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Lifestyle and Lipids Liz Freitick, RD, MA, CD Nutritional Factors affecting Cardiac Risk Weight LDL-C TGs Calories Exercise ✔ ✔ ✔ Saturated Fat ✔ Cholesterol ✔ Fiber ✔ Glucose ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Plant Stanols ✔ ✔ ✔ ✔ ✔ Sodium Fish oil supplements BP ✔ Carbohydrates Alcohol HDL-C ✔ Calories Modest weight loss of 10-15% 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 National Weight Control Registry 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 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 Calories Weight loss approaches 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 Approaches to encourage Losing weight: Maintaining weight: Weigh weekly Limit sugar Planning and preparation Healthy snacks available Weight loss programs Exercise variety Consistent lean protein Consistent exercise Renew as priority Reward yourself Weigh regularly Calories Degrees of weight loss 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 What works 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) LDL-C lowering estimates with diet 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 sterols 6-15 % Addition of 25 grams soy protein daily Total LDL-C lowering 3-5 % 25-35 % Saturated Fats 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 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 butter1T 1.7 Prime rib 12 Dark chicken 2.3 Almonds-1oz 1.8 Ground round 4 Tuna in water 0.7 Avocado- 1/4 0.9 Meat, poultry, fish are 3 ounce portions New trend is coconut oil 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 Types of Saturated Fats Lauric Myristic Palmitic Stearic Butterfat 3 18 26 12 Coconut oil 49 18 8 3 Beef fat 0 3 26 22 Cocoa butter 0 0 26 35 Less LDL-C increase Increases LDL-C No LDL-C effect Trans fat recommendations Limit to <1% of total calories (2000 calories per day = 2 grams) Trans fat in foods 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 Margarine/Butter Butter Total Saturated Trans Sat + Trans 10.8 grams 7.2 grams 0.3 grams 7.5 grams Margarine Regular stick 11.4 2.3 2.4 4.7 Regular tub 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 Recommendation AHA 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 Fruit • • • Smaller plates More home prepared Boost vegetables, limit starch, meat Read food labels Summary Be 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