2500 kcal respectively

Culvers 1 scoop Turtle Sundae

980 calories

27 grams saturated fat

Saturated Fats

Saturated Fats

Food-amt sat fat Food- amt sat fat

Food- amt sat fat

Butter- 1T 7.6 Ground beef

6 Salmon 0.5

Margarine, tub- 1T

1.5 Brat 16 Chcheese-1oz

6

Olive oil- 1T 1.8 Turkey 0.5 Ice cream-1c

9

Mayo- 1T 1.5 Pork chop 2.5 Skim milk-1c

0.3

Cream cheese-1oz

6.2 Salmon 0.5 Peanut butter-1T

1.7

Prime rib 12 Dark chicken

2.3 Almonds-1oz

1.8

Ground round 4 Tuna in water

0.7 Avocado- 1/4

0.9Meat, poultry, fish are 3 ounce portions

Claims:

Reduce heart disease

Anti-viral

Anti-bacterial

Weight loss

Reduce cancer

Better for cooking

Normalize thyroid

Good for skin and hair

Improve immune function

New trend is coconut oil

Types of Saturated Fats

Butterfat

Lauric 3

Myristic 18

Palmitic 26

Stearic 12

Coconut oil 49 18 8 3

Beef fat 0 3 26 22

Cocoa butter

0 0 26 35

Less LDL-C increaseIncreases LDL-C No LDL-C effect

Trans fat recommendations

Soft tub margarine, 1 T.0-2 grams

Stick margarine, 1 T. 2-3.5 grams

Vegetable shortening, 1 T. 0-3 grams

KFC Chicken Pot Pie 14 grams

Burger King hash browns 13 grams

McDonald’s medium fries 5 grams

Limit to <1% of total calories (2000 calories per day = 2 grams)

Trans fat in foods

Margarine/Butter

Total Saturated

Trans Sat + Trans

Butter 10.8 grams

7.2 grams 0.3 grams 7.5 grams

Margarine

Regularstick

11.4 2.3 2.4 4.7

Regulartub

11.2 1.9 0 1.9

Lite stick 9.5 1.6 1.8 3.4

Lite tub 5.6 1.1 0 1.1

Cholesterol in Foods

Only found in animal products

Influence on LDL-C more variable than saturated fat

Control intake

Low-fat dairy

Less lean meat

> 2-4 egg yolks per week

Shrimp > once a week

Liver?

Goal is > 200 mg daily

Fiber

Soluble (gummy or viscous)

Slows glucose absorption,decreases blood cholesterol

Increases fecal excretion of bile acids

Delays gastric emptying

Psyllium supplements–10.2 g (3 doses per day)– see decreased in LDL- C from 5% to 10% depending, more if from typical American diet

Stanols/Sterols

5 chews per day for 2 grams plant stanols

6 capsules for 2 grams plant stanols

4 T Benecol margarine provide 2 grams

Carbohydrates

Raise TG, lower HDL-C

Processed CHO, especially fructose, can increase TG dramatically

Very low fat diets likely too high in CHO for patients with elevated TG

50-60% CHO as goal (starches, fruit, sugars)

Fish Oil Supplements

High doses can reduce TG, raise HDL

Low doses can reduce stickiness of blood, reduce inflammation, and irregular heart beats

? prophylactic 1 gram level, 3- 4 gram for lipid lowering

DHA and EPA are protective components

Cod liver oil and flaxseed oil-not recommended

Check supplement label to assess potency, serving size–many varieties and not regulated or standard

Alcohol

Increases TG production, VLDLs

Effects more pronounced in those who drink large amounts of ETOH

Are overweight/obese

Have diabetes

Have TG disorder

What is a serving?

12 ounce beer

5 ounce wine

1.5 ounces of 80 proof liquor

Sodium RecommendationAHA and US Dietary Guidelines

2300 mg per day or less, 1500 mg eventual goal

DASH Diet benefits

Restaurant Menu Item mg of sodium

Jimmy John’s Turkey #4 1075

Panera-Bacon, Egg, Cheese on Ciabatta Roll 1170

Applebee’s Spicy Cheese Nachos 4270

Auntie Anne’s Original Pretzel 1060

Buffalo Wild Wings Boneless Wings– 50 pieces 19,590

Papa John’s Favorite Original Crust Pizza 1110

Taco Bell Supreme Beef Burrito 1110

Plan meals

• Smaller plates

• More home prepared

• Boost vegetables, limit starch, meat

Fruit

Read food labels

SummaryBe active

Healthy weight

Mainly plant foods

Unsaturated fats

Smaller amounts of poultry, lean meat and cheese

Less processed foods to reduce salt, sugar and add more fiber

Alcohol moderation

HealthDecision™.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