Posts for the ‘Cholesterol’ Category

IN CONTROL – Person of the Month: Bill S.

By Kelly Sedgwick, Take Control Health Coach

Bill was smart with how he used the Take Control program. He saw it as an opportunity — a vehicle to get him moving in the right direction — despite his challenges with back pain. Rather than focusing on the numbers, he really had his heart set on the ability to get out and hunt.

Bill worked diligently at his own pace. He recognized that he needed to begin farther back than he’d hoped, but he didn’t beat himself up about it. He just recognized it, worked at it, and gradually saw improvement.

What made you decide to join Take Control’s Lifestyle Management program? I honestly joined on a bit of a whim. Shortly after my first health screening in 2015, I got a friendly phone call from Take Control folks telling me that I qualified for the program and asking me whether I wanted to participate. At that moment my answer could have gone either way, but the friendly voice and no-downside approach influenced me to say, “sure, why not.” I’m very glad I did.

What were your reasons/motivation for wanting to make changes regarding your health? Years of “driving a desk for a living” and a series of painful lower back injuries had left me in neglectful shape. High cholesterol runs in the family, and I knew on some level that it was something that I would eventually have to watch. My 2015 health screening revealed my total cholesterol to be at a scary 290. I was well on my way to heart-attack territory, and I was only 35. That was one of those wake-up calls that concentrates the mind. I began thinking about the many things that I liked doing and still wanted to accomplish in life. At the top of the list was home ownership (and all the physical demands that entails), backpacking, fishing, and hunting trips. My wife and I were even discussing becoming parents, and the thought of not being there to raise my (at the time) hypothetical kid was sobering, as well.

What are the biggest challenges and accomplishments in your health since you started? What do you feel was your biggest obstacle? The biggest challenge of getting started was simply getting started. Inertia is a very real thing, and deep-worn physical and mental ruts are tough to break. Beyond that, my always present, usually mild, occasionally debilitating back pain made it hard to progress in any real exercise program. My back was in such bad shape at times that even mild physical activity could send me to the local urgent care, writhing in pain and in need of medication to function on even a basic level. At the beginning of the program, setbacks were the norm, and this reoccurring injury made it feel like I was never going to be able to progress. This project felt like fighting a war on multiple fronts, and setbacks in one area would cause setbacks in another. “Exercise” presented itself as a goal, a solution, an obstacle, and something that could actually harm me from time to time, if that makes any sense. In any case, I felt stuck. Cole, my Take Control coach at the time, helped me realized that I needed to start WAY back at the beginning — physical therapy — in order to push the reset button. Slowly, painfully began the non-linear process of repairing my lower back so that I could begin very mild exercise and gradually progress from there. Progress was slow and arduous at times, but I eventually began to win back mobility, strength, endurance and confidence.

What did you do to stay motivated? There were definitely times that I wanted to give up — especially at the beginning. It’s a rotten feeling to know that you’re doing everything you’re supposed to, following all the experts’ advice, seeing tiny bits of progress, and then having everything fall apart and the lower back pain return. And when it did, I had to stop everything, literally lay on the floor, put my feet up on a chair or couch, and stare at the ceiling for hours or days on end. During that downtime, I would often pass the hours listening to hunting and fishing podcasts and videos. I started to get really excited and motivated about the 2016 hunting season, and I even dared to dream about roaming the mountains on foot looking for deer and elk — one of those unmet life goals I had often thought about in the preceding years. This was a ridiculous dream at the time for someone who, on those really bad days, needed help putting on my own socks. But I can be forgetful and stubborn, and those qualities kept me dreaming, and, unlikely though it was, I set my sights on getting well enough to hunt in 2016. I doubled down on my motivation and recommitted to doing everything the physical therapist and doctor told me to do. I had to recommit a few more times after that, too, but each ensuing setback was gradually less severe and shorter in duration. I began to bounce back quicker and develop some resiliency, which served as verifiable positive reinforcement. I was beginning to reclaim bits of my life and all of the sudden, extended hikes in the backcountry didn’t seem to be such a distant dream. During this time, an interesting thing happened. I actually stopped thinking altogether about my cholesterol or any typical training metrics one might set for improvement. I just simply thought about getting myself in good enough shape to get out in the mountains again, under my own weight, and be able to carry a pack. Everything that happened next followed from that mindset.

What have you gained through this process? No sane person would have voted me the most likely person to notch an elk tag in 2016, but in November I did just that. It wasn’t easy and it involved months of training in the gym, weeks of scouting in the mountains, and long days of hiking a lot of miles over steep terrain. But eventually sweat, hard work, determination, and a dash of luck coalesced into the opportunity I had been imagining for months. Getting the animal out was a slow process that took numerous trips over two days, but I packed every last bit out on my own back using my own two legs. That’s an accomplishment I’ll remember forever and a memory made sweeter by knowing what I had to first go through before showing up for opening day. A freezer full of elk meat is a very nice fringe benefit, but what I really gained through this was a better understanding of my body’s own resiliency and awareness of my ability to simply decide to change course. Inertia, after all, works both ways — it may be tough to get started and establish a routine, but keeping things going is relatively easy by comparison.

And the hypothetical kid my wife and I had been talking about earlier? She’s not so hypothetical now. My baby girl will be born in March, 2017. I swelled with pride at Christmas this year, as my wife and I ate Montana bull elk, knowing my unborn daughter was receiving the nutritional gift of the elk through my hard work and persistence. I’ve given her a father who is in better shape, and who (thanks to exercise, lean meat, and a statin), now has a cholesterol number that is down to a less outrageous 180. I’m nowhere near as good as I’ll be, but I’m a lot better than I was. My family deserves that and so do I.

What differences do you see in yourself and the impact it has had on your health and life? I’m still the same lazy, stubborn, flawed person that allowed my physical health to slowly deteriorate. But thanks to Cole, Kelly, and others at Take Control, I’ve identified some life hacks that allow me to recognize those challenges and work around them. One of the biggest differences is that I say “yes” more often to invitations to do things that involve physical exertion. As recently as a year ago, I would regularly turn down invitations to go skiing, for fear that my back would suddenly go out. Now, my back episodes are much fewer, less severe, more manageable, and less frightening. The resiliency I’ve built has increased my confidence to venture further out from my comfort zone, which has, in turn, created opportunities for larger successes, which again increases confidence. I’m in a positive feedback loop now that reinforces my commitment to exercising, eating well, and taking care of myself.

What advice or encouragement would you give others in our program? The main advice I have is simply to follow that old Nike tagline — just do it. No matter your starting point, just accept it, and begin as slowly and thoughtfully as your situation allows. And when you don’t feel like keeping up with your commitment, do it anyway. Eventually the changes become part of your daily routine, and from there everything gets easier. It’s probably also worth pointing out that, for me, it was far more effective to focus on a genuine aspirational motivator (“bring home elk”) that complemented my fitness goals rather than to obsess about abstract obligations like “lower my cholesterol” or “lose some weight.” In my case, those secondary benefits manifested as happy byproducts, not ends unto themselves, so consider talking with your Take Control coach about identifying your own fun, meaningful, big-picture goal.

The best part of his accomplishment was hearing the pride in his voice as he told me about his hunting trip. He recognized the consistent effort he invested in his goal and was incredibly proud and grateful to have been able to accomplish it. It’s the ultimate goal as a health coach to have someone prove to themselves that the CAN achieve the goal and to know the FEEL the pride in that achievement. Was one of my favorite coaching calls with him – I could not have been happier for him.

Results:

  • Reduced total cholesterol by 119 points
  • Decreased LDL (bad) cholesterol by 111 points
  • Maintained HDL (good) cholesterol levels
  • Reduced systolic blood pressure by 10 points and diastolic blood pressure by 20 points
  • Reduced back problems
  • Accomplished major goal of harvesting and hauling a Bull Elk on his own
  • Is expecting his first child as a healthier man
  • Now accepts friend’s invitations for physical activities

 

Chocolate and Red Wine — Benefit or Not?

By Alicia Kaluza, MS, RD, LN Take Control Health Coach

With Valentine’s Day this week you might be thinking about wine and chocolate. Recent news stories have reported that drinking red wine can be good for you. Other stories report that dark chocolate is good for you. But is this really true?

Both red wine and dark chocolate contain antioxidants, which is where the benefits are believed to come from. What we don’t often hear is that if you consume too much of either, the benefit is negated by the other components of these items.

For example, red wine contains an antioxidant called resveratrol. Other foods with similar antioxidants include blueberries and cranberries. Scientists have found that these antioxidants may help increase HDL cholesterol levels, prevent cholesterol build-up, and reduce inflammation. However, research also shows that certain levels of alcohol cancel out the positive benefit of the antioxidants in red wine.

So how do you get the benefit of drinking red wine? Moderation. An occasional glass is okay. More than that on a regular basis, and not only is the benefit gone, but it can become a poor choice for your health.

How about dark chocolate? Dark chocolate is also rich in anti-oxidants including polyphenols and flavonols. Milk chocolate has some anti-oxidants, but not as much as dark chocolate. Milk chocolate contains more fat, so typically dark chocolate is recommended as a healthier option. Research has shown that the anti-oxidants in dark chocolate have small, but significant impacts on decreasing blood pressure, increasing HDL cholesterol, and decreased overall cardiovascular risk. A lot of research shows positive health impacts from cocoa, but consuming excessive amounts on a daily basis will lead to excess calories and potentially, weight gain, which would create a negative impact on heart health.

As with wine, enjoy dark chocolate in moderation. When choosing dark chocolate, look for products with a higher cocoa content. The darker the better — greater than 60% cocoa is a good aim. Read the ingredients list, and watch out for partially hydrogenated or hydrogenated fats. Finally, limit yourself to a one-ounce serving per day; or 7 ounces total for the week.

Valentine’s Day is the perfect day to indulge in a little dark chocolate and red wine – or whatever treat is your favorite. Moderation is the key to enjoying life and good health.

Fats: The Good, The Bad, The Ugly

In our prior post, we told you about The Importance of Fat in Your Diet. Here is a great chart by the American Heart Association that lists the good fats — and the bad and the ugly. You can lower your risk of heart disease and stroke by choosing good fats that lower your LDL cholesterol, and avoid saturated fats, and trans fats, which raise your blood cholesterol level.

The easiest way to track your fat and other nutrients is to use a food diary to keep track of what you eat for a period of time. We recommend My Fitness Pal, My Food Diary,  or SparkPeople.

Click image to enlarge.

Triglycerides and Your Diet

A diet high in carbohydrates, especially in refined carbohydrates (like sweeteners, white flours, and other highly refined carbohydrates) can raise triglyceride levels. Triglycerides are another type of fat in the blood. When you eat, your body converts any calories that it does not immediately need into triglycerides which are stored in fat cells. As such they can provide your body with energy when necessary.

What contributes to high triglyceride levels? High triglycerides can sometimes be a sign of poorly controlled diabetes. Other things that contribute to elevated triglyceride levels are obesity, an under-active thyroid, diabetes, kidney disease, and smoking. A low intake of omega-3 fatty acids may also raise triglycerides. Additionally, some medications may raise triglyceride levels.

Why is my triglyceride level important? We are not sure how exactly high triglycerides may contribute to the hardening of arteries or thickening of artery walls. What we do know is that this hardening and thickening of artery walls raises the risk for heart disease including both strokes and heart attacks. Dr Michael Miller (University of Maryland, Baltimore) states, “We’ve known that triglycerides are linked with LDL cholesterol in that high levels of both confer a greater risk than either one alone,”. “In fact, having a high triglyceride level, above 200 mg/dL, with elevated LDL cholesterol confers about a twofold risk of heart disease. The question is how you tease out triglycerides from other risk factors, because typically people who have high triglycerides often have insulin resistance, low HDL cholesterol, and high blood pressure.”

How do I lower my triglyceride level? Diet and exercise are the cornerstones of treatment for patients with elevated triglyceride levels, according to a new scientific statement from the American Heart Association. The American Heart Association (AHA) states that a triglyceride level of <100 is optimal and improves heart health. Additionally, in May 2011 the AHA released guidelines on the treatment for high triglycerides. For patients with borderline triglyceride levels, those ranging from 150 to 199 mg/dL, experts recommend losing 5% of current body weight and limiting carbohydrates to 50% to 60% of daily caloric intake. A 5% to 10% weight reduction may result in a 20% decrease in triglycerides, an approximate 15% reduction in LDL cholesterol, and an 8% to 10% increase in HDL cholesterol. The AHA further recommends limiting added sugars to less than 10% of daily caloric intake and provides new guidance on fructose consumption, recommending that borderline patients consume less than 100 grams per day from all sources. Among individuals with borderline, high, and very high triglyceride levels, weight loss of up to 10% of body weight is recommended.

Even if people have not been diagnosed with triglycerides outside the normal range, if they eat too many simple sugars (refined grains, added sugars and alcohol) their triglycerides will increase.

A well-balanced diet high in fiber, with whole grains and containing plenty of fruits and vegetables, along with fat-free or low-fat milk and milk products, seafood, lean meats and poultry, beans, nuts and seeds will help to lower triglyceride levels. Additional tips to lower triglycerides levels include:

  • Lose weight. There is evidence that a 5-10 percent weight loss results in a 20 percent decrease in triglycerides – the amount of decrease in triglycerides are directly related to the amount of weight lost.
  • Decrease your calorie intake – this will help with weight loss and also decrease triglycerides.
  • Limit your alcohol intake to one drink daily for women and two drinks per day for men. Alcohol in high amounts increases triglyceride levels in some people. For people with very high triglycerides, abstinence from alcohol is recommended.
  • Avoid sugary and refined carbohydrates. The type of carbohydrates that you eat makes a difference – and foods that contain high amounts of simple sugars, especially fructose raise triglyceride levels.
  • Limit cholesterol intake from meat, dairy products, butter and margarine.
  • Choose healthier fats like monounsaturated fats and foods high in omega-3 fatty acids.
  • Saturated and Trans fats raise triglycerides – Eliminate trans-fats in your diet, and decrease saturated fat intake to no more than 7 percent of total daily calories. That means, for example, if you need about 2,000 calories a day, no more than 140 of them should come from saturated fats. That’s about 16 grams of saturated fats a day.
  • Physical activity plays an important role in lowering triglycerides. Work to increase your physical activity to a minimum of 150 minutes per week.

Everyone – whether or not they have high triglycerides – should focus on fiber-rich complex carbohydrates, such as vegetables and whole grains, instead of simple sugars.

 

6 Ways to Raise Your HDL Cholesterol

Make Your Lifestyle Count

Your lifestyle has the single greatest impact on your HDL cholesterol. Even small changes to your daily habits can help you meet your HDL target.

Diet and lifestyle changes that can help boost HDL cholesterol levels:

  1. Don’t smoke. If you smoke, quit. Quitting smoking can increase your HDL cholesterol by up to 10 percent. Quitting isn’t easy, but you can increase your odds of success by trying more than one strategy at a time. Talk with your doctor about your options for quitting.
  2. Lose weight. Extra pounds take a toll on HDL cholesterol. If you’re overweight, losing even a few pounds can improve your HDL level. For every 6 pounds (2.7 kilograms) you lose, your HDL may increase by 1 mg/dL (0.03 mmol/L). If you focus on becoming more physically active and choosing healthier foods — two other ways to increase your HDL cholesterol — you’ll likely move toward a healthier weight in the process.
  3. Get more physical activity. Within two months of starting, frequent aerobic exercise can increase HDL cholesterol by about 5 percent in otherwise healthy sedentary adults. Your best bet for increasing HDL cholesterol is to exercise briskly for 30 minutes five times a week. Examples of brisk, aerobic exercise include walking, running, cycling, swimming, playing basketball and raking leaves — anything that increases your heart rate. You can also break up your daily activity into three 10-minute segments if you’re having difficulty finding time to exercise.
  4. Choose healthier fats. A healthy diet includes some fat, but there’s a limit. In a heart-healthy diet, between 25 and 35 percent of your total daily calories can come from fat — but saturated fat should account for less than 7 percent of your total daily calories. Avoid foods that contain saturated and trans-fats, which raise LDL cholesterol and damage your blood vessels.
    • Monounsaturated and polyunsaturated fats — found in olive, peanut and canola oils — tend to improve HDL’s anti-inflammatory abilities. Nuts, fish and other foods containing omega-3 fatty acids are other good choices for improving your LDL cholesterol to HDL cholesterol ratio.
  5. Drink alcohol only in moderation. Moderate use of alcohol has been linked with higher levels of HDL cholesterol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. If you don’t drink alcohol, don’t start just to try raising your HDL levels.

Wellness Screening Lab Results

Solve the Mystery of Your Lab Results: What Do These Numbers Mean?

By Laura Del Guerra, RD, CDE

You’ve received the results from your annual or bi-annual wellness screenings, but what do they mean? Interpreting all of the numbers and categories can be confusing. We consulted a local physician to get an explanation on what wellness lab results mean, and why they are an important indicator of health:

Q: Why is it important to have your labs drawn periodically?
Depending on which tests are done, they serve as a barometer of control. Tests like the hemoglobin A1c, and others serve to indicate how well a condition is controlled, and if there might be complications from a chronic medical condition. Others like liver function and kidney tests can be used to ascertain how well your body is tolerating certain medications. For example, liver function tests are reviewed for people who are taking statin drugs (for lowering cholesterol).

Q: Once my blood is drawn and analyzed then what happens?
All results are returned to the individual. For those covered by certain insurance plans, you may get an additional letter from the company who drew that labs at your well check event recommending that you make an appointment to see your primary care provider about these results. This is especially true with results like the A1c, PSA, and lipid panel.

Q: Where can I get a description of what each test means?
Your test results contain a lot of information to assist you in understanding what your results mean. When reviewing your results you may notice an asterisk (*) next to results that fall outside the indicated range for your age and gender. You can also visit the “Lab Tests Online” web site (http://labtestsonline.org/) run by the American Association for Clinical Chemistry (AACC). They have information on the individual tests and what your results mean. Finally, remember that your Primary Care Provider is the best person for providing you with sound information and medical advice as well as possible treatment strategies.

Q: Is it important to share these results with my Primary Care Provider?
Yes! It is extremely important to share a copy with your PCP. If you have abnormal results it’s a good idea to make an appointment to discuss your results.

Q: Is there a “best way” for me to review my lab report?
Not really. Everyone has their own method for looking through the report. There is a lot of good information on the report and nothing is left out; all the basics are there. It is a good idea to keep the reports so that you can see trends; especially for the results that are not graphed.

Q: My red/white cell counts are out of normal range. At what point should I be concerned?
It is normal for our body to respond to the environment, and white blood cell counts have to change in order to attack germs. Therefore, we expect to see a white blood cell count that might be out of the reference range due to the body’s natural response to the environment. However, if the differential is abnormal it should be reviewed with your PCP. Any abnormality in red blood cells, the MCV, hemoglobin, hematocrit, and MCHC should all be brought to the attention of your PCP.

Q: What is blood urea nitrogen (BUN)? Should I be concerned if it elevated? What causes an elevation?
BUN is one measure of how well the kidneys are able to filter waste products from your blood. The BUN value increases with age, and is often higher in men than women. Dehydration, a high protein diet, and intense exercise can cause elevations in BUN. The BUN alone does not give enough information about kidney function.

Q: What is creatinine and glomerular filtration rate (GFR)?
Creatinine is another estimate of kidney function. An elevated level may indicate that the kidney is not doing its job as a filter.
The GFR is another estimation of how well the kidneys are doing their job as filters. If the GFR is low the kidneys don’t have enough to do (not enough is being put into the filter system). It is the most sensitive estimate of whether or not the kidneys are doing what they are supposed to.

See also:

6 Ways to Raise Your HDL cholesterol
Triglycerides and Your Diet
To Statin or Not to Statin?

To Statin or Not to Statin?

A Physician and Dietitian Provide Insight Into High Cholesterol and How to Treat It

By Laura Del Guerra, RD, CDE

What do I do about my cholesterol? It is one of the most common questions Take Control Health Coaches are asked. The internet contains a wealth of information, both accurate and just plain scary. New recommendations for the treatment of cholesterol were published just a little over a year ago, and the media buzz hyped that most of America would now be placed on a statin. However, a Missoula physician stated that more goes into the new recommendations than just your total cholesterol number. The recommendations stress that ‘A person’s risk index must be evaluated before any treatment is advised.’ We’ve compiled the interview with the physician, research, and a Registered Dietitian’s thoughts to provide you with information on how to tackle high cholesterol.

Question: Many people do not want to take a statin to control high cholesterol. Are there other choices?

The best answer to this question is: ‘Talk to your doctor.’ The new recommendations stress risk indexing, which assists in predicting the likelihood of a person having a heart attack or stroke. Having an honest conversation with your doctor, including a discussion about your cholesterol results, lifestyle, and family history, is most important for determining treatment options. It is a matter of benefit versus risk. There are many new generation statins on the market that have far less side effects than the original drugs. It is also important to remember that statins do not cause liver disease. They can, however, make existing liver disease worse. (For more on how risk scores are calculated visit: http://cvdrisk.nhlbi.nih.gov/calculator.asp)

Question: Why were statins chosen as the primary (medication) treatment option?

Statins seem to lower the risk for cardiovascular disease regardless of a person’s cholesterol level. That is, with a statin, there is a meaningful risk reduction rather than just a lowering of the cholesterol number.

Source: NYTimes Blog: 3 Things to Know About the New Cholesterol Guidelines

Treatment recommendations at a glance: Statins are recommended for these four (4) groups:

  • People with existing cardiovascular (heart) disease.
  • People with an LDL (bad) cholesterol above 190mg/dl.
  • People between the ages of 40 and 70 years old who have diabetes.
  • People with an estimated ten (10) year risk of cardiovascular disease of 7.5% or higher who are between the ages of 40 and 70.

Source: heart.org: Understanding the New Prevention Guidelines

Question: My HDL (good) cholesterol is low. How can I raise it?

  • Smoking lowers HDL levels. Quitting will modestly raise your HDL levels and lower your risk of heart disease over time.
  • Weight loss: If your BMI is above the healthy range, every 6 pounds of weight lost can equate to a 1mg/dl increase in HDL.
  • Increase physical activity: Just 30 minutes of brisk walking 5 times a week can increase HDL cholesterol by 5% within 2 months.
  • Choose healthier fats: While 25-35% of our diet should consist of fat, it’s important to choose sources of fat wisely. For oils stick with olive, peanut, and canola. When eating nuts choose walnuts, almonds, and Brazil nuts. Finally, choosing foods like fish and others with Omega-3 Fatty acids will help increase your HDL levels.
  • Drink in moderation: This is nothing new, consuming alcohol in excess of what is recommended can decrease HDL levels.
  • Finally, drugs like Niaspan can increase HDL cholesterol (the prescription form is the best choice as it has less side effects).

Question: What about LDL (bad) cholesterol – how can I lower my LDL cholesterol?

  • Avoid saturated fats: Saturated fats are solid at room temperature and are found in cheese, milk (whole, 2%), meats, sausage, and butter. Don’t forget that saturated fats hide in foods like pizza and grain-based desserts (cookies, pies, cakes, etc).
  • Add more fiber to your diet by eating more fruits, vegetables, and whole grains.
  • Consider adding Plant Sterols found in margarines like Promise Active and Benecol. They have been shown to help lower cholesterol levels.
  • Get moving: In addition to helping increase HDL levels, regular physical activity will help lower LDL levels as well.

Question: What are triglycerides and how can I lower them?

Triglycerides are a type of fat in the blood and provide energy to the body. They are well stored by the body and can be elevated in people who are overweight, have poorly controlled diabetes, hypothyroidism, and kidney disease. Triglycerides may also be elevated in people who consume too many calories or excessive amounts of alcohol.

Ways to lower triglycerides:

  • Limit alcohol intake to no more than 1 drink per day if you are female or no more than 2 drinks per day if you are male. For some this might even be too much, and they may need to completely stay away from alcohol.
  • Exercise 5 or more days a week.
  • Weight loss of 5-10% can significantly lower triglycerides. Belly fat is associated with higher triglyceride levels.
  • Lowering the amount of saturated fat and trans fat in your diet, as well as eating less carbohydrates can help decrease triglycerides.
  • Adding more Omega-3 fatty acids can also help to lower triglycerides. Salmon and walnuts are good natural sources. Foods like eggs, milk, and juice can be fortified with omega-3 fatty acids.

For more information about how to best treat your high cholesterol, talk to your doctor. Your doctor can evaluate all of your risk factors and guide you to the best decisions for your individual situation.