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Lifestyle and Lipids
Liz Freitick, RD, MA, CD
Nutritional Factors affecting Cardiac Risk
Weight LDL-C TGs
Calories
Exercise
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Saturated Fat
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Cholesterol
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Fiber
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Glucose
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Plant Stanols
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Sodium
Fish oil
supplements
BP
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Carbohydrates
Alcohol
HDL-C
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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.
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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
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Approaches to encourage
Losing weight:
Maintaining weight:
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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
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Degrees of weight loss
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Successful weight loss can contain plateaus and
fluctuations
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Prevent further weight gain
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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
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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:
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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
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Soft tub margarine, 1 T. 0-2 grams
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Stick margarine, 1 T.
2-3.5 grams
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Vegetable shortening, 1 T.
0-3 grams
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KFC Chicken Pot Pie
14 grams
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Burger King hash browns
13 grams
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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
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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
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Soluble (gummy or viscous)
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Slows glucose absorption,decreases blood cholesterol
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Increases fecal excretion of bile acids
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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
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5 chews per day for
2 grams plant
stanols
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6 capsules for 2
grams plant stanols
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4 T Benecol
margarine provide 2
grams
Carbohydrates
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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
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High doses can reduce TG, raise HDL
Low doses can reduce stickiness of blood, reduce inflammation,
and irregular heart beats
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? prophylactic 1 gram level, 3- 4 gram for lipid lowering
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DHA and EPA are protective components
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Cod liver oil and flaxseed oil-not recommended
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Check supplement label to assess potency, serving size–many
varieties and not regulated or standard
Alcohol
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Increases TG production, VLDLs
 Effects more pronounced in those who drink large amounts
of ETOH
 Are overweight/obese
 Have diabetes
 Have TG disorder
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What is a serving?
12 ounce beer
5 ounce wine
1.5 ounces of 80 proof liquor
Sodium Recommendation
AHA and US Dietary Guidelines
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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
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Smaller plates
More home prepared
Boost vegetables, limit
starch, meat
Read food labels
Summary
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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